WQ0042387_Application (FTSE)_20210318

BLACK & VEATCH
March 3, 2021
IVED/NCDEQ/DWR
MA5 202,
Black & Veatch International Company
175 Regency Woods Place, Suite 200, Cary, NC 27518
P [phone]E ' WM'S ,a /DWR
W©R a S
MOORESVILLE REGIONAL OFFICE
Charlotte Water
Clarks Creek Pump Station Improvements Project
NC Department of Environmental Quality
Mooresville Regional Office, Water Quality Section
610 East Center Avenue, Suite 301
Mooresville, NC 28115
Subject: Sewer Fast Track Permit Application
MAR 18 2021
WOROS
MOORESVILLE REGIONAL OFFICE
B&V Project 198222
B&V File 192816.3400
On behalf of Charlotte Water, we are submitting the enclosed sewer fast track permit for the Clarks
Creek Pump Station Improvements project. The following items are included in this package:
• A check for $480 to cover the review fee
• This cover letter with a brief project narrative
• Fast Track Application Form FTA 04-16
• Topographic site map
• Street level aerial map
The Clarks Creek Pump Station Improvements project includes the construction of a new
submersible style pump station to replace the existing wet/dry pit pump station. Capacity of the
new station will be 750 gpm, which is not an increase of the existing station. No new wastewater
flows are generated as part of this project and the existing force main will remain in service.
The project is located at 13301 Ramah Church Road, Huntersville, NC.
If you have any questions or need further information, please contact me at [phone] (email:
[e-mail]). We will respond immediately to any of your concerns or questions.
Very truly yours,
Black & Veatch International Company
Lee Campbell, P.E.
Engineering Manager
BUILDING A WORLD OF DIFFERENCE'S
////////////////////%////////////,�///!

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: 141 Q )`[-34 7(to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Charlotte Water (company, municipality, HOA, utility, etc.)
RECEIVED/NCDEO/DWR
MAR 1 8 2021
WQROS
MOORESVILLE REGIONAL OFFICE
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County /1 Municipal ❑ Other
3. Signature authority's name: Joseph C. Wilson 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: (Irene Okioga) irene.okioga(a,ci.charlotte.nc.us
II. PROJECT INFORMATION:
1. Project name: Clarks Creek Pump Station Improvements
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: Mecklenburg
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.4271N ° Longitude:-80.8141W°
5. Parcel ID (if applicable): 01116119
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: D. Lee Campbell, Jr.
Firm: Black & Veatch
Mailing address: 175 Regency Woods Place, Suite 200
City: Cary State: NC
Zip: 27518-
License Number: 034362
Phone number: [phone] Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: McDowell Creek Wastewater Treatment Facility Permit Number: NC0036277
Owner Name: Charlotte Water
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ Downstream (Receiving) Sewer Size: 12 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s): Charlotte Water
FORM: FTA 04-16 Page 1 of 5

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

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
El 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?
El Yes ❑No ON/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
® Residential Leased
❑ School / preschool / day care
❑ Food and drink facilities
❑ Businesses / offices / factories
5. Nature of wastewater :
❑ Retail (stores, centers, malls)
❑ Retail with food preparation/service
❑ Medical / dental / veterinary facilities
❑ Church
❑ Nursing Home
100 % Domestic/Commercial % Commercial
% Industrial (See 15A NCAC 02T .0103(20))
>Is there a Pretreatment Program in effect?
6. Has a flow reduction been approved under 15A NCAC 02T .0114(f)? ❑ Yes
➢ If yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
❑ Car Wash
❑ Hotel and/or Motels
❑ Swimming Pool /Clubhouse
❑ Swimming Pool/Filter Backwash
❑ Other (Explain in Attachment)
❑ Yes
Z No
❑ No
Establishment Type (see 02T.0114(f))
Daily Design Flow a,b
No. of Units
Flow
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
0 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.01 14] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 0 GPD (per I5A 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 SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
15 5
DIP
➢ Section II & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section III contains information related to minimum slopes for gravity sewer(s)
➢ Oversizing lines to meet minimum slope 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: Clarks Creek Pump Station
2. Approximate Coordinates (Decimal Degrees): Latitude: 35.42714° Longitude: -80.81411°
3. Design flow of the pump station: 1.06 millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): 750 gallons per minute at 250 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 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 l 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(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 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 N/A
> 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 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
individual permits or 401 Water Quality Certifications?
> Information can be obtained from the 401 & Buffer Permitting Branch
Yes ® No
5. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? ►1 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 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 supporting documents.
2. Professional Engineer's Certification:
D. Lee Campbell, Jr.
(Professional Engineer's name from Application Item III.1.)
attest 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:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
Joseph C. Wilson, Chief Engineer
I attest that this application for
(Signature Authority's name & title from Application Item I.3.)
011111111111810
a� SEAL 9� i •
. 034362 c,A6 liCeifi,
a
2021.03.17 16:04:40-04'00'
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:
Joseph C. WilsonDigitally signed by Joseph C. Wilson
Date: 2021.03.17 09:41:16 -04'00'
Date:
FORM: FTA 04-16 Page 5 of 5

