WQ0042426_Permit (Issuance)_20210415

ROY COOPER.
Coverrror
DIONNE DELLI-GATTI
,Sea -Nary
5, DANIEL SMITH
IAfror
Mr. Adrian Miller, City Manager
City of Belmont
37 N Main Street
Belmont, North Carolina 28012
NORTH CAROLINA
Ertkrorkerierttal Quality
April 15, 2021
Subject: Permit No. WQ0042426
City of Belmont
CaroMont Regional Medical Center Belmont - Public Sewer
Wastewater Collection System Extension Permit
Gaston County
Dear Mr. Miller:
In accordance with your application received April 6, 2021, and additional information received on April
12, 2021, we are forwarding herewith Permit No. WQ0042426 dated April 15, 2021 to the City of
Belmont (Permittee) for the construction and operation upon certification of the subject wastewater
collection system extension. This permit shall be effective from the date of issuance until rescinded, and
shall be subject to the conditions and limitations as specified therein. This cover letter shall be
considered a part of this permit and is therefore incorporated therein by reference.
Please pay particular attention to the following conditions contained within this permit:
Condition 11.1: This permit shall not be automatically transferable; a request must be made and
approved.
Condition 11.4:
Condition 11.7:
Requires that the wastewater collection facilities be properly operated and maintained
in accordance with 15A NCAC 2T .0403 or any individual system -wide collection system
permit issued to the Permittee.
Upon completion of construction and prior to operation of these permitted facilities, the
completed Engineering Certification form with checklist attached to this permit shall be
submitted with the required supporting documents to the address provided on the form.
Permit modifications are required for any changes resulting in non-compliance with
this permit, regulations, or the Minimum Design Criteria. [15A NCAC 02T.0116]
It shall be responsibility of the Permittee to ensure that the as -constructed project meets the appropriate
design criteria and rules. Failure to comply may result in penalties in accordance with North Carolina
General Statute §143-215.6A through §143-215.6C, construction of additional or replacement
wastewater collection facilities, and/or referral of the North Carolina -licensed Professional Engineer to
the licensing board.
GDEQi
North Carolina Department of EarvSronmenlal Quallly I Division of Water Resources
Mooresville Rtglorial4FOce I fiIO East Center Avrgrue, State 301 I Mooresville, North Carolina 28115
704.bb3.1694

City of Belmont
Permit No. WQ0042426
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the right to
request an adjudicatory hearing upon written request within 30 days following receipt of this permit. This
request must be in the form of a written petition, conforming to Chapter 150B of North Carolina General
Statutes, and filed with the Office of Administrative Hearings, 6714 Mail Service Center, Raleigh, NC
27699-6714. Unless such demands are made, this permit shall be final and binding.
If you need additional information concerning this matter, please contact Ori Tuvia at [phone] or
via e-mail at [e-mail].
Sincerely,
—DocuSigned by:
"—A14CC681AF27425...
for S. Daniel Smith
Director, Division of Water Resources
forW. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NCDEQ
cc: Mark McAuley (P.E.) (electronic copy)
Mooresville Regional Office Files (Laserfiche)
Water Resources Central Files (Laserfiche)
Municipal Permitting Unit (electronic copy)
Page 2 of 9

NORTH CAROLINA
Environmental Quality
WASTEWATER COLLECTION SYSTEM EXTENSION PERMIT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules, and Regulations, permission is hereby granted to the
City of Belmont
Gaston County
For the construction and operation of 4,127 linear feet of 12-inch gravity sewer to serve a hospital with
54 Beds as part of the CaroMont Regional Medical Center Belmont development, and the discharge of
34,200 gallons per day of collected wastewater into the City of Belmont's existing sewerage system,
pursuant to the application received April 6, 2021, and additional information received on April 12, 2021,
and in conformity with 15A NCAC 2T; the Division's Gravity Sewer Minimum Design Criteria adopted
February 12, 1996, as applicable; the Division's Minimum Design Criteria for the Fast -Track Permitting of
Pump Stations and Force Mains adopted June 1, 2000, as applicable; and other supporting data
subsequently filed and approved by the Department of Environmental Quality and considered a part of
this permit. The will be no change in the sewer length or permitted flow,
This permit shall be effective from the date of issuance until rescinded and shall be subject to the specified
conditions and limitations contained therein.
DocuSigned by:
`—A14CC681 AF27425...
for S. Daniel Smith
Director, Division of Water Resources
for W. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NCDEQ
By authority of the Environmental Management Commission
Permit Number: WQ0042426
Permit Issued: April 15, 2021

