WQ0039906_Regional Office Historical File Pre 2018

Water Resources
VIROP4MENTAL GUALtIr
Warren Wood, City Manager
City of Hickory
P.O. Box 389
Hickory, NC 28603
Governor
MICHAEL S. REGAN
Secretary
LINDA CULPEPPER
Interim Director
May 14, 2018
Subject: Permit No, WQ0039906
City of Hickory
Pepperstone Apartments
Wastewater Collection System Extension Permit
Catawba County
Dear Mr. Wood:
In accordance with your application received April 9, 2018, with additional infomiation received May 14,
2018,.we are forwarding herewith Permit No. WQ0039906 dated May 14, 2018 to the City of Hickory
(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system extension, This permit shall be effective from the date of issuance until rescinded and shall be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 perrnit and is therefore incorporated therein by reference,
Please pay particular attention to the following conditions contained within this 'permit:
Condition II. I.: This permit shall not be automatically transferable; a request must be made and approved,
Condition 11.4: Requires that the wastewater collection facilities be properly operated and maintained in
accordance with 1.5A NC -AC 21 .0403 or any individual system -wide collection system
permit issued to the Permittee.
It shall be the responsibility of the Pemiittee 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 §1.43-215,6C, construction of additional or replacement wastewater
collection facilities, andlor referral of the North Carolina -licensed Professional Engineer to the licensing
board.
State or North Carolina Environmental Quality Water Resources 1 Water Quality Regional Operations
Mooresville Regloaal Office 1610 East Center Avenue, Suite 301 1 Mooremik„ North CaMlina 11.51
704 663 1699

If any parts, requirements, or limitations contained in this permit are unacceptable, you have the right to
request an ad)udicatory hearing uponwrittenrequest 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 ssith the Office of Administrative Hearings, 6714 Mail Service Center,Raleigh, NC
7 i -671 . Unless such demands are made, this penmit shall be final and binding.
If you need additional information co ace ing this matter, please contact Lon Snider at (704) 2 21% or
pia e-mail at 19u,sniderAriedenr.gov,
ir'trerel ,
DocuSigned by:
kb:ICC6 AF 4
by W. Corey Basinger, er, .e ional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NCDEQ
c Dan 1 re%ver, PE (1 copy)
Tonal t..fhce 1 ilea
Water Resources Central Files
PFRC; (-copy)

Env=tram
Qua
n tal
STATE OF NORTH C,A.ROI„ INA
ENV IRONMFNTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENTAL QIJ &L[TY
WASTEWATER COLLECTION SYSTEM EXTENSION PER 'IIT
In accordance with the provisions of Article 21 of Chapter 1.43, General Statutes of North
Carolina. as amended, and other applicable Laws, Rules, and Regulations„ permission is hereby
granted to the
City of I ickory
Catawba County
for the construction and operation of approxinately 976 linear feet of -inch public gravity
sewer, to serve an apartment complex as part of The Pepperstone Apartments project, and the
discharge of 34,560 gallons per day of collected wastewater into the City of Hickory existing
sewerage system,, pursuant to the application received April 9, 201 S, and in conformity with 15A
NCAC 2T; the Division's Gravity Sewer Minimum Design Criteria adopted February 1.2, 1996,
as applicable; the Division's Minimum Design Criteria for the Fast -Track Permitting of Pump
Stations and Force Mains adopted rune 1, 2000, as applicable; and other supporting data
subsequently filed and approved by the Department of Environment and Natural Resources and
considered a part of this permit.
This permit shall be effective from the date of issuance unti
the specified conditions and limitations contained therein.
DocuSigned by:
1AF27425...
by W. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NCDEQ
By authority of the Environmental Management Commission
Permit Number:. WQ0039906
Permit Issued: May 14, 2018
cinded and shall be subject to
Page 3 of 8

SUPPLEMENT TO PERMIT COVER SHEET
City of Hickory 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 Hickory Northeast Waste
Water Treatment Facility in accordance with Permit Number NC0020401
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 co .-tingent upon compliance with the Standard Conditions and any Special
Conditions identified below,
SPECLkL CONDITIONS
1) No flow in excess of the quantity permitted herein, 34,560 GPI), 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. [1.5A NCAC 02T.0304 (b)],
11..STANDARD CONDITIONS
I. 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 approvai of this request shall be considered on its
merits and may or rn.ay not be approved, [ISA NCAC 02T,0104; G.S 143-215_1 03)]
L This permit shall become voidable unless the wastewater collection facilities are constructed in
accordance with the conditions of this permit; 15A. NCAC 21'; 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,01,101
3. This permit shall be effective only with respect to the nature and volume of wastes described in the
application and other supporting data, [15.A NC AC 02T ,01.10.]
4, The wastewater collection facilities shall be property .maintained and operated at all times, The
Perrninee shall maintain compliance with an individual system -wide collection system permit for the
operation and maintenance of these facilities as required by 15.A NCAC 2T ,0403. if an individual
permit is not required, the following performance criteria shall be rneti [15A. NCAC 02T .010.8(b)j:
Page 4 of 8

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 leastonce per year.
g. Overflows and bypasses shall be reported to the appropriate Division regional office in
accordance with 15A. NCAC .213 ,0506(a), and public notice shall he provided as required by
North Carolina General Statute §1.43-21.5„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 representative3. .
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. Rn.tht-of-ways and easements shall be maintained in the full easement width for personnel and
equipment accessibilityj. .
Documentationshall 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 (704) 6,63-1699., as soon as possible, but in no case more than 24 hours
following the occurrence or first knowledge ofthe 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 andlor spill over 1,000 gallons or
c, Any SSO and/or spill, regardless of volume, that reaches surface water
Page 5 of

