WQ0040047_Application (FTSE)_20200115

LmdDesip.
CREATING PLACES
THAT MATTER.
NCDENR Division of Water Quality
Mooresville Regional Office
610 E. Center Avenue
Mooresville, North Carolina 28115
Subject: Fast Track Sewer System Extension Application for Permit Modification
Project: Stevens Creek Lift Station, Forcemain and Gravity Sewer
LandDesign PN: 1016224
SEWER SYSTEM APPLICANT:
Charlotte Water
5100 Brookshire Blvd
Charlotte, NC 28216
` F
January15, 2020
ITEMS INCLUDED:
Enclosed is the Fast Track Application for Permit Modification for Charlotte Water's Stevens Creek Lift Station,
Force Main, and Gravity Sewer Improvements project located in Mint Hill, North Carolina. Included you will find
a complete application form, application fee, project USGS Topographic Map, and multiple street level aerial
maps identifying the location of proposed sanitary sewer improvements. One additional copy of the application
and supporting documentation is also provided.
DESCRIPTION:
The proposed sanitary sewer improvements include the installation of a regional tri-plex pump station (4.32
MGD capacity), approximately 14,610 LF of PVC/DIP force main, and approximately 12,822 LF of PVC/DIP
gravity sewer. The proposed modification is to upsize several of the gravity sewer as follows:
CURRENTLY PERMITTED GRAVITY SEWER
Size inches
Length feet
Material
8
4,350
PVC/D I P
12
4,080
PVC/DIP
16
4,170
PVC/DIP
24
222
DIP
PROPOSED GRAVITY SEWER
Size inches
Length feet
Material
8
4,350
PVC/DIP
16
4,080
PVC/DIP
20
4,170
PVC/D I P
24
222
DIP
Flow to the proposed lift station and gravity sewer will be subsequently permitted and sent to the McAlpine
Creek Wastewater Treatment Plant (NPDES permit number NC0024970).
The lift station, forcemain, and gravity sewer will be constructed per Charlotte Water Standards and
Specifications. Activation of the proposed Stevens Creek Lift Station, Force Main, and Trunk Sewer project is
contingent upon the construction and activation of Charlotte Water's Irvins Creek Tributary Trunk sewer
improvements (Charlotte Water Project No. 7030600111-17-571).
Sincerely,
Dale C. Stewart, PE
LANODEStGN.COM
223 N. GRAHAM STREET • CHARLOTTE, NC 28202 • 704.383,0325
CHARLOTTE • WASHINGTON D.C. - DALLAS - ORLANDO - SAN FRANCISCO - BOULDER

at
State of Noi-th C-olina
j 1 � Depai-t rent of Environmental Quality
Division of Water Resout°ces
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM[ EXTENSION APPLICATION
Division o Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number. � � � �� � (to be completed by DWR)
i, a
All items must be completed or the aDDlication will be returned t
I. APPLICANT INFORMATION:lj-
v
1. Applicant's name: Charlotte Water (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State/County ® Municipal
3. Signature authority's name: Joseph C. Wilson, PE per 15A NCAC 02T .0106(b)
Title: Chief Engineer
4. Applicant's mailing address: 5100 Brookshire Blvd
City: Charlotte State: NC Zip: 28216-
5. Applicant's contact information:
Phone number: [phone] Email Address: cwilson charlottenc.gov
I1. PROJECT INFORMATION:
❑ Privately -Owned Public Utility
❑ Other
1. Project name: Stevens Creek Lift Station, Forcemain & Gravity Sewer
2. Application/Project status: ❑ Proposed (New Permit) ® Existing Permit/Project
If a modification, provide the existing permit number: WQ0040047 and issued date: 06/22/2018
If new construction but part of a master platy, provide the existing permit number: WQOQ
3. County where project is located: Mecklenburg
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.14230' Longitude:-80.64045'
5. Parcel ID (if applicable): 19701145
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
I . Professional Engineer: Dale Stewart, PE License Number: 6988
Firm: Land Design
Mailing address: 223 N Graham Street
City: Charlotte State: NC Zip: 28202-
Phone number: [phone] Email Address: dstewart0mlanddesign.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: McAlpine Creek WMF Permit Number: NCO024970
Owner Name: Charlotte Water
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ Downstream (Receiving) Sewer Size: 8 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS00001
Owner Name(s): Charlotte Water
FORM: FTA 04-16 Page I of 5