RECEiVED//NC0 /
Division of Water Resources
MAR -52
WQROS
MOORESVILLE REGIONAL OFFICE,_
15A NCAC 02T .0300 — FAST TR K SEWER SYSTEM EXTENSION APPLICATION
FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number:
(
State of North Carolina
Department of Environmental Quality
Division of Water Resources
o be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Charlotte Water (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State/County ►/ Municipal
RECEIVED/NCDEQ/DWR
MAR - 5 2021
wQROS
MOORESVILLE REGIONAL OFFICE
❑ Privately -Owned Public Utility
❑ Other
3. Signature authority's name: Joseph C. Wilson 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: (Irene Okioga) irene.okioga{a ci.charlotte.nc.us
II. PROJECT INFORMATION:
1. Project name: Clarks Creek Pump Station Improvements
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: Mecklenburg
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.4271N ° Longitude:-80.8141 W°
5. Parcel ID (if applicable): 01116119
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: D. Lee Campbell, Jr.
Firm: Black & Veatch
Mailing address: 175 Regency Woods Place, Suite 200
City: Cary State: NC Zip: 27518-
Phone number: [phone] Email Address: [e-mail]
License Number: 034362
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: McDowell Creek Wastewater Treatment Facility Permit Number: NC0036277
Owner Name: Charlotte Water
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ Downstream (Receiving) Sewer Size: 12 inch
System Wide Collection System Per Number(s) (if applicable): WQCS
Owner Name(s): Charlotte Water
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 ►1N/A
2. If the Applicant is a Developer of lots tobe sold, has a Developer's Operational Agreement (FORM: DEV) been attached?
❑ Yes ❑No ►1N/A
If the Applicant is a Home/Property Owners' Association,
4. Origin of wastewater: (check all that apply):
® Residential Owned
® Residential Leased
0 School / preschool / day care
❑ Food and drink facilities
0 Businesses / offices / factories
ias an Operational Agreei
0 Yes ❑No N/A
❑ Retail (stores, centers, malls)
0 Retail with food preparation/service
0 Medical / dental / veterinary facilities
0 Church
❑ Nursing Home
Nature of wastewater : 100 % Domestic/Commercial % Commercial
% Industrial (See 15A NCAC 02T .0103(20))
ent (FORM: HOA) been attached?
0 Car Wash
0 Hotel and/or Motels
0 Swimming Pool /Clubhouse
0 Swimming Pool/Filter Backwash
0 Other (Explain in Attachment)
DIs there a Pretreatment Program in effect? 0 Yes 0 No
6. Has a flow reduction been approved under 15A NCAC 02T .0114(f)? 0 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 ".t'
No. of Units
Flow
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
0 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.01 14J shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 0 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
0 Flow has already been allocated in Permit Number:
® Rehabilitation or replacement of existing sewer with no new flow expected
0 Other (Explain):
FORM: FTA 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
15
5
DIP
➢ Section II & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section III contains information related to minimum slopes for gravity sewer(s)
➢ Oversizing lines to meet minimum slope 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: Clarks Creek Pump Station
2. Approximate Coordinates (Decimal Degrees): Latitude: 35.42714° Longitude: -80.81411°
3. Design flow of the pump station: 1.06 millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): 750 gallons per minute at 250 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(t)):
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 provided for sewer systems:
►Z/
Yes ❑ No
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
24 inches
Water mains (vertical -water over sewei 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(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 webpage
➢ If noncompliance with 02T.0305(1) or (e), see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ❑ Yes ❑ No I;/ N/A
➢ 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 setbacks found in the river basin rules per 15A NCAC 02B .0200? ❑ Yes ❑ No 11 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
individual permits or 401 Water Quality Certifications?
> Information can be obtained from the 401 & Buffer Permitting Branch
Yes
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 rI 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 1SA NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit.
FORM: FTA 04-16 Page 4 of 5