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 .Divisionapproved 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 fomi) can also be completed to show that the SSO was beyond control, [G.S, 143-
215,1C(al.)1
Constniction of the gravity sewers, pump stations, and force mains shall be scheduled so a.s 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. li5A.NCAC 021.01081,b.Yi
7, Upon completion of construction and prior to operation of these permittedfacilities, the com.pleted
Engineering Certification form attached to this .pennit shall he 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 Engineers
Certification shall be considered a violation of the permit and shall subject the Pernnttee 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 he 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 ((D 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.
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 cycl.e, 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 fomi.
Prior to Certification (Final or Partial): Pemnt modifications are required for any changes resulting
in non-compliance with this 'permit (including pipe length increases of 1.0°,/0 or greater, increased
flow, pump station design capacity design increases. of .5% or greater, and increases in the
numberitype of:connections), regulations,. or the Minimum Design Criteria., Requested modifications
Page 8 of 8

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 he 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 .01.16]
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 shali 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. [15.A NCAC 02T .0116]
10, Failure to abide by the conditions and limitations contained in this permit; ISA NCAC 21; 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 Purnp 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„oi„ replacement wastewater. colle"etion„facilities,„
and'or referral of the North Carolina -licensed Professional Engineer to the licensing board. [I5A
NCAC 02T .0104; 15A. NCAC 02T .0108(b-c)i
11. in the event that the wastewater collection facilities, fail to perform satisfactorily., including the
creation of nuisance conditions, the Perrnittee 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)1
12. The issuance of this permit shall not exempt the .Pemiittee, from complying with any and allstatutes,
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. [GS. 14.3-215.1M
Page 7 of 8

FAST TRACK SEWER ENGINEERING CERTIFICATION
PERMITTEE: CITY OF HICKORY
PERMIT #: WQ0039906
PROJECT: PEPPERSTONE APARTMENTS
ISSUE DATE: MAY 14,2018
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 -looter,
Any wastewater flow made tributaryto 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
1, 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 information to the Permittee, and the Pennittee is prepared to operate & maintain the
wastewater collection system permitted herein or portions thereof„
Printed Name, Title
Signature Date
ENGINEER'S CERTIFICATION
1, , as a duly registered Professional Eineer in the State of North Carolina,
having been authorized to observe ( , periodically, weekly, ime) the construction of the
project name and location as referenced above for the above Permit e hereby state that, to the best of my
abilities, due care and diligence was used in the observation of the constmction such that the construction
was observed to be built within substantial compliance of this pennit, 1.5A 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 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]

Division of Water ,Reno►irces
f North Carolina
t►viro►autet►tatl Quality
" Water Resources
I5A \C1C: 02Tw .0300 . FAST TRACK, SEWER S1`'STEM E:NTENSION APPLICATION
Tr:1 0-1-16 & SUPPORTING ,"G; I)OCtiNIE\"1 ATION
Appiicatton Number:
a111 items must be col
APP. o1 T I 'FORMATION:
i. \t 4 iicartt`s tta° ►etc. CITY. OF:...HICK
1 Individual
t ` (eorttpau)„ m
[� Corporation
[� Statecouuty
4. A1tl lic tt's tttailittg address-. 1.441 i7`'',
State. NC
a inform.
Phone number: (828) 32 33-7427 Email Address: KG
PROJECT 1NFORMA'1ION:
1. Project name; PEPPERST ONL "li'. I T \ TENTS
?. Applicatioiaroject status: Proposed New Pern
if a modification, provide the es
(h alr licatio�
it
VQ00.
t part of a master plan, prowie e tltc e. i .fir
is l Gated' C1'I'A\VBA
ordinate
Parcel ID (if applicable): 37l:i1k3359993
(or Parcel IT) to closest downstream sewer)
III. CONSULTANT INFORMATION:
I. Professional Engineer: WVILLIAMSCLAY"1` IN
Form; CL \ `TON ENGINEERING & Ft1'.SICiN ,
Mailing. address, PO BOX 2351
City: HICKORY State: NC
Phone number: (828) 4,55-3456
D\4'R)
EIOAetc")
ip © PrivaOwned Public 1.
g perms
35.45.00'
L fisting Permit
ued clttte;
her: AVQO(7_.
d
Other
License Number: 040758
Zip: 2.8603-
Email Address: t"CLAY"TON(iP,CL„r1"ti'T"ON-ENCINLERING.NE1
IV. "1'E'ASTFAVA°TER TREATMENT FACIT"ITY" (WWTF) INFORMATION:
I. Facility Name. NORTHEAST WWII' Permit. Number: NC0020401
Owner Name: (:1"I Y' (I° 1fiCt;'KOR.Y
RECEIVING DOWNSTREAM SEWER I FORMATION (irdifte►t rtt ttt:
I, Permit Number(s): WC) Downstream (Recei+°ing) Sewer
Systein n Wide Collection S �stt►,� Pe tt i( t • tt+ber(s(flt'applicable ) \VACS
()weer Nantc(s)_ CITY OF HICKORY
ize:
FORM: FTA 04-16
Page 1 of 5

