WQ0041471_Application (FTSE)_20200210

i
The : Group
Commercial Real Estate Development
The Broadway Group, LLC • 216 Westside Square • Huntsville, AL 35801 • Phone: 256,533.7287 • Fax: [phone]
January 10, 2020
Tim Heim, PE
NCDEQ — Division of Water Resources
Asheville Regional Office
2090 US Highway 70
Swarm anoa, North Carolina 28778
Morganton Blvd Retail Store
CDC Project No.: 21971
Water Quality Regional Operations
Asheville Regional Office
We are seeking engineering approval for the proposed relocated sanitary sewer line extension to
allow for construction of a retail store at 2160 Morganton Blvd SW. No additional flows will be
generated by the project. Please find enclosed the following items for your review and approval:
• Check in the amount of $480.00
• Fast Track Sewer Application
• Flow Tracking/Acceptance for Sewer Extension Applications
• Site/DSGS Maps
• 2406 Plan Sets (submitted via email)
If there are any questions, please call our office.
Sincerely,
Kristyna Moore
The Broadway Group

State of North Carolina
13` l ,� Department of Environmental Quality
w Division of Water Resources
15A NCAC 02T.0300—FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
A' Division of Water Resources ETA 04-16 & SUPPORTING DOCUMENTATION
U L``1 t..11. r'�
Application Number.�l V1 no be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
I. Applicant's name: The Broadway Group. LLC (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: Robert M. Broadway per 15A NCAC 02T .0106(b)
Title: President
4. Applicant's mailing address: P.O. Box 18968
City: Huntsville State: AL Zip: 35804-
5. Applicant's contact information: I,,,, .{,'
Phone number:[phone] Email Address: knst(w Mow
It. PROJECT INFORMATION:
1. Project name: Morganton Blvd Retail Store
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: W000 and issued date:
If new construction but part of a master plan, provide the existing permit number: W000
3. County where project is located: Q�dWel1
u
4. Approximate Coordinates (Decimal Degrees): Latitude: .�lao . Longitude: -81. �D4A4.
5. Parcel ID (if applicable): 1 ,3"tgQq"I33 F
(or Parcel ID to closest downstream sewer)
DL CONSULTANT INFORMATION:
1. Professional Engineer: Jason Foster
Firm: Civil Design Concepts, PA
Mailing address: 168 Patton Avenue
City: Asheville State: NC
Phone number: [phone]
License Number: 47671
Zip: 28801-_
Email Address:
Water Quality Regional Operations
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION: Asheville Regional Office
1. Facility Name: Permit Number:_
Owner Name:
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ Downstream (Receiving) Sewer Size: inch
System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s):
FORM: FTA 04-16 Pagel o£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 Aereement (FORM DEVI 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 %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(f) ❑ Yes ❑ No
➢ If yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02101/40
Daily Design Flow a.a
No. of Units
Flow
Retail Store
125 gal/fixture
9
1,125 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
1,125GPD
a See 15A NCAC 02T .0114(b)(ch (e)(D 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 new 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: _ 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: ETA 04-16 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
8 284 i 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 requirement is not allowed and a violation of the MDC
VIIL PUMP STATION DESIGN CRITERIA (If Applicable)-02T.0305 & MDC (Pomp 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: .N/A° Longitude: - .N/A°
3. Design flow of the pump station: N/A millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): N/A gallons per minute at N/A feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
N/A
N/A
N/A
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(11:
❑ 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(Q):
1. Does the project comply with all separations found in 15A NCAC 02T .0305(t) & (e) ® Yes ❑ No
J ➢ 15A NCAC 02T.0305 contains minimum 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 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
100 feet
** Waters classified W S (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(a) contains alternatives where separations in 02T.0305(D cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webuage
➢ If noncompliance with 02T.0305(f) or (a). see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ❑ Yes ❑ No ®N/A
➢ Seethe 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 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 2B.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.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.04021 "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:
L 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 ofthe recruest is recruited prior to submittal of the Fast Track Application and supporting documents.
2. Professional Engineer's Certification:'1,1r
I, Ruhard Jolso ,,,, I (Vs}IUp�-
attest that this application for
(Professional Engineer's name from Application Item Ell. 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, Gravity Sewer
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track Permitting
of Pump Stations and prince 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.
North Carolina Professional Engineer's seal, signature, and date:
SEAL
047671
3. Applicant's Certification per 15A NCAC 02T .0106(b)::
I, RbbefM. r1y Lwa— b)Siofrattest 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 me not completed and that if all required supporting documentation and attachments are not included, this
application package is subject to being returned as incomplete. 1 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. 1 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 143-215.613 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 flue not to exceed $t0,000 as well as civil penalties up to $25,000 per violation.
Signature: Date: I
FORM: ETA 04-16 Page 5 of 5