SUPPLEMENT TO PERMIT COVER SHEET
City of Belmont is hereby authorized to:
Construct, and then operate upon certification the aforementioned wastewater collection extension. The
sewage and wastewater collected by this system shall be treated in the City of Belmont's Regional
Wastewater Treatment Facility in accordance with Permit Number NC0021181.
Permitting of this project does not constitute an acceptance of any part of the project that does not meet
15A NCAC 2T; the Division's Gravity Sewer Minimum Design Criteria adopted February 12, 1996 as
applicable; and the Division's Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and
Force Mains adopted June 1, 2000 as applicable, unless specifically mentioned herein. Division approval
is based on acceptance of the certification provided by a North Carolina -licensed Professional Engineer in
the application. It shall be the Permittee's responsibility to ensure that the as -constructed project meets
the appropriate design criteria and rules.
Construction and operation is contingent upon compliance with the Standard Conditions and any Special
Conditions identified below.
I. SPECIAL CONDITIONS
1. No flow in excess of the quantity permitted herein 34,200 GPD shall be made tributary to the subject
sewer system until an application for permit modification for an increase in flow has been submitted
to and approved by the Division. [15A NCAC 02T.0304(b)]
II. STANDARD CONDITIONS
1. This permit is not transferable. In the event there is a desire for the wastewater collection facilities
to change ownership, or there is a name change of the Permittee, a formal permit request shall be
submitted to the Division accompanied by documentation from the parties involved, and other
supporting materials as may be appropriate. The approval of this request shall be considered on its
merits and may or may not be approved. [15A NCAC 02T.0104; G.S 143-215.1(d3)]
2. This permit shall become voidable unless the wastewater collection facilities are constructed in
accordance with the conditions of this permit; 15A NCAC 2T; the Division's Gravity Sewer Minimum
Design Criteria adopted February 12, 1996, as applicable; the Division's Minimum Design Criteria for
the Fast -Track Permitting of Pump Stations and Force Mains adopted June 1, 2000, as applicable; and
other supporting materials unless specifically mentioned herein. [15A NCAC 02T.0110]
3. This permit shall be effective only with respect to the nature and volume of wastes described in the
application and other supporting data. [15A NCAC 02T .0110]
4. The wastewater collection facilities shall be properly maintained and operated at all times. The
Permittee shall maintain compliance with an individual system -wide collection system permit for the
operation and maintenance of these facilities as required by 15A NCAC 2T .0403. If an individual
permit is not required, the following performance criteria shall be met: [15A NCAC 02T .0108(b)]:

a. The sewer system shall be effectively maintained and operated at all times to prevent discharge
to land or surface waters, and to prevent any contravention of groundwater standards or
surface water standards.
b. A map of the sewer system shall be developed and shall be actively maintained.
c. An operation and maintenance plan including pump station inspection frequency, preventative
maintenance schedule, spare parts inventory and overflow response has been developed and
implemented.
d. Pump stations that are not connected to a telemetry system shall be inspected every day (i.e.
365 days per year). Pump stations that are connected to a telemetry system shall be inspected
at least once per week.
e. High -priority sewer lines shall be inspected at least once per every six months and inspections
documented.
f. A general observation of the entire sewer system shall be conducted at least once per year.
g. Overflows and bypasses shall be reported to the appropriate Division regional office in
accordance with 15A NCAC 2B .0506(a), and public notice shall be provided as required by North
Carolina General Statute §143-215.1C.
h. A Grease Control Program is in place as follows:
1. For public owned collection systems, the Grease Control Program shall include at least
biannual distribution of educational materials for both commercial and residential users and
the legal means to require grease interceptors at existing establishments. The plan shall
also include legal means for inspections of the grease interceptors, enforcement for
violators and the legal means to control grease entering the system from other public and
private satellite sewer systems.
2. For privately owned collection systems, the Grease Control Program shall include at least
bi-annual distribution of grease education materials to users of the collection system by the
permittee or its representative.
3. Grease education materials shall be distributed more often than required in Parts (1) and
(2) of this Subparagraph if necessary to prevent grease -related sanitary sewer overflows.
i. Right-of-ways and easements shall be maintained in the full easement width for personnel and
equipment accessibility.
j. Documentation shall be kept for Subparagraphs (a) through (i) of this Rule for a minimum of
three years with exception of the map, which shall be maintained for the life of the system.
5. The Permittee shall report by telephone to a water resources staff member at the Mooresville
Regional Office, telephone number [phone], as soon as possible, but in no case more than 24
hours following the occurrence or first knowledge of the occurrence of either of the following:
a. Any process unit failure, due to known or unknown reasons, that renders the facility
incapable of adequate wastewater transport, such as mechanical or electrical failures of
pumps, line blockage or breakage, etc.; or

b. Any SSO and/or spill over 1,000 gallons; or
c. Any SSO and/or spill, regardless of volume, that reaches surface water
Voice mail messages or faxed information is permissible, but this shall not be considered as the initial
verbal report. Overflows and spills occurring outside normal business hours may also be reported to
the Division of Emergency Management at telephone number [phone] or [phone].
Persons reporting any of the above occurrences shall file a spill report by completing and submitting
Part I of Form CS-SSO (or the most current Division approved form) within five days following first
knowledge of the occurrence. This report must outline the actions taken or proposed to be taken to
ensure that the problem does not recur. Part 11 of Form CS-SSO (or the most current Division approved
form) can also be completed to show that the SSO was beyond control. [G.S. 143-215.1C(a1)]
6. Construction of the gravity sewers, pump stations, and force mains shall be scheduled so as not to
interrupt service by the existing utilities nor result in an overflow or bypass discharge of wastewater
to the surface waters of the State. [15A NCAC 02T.0108(b)]
7. Upon completion of construction and prior to operation of these permitted facilities, the completed
Engineering Certification form with checklist attached to this permit shall be submitted with the
required supporting documents to the address provided on the form. A complete certification is one
where the form is fully executed and the supporting documents are provided as applicable. Any
wastewater flow made tributary to the wastewater collection system extension prior to completion
of this Engineer's Certification shall be considered a violation of the permit and shall subject the
Permittee to appropriate enforcement actions.
If the permit is issued to a private entity with an Operational Agreement, then a copy of the Articles
of Incorporation, Declarations/Covenants/Restrictions, and Bylaws that have been appropriately
filed with the applicable County's Register of Deeds office shall be submitted with the certification.
A complete certification is one where the form is fully executed and the supporting documents are
provided as applicable. Supporting documentation shall include the following:
a. One copy of the project construction record drawings (plan & profile views of sewer lines &
force mains) of the wastewater collection system extension. Final record drawings should be
clear on the plans or on digital media (CD or DVD disk) and are defined as the design drawings
that are marked up or annotated with after construction information and show required
buffers, separation distances, material changes, etc.
b. One copy of the supporting applicable design calculations including pipe and pump sizing,
velocity, pump cycle times, and level control settings, pump station buoyancy, wet well storage,
surge protection, detention time in the wet well, and force main, ability to flush low points in
force mains with a pump cycle, and downstream sewer capacity analysis. If a portable power
source or pump is dedicated to multiple stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, include travel
timeframes, shall be provided.
c. Changes to the project that do not result in non-compliance with this permit, regulations, or the
Minimum Design Criteria should be clearly identified on the record drawings, on the
certification in the space provided, or in written summary form.