VI GENERAL REQUIREMENTS
1, Lithe Applicant is a Privately -Owned Public Utility, has a Certificate of 'Public Convenience imd "ecesity
E,1 Yes 0No MN/A
2. lithe Applicant is a Developer of lots to be sold,has a Developer's Operational Affeement (1 ORN.1: DEY) been attached'?
Yes [JNo E1N/A
3. If the Applicant is a Home.,:Propertv Owners' Association, has an gperationa Agreement (FORWHOA) been attached?
0 Yes DN0 MNIA
4, Origin of wastewater: (check all
Residential Owned
Residential. Leased
El school / preschool / day care
Ej Food and drink facilities
0 Businesses. / offices factories
apply):
Li Retail (stores, centers, malls)
0 Retail ‘vith food preparation/service
E Medical / dental veterinary facilities
0 Church
0 Nursing Flome
5, Nature of wastes : 1009,4). Domestic/Commercial
°/0 Commercial
industrial (See l3A "(,'AC 021 .0 030011)
is there a Pretreatment Program in effect?
6. Has a flow reduction been approved under 13A NCAC 02T „01 4(11)? D Yes
> lives, provide a co ow rethietwit ajnjoyal lettr
7, Summarize xvastewater generated by project;
Es a . "sit
t Type (see )2T,01I4(f
Daily Design Flow
APARTMENTS (1.44 TOTAL ROOMS) 240 gal/DAY
gal/
gal/
Car Wash
El Hotel and/or Motels
[] swimmiog Pool /Clubhouse
[1] Swimming Poolifilter Backwash
Lill Other (Explain in Attachment)
El Yes 0 No
No
'a, of Units
'F low
3.4,560 GPD
GPD
GPI)
GPD
GPD
GPD
34,560 GPD
a See 15.A. NCAC 02T .0114()). (d), (Or (jJjLi for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential develop') 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 1.5A NCAC 02'1 .01 14(c), design flow rates for establishments not identified [in table 5A NCAC 02T,0 141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 23,040 GPD (per ISA NCAC 02T ,0114)
> Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why;
Eiii Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
LI Flow has already been allocated in Permit Number
El Rehabilitation or replacement .of exist] g s
[1 Other (Explain):
'ef
o new flow expected
FORM; .FT". 0446
Page 2 of 5

VII, GRAVITY SEWER DESIGN crurr ERIA (If A p & !MD Gyayjl v_SQvcIELI:
. Summarize gravity sewer to be permitted:
Length (feet) Nlaterial
Section 11. & of the iN,IDC for Permitting of Gravity Sewers contains information related to design criteria
• Section 1 1 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
\ PUMP STATION DESIGN CRITERIA (If Applicable) — 02T ,0305 & MDC (Pump Stations/Force Mains
COM "LETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
I, Pump station number or name:
2. Approximate Coordinates (Decintal Degrees): Latitude, Longitude: -
3. Design now of the pump station: millions gallons per day (firm capacity')
4. Operational point(s) oldie pump(s):: gallons per minute at feet total dynamic head (TDH)
5, Summarize the force main to be permitted (tor this Pinny Station):
Length (feet) Material
6. Power reliability in accordance %sit) I 5.A NCAC 02'] .0.3050101
0 Standby power source or pump with automatic activation and telemetry - NCAC 02T ,.0305(h)(I)(D);
• Required for all. pump stations with an average daily flow greater than or equal to 15,000 gallons per day
Must he permanent to facility'
Or if the pump station has an average daily flow less than 15,000 gallons per day:
0 Portable power source \Nat'l manual activation, quick,-conneetion receptacle and telemetry - 15A. NCAC 02T
.0305(h)(l)(C)
or
0 Portable pumping unit with plugged emergency pump connection and telen. - - I5A NCAC 021 .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.
Hate 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 14116:m11.es,, shall be provided
in the case of a multiple station power outage.
FORM- FTA 04-16 Page3 of5

I\. SETBACKS & SEPARATIONS - (0213 .0200 & I5A N( AC 02T .0305(1)):
1. Does the projec1 comply vih all sepinations found in )5 NCA( 02T .0305fj (g)
15A 'CAC 021.0305(0 contains minimum separations that shall be provided for se% systems:
Se back Parameter* Searation Requited
Stalin sewers and other utilitiesiniIitie no htcd below(vei'tical) 24 inhcs
atet mains (vei tical-water over sewer including in benched trenches) 18 ine
'ate r -(borizontal) 10 feet
d water lines (vertical - reclaimed over sewer)
ied water lineslhorizontal - reclaimed over sewer)
**Any private or public water supply source, including any wells, WS-1 waters of Class 1 cm
Class 11 impounded leservoirs used as a source of drinking water
*Waters classified WS (except WS-I or WS.V), 13, SA, ORW, HQW, or SL3 from normal
MI water (or tide elevation) and Nve land s (see item 1X,2)
**.Any other stream, lake, impoundment, or ground water lowering and surface drainage
itches
y building foundation
Any basement
10 slo
s of 2 feet or more vertical height
Drainage systems and intercTtor drains
ing pools
grin](ericaI)
M Yes LI No
50 feet
10 feet
5 feet
10 feet
10 feet
5 feet
10 feet
36 inches
• 15A NCAC 02T.0305(g) contains alternatives where separations in 021'.0305(1) cannot be achieved.
• "Stream classifications can be identified using the Division's NC Surface Water Classifications webpag,
• If noncompliance with 021.0305(t) or (), see Section \ of this application
2. Does the project comply withseparation requirements for wetlands? (50 feet of separation) LI Yes fl No NiA
> See the Division's draft separation requirements for situations where separation cannot be meet
i',. 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 mks per 15.,1. NCAC 02.13 .0200? El Yes E] No
>. This would include Trout Buffered Streams per 15A .NCAC 213,0202
4.. Does the project require coveragelauthorization under a 404 Nationwide or
individual permits or 401 Water Quality Certifications?
Information can be .obtained from the 401 & Buffer Permitting. Branch
Li Yes
N/A
5. Does project comply with 15A N( .AC 021,0 105 '6) (additional permitsicertifications)? Yes El No
Per I5A NCe‘C 02T,0105 .6", directly related environmental permits or certification applications are being prepared, have
been applied for, or have been obtained. Issuance of this pernnt is contingent. on issuance of dependent permits (erosion and
sedimentation control plans, stortuwater management plans, etc,).
6. Does this project include any sewer collection lines that are deemed "high -priority?"
Per 15A. NCAC 021.0402, "high -priority seNver" 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.
[1] Yes El No D N/A
if yes, include an attachment 'with details for each Inc. 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 15.A NCAC 021%0403(a)(5) or the permitees individual System -Wide Collection permit.
FORM: FTA 0.4-16 Page .4 of 5

