HomeMy WebLinkAboutWQ0042050_Final Permit_20201021October 13, 2020
North Carolina Department of Environmental Quality
Division of Water Resources
Asheville Regional Office
2090 US Highway 70
Swannanoa, NC 28778
Re: Fast Track Permit Application
Kattz Corner Apartments
316 Lower Creek Drive
Lenoir, NC
To Whom it May Concern,
TRANSMITTAL D
®cr!T3
Water Quality Regional Operations
Asheville RegionN Office
Please find attached the following information regarding the above -mentioned project:
1. One original and one copy of the Fast Track Application — Private portion
2. One original and one copy of the Fast Track Application _ Public portion
3. Two checks for $480.00
4. One original and one copy of the Downstream Sewer Flow Tracking/Acceptance Form
5. Two copies of the USGS Topographic map and street level map
The proposed sanitary sewer extension will serve a multi -family apartment complex consisting of 11-1 bedroom units, 33 —2
bedroom units, and 24 - 3 bedroom townhomes for Kattz Corner Apartments. The project is located at 316 Lower Creek Drive in
Lenoir, North Carolina. The sewer extension will consist of 828 linear feet of 8" SDR 35 and 143 linear feet of 8" DIP sanitary sewer
line. The proposed public portion of extension will be owned and maintained by the City of Lenoir. The proposed private portion
of the extension will be owned and maintained by Kattz Corner, LLC.
Please call if you have any questions.
Thank you,
Steve Schlegelmilch
Borum, Wade and Associates, P.A.
621 Eugene Court, Suite 100
Greensboro, NC 27401
Phone : (336) 275-0471 x 116
Fax : (336) 275-3719
Email: steves@borum-wade.com
Website: borum-wade.com
621 Eugene Court, Suite 100, Greensboro, NC 27401-2711 • PO Box 21882, Greensboro, NC 27420-1882
Phone 336-275-0471 • Fax 336-275-3719
Website: www.borum-wade.com
N.C. License #: C-0868
State of North Carolina
DWIft
E AP Department of Environmental Quality
A Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: (to be completed by DwR)
All items must be completed or the auplication will he returned
L APPLICANT INFORMATION:
1. Applicant's name: City of Lenoir (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: Radford Thomas per 15A NCAC 02T .0106(b)
Title: Director of Public Utilities I J 1 f �1`•`
4. Applicant's mailing address: 51013 Greer Circil SW �j l
City: Lenoir State: NC Zip: 28645-_
5. Applicant's contact information: �N469
Phone number: 828 757-2219 Email Address: rlthomas e.CLLENOIR.NC.US Water Quality Regional Operntier
Asheville Regional Offlct,
H. PROJECT INFORMATION:
1. Project name: Kattz Corner Apartments
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: Caldwell
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.917472' Longitude:-81.515672'
5. Parcel ID (if applicable): 2759488961, 2759488577
(or Parcel ID to closest downstream sewer)
M. CONSULTANT INFORMATION:
1. Professional Engineer: Thomas Eugene Mustin License Number: 20709
Firm: Borum. Wade. and Associates. P.A.
Mailing address: 621 Eugene Court, Suite 100
City: Greensboro State: NC Zip: 27401-_
Phone number: 336 275-0471 Email Address: genemustin(a)borum-wade.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Lower Creek W WTF Permit Number: NCO023981
Owner Name: City of Lenoir
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWII):
1. Permit Number(s): WQ_ Downstream (Receiving) Sewer Size: 8 inch
System Wide Collection System Permit Number(s) (if aoolicable): WQCS00035
Owner Name(s): City of Lenoir
FORM: FTA 04-16 Page 1 of 5
VL 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 Ovaiers' 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(f9? [--]Yes ❑ No
➢ If Yes, provide a cony of flow reduction anoroval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow °"
No. of Units
Flow
I Bedroom Unit
240 gal/day
11
2,640 GPD
2 Bedroom Unit
240 gal/day
33
7,920 GPD
3 Bedroom Unity
360 gal/day
24
8,640 GPD
gall
GPD
gal/
GPD
gal/
GPD
To
19,200 GPD
a See 15A NCAC 02T .0114(b). (dd), (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: 19200 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
VH. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
S" 143 Ductile Iron
➢ 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
VHI. 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:
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: -
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) Length (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(f) & (g)
➢ 15A NCAC 02T.0305(f) contains minimum separations that shall be nrovided for sewer aystemw
® 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 II impounded reservoirs used as a source of drinking water
100 feet
**Waters classified WS (except WS-1 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(g) contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webnage
➢ 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 ® 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 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.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 ® 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 Penuitting_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 VariancetAltemative Design Request application (VADC 10-14) and supporting documents for
review. Approval of the reauest is required prior to submittal of the Fast Track Application and supaortins documents
2. Professional Engineer's Certification:
s name from APplication Item 1111.)
that this application for
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 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.
