WQ0043251_Application (FTSE)_20220316

RECEIVED/CDEO/DWR
Transmittal
From:
MOOR
42022
os LITow r�
SVILLE R GIONAL OFFICE F#p®Ii3
DIVERSIFIED Qt NSULTING
Little Diversified Architectural Consulting
615 South College Street, Suite 1600
Charlotte, NC 28202
Date:
MAR - 7 2022
WOROS
MOOHtbVILLE REGIONAL OFFICE
02/28/2022
Project No: 112-16941-01
To:
NCDEQ Mooresville Regional Office
610 East Center Avenue
Mooresville, North Carolina 28115
Attention: Water Quality Section
RE:
Fast Track SS Application —
Charlotte Latin HOS
We are sending you:
C Shop Drawings
C Copy of Letter
Z Attached
Prints
❑ Change Order
C Under Separate Cover
via the following items
C Samples
❑ Specifications
❑ Other
Copies
Date
Description
Action Req`d
1
02/28/2022
Cover Letter
1
02/28/2022
Fast Track Sewer System Extension Application (Original)
1
02/28/2022
Fast Track Sewer System Extension Application (Copy)
1
-
Registered Business Document per NC Secretary of State
1
-
USGS Topographical Map
1
-
Aerial Vicinity Map
1
-
Review Fee Check ($480)
These are transmitted as checked below:
® For Approval
For Your Use
❑ As Requested
❑ For Review & Comment
n For Bids Due
n Reviewed
n Rejected
Furnished as Corrected
❑ Not Marked
❑ Revise & Resubmit
❑ Submit Copies for Distribution
and Return Corrected Prints
❑ Prints Returned after Loan to Us
Remarks:
Attached is the submittal of the Fast Track Sewer System Extension Application for the Charlotte Latin HOS
Renovations Project. Please let us know if anything else is required for approval. Thanks!
Copy to:
Eric Fox, PE
[e-mail]
Signed:
Printed Name:
Skyr Gomez, El
Email: [e-mail]
If enclosures are not as noted, please notify us.
Little Diversified Architectural Consulting I 615 South College Street, Suite 1600, Charlotte, NC 28202 I 704.525.6350
LETTER OF TRANSMITTAL 1

February 28`", 2022
NCDEQ
Mooresville Regional Office
Water Quality Section
610 East Center Avenue
Mooresville, North Carolina 28115
Reference: Charlotte Latin Head of School (HOS) Renovations
Fast -Track Sanitary Sewer Application
To Whom It May Concern:
Attached, you will find the following for the referenced project:
• Fast -Track Sanitary Sewer Application
• Application Fee of $480
• 8.5" x 11" color copy of USGS topography map with project location
• 8.5" x 11" color aerial map with project location
• Registered Business Documentation
LITTLE
DIVERSIFIED ARCHITECTURAL CONSULTING
RFC
IVED/NCDEQ/D
22
MOORESVILLE/EGIONAL OFFICE
RECEIVED/NCDEQ/DUVR
MAR - 7 2022
O�S,t
MOORESVILWQROS
LE REGIONAL OFFICE
The Charlotte Latin HOS Renovation project proposes interior building renovations of the Head of School (HOS) building
on the campus of Charlotte Latin School. There is an existing 4" PVC sanitary sewer pipe that serves this building and
other adjacent campus buildings.
The existing 4" sanitary sewer line is owned by Charlotte Latin School. This sanitary sewer line runs between the
300/9503 and 700 Buildings, then feeds into a private 6" line before finally exiting the western side of the property.
Treatment is provided by the McAlpine Wastewater Treatment Plant on Lancaster Highway in Pineville, NC (NPDES
Permit # NC0024970).
The current total enrollment for Charlotte Latin School is 1,500 students, and the renovation of the HOS Building is not
expected to increase enrollment.
Please contact us if there are additional items needed for review and approval. Thank you.