1. Does the submitted system complyv tI 15A„ , the Minimum Design Criteria for the Perunuint4. of Pam Stations
andEk-eeNtartisrlatestversjonl, and die Gravity Sewer Isliniinnin Desien ( riteriallatest version) as applicable?
N
If No, complete and submit the Variance/Alternative Desiszn Request application (NAD(, 1014) and supporting documents for
review. .koproval of the Teeniest is iu to submittal of the Fast 'Track Application and suppertino documents.
2. Professional Engineer's Certification:
1, V'iii-Liots!" S. ,„..C1.14f_rill attest that this, application for
(Professional Engineer s name from Application hem III,1.)
has been reviewed by me and is ileCliTate. complete and consistent with the information supplied in the plans, specifications,
engineering calculations, and all other supporting dockfIllen(ation 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. MitillS (latest version). Although other professionals ma.y have developed certain portnms 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 he consistent with the proposed design,
NOT -- In accordance ‘vith General Statutes 143-215,6A and 143-215,68, any person i,vho 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 S10,000, as well as civil .penalties up to S25,000 per violation,
---
North Carolina Professional Engineer's seal, signature, and date:
<Z- S •
- v
3, Apphca
441 s,
olitillo
Li 1,5A NCA( 02T .0106(b):
attest that this applicanon
(Signature Authority's name & 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 it 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 sor Ince waters .or the land will result in an immediate enforcement action that may include civil penalties,
injunctive relief, amEor criminal prosecution. 1 will make no ,claim against the Division of Water Resources should a condition.
of this permit be violated. !also understand that &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 1432156A and 143-215,613, any person who knowingly makes any false
stateme,rd, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a tine not to exceed S10,000 as well as civil penalties up to S25.000 per violation,
6
Date:
FORM:FT 04-.16 Ignite 5, of ,5

State of North Carolina
Department of Environmental Quality
Division of NVater H„esoit revs
Flow Tracking/Acceptance for Sewer Extension Applications
(FTS E 0416)
Entity Requesting Allocation: CITY OE HICKORY
Project Name for which flow is being requested: INPPFRST()NIi APA !MI FATS
Afore than one FTST, 'nay requirediOr tt single project tic the owner of the 1111TP is un responsible for pump
shalom ettotw the route ref the pied waytewater flow,
Complete this section only if you are the owner of the ‘vastewater treatment plant.
a. WWTP Facility Name: Northeast
b. WWTP Facility Permit NC002040
c„ \wry facility's permitted flow
Allfloivs are in MGD
(i.()
d. Estimated obligated flow not yet tributary to the WWFP 0307149
e, W WIT facility's actual avg. flow 3..175
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
0.0345
3.51664
58.6%
11, Complete this section for each pump station you are responsible for along the route of this
proposed ‘vastewater flow.
List pump stations located between the project connection point and the WWTP:
(A) (II) ((') (D)--(lti-(:) (E)--(A-D)
Design Obligated,
Pinup Average Daily Approx. Not Yet Total Current
Station Firm Flow** Current Avg. Tributary Flow Plus
(Name or Capacity, * (Firm / pi), Daily Flow, Daily How, Obligated Available
Number) MGD MGD MGD MGD Flow Capacity***
N/A
The Firm Capacity of any pump station is defined as the maxiniton pumped
can be achieved with the largest pump taken out of service.
" Design Average Daily Flow is the firm capacity of the pmnp station divided by a peaking
factor (pf) not less than 2.5.
A Planning Assessment Addendum shall be attached for each pomp station located
between the project connection point and the WWII' where the Available Capacity is < 0.
Downstream Facility Name (Sewer):
Downstream Permit 'Number:
Page 1 of 6
VISE 04- t.

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0 -1

March 29 2018(Revised 31118
NCDEQ DAR
610 East Center Avenue
Mooresville. NC 8115
Re: Pepperstone Apartments New Sewer Services
Project Narrative
CED Job # 2017044
Dear Sir or tvtedam,
Clayton Engineering & Design has been selected by LH Developers to prepare plans and
specifications for the proposed Peperstone Apartments on a vacant parcel of land on 86 St Dr
NE in Hickory, NC, Site development will require the construction of " gravity sewer line to serve
the apartment buildings, Approximately 76 LE of 3", gravity sewer is to be constructed. The
proposed development will generate 34,0 qpd.
If you have any questions or need additional information, please feel no to call
( 23) 455-3456 or email wcla ton ciavton-engineering net.
Sincerely
Clayton En
neerin
1iulliarn S. Claton, PE
President.
Design, PLLC
304 151 EIPO Box
Hicks r. NC 28603
[8281455-3456 P-146

Public Ut tI
Tos Warren Wood, City Manager
Fro Shawn Pennell, Assistant Pubervlces t
CCI Kevin Greer, P.E., Public Services Director
Date: 4/24201 tl
Ref Permitting for Pepperstone Apartments
Public Utilities
Please find attached INC DWR perrritttng application for the re
Heniine. This project will be adjacent to the Highland Rec Center °ar
192, 2 bedroom apartments. This is a revision of a previous a
Please let me know if you have any questions.
ed• by Larry
it of approximately
due to DWR comments.