V1. GENERAL REQUIREMENTS
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 HomelProperty Owners' Association has an Operational Agreement (FORM HOA) been attached?
❑ Yes ❑No ®NIA
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
El Businesses loffices /factories ❑Swimming Pool/Filter Backwash
❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 % Domestic/Commercial % Commercial
% Industrial (See 15A NCAC 02T .0103(20))
"Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(t)? ❑ Yes ❑ No
If yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow °''
No. of Units
Flow
0 gpd
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
GPD
a See 15A NCAC 02T .0114(b),(d (e)(1) and (c(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 pt•oject: 0 GPD (per 15A NCAC 02T .0114)
Do not include fixture 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 (1f Applicable) -. 02T .0305 & MDC. (Gravity Sewers):
L Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8'
4,350
PVC/ DIP
16"
4,080
PVC/ DIP
20"
4,170
PVC/ DIP
24"
222
DIP
Section 11 & 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 sewers)
9 Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
V1I1. 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: Stevens Creek Lift Station
2. Approximate Coordinates (Decimal Degrees): Latitude: 35.142300 Longitude:-80.64045'
3. Design flow of the pump station: 4.32 millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): 650 960 1300 1600 3000 gallons per minute at 164, 168, 174 181 226 feet total
dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
12"
50
DIP
20"
14,560
PVC/ DIP
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(I ):
® 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
9 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)
.I
❑ 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 timeftames, 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(t & ul 0 Yes [] No
15A NCAC 02T.0305( contains mininnrm separations that shall be provided for sewers stems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below vertical
24 inches
Water mains (vertical -water over sewer inchrdin in benched trenches)
18 niches
Water mains (horizontal)
10 feet
Reclaimed waterlines (vertical - reclaimedover 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 11 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 fi-om 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(a) contains alternatives where separations in 02T.0305(f} cannot be achieved.
)> "Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
If noncompliance with 02T.0305(f) or(g), see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ®yes ❑ No ❑ NIA
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
9 As built documents should reference the location of areas effected
3. Does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ❑ Yes ❑ No ® N/A
➢ This would include Trout Buffered Streams per 15A NCAC 213.0202
4. Does the project require coverage/authorization under a 404 Nationwide or ®Yes ❑ No
individual permits or 401 Water Quality Certifications?
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.0I05(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, storrnwater 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 ❑ N/A
If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at least once every six -months and inspections
documented per 15A NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit.
FORM: FTA 04-16 Page 4 of 5

X. CERTIFICATIONS:
Does the submitted systeni comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Purr Stations
and Force Mains (latest version), and the Gravity Server Iylinirnunr 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 tile request is required pt for to submittal of the Fast Tr aek Application and supporti�rg documents
2. Professional Engineer's Certification:
I' c" l e, C. S attest that this application for
(Professional Engineer's name from Application Iteni III.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 vest of my knowledge. I further attest that to the best
of my knowledge the proposed design has been prepared in accordance with the applicable regulations, Gravity Sewer
Minimum Design Criteria for Gravity Seders (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 application package shall be guilty of Class 2 mis ei nor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation r
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
M
(Signature Authoiity's name & title
Application Item I.3.)
attest that this application for
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required parts of
this application are not completed and that if all required supporting documentation and attachments are not included, this
application package is subject to being returned as incomplete. I understand that any discharge of wastewater fi•om 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 — hi 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: h
g t c Date: tZ Zo l
3
FORM: FTA 04-16 Page 5 of 5