Sincerely,
Skylar Gomez, El
Land Development Studio
Little Diversified Architectural Consulting
sl;ylal.dematteisrOlittleonline.com
704-561-3240
Little Diversified Architectural Consulting 615 South College Street, Suite 1600, Charlotte, NC 28202 j 704.525.6350
LETTER

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
Application Nttmbeu (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
RELIVED/NCDEQI,DWR
MAC N 2022
YWQROS
MOORESVILLE REGIONAL OFFICE
1. Applicant's name: Charlotte Latin Schools, Inc. (company, municipality, HOA, utility, etc.) (;
2. Applicant type: ❑ Individual ® Corporation CE� itc UD.(/IDWR
p ❑General Partnership Privately-O�Fne u uc tduty
❑ Federal ❑ State/County ❑ Municipal ❑ Other
3. Signature authority's name: Fletcher Gregory per 15A NCAC 02T .0106(b)
Title: Director of Finance
4. Applicant's mailing address: 9502 Providence Road
City: Charlotte State: NC Zip: 28277-
5. Applicant's contact information:
Phone number: [phone] Email Address: fgregory(c�charlottelatin.org
II. PROJECT INFORMATION:
1. Project name: Charlotte Latin Head of School (HOS) Renovations
2. Application/Project status: ® Proposed (New Permit)
❑ Existing Permit/Project
MAR ®7 2022
WQROS
MOORESVILLE REGIONAL OFFICE
If a modification, provide the existing permit number: WQ00 and issued date:
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: Mecklenburg
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.0795' Longitude: -80.7740°
5. Parcel ID (if applicable): 22513564 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Eric Fox License Number: 043375
Firm: Little Diversified Architectural Consulting
Mailing address: 615 South College Street, Suite 1600
City: Charlotte State: NC Zip: 28202-
Phone number: [phone] Email Address: eric.fox a,littleonline.cotn
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: McAlpine WWTP Permit Number: NC 0024970
Owner Name: Charlotte Water
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQNCEMC 12197
2. Downstream (Receiving) Sewer Information: 12 inch
© Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s): Charlotte Latin
FORM: FTA 06-21
Page 1 of 5

THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional Office
2090 US Highway 70
Swannanoa, North Carolina 28778-8211
[phone]
[phone] Fax
Avery, Buncombe, Burke, Caldwell, Cherokee,
Clay, Graham, Haywood, Henderson, Jackson,
Macon, Madison, McDowell, Mitchell, Polk,
Rutherford, Swain, Transylvania, Yancey
Water Quality Section
Fayetteville Regional Office
225 Green Street Suite 714
Fayetteville, North Carolina 28301-5095
[phone]
[phone] Fax
Anson, Bladen, Cumberland, Harnett, Hoke,
Montgomery, Moore, Robeson, Richmond,
Sampson, Scotland
Water Quality Section
Mooresville Regional Office
610 E. Center Avenue
Mooresville, North Carolina 28115
[phone]
[phone] Fax
Alexander, Cabarrus, Catawba, Cleveland,
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
Stanly, Union
Water Quality Section
Raleigh Regional Office
3800 Barrett Drive
Raleigh, North Carolina 27609
[phone]
[phone] Fax
Chatham, Durham, Edgecombe, Franklin,
Granville, Halifax, Johnston, Lee, Nash,
Northampton, Orange, Person, Vance, Wake,
Warren, Wilson
Water Quality Section
Washington Regional Office
943 Washington Square Mall
Washington, North Carolina 27889
[phone]
[phone] Fax
Beaufort, Bertie, Camden, Chowan, Craven,
Currituck, Dare, Gates, Greene, Hertford, Hyde,
Jones, Lenoir, Martin, Pamlico, Pasquotank,
Perquimans, Pitt, Tyrrell, Washington, Wayne
Water Quality Section
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, North Carolina 28405
[phone]
[phone] Fax
Brunswick, Carteret, Columbus, Duplin, New
Hanover, Onslow, Pender
Water Quality Section
Winston-Salem Regional Office
450 W. Hanes Mill Road
Suite 300
Winston-Salem, North Carolina 27105
[phone]
[phone] Fax
Alamance, Alleghany, Ashe, Caswell, Davidson,
Davie, Forsyth, Guilford, Rockingham, Randolph,
Stokes, Surry, Watauga, Wilkes, Yadkin
Water Quality Section
INSTRUCTIONS FOR FORM: FTA 05-21 & SUPPORTING DOCUMENTATION Page 3 of 3

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?