Departntitent of Ett
Division.
at th Caroling'
tal Quality
Resources
ISA NCAC 2T ,t Q- FAST TRAC WE STSTEM EXTENSION APPLICATION
INST .. JCTK lS FOR FORM: Ii"IA 44-i6 MING DOCUMENTATION
gravity sewers, pump stations and force mains ut any eornbinatien
pot that the project meets the requirements tip lS NC C tl2T.and the
rdons rind supporting documents hive been prepared: in accordance w
T. ; ti0; i#i t tent ttellci And good engineerina practices.
While no upfront engineering design docurttr nts are required for submittal, in accordance ,vith. I5A NCAC 02T .0305(b), design
documents must be prepared prior to submittal of a fast track permit application to the Division, This would include plans, design
calculations, and project specifications referenced in J5A i'fCAG 02T AIM and the applicable minimum design criteria. These
documents shall' be available upon request by the Division,
Projects thatare deemed permitted (do not require a permit from the Division) rtr explained in ➢SA NCAC 02T+ :3
Projects not eligible for review via the fast track process (must he submitted for MI teehnicat review):
A Projects that require an environmental assessment in accordance with ➢ SA NCAC IC .0100;
• Projects that do not meet any part of the minimum design criteria (MDC) document;
> Projects that involve at variance from the requirements of 15A NCAC 2T;
> Pressure sewer systems utilizing septic tank -effluent pumps (STEPs) or simplex .gr grinder pumps;
• STEP or simplex grinder pumps connecting to pressurized systems (e.g. farce mains);
• Vacuum sewer systems.
General - When submitting an application, films tree dte following instructiuttaas a eltecklistin order to ensure all required items
are submitted, Adherence to these itiatrttctinns and checking the provided buees vill'help produce a quicker review time and:
reduce the amount of requested additional infrtntatien. Felrre to submit all required items will necessitate additional
processing and review time, and may result In return of the application. Unless otherwise noted, the Applicant shall submit
one original and one copy of the application and supporting documentation.
A. One Qrigivat and One Copy of Application and Supporting Documents
*:s Required unless otherwise noted
(Required for All Apptic tttrtrt Packages)
u Ioded;'in the application package, its well as a brief description of the requested permitting action.
o the system type, number of homes served, flow allocation required, etc.
r clarity, include attachments to the application. form.
C. Application Fee (Ali New and Major Modification Application Packages);
Subnylt a check or money order in the amount of S480.00 dated within 90 days of application submittal_
9 Payable to North Carolina Department of Environmental Quality (NCDEQ)
D. Fast Track (Form: FIA 04-16) Application (Required. for MI Application Packaages):
b,Submit the completed and appropriately executed application.
l If necessary for clarity or due to s=.ce`restrictions, attachments to the application may i made.
D lithe Applicant Type in Item I.2 is a corporation or company, provide documentation it is registered for business with
the North. Carolina Secretary of State.
El If the Applicant Type in Rem L2 is a partnership or d/bi"a, enclose a copy of the certificate filed with the Register of
Deeds in the county of business:
C) The Project Name in Item I1.1 shall be consistent tuitli the project mine colt the Clow acceptant
o The Professional Engineer's Certification on. Page S of'the application sha!
Carolina licensed professional Engineer.
The Applicant's Certification an Page 5 of the application. shall be signed in accordanceA NCAC.
Per ISA NCAC 02T .0106(c), an alternate person may be desi ted as thesigning offr rai if a del
provided from a person who meets the criteria in l5A NCAC 02T .0106(b).
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION
agreements, etc.
:tl dated by a North
Page 1' of 3

E. Flow Tracking/Acceptance Form (Form: FTSE 04-16) (IfApplicabl ).
Submit the completed and executed FTSE form from the owners of the downstream sec+ers rind treaty
➢ Multiple forms maybe required where the downstream sewer owner and wastewater treatment facility a difl`ertuut
The flow acceptance indicated in form FTSE must not expire prior to permit issuance and must be dated less than € ne
year prior to the application date.
A Submittal of this application and form FTSE indicates that owner has adequate capacity and will, not violate faa,S, lf-
215,67(a).
➢ Intergovernmental agreements or other contracts wilt not be accepted in lieu of a project -specific FTSE.
Maps (All Ap,pllcatiartFs+ ltteges):
Submit an 8.5-inch x I1-inch color copy of a USGS Topographic Map of sufficient sc
area and closest surface waters.
A Location of the project (gravity sewer, pump stations & force main)
9 Downstream connection points and permit number (if known) for the teeeivin se ver
Include a street level map (aerial) showing general project area so that Division staff car
G. Existing Permit (All Modification Packages):
p Submit the most recently issued existing pe
p Provide a list of any items within the permit the Applicant r+rotuid like the Division tta address during tlx: permi
modification i.e,, permit description, flow aliocatiion, treatment facility, etc.).
idereti the entire project
ily locate it in the field;
H. Power Reliability Plan (Required if portable reliability option utilized for Pump Station):
Q Per ISA NCAC 02T:.0305(h1(1), submit documentation of power, reliability for pumping stab
• This alternative is only available for average daily flows less than 15,000 gallons per day
• It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant and is compatible,
with the station, The Division will accept a letter signed by the applicant (see ISA NCAC 02T .0106(0) or proposed
contractor, scat' », that "the portable power generation unit or portable, independently -powered punning units, associated.
appurtenances and personnel are available for distribution and operation of this pump station."
• If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump
stations' storage capacities and the rotation schedule of the portable power source or pump, including travel
t meframes, shall be provided in the case ofa multiple station power outage. (Required at time of certification)
C+ertiticate of Public Conve
© Per
Clti,liies Counauuission demo
the sewer estens on,
1p Provide a letter from the
application for a franchise has
franchise approval is expected,
and Necessity (All Application Packages for Privately -Owned Public Utilities):
provide the Certificate of Public Convenience and Necessity from the Werth Care l`tr
g the Applicant is authorized to hold theutility franchise for the area to be served by
lit a i r i ion's iv' i, stating an
:eived and that the service area, is coati uous to an existing franchised area or that
J; Gtperational Agreements (Applications from HOA/POA and Developers for lots to be sold):
operty Owners' Associations.
Per C submit: the properly executed Qperatioual Agreement (FORM„ UOA].
0 Per ISA NCAC 02T Al i 5(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
O Developers of lots to be sold
CI Per 15A NCAC 02T .011.5(b), submit the properlyexecuted Operational Agrcernent(FORM DEV).
For more inrtrr motion, visit the Division 's collection systems website
INSTRUCT10NS FO FORM: FTA t14-16 &, SUPPORTING 17DCtcf dENTATI©N Page 2 of 3

