WQ0040719_Application_20190319

KAMAVOPublic s
March 12, 2019
North Carolina Department of Environmental Quality
Mooresville Regional Office - Water Quality Section
610 East Center Avenue, Suite 301
Mooresville, North Carolina 28115
Re: Crescent Street Water and Sewer Improvements
Sewer Extension
City of Kannapolis — Cabarrus County
Dear Sir or Madam:
REC .-D/N(,P 'P.IRIMVR
klAR 18 2019
M0t.;F' SVILLPREGIONALOFFICE
Please find attached for your review and approval the original and one copy of the
permit application along with the $480 processing fee for the above referenced project.
Also enclosed is the flow acceptance letter from the Water & Sewer Authority of
Cabarrus County stating they will accept and treat the additional wastewater at the
Rocky River Regional Wastewater Treatment Plant.
The proposed extension will connect to the existing Kannapolis sewer system which
extends to the WSACC Irish Buffalo Creek Interceptor. This proposed wastewater
collection system will replace an existing private system on Crescent Street that was
installed by a resident.
The Water and Sewer Authority of Cabarrus County Standard Specifications for
Wastewater Collections Systems were approved by your office and are being
maintained by the Division of Environmental Management. This project will be installed
in accordance with these Standard Specifications.
Please call me at 704-920-4235 if you have any questions.
Sincerely,
f
Beth Hassenfritz, PE
PUBLIC WORKS 401 LAUREATE WAY KANNAPOLIS, N.C. 28081
704-920-4200 wwW.KANNAPOLISNC.GOV

DWR
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 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: City of Kannapolis (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State/County ® Municipal
3. Signature authority's name: Wilmer Melton, lII per 15A NCAC 02T .0106(b)
Title: Director of Public Works
4. Applicant's mailing address: 401 Laureate Way
City: Kannapolis State: NC Zip: 28081-0005
5. Applicant's contact information:
Phone number: [phone] Email Address: [e-mail]
II. PROJECT INFORMATION:
�'1= ". FIVTcDINCC)E=NR/i)WR
IgOROS
!�^U:'f1'i SVfU_� REGIONAL OFFICE
❑ Privately -Owned Public Utility
❑ Other
1. Project name: Crescent Street Water and Sewer Improvement
2. Application/Project status: ® Proposed -(New Permit) ❑ 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: Cabarrus
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.465660' Longitude:-80.621452'
5. Parcel ID (if applicable): within road R/W between parcels 5612-69-8136 and 5612-79-1079
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Elizabeth H. Hassenfritz License Number: NC 030941
Firm: City of Kannapolis
Mailing address: 401 Laureate Way
City: Kannapolis State: NC Zip: 28081-0005
Phone number: [phone] Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Rocky River Regional Wastewater Treatment Plant Permit Number: NCO036269
Owner Name: Water & Sewer Authority of Cabarrus County
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ
System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s):
FORM: FTA 04-16 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?
❑ Yes ❑No ®N/A
3. If the Applicant is a Home/Property Owners' Association. has an Operational Agreement (FORM: HOA) been attached?
❑ Yes ❑No ®N/A
4. Origin of wastewater: (check all that apply):
® Residential Owned ❑ Retail (stores, centers, malls) ❑ Car Wash
❑ Residential Leased ❑ Retail with food preparation/service ❑ Hotel and/or Motels
❑ School / preschool / day care ❑ Medical / dental / veterinary facilities ❑ Swimming Pool /Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 % Domestic/Commercial 0 % Commercial
0 % Industrial (_See 15A NCAC 02T .0103(201)
1 1, Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(f)? ❑ Yes ®No
➢ If yes, provide a copv of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(fl)
Daily Design Flow a,b
No. of Units
Flow
3 bedroom dwelling units
360 gal/day
7
2,520 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
2,520 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.01141 shall
be determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 2,520 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 04-16 Page 2 of 5