❑ Yes ❑ No ® N/A
3. If the Applicant is a Home/Property Owners' Association, has an IIOA/POA Operational Agreement (FORM: 1IOA) and
supplementary documentation as required by 15A NCAC 02T.01 I5(c) been attached?
❑ Yes ❑ No ®N/A
4. Origin of wastewater: (check all that apply):
❑ Residential (Individually Owned)
❑ Residential (Leased)
® School / preschool / day care
El Food and drink facilities
❑ Businesses / offices / factories
❑ Retail (stores, centers, malls)
El Retail with food preparation/service
❑ Medical / dental / veterinary facilities
❑ Church
❑ Nursing Home
❑ Car Wash
❑ Hotel and/or Motels
El Swimming Pool/Clubhouse
❑ Swimming Pool/Filter Backwash
El Other (Explain in Attachment)
5. Nature of wastewater : 100 % Domestic % Commercial % Industrial (Sec 15A NCAC 02T .0103(2(1))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes El No
6. Has a flow reduction been approved under 15A NCAC 02T .01 14(f)? El Yes El No N/A
If yes, provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project: N/A
Establishment Type (see 02T.0114(f))
Daily Design Flow a,b
No. of Units
Flow
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
GPD
a See I5A NCAC 02T .01 14(b), (d), (e)( I) 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.0I 14] 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 .01 14)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero, please indicate why:
El 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: Issuance Date:
❑ Rehabilitation or replacement of existing sewers with no new flow expected
® Other (Explain): Renovation of existing building with no net increase in flow, but new sanitary sewer connection.
FORM: FTA 06-21
Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
4
10
PVC
➢ Section II & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
D. Section III contains information related to minimum slopes for gravity sewer(s)
➢ Oversizing lines to meet minimum slope requirements is not allowed and a violation of the MDC
N/A VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: N/A
2. Approximate Coordinates (Decimal Degrees): Latitude: N/A Longitude: - N/A °
3. Total number of pumps at the pump station: N/A
3. Design flow of the pump station: N/A millions gallons per day (firm capacity)
➢ This should reflect the total GPM for the pump station with the largest pump out of service.
4. Operational point(s) per pump(s): N/A gallons per minute (GPM) at N/A feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station): NIA
Size (inches)
Length (feet)
Material
If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.01C.1.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
N/A 6. Power reliability in accordance with 15A NCAC 02T .0305(h)(1):
❑ Standby power source or ❑ Standby pump
➢ Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(1)(B):
D. 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 and may not be portable
Or if the pump station has an average daily flow less than 15,000 gallons per day 15A NCACO2T.0305(h)(1)(C):
N/A ❑ Portable power source with manual activation, quick -connection receptacle and telemetry -
or
N/A ❑ Portable pumping unit with plugged emergency pump connection and telemetry:
➢ Include documentation that the portable source is owned or contracted by the applicant and is compatible with the station.
D. 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 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations/alternatives found in 15A NCAC 02T .0305(f) & (g)?
15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
Yes ❑ No
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
'Water mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
'Water mains (horizontal)
10 feet
Reclaimed water lines (vertical - reclaimed over sewer)
18 inches
Reclaimed water lines (horizontal - reclaimed over sewer)
2 feet
**Any private or public water supply source, including any wells, WS-I waters of Class I or
Class II impounded reservoirs used as a source of drinking water, and associated wetlands.
100 feet
**Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal
high water (or tide elevation) and wetlands associated with these waters (see item iX.2)
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches, as well as wetlands associated with these waters or classified as WL.