THE CO ET D APPLICATION PACKAGE INCLDHNG ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE:
Office
log
it
atop.-aie#n Recdolrai 0
Water Quality Sect
ADDRESS COUNTIES SERVED.
2139E US Highway 70
Swanrlanoe, North Caro
[phone]
[phone] Fax
Pin
225 Green Street Suite `714
Fayetteville, North Carolliraa 28301-5
[phone]
[phone] Fax
Avery, Buncombe, Burke, Catch II, Cherokee,-
28778. Clay, Graham, Haywood, Henderson, Jackson,
Macon, Mad an, McDowell, Mitchell, Polk,
Rutherford, Swain, Transylvania, Yancey
0 E. Center Avenue
vfHe, North Carolina 28115
aa9
0 Fax
(252)
(252) 975-
7215
0I3502 Fax.
, 8laden, Cuniberiand, l-lore#„ Hoke,
tg©mery, Moore, Robeson, Richmond,
mpson, Scotland
Stair*, Union
Center C
2
na 278
ien on
Carolina 28405
Ha
Suite 300
V insten-Sateen, No
770-9800
Carolina 27105
Edgeccxnbe, Franklin,
hriston, Lee, Nash,
Person, Vance, Wake,
, Camden, i howarn, Craven,
Currltu Dare, Gates, Greene, Hertford, Hyde,
Jones, i noir, Martin, Pamlico, Pasquotank,
Perquinnans, Pitt, Tyrrell, Washington, Wayne
Bru
Hanover
ret, Cotumbus, Dublin,
Pender
Ashe, Caswell, Davidson,
rd, Rockingham, Randolph,
e, Whites, Yadkin
[NSI:RUCT(ONS FOR FORM FTA 04 t6 SIFI'PORTING :NTATION Page 3 of 3

ISA NCAC 02T .0300 — FAST
All items must be cu
PPL1CANT INFOI
I. Applicant's name:
Applicant types 0 Individual
© Federal.
State of North Carttiina
Department of Environmental Quality
Division of Water Resources
EWER SYSTEM EXTENSION APPLICATION
FTA 04-16 & SUPPORTING DOCUMENTATION
OKY (company, muttacipality; HOA, utility, etc.)
© Corporation j General Partnership 0 Privately -Owned Public Utility
0 State/County Muntcipal
Signature authority's name: Warren Wood per 15A NCAC 02T .01 ( )
Title:
4. Applicant's
City:
5, Applico
Phone n
ll. PROJECT INFORMAT
1. Project name:
2. Application/Praje
l 441 9th Ave
Zip: 286 -
ion:
7427 Email Address: KGREEIt Ali K RYNC. i V
ICI:
wNE,APARITS
Proposed (New Permit) Q Existing Perri'raject
If a modification, provide the existing permit number: WQOO and issued date:
If new construction but part of a master plan, provide the existing permit number: WQOO
3. County where project i located: CATAWBA
4. Approximate Coordinates (Decimal Degrees): Latitude} 5.4 .00' Longitude:. 1 °
5. Parcel ID (if applicable): 371310159993
(or Parcel ID to closest downstream server)
Other
III. CONSULTANT INFORMATION:
1. Professional Engineer: WILLIAMwS. CLAYTQN
Firm: CLAYTON ENGINEERING &.DESIGN, PLLG
Mailing address: PO BOX 235 1,
City: HICKORY State: NC Zip: 2803-
Phone number: [phone] Email Address: W'CL YTON(caCL, YTQN-ENGiNEERING.NET
V. WASTEWATER TREATMENT FACILITY (WWTF);1NFORMATION:
1. Facility Name: NORTHEAST WWIE Permit Number: NC0020401.
Owner Nance: CITY OF HICKORY
7S
to Numb
V. RECEIVING DOWNSTREAM SEWER INFO I?tiriAT1ON (if different an WWTF):
I. Permit Nurnber(s): WO Downstream (Receiving) Sewer Size:
System. Wide Collection System PetmitNumber(s) (if applicable): WQCS�
OwnerName(s): CITY OF HICKORY
FORM; FTA 04-16 Page