VII. GRAVITY SEVER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 246 PVC
➢ Section II & III of the I/IDC 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 requirement is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: N/A
2. Approximate Coordinates (Decimal Degrees): Latitude: 0Longitude: - °
3. Design flow of the pump station: millions gallons per day (firm capacity)
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):
Size (inches) FLength (feet) Material
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(1):
❑ Standby power source or pump with 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
Or if the pump station has an average daily flow less than 15,000 gallons per day:
❑ Portable power source with manual activation, quick -connection receptacle and telemetry - 15A NCAC 02T
.0305(h)(1)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry - 15A NCAC 02T .0305(h)(1)(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 timeframes, shall be
provided in the case of a multiple station power outage.
FORM: FTA 04-16 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations found in 15A NCAC 02T .0305(fl & (g)
➢ 15A NCAC 02T.0305(fl 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)
24 inches
Water mains vertical -water over sewer 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 H impounded reservoirs used as a source of drinking water
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 see item IX.2
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches
10 feet
Any building foundation
5 feet
Any basement
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
➢ 15A 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 Water Classifications webpaee
➢ If noncompliance with 02T.0305 fl or (g), see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ® Yes [:]No
➢ 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
3. Does the project comply with all setbacks found in the river basin rules per 15A NCAC 02B .0200? ® Yes ❑ No
➢ This would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Does the project comply with an individual 404 Permit or any 401 Certifications? ® Yes ❑ 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 & Buffer Permitting Branch
5. 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 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 streambanks that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes ® No
➢ If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at least once every six -months and
inspections documented per 15A NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit.
FORM: FTA 04-16 Page 4 of 5

Y. 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, complete and submit the Variance/Alternative Design Request application (VADC 10-14) and supporting documents
for review. Approval of the request is required prior to submittal of the Fast Track Application and supportini:
documents.
Professional Engineer's `C_ertification:
I, a,, � [ \ C, (ti �� �t- attest that this application for
(Professional Engineer's name from Application Item I11.1.)
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 hi accordance with the applicable regulations, Gravity Sewer
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track
Permitting of Pump Stations and Force Mains (latest version). Although other professionals may have developed certain
portions of this submittal package, inclusion of these materials under my signature and seal signifies that I have reviewed this
material and have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.613, any person who knowingly makes any false
statement, representation, or certification in any appheation 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 seat, signature, and date:
a� SEA1 Z4 =
f j IXiS�rl nl'°
3. Applicant's Certification per 15A NCAC 02T .0106(b):
O-U-( /VVLt-bn � m 1(L)i fPCiv 6 XSRC WWK5 attest that this application for
(Signature Authority's name k, title from Application Item I.3.)
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: /.i Date: j, -17 - %
FORM: FTA 04-16 Page 5 of 5

? V ,L Ar'N 51 •n:� C LUNiECL 1 -•� C JK 51
C 4
Q N 5
1
k C
5Uh1MER
1 SSELL 51 O anna IS
I - Rp r0 FT I L
00 Sr �9LC' _ �F z O n C0
ACt4 Sf
C \ n O D
Q O - p An/NJ.l VE U
O O 2 rJRPVCT
O ` ROGERS L KF RUB m yy 00RSAE
R
000
ARW )OU 5Ttip
Tha FSr
AIIONLN
t 1 I1I h� J M
I �� -- -- 7 I 1 a CotTA •F !} I
\.`•, wl, - v-'� I1 fUULFhlANN
1 w pp
W a O s i 7: SUfdN 12 51
Q CORR .0 �.. \`•'tl
uR
S7
Rt\JGE •� 1. 1. 1 k
E BL \
IR �
PIN Co\ .. _ ,,
J SET1LERti 1, \ MAR GOLU DR
l � I � � � � \ NEJAD!•
MOS R fiRECKC�IRIUGEgrI
/, - NNiiryOV ` Q - I.AVIZ DR
00\y
NRO 5
bS - ST
�
51j
UAKOTA 51
./f
.� UUURN
\ IORNf. 7. f! S
\ 51
�' \ Proposed 8 inch UANLO"v OR 411 1LE ,
_ Extension hruRn=�R" i 51
COUR?LAP10 C7_ j RU OL4 I
CE
A
1. � •., �?`!''?aorT E��.- - ---F GREEN -
Y. ENV
_ pif0 � �+ •S
UR
SOU
st 21 r ( a0
E25NER
St
Crescent Street Sewer Extension CABBIE
C 3 � r1AHN S1
z
Kannapolis, NC
L
i2 Lrl f;asr+ P°gal
0 1,000 2,000 `s
Feet
1 inch = 1,000 feet
III I''`A' •,}