10 feet
Any building foundation (horizontal)
5 feet
Any basement (horizontal)
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
➢ If noncompliance with 02T.0305(1) or (A), see Section X.1 of this application
*I 5A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(f) cannot be achieved. Please check "yes"
above if these alternatives are used and provide narrative information to explain.
**Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
2. Does this project comply with the minimum separation requirements for water mains? ❑ Yes ❑ No ® N/A
➢ if no, please refer to 15A NCAC 1 8C.0906(f) for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands?
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ See the Division's draft separation requirements for situations where separation cannot be met.
➢ No variance is required if the alternative design criteria specified is utilized in design and construction.
❑ Yes ❑ No Z N/A
4. Is the project located in a river basin subject to any State buffer rules? ❑ Yes Basin name: ® No
If yes, does the project comply with setbacks found in the river basin niles per 15A NCAC 02B .0200? ❑ Yes ❑ No
➢ This includes Trout Buffered Streams per 15A NCAC 2B.0202
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ❑ Yes ►/ No
or 401 Water Quality Certifications?
➢ Please provide the permit number/permitting status in the cover letter if coverage/authorization is required.
6. Does project comply with l5A NCAC 02T.0105(c)(6) (additional permits/certifications)? ❑ Yes ® No
Per 15A NCAC 02T.0I05(c)(6), directly related environmental permits or certification applications must be 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.).
7. Does this project include any sewer collection lines that are deemed "high -priority?" ❑ Yes ® No
Per I5A NCAC 02T.0402, "high -priority sewer" means any aerial sewer, sewer contacting surface waters,
siphon, or sewers positioned parallel to streambanks that are subject to erosion that undermines or deteriorates the sewer.
Siphons and sewers suspended through interference/conflict boxes require a variance approval.
➢ 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 02T.0403(a)(5) or the permittee's individual System -Wide Collection permit.
FORM: FTA 06-21 Page 4 of 5

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
Application Number: (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Charlotte Latin Schools, Inc. (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: Fletcher Gregory per 15A NCAC 02T .0106(b)
Title: Director of Finance
4. Applicant's mailing address: 9502 Providence Road
City: Charlotte State: NC Zip: 28277-
5. Applicant's contact information:
Phone number: [phone] Email Address: [e-mail]
II. PROJECT INFORMATION:
1. Project name: Charlotte Latin Head of School (HOS) Renovations
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ00 and issued date:
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: Mecklenburg
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.0795' Longitude: -80.7740°
5. Parcel ID (if applicable): 22513564 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Eric Fox License Number: 043375
Firm: Little Diversified Architectural Consulting
Mailing address: 615 South College Street, Suite 1600
City: Charlotte State: NC Zip: 28202-
Phone number: [phone] Email Address: eric.fox a,littleonline.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: McAlpine WWTP Permit Number: NC 0024970
Owner Name: Charlotte Water
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQNCEMC 12197
2. Downstream (Receiving) Sewer Information: 12 inch ® Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s): Charlotte Latin
FORM: FTA 06-21
Page 1 of 5

THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional Office
2090 US Highway 70
Swannanoa, North Carolina 28778-8211
[phone]
[phone] Fax
Avery, Buncombe, Burke, Caldwell, Cherokee,
Clay, Graham, Haywood, Henderson, Jackson,
Macon, Madison, McDowell, Mitchell, Polk,
Rutherford, Swain, Transylvania, Yancey
Water Quality Section
Fayetteville Regional Office
225 Green Street Suite 714
Fayetteville, North Carolina 28301-5095
[phone]
[phone] Fax
Anson, Bladen, Cumberland, Harnett, Hoke,
Montgomery, Moore, Robeson, Richmond,
Sampson, Scotland
Water Quality Section
Mooresville Regional Office
610 E. Center Avenue
Mooresville, North Carolina 28115
[phone]
[phone] Fax
Alexander, Cabarrus, Catawba, Cleveland,
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
Stanly, Union
Water Quality Section
Raleigh Regional Office
3800 Barrett Drive
Raleigh, North Carolina 27609
[phone]
[phone] Fax
Chatham, Durham, Edgecombe, Franklin,