Prior to Certification (Final or Partial): Permit modifications are required for any changes resulting
in non-compliance with this permit (including but not limited to pipe length changes of 10% or
greater, increased flow, pump station design capacity design increases of 5% or greater, and
increases in the number/type of connections), regulations, or the Minimum Design Criteria.
Requested modifications or variances to the Minimum Design Criteria will be reviewed on a case -
by -case basis and each on its own merit. Please note that variances to the Minimum Design Criteria
should be requested and approved during the permitting process prior to construction. After -
construction requests are discouraged by the Division and may not be approved, thus requiring
replacement or repair prior to certification & activation. [15A NCAC 02T .0116]
8. Gravity sewers installed greater than ten percent below the minimum required slope per the
Division's Gravity Sewer Minimum Design Criteria shall not be acceptable and shall not be certified
until corrected. If there is an unforeseen obstacle in the field where all viable solutions have been
examined, a slope variance can be requested from the Division with firm supporting documentation.
This shall be done through a permit modification with fee. Such variance requests will be evaluated
on a case -by -case basis. Resolution of such request shall be evident prior to completing and submitting
the construction certification. [ 15A NCAC 02T.0105(n)]
9. A copy of the construction record drawings shall be maintained on file by the Permittee for the life of
the wastewater collection facilities. [15A NCAC 02T .0116]
10. Failure to abide by the conditions and limitations contained in this permit; 15A NCAC 2T; the Division's
Gravity Sewer Design Criteria adopted February 12, 1996, as applicable; the Division's Minimum
Design Criteria for the Fast -Track Permitting of Pump Station and Force Mains adopted June 1, 2000,
as applicable; and other supporting materials may subject the Permittee to an enforcement action by
the Division, in accordance with North Carolina General Statutes §143-215.6A through §143-215.6C,
construction of additional or replacement wastewater collection facilities, and/or referral of the North
Carolina -licensed Professional Engineer to the licensing board. [15A NCAC 02T .0104; 15A NCAC 02T
.0108(b-c)]
11. In the event that the wastewater collection facilities fail to perform satisfactorily, including the
creation of nuisance conditions, the Permittee shall take immediate corrective action, including those
as may be required by this Division, such as the construction of additional or replacement facilities.
[15A NCAC 02T .0110; 15A NCAC 02T .0108(b)]
12. The issuance of this permit shall not exempt the Permittee from complying with any and all statutes,
rules, regulations, or ordinances that may be imposed by the Division any other Federal, State, or
Local government agencies which have jurisdiction or obtaining other permits which maybe required
by the Division or any other Federal, State, of Local government agencies. [G.S. 143-215.1(b)]