' State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
" ISA NCAC 02T.0300— FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
'Dlvlshm of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: (to be completed by DWR)
All Items must be cost nleted or the application will he returned
1. APPLICANT INFORMATION:
1. Applicant's name: The Broadway Group. LLC (company, municipality, EGA, utility, etc.)
2. Applicant type: ❑ Individual ® Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ❑ Municipal ❑ Other
3. Signature authority's name: Robert M. Broadway per 15A NCAC 021.0106(b)
Title: President
4. Applicant's mailing address: P.O. Box.18968
City: Huntsville State: AL Zip: 35804-
5. Applicant's contact information: 1,,,, },' //�� _,1
Phone number:(2� 533-7287 Email Address: knstyia.Move(h bv00AWa1 qVb P'"-
11. PROJECT INFORMATION: t/
1. Project name: Monsanto Blvd Retail Store
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Pennit/Project
If a modification, provide the existing permit number: W000_ and issued date:
If new construction but part of master plan, provide the existing permit number: WQOO
3. County where project is located: LaLdWeI t
4. Approximate Coordinates,-
(Decimal Degrees): Latitude: .19 30. Longitude: -8I 5ldobd°
5. Parcel ID(if appl'icable): ei3�gOq%33
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
L Professional Engineer: Jason Foster License Number: 47671
Firm: Civil Design Concepts, PA
Mailing address: 168 Patton Avenue
City: Asheville State: NC Zip: 28801-_
Phone number: 828 252-5388 Email Address: _
IV. WASTEWATER TREATMENT FACILITY(WWTF) INFORMATION:
1. FacilityName: Permit Number:
Owner Name:
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
L Permit Number(s): WQ Downstream (Receiving) Sewer Size: inch
System Wide Collection Svsigm.Permit Numbcr(s)(if npplicable): WQCS
Owner Narre(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 Onuational Agreement (FORM: DEV) been attached?
❑ Yes ❑No ®N/A
3. If the Applicant is a Home/Propertv. 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 _%Commercial
Industrial (See 15A NCAC 02T.0103(20))
"Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under I SA NCACO2T A 114(D? ❑ Yes ❑ No
D If yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.01140
Daily Design Flow '°
No. of Units
Flow
Retail Store
125 gal/fixture
9
1, 125 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal
GPD
gal/
GPD
Total
1,125 GPD
a See I5A NCAC.02T 01'14(b) (d). (e)f 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 O.S. 42A-4d.
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.0.1141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
S. Wastewater generated by project: _ 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: ETA 04-16 Page 2 of 5