WSACC
R 14001;1001 + NO Sfar Mlt Swor + ONSAS %1110Ol
March 6, 2019
Mr. Michael Legg
City Manager
City of Kannapolis
401 Laureate Way
Kannapolis, NC 28081
Subject: Flow Acceptance Request — City of Kannapolis
Crescent Street Water and Sewer Improvement
Dear Mr. Legg:
WATER & SEWER AUTHORITY
OF CABARRU5 COUNTY
232 Davidson Hwy,
Concord, NC 28027
704.786.1783 ♦ 704,795.1564 Fax
v v.vrsacc.org
MR 1 -12G 19,
This is a notice of capacity for the flow acceptance request received by the Water and Sewer Authority of Cabarrus
County (WSACC) from the City of Kannapolis on March 5, 2019. WSACC has or will have capacity at the Rocky
River Regional Wastewater Treatment Plant and appropriate sewer interceptors to transport and treat the domestic
wastewater from the proposed project entitled Crescent Street Water and Severer Improvement, located along
Crescent Street. The referenced project will serve seven homes, with a projected wastewater flow of 2,520 gallons
per day (gpd). The wastewater generated by this project will be conveyed through a proposed gravity system,
through the existing gravity system, and then enter WSACC's system at the existing 48-inch Irish Buffalo Creek
Interceptor. WSACC acknowledges it has or will have capacity for wastewater from the proposed development
based on information provided by City of Kannapolis (Civil Engineer for the project) using North Carolina
Department -of Environmental Quality (NCDEQ) wastewater flow guidelines.
The WSACC Capital Improvement Program (CIP) has been on pay as you go since Fiscal Year 2005 -- 2006,
funding Capital Projects entirely from Capital Reserves, and WSACC expects to continue this policy into the future.
Projects on the CIP are subject to approval by WSACC's Board of Directors, support from local governing bodies,
regulatory approval, and funding availability. The list and schedule of CIP projects are tentative and are revised
periodically to reflect changing conditions and needs.
If construction of this project does not cormnence within two (2) years of the date of this notice, the notice is
rescinded and a second request and notice will be required before flow capacity is accepted. Please notify WSACC,
in writing, when construction of this project is initiated. This sewer capacity allocation may also be cancelled
pursuant to the conditions set forth in the WSACC Sewer Allocation and Commitment Policy.
Please note that the final committnent to service to provide wastewater treatment services shall occur upon
application for a building permit for the project and when system development fees are paid pursuant to N.C.G.S
§I62A, Article 8.
If you have any questions, please call me at [phone], extension 104.
Sincerely,
li"" ay-
J. Thomas Hahn, PE
Utility Systems Engineer
cc: Misty Lippard, PE/Kannapolis
Wilmer Melton/Kannapolis
Elizabeth H. Hassenfritz, PE/Kannapolis
Michael Wilson/WSACC
Chad VonCannon, PE/WSACC
Mark Lomax/WSACC