North Carolina Professional Engineer's seal, signature, and date:
lllllll11t1��
3. Applicant's Certification per 15A NCAC 02T .0106(b):
• 1-�./�'±iz..l' - it� rG� j��J� %.° S ,L.I�r^a =.z" r" attest that this application for
(Signature Authority's name & 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 143-215.6E 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: �,a"r .�� Date:
.i
FORM: FTA 04-16 Page 5 of 5
State of North Carolina
nw
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: (to be completed by DWR)
All items must be completed or the aoolication will be returned
L APPLICANT INFORMATION:
1. Applicant's name: City of Lenoir (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: Radford Thomas per 15A NCAC 02T .0106(b) ���
Title: Director of Public Utilities
4. Applicant's mailing address: 510B Greer Circil SW D
City: Lenoir State: NC Zip: 28645-_ ®CT ' J 6VLu
5. Applicant's contact information:
Phone number; 828) 757-2219 Email Address: rlthomas(t),CLLENOIRNC.U&r uaiei Qua Regional ( l`ei'ailOtlS
IL PROJECT INFORMATION: AsheOle Re910MA Off'oe
1. Project name: Kattz Corner Apartments
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: Caldwell
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.917472' Longitude:-81.515672'
5. Parcel ID (if applicable): 2759488961 2759488577
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Thomas Eugene Muslin License Number: 20709
Firm: Borum. Wade. and Associates. P.A.
Mailing address: 621 Eugene Court, Suite 100
City: Greensboro State: NC Zip: 27401-_
Phone number: 336) 275-0471 Email Address: genemustin(a),borum-wade.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Lower Creek W WTF Permit Number: NCO023991
Owner Name: City of Lenoir
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than W WTF):
1. Permit Number(s): WQ Downstream (Receiving) Sewer Size: 8 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS00035
Owner Name(s): City of Lenoir
FORM: FTA 04-16 Page 1 of 5
VL 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 % 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 cony of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 021.01140
Daily Design Flow wb
No. of Units
Flow
1 Bedroom Unit
240 gal/day
11
2,640 GPD
2 Bedroom Unit
240 gal/day
33
7,920 GPD
3 Bedroom Unity
360 gal/day
24
8,640 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: 19200 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
VH. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8" 143 Ductile Iron
➢ 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
VHL PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
I. Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: - °
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) Length (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( &
➢ 15A NCAC 02T.0305(t) contains minimum separations that shall be provided for sewer systems:
® Yes ❑ No
Setback Parameter*
Separation Reuired
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 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(0 contains alternatives where separations in 02T.0305 cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webnake
➢ If noncompliance with 02T.0305( or (g), 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 211.0202
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.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:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Pum t Station
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/Altemative Design Request application (VADC 10-14) and supporting documents for
review. Aooroval of the reauest is required Prior to submittal of the Fast Track Application and supporting documents
2. Professional
—Engineer's Certification:
1. al
name
that this application for
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 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 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. „„I
North Carolina Professional Engineer's sent, signature, an
Jw
3. Applicant's Certification per 15A NCAC 02T .0106(b):
Z , - ��� f� �� �& a s r'" attest that this application for
(Signature Authority's name & 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 143-215.6E 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:�r�_, ,c��� ., ,_� Date:
FORM: FTA 04-16 Page 5 of 5
OCT 15 I State of North Carolina
Department of Environmental Quality
Division of Water Resources
3 dater Quality Re Tonal 0 atlo
ap� 4af i(Acceptance for Sewer Extension Applications.
(FTSE 04-16)
Entity Requesting Allocation:: Kattz Corner, LLC
Project Name for which flow is being requested: Kattz Corner Apartments
More than one FTSE maybe required for a single project if the owner of the WWTP is not responsible for al! pump
stations along the route ofthe proposed wastewater flow.
i. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name:
b. WWTP Facility Permit;
c.
WWTP facility's permitted flow
6.0
d.
Estimated obligated flow not yet tributary to the WWTP
.050
e.
WWTP facility's actual avg. flow
2.29
f.
Total flow for this specific request
.0192
g.
Total actual and obligatedflows to the facility
2.3592
h.
Percent of permitted flow used
39.32%
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 WWTP:
(A)`
Design
Pump
Average Daily
Station
Firm Flow**
(Name or
Capacity, * (Firm / pi),
Number)
MGD MGD
N/A
(B)
(C)
(D)=(B+C) (E)=(A-D)
Obligated;
Approx.
Not Yet
Total Current
Current Avg.
Tributary
Flow Plus
Daily Flow,
Daily Flow,
Obligated Available
MGD
MGD
Flow Capacity***
* 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 (pf) not less than 2.5.
* ** A Planning Assessment Addendum shall be attachedfor 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:
1 of 6
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 addendums for which I am the responsible party.
Signature of this form indicates acceptance of this wastewater flow.
Page 2 of 6
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Annual Report loan
Limited Liability Company
Legal Name
Kattz Corner, LLC
Information
Sosid: 7865953
Status: Current -Active O
Date Formed: 8282019
Citizenship: Domestic
Annual Report Due Date: April 15th
Curnentgnnuat Report status:
Registered Agent: Blanco Tackabery&Matamoros, P.A.
Addresses
Reg Office PrinclpaL Office Reg Malting Mailing
110 South Stratford Road-5th Floor 2408 Lake Oak Ot R0. Drawer25008 PO Box 16038
Winston Salem, NO 27104 High Point, NO 27265 Winston-Salem, NO 27774 High Point, NO 27261
Company Officials
All LLCs are managed by theirmanagerspursuant to N.C.G.S. 57D3-20.
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