t r State of North Oarotina
a, Depnrtrtrex�i of Envirt>n�nex�tal duality
Division of Water resources
l5A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION
This application is for sewer extensions involving gravity sewers, pump stations and force mains, or any combination that has been
certified by a professional engineer and the applicant that the project meets the requirements of 15A NCAC 02T and the Division's
Minimum Design Criteria and that plans, specifications and supporting documents have been prepared in accordance with, ISA
NCAC 02T, 15A NCAC 02T .0300, Division policies and good engineering practices.
While no upfi-ont engineering design documents are required for submittal, in accordance with 15A NCAC 02T .0305(b), design
documents must be prepared prior to submittal of a fast track permit application to the Division. This would include plans, design
calculations, and project specifications referenced in 15A NCAC 02T .0305 and the applicable minimum design criteria. These
documents shall be available upon request by the Division.
Projects that are deemed permitted (do not require a permit from the Division) are explained in 15A NCAC 02T.0303.
Projects not eligible for review via the fast track process (must be submitted for full technical review):
Projects that require an environmental assessment in accordance with 15A NCAC 1 C .0100;
➢ Projects that do not meet any part of the minimum design criteria (MDC) document;
➢ Projects that involve a variance fi•orn the requirements of 15A NCAC 2T;
➢ Pressure sewer systems utilizing septic tank -effluent pumps (STEPS) or simplex grinder pumps;
➢ STEP or simplex grinder pumps connecting to pressurized systems (e.g. force mains);
Vacuum sewer systems.
General — When submitting an application, please use the following instructions as a checklist in order to ensure all required items
are submitted. Adherence to these instructions and checking the provided boxes will help produce a quicker review time and
reduce the amount of requested additional information. Failure to submit all required items will necessitate additional
processing and review time, and may result in return of the application. Unless otherwise noted, the Applicant shall submit
one original and one copy of the application and supporting documentation.
A. One Original and One Copy of Application and Supporting Documents
® Required unless otherwise noted
B. Cover Letter (Required for All Application Packages):
® List all items included in the application package, as well as a brief description of the requested permitting action.
➢ Be specific as to the system type, number of homes served, flow allocation required, etc.
➢ If necessary for clarity, include attachments to the application form.
C. Application Fee (All New and Major Modification Application Packages):
® Submit a check or money order in the amount of $480.00 dated within 90 days of application submittal.
➢ Payable to North Carolina Department of Environmental Quality (NCDEQ)
D. Fast Track (Form: FTA 04-16) Application (Required for All Application Packages):
® Submit the completed and appropriately executed application.
➢ If necessary for clarity or due to space restrictions, attachments to the application may be made.
❑ If the Applicant Type in Item I.2 is a corporation or company, provide documentation it is registered for business with
the North Carolina Secretary of State.
❑ If the Applicant Type in Item 1.2 is a partnership or d/b/a, enclose a copy of the certificate filed with the Register of
Deeds in the county of business.
® The Project Name in Item II.1 shall be consistent with the project name on the flow acceptance letters, agreements, etc.
® The Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a North
Carolina licensed Professional Engineer.
® The Applicant's Certification on Page 5 of the application shall be signed in accordance with 15A NCAC 02T .0106(b).
Per 15A NCAC 02T .0106(e), an alternate person may be designated as the signing official if a delegation letter is
provided from a person who meets the criteria in 15A NCAC 02T .0106(b).
INSTRUCTIONS FOR FORM: FTA 04-16 R SUPPORTING DOCUMENTATION Page] of 3