VIL GRAVITY SEWER DESIGN CRITERIA (if Applicable) -02T.0305& MDC (Gravity Sewers:
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 284 PVC
➢ Section 11 & III of the MCC 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
VIIL PUMP STATION DESIGN CRITERIA (If Applicable)-02T.0305 & MDC (Pumo Stations/Fore¢ Mnlns):
COMPLETE 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. Design flow of the pump station: N/A millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): N/A gallons per minute at N/A feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
N/A N/A N/A
6. Power reliability in accordance with 15A NCAC:02T 0305(h)(D:
❑ Standby power source or pump with 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
D 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 - l5A NCAC 02T
.0305(h)(1)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry - I5A 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 stalions'storage
capacities and the rotation schedule of the portable power source or pump, including travel timefrsmes, shall be provided
in the case of a multiple station power outage.
FORM: ETA 0446 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B.0200 & 15A NCAC 02T.0305(Q):
1. Does the project comply with all separations found in I SA NCAC 02T .0305(D & (a) ® Yes ❑ No
D ISA NCAC 02T.0305(Fl contains minimum seneratinns that ¢hall he nrnvided fnr sewer systeme�
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
l0 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 It 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 sloe 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 laradc vertical
36 inches
D ISA NCAC 02T.0305(a) contains alternatives where separations in 02T.0305(Fl:cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC: Surface Water Classifications weboage
➢ If noncompliance with 02T.0305(D or (a), see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ❑ Yes ❑ No ® N/A
D Seethe Division's draft separation requirements for situations where separation cannot be meet
D No variance is required if the alternative design criteria specified is utilized in design and construction
D 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 2B.0202
4. Does the project require coverage/authorization under a 404 Nationwide or ❑ Yes ® No
individual permits or 401 Water Quality Certifications?
➢ Information can he 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 I SA 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 permitte , 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 of5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02'f the Minimum Design Criteria for the Permitting of Pr im Stations
and. Force Mains (latestversiunl, and the Gravity Sewer Minimum Des'a r Criteria (latest version) as applicable?
® Yes ❑ No
1fNo, complete and submit the Variance/Altemative Design Request application (VADC 10-14) and supporting documents for
review. Approval ofthe request is squired Prior to submittal ofthe FastTrack Annlication and supporting documents.
2. Professional Enggineer'gCertification: r
1,_ RiChad E�GiSL0 f6Sb.' attest that this application for
(Professional Engineer's name from Application Item III.L)
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 hest 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 Sewers (latest version), and the Minimum Design Criteria for the Past -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
havejudged 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.
North Carolina Professional Engineer's seal, signature, and date:
SEAL
047071
3. ApplicannJfslCeeftii/ficat11io11npefr�l5A,NC,(ACO2T.0106(b❑):_
1, Robert IVM. I�rOG�W44G�-2_TlllfkTt attest that this application for
(Signature Authority's nam &title from Application Item 1.3.)
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: Date:
FORM: ETA 04-16 Page 5 of 5

20
E
- 6 99�99iof North Carolina
Departr`tr t of Environmental Quality
DWR Division of Water Resources
Water Quality Regional Operations
' Division of Water Resources 'l Flo@SW�'dldifl#ffra$®i'P,@O Extension Applications
W �46t 1 I (FTSE 10-18)
Entity Requesting Allocation: The Broadway Group
Project Name for which flow is being requested: Morganton Blvd Retail Store
More than one FTSE maybe requiredfor a single project if the owner of tire WWTP is not responsible for all pump
stations along the route of the proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a.
W WTP Facility Name: City of Lenoir - ower Creek W WTP
b.
W WTP Facility Permit #: NCO023981
All flows are in MUD
c.
W WTP facility's permitted flow
6.0
d.
Estimated obligated flow not yet tributary to the W WTP
.0500
e.
W WTP facility's actual avg. flow
2.30
f
Total flow for this specific request
.001125
g.
Total actual and obligated flows to the facility
2.351125 /
It.
Percent of permitted flow used
39.18%
II. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
List pump stations located between the project connection point and the W WTP:
(A)
(B)
(C)
(D)=(B+C)
(E)=(A-D)
Design
Obligated,
Pump
Pump
Average
Approx.
Not Yet
Total Current
Station
Station
Firm Daily Flow**
Correct
Tributary
Flow Plus
(Name or
Permit
Capacity, * (Firm / pf),
Avg. Daily
Daily Flow,
Obligated
Available
Number)
No.
MOD MOD
Flow, MOD
MOD
Flow
Capacity***
* 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 peaking factor
(pf) not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the W WTP where the Available Capacity is <0.
Downstream Facility Name (Sewer):
Downstream Permit Number:
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I Radford L. Thomas 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
addendim s for which I am the responsible party. Signature of this form certifies that the receiving
collection system or treatment works has adequate capacity to transport and treat the proposed new
wastewater.
bfhlbfrr. 4669,�
Title of Signing Ofcial
Page 2 of 6
FTSE 10-18

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