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking/Acceptance for Sewer Extension Applications
Division of water Resonmes (FTSE-04/16)
(WSACC USE ONLY) Crescent Street Water and Sewer Improvement
Section I. Name of wastewater treatment facility (WWTF) receiving wastewater:
® Rocky River Wastewater Treatment Facility — Permit #NC0036269
Muddy Creek Wastewater Treatment Facility — Permit 4NCO081621
WWTP facility's permitted flow, MGD 26.500
Estimated obligated flow not yet tributary to the WWTP, MGD 2.069
WWTP facility's actual avg. daily flow, MGD 20.070 (75.74% of permit)
Total flow for this specific request, MGD 0.003
Total actual and obligated flows to the facility, MGD 22.142
Percent of nerxnitted flow used 83.55%
Section II. Pump stations along the route from the Jurisdiction's connection point to the WWTP.
A x.C D = B+C (E)=(A-D)
Pump Station Firm Capacity * Design Average Daily Flow ** Approx. Current Obligated, Not Yet Total Cuurent Flow Available
(Name or Number) MGD (Firmlpf) Average Daily Flow Tributary Daily Flow Plus Obligated Flow Capacity***
MGD i4IGD MGD MGD MGD
RRRO6'WTP MPS 55.440 22.176 11.945 0,495 12.440 9,736
* 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 not less than 2.5.
***A Planning Assessment Addendum shall be attached for each pump station located bet%veen the project connection point and the wwTP inhere Available Capacity is < 0.
Section III. WSACC Certification Statement:
I, J. Thomas Hahn, PE, 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 from the connection to the WSACC interceptor 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 Section I and Section lI plus all attached planning
assessment addendums for which I am the responsible party. Signature of this form indicates WSACC's guarantee of
capacity for this wastewater flow. Notwithstanding the guarantee of capacity, WSACC does not make a commitment to
service this wastewater flow until a building permit is requested through the Cabarrus County Building Inspections
Department and WSACC receives payment of the System Development Fee.
CC's Signing Official Signature

D. R
W,
State of North Carolina
Department of Environment and Natural Resources
11 IVISl61b of Water Resources c Division of Water Resources
Flow Tracking/Acceptance for Sewer Extension Permit Applications
(FTSE 41/14)
(JURISDICTION USE ONLY)
Jurisdiction Requesting Flow Acceptance for Collection System:
❑City of Concord ®City of Kannapolis ❑Town of Harrisburg ❑Town of Mt. Pleasant
❑Charlotte Mecklenburg Utilities
Project Title, Description, and Number of Lots[Unit:
Project Title: Crescent Street Water and Sewer Improvement
Description: The Crescent Street Water and Sewer Improvementengineering plans and specifications, as prepared and
sealed by Elizabeth H. Hassenfritz. NCPE, with City of Kannapoiis, for the wastewater collection system extension consisting
of approximately 246 linear feet of 8-inch sanitary sewer with 1 manholes and other appurtenances to serve 7 located off/on of
Crescent Street, with a wastewater discharge of 2,520 GPD.
What is the quantity of flow that will be discharged? 2,520 GPD
Flow type:
® Domestic 100 % ❑ Commercial % ❑ Industrial %
Section I - List the Jurisdiction's pump stations located between the project connection point and the WSACC
Interceptor connection point.
Pump Station
(Name or Number)
Firm Capacity "
MGD
(A)
Design Average Daily Flow **
(Firm/pt)
MGD
(B)
Approx. Current
Average Daily Flow
MGD
(C)
obligated, Not Yet
Tributary Daily Flow
MGD
(D) = (B+C)
Total Current Flow
Plus Obligated Flow
YIGD
(E)=(A-ID)
Available
Capacity***
MGD
* 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 not less than 2.5.
***A Planning Assessment Addendum shall be attached for each pump station located between the project connection point and the wWTPwhere Available Capacity is < 0.
Section H. Jurisdiction's Certification Statement:
I, Wilmer Melton, III, Director of Public Works, certify that, to the best of my knowledge, the addition of the volume
of wastewater to be permitted in this project has been evaluated along the route to the receiving WSACC interceptor; and the
flow from this project is not anticipated to cause any capacity related sanitary sewer overflows or overburden on any
downstream pump station in route to the receiving WSACC interceptor 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 Section I plus all attached planning assessment addendums for which, to the best of my knowledge, will not adversely affect
the doymshiKm sewer capacity. Signature of this form indicates acceptance of this wastewater flow.
Jurisdiction
Official Signature
Date
Revision Date: 08/09/ 13