Granville, Halifax, Johnston, Lee, Nash,
Northampton, Orange, Person, Vance, Wake,
Warren, Wilson
Water Quality Section
Washington Regional Office
943 Washington Square Mall
Washington, North Carolina 27889
[phone]
[phone] Fax
Beaufort, Bertie, Camden, Chowan, Craven,
Currituck, Dare, Gates, Greene, Hertford, Hyde,
Jones, Lenoir, Martin, Pamlico, Pasquotank,
Perquimans, Pitt, Tyrrell, Washington, Wayne
Water Quality Section
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, North Carolina 28405
[phone]
[phone] Fax
Brunswick, Carteret, Columbus, Duplin, New
Hanover, Onslow, Pender
Water Quality Section
Winston-Salem Regional Office
450 W. Hanes Mill Road
Suite 300
Winston-Salem, North Carolina 27105
[phone]
[phone] Fax
Alamance, Alleghany, Ashe, Caswell, Davidson,
Davie, Forsyth, Guilford, Rockingham, Randolph,
Stokes, Surry, Watauga, Wilkes, Yadkin
Water Quality Section
INSTRUCTIONS FOR FORM: FTA 05-21 & SUPPORTING DOCUMENTATION Page 3 of 3

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?
❑ Yes ❑ No ® N/A
3. If the Applicant is a Home/Property Owners' Association, has an I-IOA/POA Operational Agreement (FORM: ITOA) and
supplementary documentation as required by 15A NCAC 02T.01 15(c) been attached?
❑Yes ❑No ZN/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
0 Other (Explain in Attachment)
5. Nature of wastewater : 100 % Domestic % Commercial % Industrial (Sec 15A NCAC 02T .0103(20))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under I5A NCAC 02T .01 14(f)? ❑ Yes ❑ No N/A
➢ If ves, provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project: N/A
Establishment Type (see 02T.0114(f))
Daily Design Flow a,b
No. of Units
Flow
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
GPD
a See 15A NCAC 02T .01 14(b), (d), (e)( I) 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.
0 Flow has already been allocated in Permit Number: Issuance Date:
0 Rehabilitation or replacement of existing sewers with no new flow expected
® Other (Explain): Renovation of existing building with no net increase in flow, but new sanitary sewer connection.
FORM: FTA 06-21
Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 112T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
4
10
PVC
➢ Section II & III of the MDC for Permitting 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 minimum slope requirements is not allowed and a violation of the MDC
N/A VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: N/A
2. Approximate Coordinates (Decimal Degrees): Latitude: N/A Longitude: - N/A °
3. Total number of pumps at the pump station: N/A
3. Design flow of the pump station: N/A millions gallons per day (firm capacity)
➢ This should reflect the total GPM for the pump station with the largest pump out of service.
4. Operational point(s) per pump(s): N/A gallons per minute (GPM) at N/A feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station): N/A
Size (inches)
Length (feet)
Material
If any portion of the force main is Tess than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.01C.1.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
N/A 6. Power reliability in accordance with 15A NCAC 02T .0305(h)(1):
❑ Standby power source or ❑ Standby pump
➢ Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(1)(B)_
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
D Must be permanent to facility and may not be portable
Or if the pump station has an average daily flow less than 15,000 gallons per day 15A NCACO2T.0305(h)(1)(C):
N/A ❑ Portable power source with manual activation, quick -connection receptacle and telemetry -
or
N/A ❑ Portable pumping unit with plugged emergency pump connection and telemetry:
➢ Include documentation that the portable source is owned or contracted by the applicant 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 timeframes, shall be provided
as part of this permit application in the case of a multiple station power outage.
FORM: FTA 06-21 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(0):
1. Does the project comply with all separations/alternatives found in I5A NCAC 02T .0305(fl &
15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
®Yes No
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
'Water mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
'Water mains (horizontal)
10 feet
Reclaimed water lines (vertical - reclaimed over sewer)
18 inches
Reclaimed water lines (horizontal - reclaimed over sewer)
2 feet
**Any private or public water supply source, including any wells, WS-I waters of Class 1 or
Class II impounded reservoirs used as a source of drinking water, and associated wetlands.