X. CERTIFICATIONS:
I. Does the submitted system comply with 15A NCAC 02"I`, the Minimum Design Criteria for the I'ermittine of Pump Stations
and Force Mains (latest version). and the Gravity Sewer Minimum Desiom Criteria (latest version) as applicable?
►1 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 supportinZ documents.
2. Professional Engineer's Certification:
attest that this application for
(Professional Engineer's name from Application Item IIL1.)
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. Nlttriti��ga
North Carolina Professional Engineer's seal, signature, and date:
uslosoo
3. Applicant's Certification per 15A NCAC 02T .0106(b):
CC , U( ,.n L:k y E-r,
(Signature Authority's name & title from 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 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 I43-215.6B, 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:
FORM: FTA 04-16
Page 5 of 5

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Luckman, Debbie
From:
Sent:
To:
Subject:
Attachments:
Campbell, Lee <[e-mail]>
Wednesday, March 17, 2021 4:07 PM
Luckman, Debbie
RE: [External] RE: Fast track application for Clarks Creek Pump Station
CCPS_DEQ FTA_Docusigned.pdf
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
Report Spam.
Debbie,
Per email below, please find attached to this email the Fast Track Application that has electronic signatures by Charlotte
Water and me. Please let me know if anything else is needed.
Lee Campbell, P.E.* [ Project Manager, Water
Black & Veatch 1175 Regency Woods Place, Suite 200, Cary, NC 27518
[phone] p I [phone] m I CampbelIDLPBV.com
*Licensed in NC
https://www.bv.com/markets/water
From: Luckman, Debbie <[e-mail]>
Sent: Tuesday, March 9, 2021 3:51 PM
To: Campbell, Lee <[e-mail]>
Subject: RE: [External] RE: Fast track application for Clarks Creek Pump Station
We need original signatures. Either original wet signature or if the documents are signed via a secure digital signature
(such as adobe or DocuSign) for both the engineer and the permittee, a digital -only submission is fine as we can consider
secure electronic signatures as "originals." However, if they are scanned copies, please follow up with the hard copy
originals.
Deborah Luckman
Environmental Assistance and Customer Service
North Carolina. Department of Environmental Quality
704-235-2111 (Office)
debbie.Iuckman;Zucdeur.eov
From: Campbell, Lee [mailto:[e-mail]]
Sent: Tuesday, March 9, 20213:48 PM
To: Luckman, Debbie <[e-mail]>
Subject: [External] RE: Fast track application for Clarks Creek Pump Station
CAUTION: External email. Do not click links or open attachments unless you verify. Send all suspicious email as an attachment to
Report Spam.
1

Ms. Luckman,
The FTSE form was not included as this is a 0 flow permit. The existing pump station is being replaced with no new flows
being added. My understanding is the FTSE is not needed if the flow is 0.
The executed application was emailed to our office for submittal by CLT Water. Let me know if this is not acceptable.
Lee Campbell, P.E.* 1 Project Manager, Water
Black & Veatch 1175 Regency Woods Place, Suite 200, Cary, NC 27518
[phone] p ( [phone] m I [e-mail]
*Licensed in NC
https://www.bv.com/markets/water
From: Luckman, Debbie <[e-mail]>
Sent: Tuesday, March 9, 2021 3:34 PM
To: Campbell, Lee <[e-mail]>
Subject: Fast track application for Clarks Creek Pump Station
Good afternoon,
We have received the above mentioned fast track application, you did not include an FTSE.
Also, it does not appear to be the original signature for Joseph Wilson on page 5.
Please advise. i will hold this application 3/19/21.
Thank you,
Debbie
Deborah Luclanan
j Environmental Assistance and Customer Service
North Carolina Deparhnent of Environmental Quality
704-235-2111 (Office)
debbie.luclanan!dmcdenr.gov
2