WQ0043492_Application_20220606

DocuSign Envelope ID: D30A23AC-97C1-4FAC-BA77-33EBO8A95CA9
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: WGZDOu34g2. (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Southern Benedictine Society of North Carolina, 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: Allan Mark per 15A NCAC 02T .0106(b)
Title: Executive Vice President for Administration, Finance and Operations 074,,..
4. Applicant's mailing address: 100 Belmont — Mt. Holly Road 4/0 �U� O�
6'
City: Belmont State: NC Zip: 28012 !r'►,��sL/`` / e'°
1N,4,
Phone number: [phone] Email Address: [e-mail] qz O
FFZ�
II. PROJECT INFORMATION:
1. Project name: Belmont Abby Housing - Wimmer Circle Residence Halls
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: Gaston
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.2612° Longitude: -81.0445°
5. Parcel ID (if applicable): 217518 (or Parcel ID to closest downstream sewer)
5. Applicant's contact information:
III. CONSULTANT INFORMATION:
1. Professional Engineer: Anthony Brent Cowan, P.E.
Firm: The Isaacs Group, PC
Mailing address: 8720 Red Oak Blvd., ste. 420
City: Charlotte State: NC Zip: 28217
Phone number: [phone] Email Address: [e-mail]
STEWATER TREATMENT FACILITY (WWTF) INFORMATION:
';ty Name: City of Belmont Permit Number: NC0021181
-vie: Belmont
NSTREAM SEWER INFORMATION:
License Number: 026462
,ewer Information: 8 inch El Gravity ❑ Force Main
n System Permit Number(s) (if applicable): WQCS
Juthern Benedictine Society of North Carolina, Inc
400004/4,
Page 1 of 5

DocuSign Envelope ID: D30A23AC-97C1-4FAC-BA77-33EB08A95CA9
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 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(f)? ❑ 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(f))
Daily Design Flow a,b
No. of Units
Flow
Dwelling units (beds)
60 gal/day/person
320
19,200 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
19,200 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: 38,400 GPD (per l5A 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: Issuance Date:
❑ Rehabilitation or replacement of existing sewers with no new flow expected
❑ Other (Explain):
FORM: FTA 06-21
Page 2 of 5

DocuSign Envelope ID: D30A23AC-97C1-4FAC-BA77-33EB08A95CA9
VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8
937
PVC
8
20
DIP
➢ 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
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:
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: - . °
3. Total number of pumps at the pump station:
3. Design flow of the pump station: 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): gallons per minute (GPM) at feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
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)
6. Power reliability in accordance with I5A 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
➢ 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):
❑ Portable power source with manual activation, quick -connection receptacle and telemetry -
or
❑ 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

DocuSign Envelope ID: D30A23AC-97C1-4FAC-BA77-33EB08A95CA9
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)? ® Yes ❑ No
15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
2Water mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
2Water 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(t) or (g), see Section X.1 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 ❑ N/A
➢ 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.
4. Is the project located in a river basin subject to any State buffer rules? ❑ Yes Basin name: Catawba ® No
If yes, does the project comply with setbacks found in the river basin rules 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 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? ® Yes ❑ No
Per 15A 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

DocuSign Envelope ID: D30A23AC-97C1-4FAC-BA77-33EB08A95CA9
X. CERTIFICATIONS:
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, Anthony Brent Cowan , attest that this application for Belmont Abby Housing - Wimmer Circle Residence Halls
(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 56.0701)
North Carolina Professional Engineer's seal, signature, and date: ````x�v�N ttCAR°, /�
,—DocuSigned by: — SEAL
a„ .o.i. Ihevit iiowan. = • 026462 •
`—BC5CD3F32F844D5... i• '� • ••. • ,
',�j .4GINEE�' • Q ���•
///''O W I B►itG,-0\
3. Applicant's Certification per 15A NCAC 02T .0106(b): 6/6/2022
I, Allan Mark , attest that this application for Belmont Abby Housing - Wimmer Circle Residence Halls
(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:
DocuSigned by:
Allan Mark
•AE3316DA0282138...
Date:
6/6/2022
FORM: FTA 06-21 Page 5 of 5

DocuSign Envelope ID: 7D15458C-FE8D-4252-8A59-BE76F41EF8A5
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: 1/0 0010 4 / c, be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
RECh1VhDINUUtUIDWR
MAY 3 1 2022
WQROS
MOORESVILLE REGIONAL OFFIC
1. Applicant's name: Southern Benedictine Society of North Carolina, 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: Allan Mark per 15A NCAC 02T .0106(b)
Title: Executive Vice President for Administration, Finance and Operations
4. Applicant's mailing address: 100 Belmont — Mt. Holly Road
City: Belmont State: NC Zip: 28012
5. Applicant's contact information:
Phone number: [phone] Email Address: allanmark(abac.edue
II. PROJECT INFORMATION:
1. Project name: Belmont Abby Housing - Wimmer Circle Residence Halls
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: Gaston
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.2612° Longitude: -81.0445°
5. Parcel ID (if applicable): 217518 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Anthony Brent Cowan, P.E.
Firm: The Isaacs Group, PC
Mailing address: 8720 Red Oak Blvd., ste. 420
City: Charlotte State: NC Zip: 28217
Phone number: [phone] Email Address: bcowanisaacsgrp.com
License Number: 026462
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: City of Belmont Permit Number: NC0021181
Owner Name: Belmont
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ
2. Downstream (Receiving) Sewer Information: 8 inch El Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s): Southern Benedictine Society of North Carolina, Inc
FORM: FTA 06-21
Page 1 of 5