100 feet
**Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal
high water (or tide elevation) and wetlands associated with these waters (see item iX.2)
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches, as well as wetlands associated with these waters or classified as WL.
10 feet
Any building foundation (horizontal)
5 feet
Any basement (horizontal)
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
➢ if noncompliance with 02T.0305(t) or (g), see Section X.I of this application
*15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(f) cannot be achieved. Please check "yes"
above if these alternatives are used and provide narrative information to explain.
**Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
2. Does this project comply with the minimum separation requirements for water mains? ❑ Yes ❑ No ® N/A
➢ if no, please refer to 15A NCAC 18C.0906(f) for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? ❑ Yes ❑ No
D. Please provide supplementary information identifying the areas of non-conformance.
➢ See the Division's draft separation requirements for situations where separation cannot be met.
D. No variance is required if the alternative design criteria specified is utilized in design and construction.
4. Is the project located in a river basin subject to any State buffer rules? ❑ Yes Basin name: ® No
if yes, does the project comply with setbacks found in the river basin mules per I5A NCAC 02B .0200? ❑ Yes ❑ No
➢ This includes Trout Buffered Streams per 15A NCAC 2B.0202
® N/A
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ❑ Yes ® No
or 401 Water Quality Certifications?
➢ Please provide the permit number/permitting status in the cover letter if coverage/authorization is required.
6. Does project comply with I5A NCAC 02T.0105(c)(6) (additional permits/certifications)? ❑ Yes ® No
Per I5A NCAC 02T.0105(c)(6), directly related environmental permits or certification applications must be 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.).
7. Does this project include any sewer collection lines that are deemed "high -priority?" ❑ Yes ® No
Per 15A NCAC 02T.0402 "high -priority sewer" means any aerial sewer, sewer contacting surface waters,
siphon, or sewers positioned parallel to streambanks that are subject to erosion that undermines or deteriorates the sewer.
Siphons and sewers suspended through interference/conflict boxes require a variance approval.
➢ 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 02T.0403(a)(5) or the permittee's individual System -Wide Collection permit.
FORM: FTA 06-21 Page 4 of 5

CERTIFICATIONS:
1. Does the submitted system comply with I5A 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, R 1'- T . IC© ?' , attest that this application for GI 4 i-Oir_ /N 7/.0. S. Rom© vAr/) v.s
(Professional Engineer's name from Application Item 111.1.) (Project Name from Application Item 11.1)
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�,54a,p,'�p1,)i
.sto
North Carolina Professional Engineer's seal, signature, and date: ;°�O P°OC. FgS10`O� �2
.,
' e�Is ALA
043375 .
3. Applicant's Certification per 15A NCAC 02T .0106(b):
1, FLE1&-\E.S CCRE(COgy , attest that this application for 6HA-.L0 TE l,AclN H.o.S. RC.N4wATt0Ns
(Signature Authority Name from Application Item 1.3.)
(Project Name from Application Item 11.1)
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 c tfication in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine no to exceed $1 00 as well as civil penalties up to $25,000 per violation.
Signature:
Date:
FORM: FTA 06-21 l' 1 Page 5 of 5

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• Upload a PDF Filing • Order a Document Online • Add Entity to My Email Notification List • View Filings
Non -Profit Corporation
Legal Name
Charlotte Latin Schools, Inc.
Information
Sosld: 0026705
Status: Current -Active 0
Date Formed: 1 /21 /1970
Citizenship: Domestic
Annual. Report Due Date:
Registered Agent: Baldecchi, Charles D.