E. Flow Tracking/Acceptance Form (Form: FTSE 04-16) (If Applicable):
❑ Submit the completed and executed FTSE form from the owners of the downstream sewers and treatment facility.
Multiple forms maybe required where the downstream sewer owner and wastewater treatment facility are different.
The flow acceptance indicated in form FTSE must not expire prior to permit issuance and must be dated less than one
year prior to the application date.
Submittal of this application and form FTSE indicates that owner has adequate capacity and will not violate G.S. 143-
215.67 a .
A Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific FTSE.
F. Site Maps (All Application Packages):
❑ Submit an 8.5-inch x 11-inch color copy of a USGS Topographic Map of sufficient scale to identify the entire project
area and closest surface waters.
> Location of the project (gravity sewer, pump stations & force main)
Downstream connection points and permit number (if known) for the receiving sewer
Include a street level neap (aerial) shouting general project area so that Division staff can easily locate it in the field.
G. Existing Permit (.All Modification Packages):
Submit the most recently issued existing permit.
Provide a list of any items within the permit the Applicant would like the Division to address during the permit
modification (i.e., permit description, flow allocation, treatment facility, etc.).
H. Power Reliability Plan (Required if portable reliability option utilized forPulnp Station):
❑ Per 15A NCAC 02T .0305(h)(1), submit documentation of power reliability for pumping stations.
This alternative is only available for average daily flows less than 15,000 gallons per day
It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant and is compatible
with the station. The Division will accept a letter signed by the applicant (see 15A NCAC 02T .0106(b)) or proposed
contractor, stating that "the portable power generation unit or portable, independently -powered pumping units, associated
appurtenances and personnel are available for distribution and operation of this pump 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. (Required at time of certification)
I. Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
C] Per 15A NCAC 02T .0115(a)(1) provide the Certificate of Public Convenience and Necessity from the North Carolina
Utilities Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served by
the sewer extension, or
❑ Provide a letter from the North Carolina Utilities Commission's Water and Sewer Division Public Staff stating an
application for a franchise has been received and that the service area is contiguous to an existing franchised area or that
franchise approval is expected.
J. Operational Agreements (Applications from HOA/POA and Developers for lots to be sold):
❑ Home/Property Owners' Associations
❑ Per 15A NCAC 02T .0115(c), submit the properly executed Operational Agreement (FORM• HOA).
❑ Per 15A NCAC 02T .0115(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
❑ Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(b), submit the properly executed Operational Agreement (FORM: DEV).
For- snore information, visit the Division's collection Systems website
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 2 of 3

REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional Office
2090 US Highway 70
Avery, Buncombe, Burke, Caldwell, Cherokee,
Water Quality Section
Swannanoa, North Carolina 28778
Clay, Graham, Haywood, Henderson, Jackson,
[phone]
Macon, Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Fayetfieville Regional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Harnett, Hoke,
Water Quality Section
Fayetteville, North Carolina 28301-5094
Montgomery, Moore, Robeson, Richmond,
[phone]
Sampson, Scotland
[phone] Fax
Mooresville Regional Office
610 E. Center Avenue
Alexander, Cabarrus, Catawba, Cleveland,
Water Quality Section
Mooresville, North Carolina 28115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
Raleigh Regional Office
1628 Mail Service Center
Chatham, Durham, Edgecombe, Franklin,
Water Quality Section
Raleigh, North Carolina 27699-1628
Granville, Halifax, Johnston, Lee, Nash,
[phone]
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
Warren, Wilson
Washington Regional Office
943 Washington Square Mall
Beaufort, Bertie, Camden, Chowan, Craven,
Water Quality Section
Washington, North Carolina 27889
Currituck, Dare, Gates, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
Wilmington Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
Water Quality Section
Wilmington, North Carolina 28405
Hanover, Onslow, Pender
[phone]
[phone] Fax'
Winston-Salem Regional Office
450 W. Hanes Mill Road
Suite 300
Alamance, Alleghany, Ashe, Caswell, Davidson,
Davie, Forsyth, Guilford, Rockingham, Randolph,
Water Quality Section
Winston-Salem, North Carolina 27105
Stokes, Surry, Watauga, Wilkes, Yadkin
[phone]
INSTRUCTIONS FOR FORM: FTA 04-16 R. SUPPORTING DOCUMENTATION Page 3 of 3

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Polaris 3G Map — Mecklenburg County, North Carolina
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Polaris 3GMecklenburg County, North Carolina
Date Printed: 1/10/2018 11:06:39 AM

Polaris 3G Map — Mecklenburg County, North Carolina
Date Printed: 1110/2018 11:50:37 AM

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