VI. GRNERAL REQU1R1±;MENTS
1. If the Applicant is a Privately -Owned Publtc Utility, has a Certificate of Public Convenien
Q Yes DNo rat N/A
2. i the Applicant is a developer of lots to be scald, has a Devekruer's Operational
0 Yes QNo m4'N/A
Iftlte Applicant is a Koine/Property C vnars` Association; has an Operational Att
Yes. ©No /A
4. Origin of wastewater: (check all th
Q Residential Owned
11134 Residential Leased
10111 School / preschool / day care
© Food and drink facilities
© Businesses / offices / factories
pply):
0 Retail (stares, centers, mad
O Retail with food preparadorr/set
0 Medical / dental / veterinary fac
Q Church
❑ Nursing. Home
5; Nature of wastewater; 1, 9..% Domestic/Commercial
% Industrial (See l CA. 02T
Ts there a Pretreatment Program i
6. Has a flow redttction bran approved under 15A NCAC t 2T „0114ij? 0 Yes
1<f ves. taravidea opv9f flow reduction approval letter
7. Summarize wastewater generated by project:
llstnbllsiatnertt Tye e 02T.11114(f) fatly Design Fla+v,s
APARTMENTS (144 TOTAL ROOMS) 240 1/ AY
gal/
and Necessity been a
FCRi%� been a
t (FORi41: HOA) been attached?
d?
© Car Wash
0 Hotel and/or Motels
© Swimming Pool /Clubhouse
0 Swimming Pool/Filter Backwash
Other (Explain in Attachment)
Yes D No
►4: No
No. of Uni'
144 34,560 GPI)
GPD
GPD
GPD
GPD
Tad
a See 15A NCAC 02T .0114(b
dwelling; proposed unknown non-residential develta
and residential property located south or east of the Atlantic Intr
in G.S. 42A);
b Per 1SA NCAC 02T .01.14(c), design flow rates for establishments not identified [in tabs
determined using available flow data, water using fixtures occupancy or operation patte
Wastewater: generated by project: 2.3,040 GPI) (per 15A NCAC 02T .0114)
Do not include future flows or previously permitted allocations
if pernllitted flow is zero, indicate why:
0 Pump Station or Gravity Sewer where 1lrri wilt be permitted in subsequent perntits that connect to this line
GPD
34,560 GPD.
0 Flow has already been at10 led in ,Pernik Number;
© Rehabilitation or re nt of existing sewer with no new flow expected
[] Other (Explain):
flow rates (i»c., ntitrimum tlow per
mated near high public use areas;
used as vacation rentals as defined
A NCAC 42T,01,141 shalt be
and other measured data.
FORM: FTA 04- l 6 Page 2 of 5

V1L GAVSEWER DESIGN CR;1TEI�I,
1. Summon z gravity sewer to be permitted:
A:
31. Section 11 & lIi of ttze MDC fttr peiittinR of Gravity Se
A Section lt1 eontaitt ittformatibon related to minimum slo
©verslzing lines to meet minimum slope requirement is n
0
PUMP STATION DESIGN CRITERIA (If Applicable) — 2T .030
DC
formation related to design criteria
r(s)
nd a violation of the MDC
C_(Pump Stations/Force
COMPLETE FOR EACH, PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:.
2. Approximate Coordinates (Decitttal Degrees):
3„ Design flow of the pump station: mi1Iicrrrs g
4. Operational point(s) of theputnp(s)> gallons per minute at
3. Summarize the force main to. be Witted tfor ttt`ts fourrtp Station):
paccity)
total dynamic head (TDH)
6. Power reliability in accordance with t o N ,:AC 02T ;0305(h)(1):
El Standby power source ar pump with automatic activation and telemetry - 15A NC C 02T .0305(h)(1
> Required ;Dar all pump status with tut average daily flow greater than or equal to tS 000 gallons per day
A Must be permanent to facility
Or if the pump station has an average daily flow fess than 15,000 gallons per day:
D Portable power source with manual activation, quick -connection receptacle and telemetry - 15A NCAC 02T
.0305(hX 1XC)
or
Portable ptrntping unit with
pump connection and telernetry - 15A NCAC 02T ,t13O5(h)(1)(C):
A It shall l demonstrated to the Division that the portable source is owned or contracted by the applicant (draft .agreement).
and is compatible with the station.
A If the portable power source or pump is dedicated to multiple pump stations, an evaluation wall the pump stations` storage.
capacities and the rotation schedule of the portable power source or pump, including travel timefrruttes, shall be provided
in the case of a multiple station power outage.
FORM• T"TA 04-16

IX, SETBACXS & SE1?A A"IONS —( ;0 O1J & ISA NCAC 0 T ,0305(0);
1. Does the project comply with all sep
Reel
ISA NCAC 02T.030S tttui
nd in .I.,,ANCAC 02T ,Q305(f) & (ad
utilities net lasted below (vertical,)
ns that shall be .krovided
grticalwater aver sewer including M. benched tr
ver see
"Any private or patlalic water supply srauree, including any wet
Class [1 impounded reservoirs used as a source of drink ng_water
ches)
"Waters classified WS (except WS-I nr WS-V), 8; SA, ORW, IIQW,.or SB h
high water (or tide elevation) and wetlands (see item IX.2) 501ke t
"Any other stream, lake, impoundment, or ground water lowering and surface
ditches
Any building foundation
Any basement
To slo ofentbatnkrnent or ou
Drainage; ay
Any swimming pools
Final earth, grade (Vert
Class' or
Yes [1] No
ion Required.
24 inches
l sA i`NC`AC:
project corn
the Division's
No variance is required if the alter
ia* As built documents should referenc
5(gg conans s
can be iden
with 02TM43050) orjg)a
where separations in 2T.0305{f cannot he achieved.
g the Division's NC So e Water Classifications welltaage
Section X of this ap
ds? (S0 feet of separation)
where separation cannot be
cilied is utilized in design and construction
as effected
arrsject comply with setbacks found in the river basin rules per I5A iCAC 02B ,0200? [j Yes © No
you'd include Trout Buffered Streams per ISA NCAC 213,0202
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 & But er_ Feranitting Brat h
[] Yes No
D Yes D Nca N(A
A
Does project comply with ISA NCAC 02T.0105(c)(6) (add tionaltpermitsicertifications)'s Yes Q No
Per 1.5A NCAC42T,0105(d)(6), directly related environmental permits or certification applications are being prepaared, have
been applied for, or have been °brained. Issuance of this permit is contingent on issuance of dependent permits (erosion and
sedimentation control plans, storniwater management plans, etc).
6. Does this project include any sewer er ldectitatr lines that are deemed "high -priority?"
Per 15A NCAC Q2T.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,
Q' Yes No Q NSA.
If yes,
High priority lin
documented per
FORM: FTA 04-16
ieh line,
uding type (aerial line, size, matal, and !b
erred by the permittee or its representative at least once every sire -months and inspections
T.0403(a)(5) or the perniitee's individual System -Wide Collection permit.
Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15
and Force Mains (latest version), and the
11"No, complete a
re+ iew`, Attrrr4vr
des
he VarianceslAltet't ative Design Re
onest is rertuired trtitrr submittai
2. Professional Engineer's Certification:
(Professional Engineers neime fa rm Application
has been reviewed by me and is accurate„ complete and consistent with the inlorntati rn snpplicd in the plena, specifications,
engineering calculations, and all other supporting documentation to the best of my ltnor ledge. 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. Mininaura Design Criteria for the Fast-Tracic. Permitting.
of Pump Stutiens and Force Mains (latest version). Ahhough other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that 1 have reviewed this material and
have judged it to be consistent with, she proposed design.
NOTE .- in accordance with. General Statutes 143-215,6A and 146B
statetnent, representation, or certification in any application package shalt
include a fine not to exceed S I0 00tl, as well as civil penalties up to $25,000
North Carolina Professional Engine er s sea1, signature, and date:;
3. Applicnrrt°s Certification per 15A NCAC 02T .010ti
T
Authority
NOTE in accordance wi
statement, representation; or ca
include a fine not to exceed-$10,
m Applicat
the beat of my icnooriedF 1 undettand that if ail re
red supporting doeurnentalimr and attachments are not si
stete. 1 understand that any dirscharge of wastewater fro+
an immediate enforcement actiarttt may include civil
claim against the. Division of Water Resources should a condition.
parts of this application package are not completed and that if
d attacts are n,ot atrcluded, this application package will be returned to me as
y false
h may
is 143-2.15.6 and 143-211.6B, any person rr
ny application package shall be guilty of a C
civil penalties up to $25,000 per violation.
Date:
tttgly makes arty false
isdetneanor, which may
A t--16
Pas/e: 5 of 5