DocuSign Envelope ID: 7D15458C-FE8D-4252-8A59-BE76F41EF8A5
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 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):
El 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
El Swimming Pool/Filter Backwash
❑ Other (Explain in Attachment)
5. Nature of wastewater : 100 % Domestic % Commercial % Industrial (See ISA 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(f)? ❑ Yes ❑ No
> If ves, provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow a,b
No. of Units
Flow
Dwelling units (beds)
120 gal/day/bed
320
38,400 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
38,400 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: 38,400 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: Issuance Date:
❑ Rehabilitation or replacement of existing sewers with no new flow expected
❑ Other (Explain):
FORM: FTA 06-21
Page 2 of 5

�ISAACS
7J
0
CIVIL ENGINEERING DESIGN AND LAND SURVEYING C
8720 RED OAK BOULEVARD, STE. 420 D
CHARLOTTE, N.C. 28217
PHONE [phone] FAX [phone]
Project Narrative
RECEIVED/NCDEO/DWR
MAY 3 1 2022
S
MOORESVILLE REGIONAL OFFICE
Belmont Abby College-Wimmer Circle Residence Halls
City of Belmont, Gaston County, North Carolina
The project site is located in the City of Belmont in Gaston County, N.C. tax parcel
217518. The total area of the Campus is 282 Acres. The development is located on
the west side of Wimmer Circle. The proposed development will be constructed in one
phase and consists of 2 buildings. Each building is 43,338 S.F. and will be served off
sewer owned and maintained by Belmont Abbey College (Southern Benedictine
Society of North Carolina, Inc.). Design sewer flow to be generated by this project is
38,400 GPD (320 bedrooms x 120 GPD/bedroom). The new sewer collection system
within the project site will be via private 8 inch gravity lines that will be owned and
maintained by Belmont Abbey College and will be tied into an existing 8" gravity line
with the demolition of approximately 286 I.f of the existing 8" sewer line. The proposed
sewer system will be treated at City of Belmont Wastewater Treatment Facility (WWTF
NC0021181), which is owned by City of Belmont.
\\ISAACSGC0 1 \Projects\Active Projects\MKC Architects\BAC Residence Halls-Wimmer Cir
21330\Engineering\Correspondence\Applications\NCDEQ-SS\Sewer Cover Letter.doc

:vision:of Water. Resources
RECEIVEID/NCDEQ/DWR
02 State of North Carolioa'
WQROS Department of Environmental mentaQuality
RESVLL.E IREGIONAL OFF E Division of Viiater eson�rces
Flow Ttrackins f r' ewer Extension t pt lications
01 :On Abbey''College Rest all:
the t es ter aj the WWT i nol respons:hfe
pro pied iuustewater Jla�v.
oniplete this section only if you are the owner of the wastewater treatment plant.
WW P Facility Name: : Ctty_ofl elmot*,t WWTP
b i+ WTP FacilityPermit #E~ N 0021181
facility's permitted flow S.
d . Estimated obligated flow not yet tributary to the W WTP 1;.
e P facility's actual avg' #ltiw 1r
f. Total flow for this specific request t)
g. Total actual and obligated flows to the facility 2
It Percent of pert tutted flow
I. Complete this section for each pump station you are responsible for along the route of this pros
wastewater flow.
on pcin
n ° igated,
PumpPump ' Average; Approx.°- . Not Vet Total Current
Station Station Firm DatlyFlow" Current Tributary Flew Plus
tune or Permit Capacity, (irm pf), t+ vg. Daily Daily Flow, ` Obligated A'valdable
Number) 1Vo. MGD MGD` Flow, MGD MGD Flow Capacity***
(E) (A-
* The Firm Capacity (design flow) .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 peeking factor
(pf) not less than 22.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shallbe attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is <0.
Downstream Facility Name (Sewer):
Downstream Permit Number:
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I Adrian T. Miller, City Manager 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
�u➢
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
thoseitems listed above in Sections I and Il plus all attached planning assessment addendums for which I
am the responsible party. Signature of this form certifies that the receiving collection system or treatment
works has eclat t to capacity to transport and treat the proposed new wastewater.
Signing Official Signature
Title of Sign Official
Page 2 of 6
FTSE 10-18

III. Certification Statement:
I Adrian T. Miller, City Manager 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 patty. Signature of this form certifies that the receiving collection system or treatment
works has adequate apacity to transport and treat the proposed new wastewater.
Signing Official Signature
Title of Signing Official
Date
Page 2 of 6
FTSE 10-18

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CONTOUR INTERVAL 20 FEET
NORTH AMERICAN VERTICAL DATUM OF 1988
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RansO 4WD
IPInterstate Route
5 Rome 0 State Route
MOUNT HOLLY, NC
2019

North Carolina Secretary of State Search Results Page 1 of 1
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Non -Profit Corporation
Legal Name
Southern Benedictine Society of North Carolina, Incorporated
Information
Sosld: 0136783
Status: Current -Active
Date Formed: 4/28/1926
Citizenship: Domestic
Annual Report Due Date:
CurrentAnnual Report Status:
Registered Agent: Not Listed
Addresses
Reg Office
XX
Reg Mailing
XX
Belmontabbey, NC 00000 Belmontabbey, NC 00000
Officers
https://www.sosnc. gov/online_services/search/Business_Registration_Results 6/ 1 /2022