Addresses
Mailing Reg Office Reg Mailing
9502 Providence Rd 9502 Providence Rd 9502 Providence Rd
Charlotte, NC 28277-8695 Charlotte, NC 28277-8695 Charlotte, NC 28277-8695
Officers

Skylar Gomez
From: Jarrett, Jason <[e-mail]>
Sent: Monday, March 7, 2022 2:05 PM
To: Skylar Gomez
Subject: RE: [EXT]RE: Willingness to Serve: Charlotte Latin HOS Renovations
Follow Up Flag: Follow up
Flag Status: Completed
This email originated from outside of our organization, so don't click links or open attachments from any unknown sources.
Thank you Skylar. Since these proposed connections are internal to your site, connecting to existing private
infrastructure, CLT Water will not need to review the plan for new service connections.
Jason Jarrett / New Services Compliance Manager — Installation and Development Services
CHARLOTTE WATER
600 East Trade Street, Suite 20 / Charlotte, NC 28202
P: 704-432-5110 / charlottewater.orq
From: Skylar Gomez <[e-mail]>
Sent: Monday, March 7, 2022 1:54 PM
To: Jarrett, Jason <[e-mail]>
Subject: [EXT]RE: Willingness to Serve: Charlotte Latin HOS Renovations
EXTERNAL EMAIL: This email originated from the Internet. Do not click any images, links or open any attachments unless you recognize and t
know the content is safe. Please click the Phish Alert button to forward the email to Bad.Mail.
Jason,
The water line connection is existing and the main line serves multiple buildings on the Charlotte Latin Campus. The plan
does propose a new sanitary sewer connection to an existing main line that also serves the campus. These lines are both
owned and maintained by Charlotte Latin School.
Please let me know if you have any other questions.
Thanks,
Skylar Gomez, El, SITES AP
Consulting Specialties I Land Development Services
Little
704.561.3240
Littleonline.com I Explore I Linkedln I Instadram I Vimeo I Twitter
From: Jarrett, Jason <[e-mail]>
Sent: Monday, March 7, 2022 1:19 PM
To: Skylar Gomez <[e-mail]>
Subject: FW: Willingness to Serve: Charlotte Latin HOS Renovations
1

This email originated from outside of our organization, so don't dick links or open attachments from any unknown sources.
Good afternoon,
The attached plan appears to propose connections to existing private water and sewer lines. Is that correct? If so, do
the private lines you're proposing to connect to belong to the same property you're proposing to serve or are they
serving an adjacent property?
Thanks,
Jason Jarrett / New Services Compliance Manager — Installation and Development Services
CHARLOTTE WATER
600 East Trade Street, Suite 20 / Charlotte, NC 28202
P: 704-432-51 10 / charlottewater.org
From: New Service Requests <[e-mail]>
Sent: Monday, March 7, 2022 1:13 PM
To: Montgomery, Geneva <[e-mail]>; Huskey, Jeffrey <[e-mail]>;
Pellicone, Zachary<[e-mail]>
Cc: Jarrett, Jason <[e-mail]>
Subject: Willingness to Serve: Charlotte Latin HOS Renovations
Cordially,
Guillermo Anzola / Engineering Assistant
CHARLOTTE WATER
5100 Brookshire Blvd, Charlotte, NC 28216
P: 704-432-5801 / charlottewater.org
From: Skylar Gomez <[e-mail]>
Sent: Monday, March 7, 2022 8:59 AM
To: New Service Requests <[e-mail]>
Cc: Eric Fox <[e-mail]>
Subject: [EXT]Willingness to Serve: Charlotte Latin HOS Renovations
EXTERNAL EMAIL: This email originated from the Internet. Do not click any images, links or open any attachments unless you
know the content is safe. Please click the Phish Alert button to forward the email to Bad.Mail.
Good morning,
recognize and trust the sender and
Please see attached for the Capacity Assurance Review Application and Utility Plan for the Charlotte Latin HOS
Renovations Project. This project connects to Charlotte Latin's existing sanitary sewer line and does not result in any
increase in flows. It is an interior renovations project with a new sanitary sewer lateral connection. Please let me know if
you have any questions.
Thanks,
Skylar Gomez, El, SITES AP
Consulting Specialties I Land Development Services
Little
615 South College Street, Suite 1600
2