CERTIFICATION CHECKLIST
To be completed by the certifying engineer prior to operation of the permitted sewers, per 15A NCAC 02T.0116.
Certifying Engineer:
Certification Review Date:
Project Name:
WQ00 Project County:
1) Has permittee information changed since the permit was issued (or last modified): change of mailing address,
change of ownership, transfer from developer to HOA/POA, etc. n Yes n No
• If yes, please provide either a change of ownership form or new contact information. Note that transfer of
permits from the developer to the HOA/POA must occur with the first certification.
2) Have the as -built drawings have been signed, sealed, and dated by an N.C. PE? n Yes n No
3) Final Engineering certification? n Yes n No
• If Partial Engineering certification, provide detailed narrative including what is being certified in the current
phase, what was previously certified (if applicable), and what is left to be certified.
4) Adequate information related to sewer lines: n Yes n No n N/A
• Three feet minimum cover has been provided for all sewers unless ferrous pipe was installed.
• Minimum diameters for gravity sewers are 8-inches for public lines and 6-inches for private lines.
• Manholes have been installed: At the end of each line, at all changes in grade, size, or alignment, at all
intersections, and at distances not greater than 425 feet; minimum diameter shall be 4 feet (48-inches).
5) Adequate information related to pump stations: n Yes n No n N/A
• Ensure power reliability option was selected per 15A NCAC 02T.0305(h).
6) Was project construction completed in accordance with all of the following: n Yes n No n N/A
• 15A NCAC 02T, Minimum Design Criteria (MDC) for the permitting of Gravity Sewers (latest version), and MDC
for the Permitting of Pump Stations and Force Mains (latest version)?
If not, a variance approval is required in accordance with 15A NCAC 02T.0105(b), prior to certification and operation.
• Contact the Central Office to discuss the variance to determine a course of action.
• Applicant must submit two copies of the variance request form, plans, specifications, calculations, and any other
pertinent information to the Central Office (one hard copy, one digital copy).
• The central office will review the variance request, and if approvable, specific language regarding the variance
will be incorporated into the permit, either via a special condition or a supplementary letter. A copy of the
reissued permit with variance language or the variance letter must be maintained with the original documents.
7) Does the project contains high priority lines (15A NCAC 02T .0402(2))? ❑ Yes ❑ No
• If yes, ensure that the permit already contains the necessary condition related to high priority lines 15A NCAC
02T.0403 (a)(5). If the permit does not include this language, the Fast Track reviewer will reissue the permit with
the appropriate language.
8) Are Permit modifications are required for any changes resulting in non-compliance with this permit (including but not
limited to pipe length changes of 10% or greater, change in flow, pump station design capacity design change of 5% or
greater, and/or change in the number/type of connections)? n Yes n No
• If yes, a permit modification request must be submitted to the appropriate Regional Office, and a modified
permit with revised certification must be issued prior to certification and operation.
NC DWR — Water Quality Regional Operations Section 610 East Center Avenue, Suite 301, Mooresville, NC 28115
Mooresville Regional Office Phone: [phone] FAX: [phone]

FAST TRACK SEWER ENGINEERING CERTIFICATION
PERMITTEE: CITY OF BELMONT
PERMIT #: WQ0042426
PROJECT: CAROMONT REGIONAL MEDICAL CENTER BELMONT - PUBLIC SEWER
ISSUE DATE: APRIL 15, 2021
This project shall not be considered complete nor allowed to operate in accordance with standard
Condition 7 of this permit until the Division has received this Certification and all required supporting
documentation. It should be submitted in a manner that documents the Division's receipt. Send the
required documentation to the Regional Supervisor, Water Quality Regional Operations Section at the
address noted in the page footer.
Any wastewater flow made tributary to the wastewater collection system extension prior to completion
of this Certification shall be considered a violation of the permit and shall subject the Permittee to
appropriate enforcement actions. The Permittee is responsible for tracking all partial certifications up
until a final certification is received by the Division. A Final Certification shall be a complete set of record
drawings and design calculations regardless of whether partials have been submitted.
PERMITTEE'S CERTIFICATION
I, the undersigned agent for the Permittee, hereby state that this project has been constructed pursuant
to the applicable standards & requirements, the Professional Engineer below has provided applicable
design/construction information to the Permittee, and the Permittee is prepared to operate & maintain
the wastewater collection system permitted herein or portions thereof.
Printed Name, Title
Signature Date
ENGINEER'S CERTIFICATION
I, , as a duly registered Professional Engineer in the State of North Carolina,
having been authorized to observe (❑ periodically, n weekly, ❑ full time) the construction of the
project name and location as referenced above for the above Permittee hereby state that, to the best
of my abilities, due care and diligence was used in the observation of the following construction:
4,127 linear feet of 12-inch gravity sewer,; such that the construction was observed to be built within
substantial compliance of this permit; 15A NCAC 02T; the Division of Water Resources' (Division) Gravity
Sewer Minimum Design Criteria adopted February 12, 1996 as applicable; the Division's Minimum
Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains adopted June 1, 2000 as
applicable; and other supporting materials.
North Carolina Professional Engineer's Seal w/signature & date:
❑ Final n Partial (include description)
Certification Comments/Qualifiers (attach if necessary):
NC DWR — Water Quality Regional Operations Section 610 East Center Avenue, Suite 301, Mooresville, NC 28115
Mooresville Regional Office Phone: [phone] FAX: [phone]