Water Rearetwes
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04- I 6)
Entity Requesting Allocation: CITY OF HICKORY
Project Name for which flow is being requested: PEPPERSTONE APARTMENTS
More than one F7SE may be requiredfor a single project if the owner of the WHIP is not responsible for allpump
stations along4 route of the proposed wastewater flow,
Complete this section only if you are the owner of the wastewaterplant.
a. WWTP Facility Name: Northeast WWTF
b. WWTP Facility Permit #: NC0020401
AI flo re in GI)
c. WWTP facility's permitted flow 6,0
d. Estimated oblitIted flow not yet tributary to the WWTP 0.307149
e. WWTP facility's actual avg. flow 3.175
f. Total flow for this specific request 0.0345
g. Total actual and obligated flows to the facility 3.51664
h. Percent ofpermitted flow used 58.6%
II, Complete this section for each pumppurnp stution you are responsible for along the route of this
proposed wastewater flow,
List pump stations located between the project connection paint and the WWTP:
(A) (B) (C) (D)-(n+C) (E)=(A-D)
Design Obligated,
Purnp Average Daily Approx, Not Yet Total Current
Station Firm Flow* Current Avg. Tributary Flow Pitts
(Narne or Capacity, * (Firm / pi), Daily Flow, Daily Flow, Obligated Available
Number) MOD MOD MOD mon Flow Capacity***
N/A
The Firm Capacity of any pump station is defined as the nmxmnm pumped flow
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 pwtklug
factor (pi) not less than 2.5.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < O.
Downstream Facility Name (Sewer):
Downstream Permit Number:
Page, I of 6
FTSE 04-16

ill. Certification Statement:
d� certify to the best of my knowledge that addition of
the vo lumen vastewater to be pei ttted in this project has been evaluated along the route to the
receiving wastewater treatment fiiity 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 ll plus all
attached planning assessment addendum for which 1 am the responsible party. Signature of this
form indicates acceptance of this wastewater flow.
Page 2 of
E t14-16

March 29, 2018
a
10 East Center Avenue
Mooresville, NC 2811
Re: l epp rstond Apartments New Seer Ser i e
Project Narrative
CED Job # 201-7044
Dear Sir or {edam,
Clayton Engineering & Design has been selected by PLFH Developers to prepare plans and
specifications for the proposed F'epperstone Apartments on a vacant parcel of lend on 8th St Dr
PEE in Hickory, NC, Site development mill rewire the construction o of gravity sewer lime to serve
the aprtrnerrt buildings. Approximately 976 LF of gravity sever is to be constructed: the
proposed development will generate 23,,040 ppd.
If you have any questions or need additional it formation„ please feel free to cell me at
() -40 or email >,
Sincerely,
Clayton Engineering Design, PLE
V"Jilltam S, Clayton, f'
President
364 90 Str
. t SEPO cx 3351 Hickory, NC 28633
2 455
Page 11

DIsision 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
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION
This application is for sewer extensions involving gravity sewers, pump stations and force mains, or any combination that has been
certified by a professional engineer and the applicant that the project meets the requirements of and the Division's
Minimum Design Criteria and that plans, specifications and supporting documents have been prepared in accordance with, IfA
02 , ',Al 10,,i 011 m 3qq and
While no upfront engineering design documents are required for submittal, in accordance with .15.A NCAC 02T ,030.5(b), desig„n
documents must be prepared prior to submittal of a fast track permit application to the Division, This would include plans, design
calculations, and project specifications referenced in and the applicable minimum. design criteria. These
documents shall be available upon request by the Division,
Projects that are deemed permitted (do not require a permit from the Division) are explained in
Projects not eligible for review via the fast track process (must be submitted for full technical review):
• Projects that require an environmental assessment in accordance with ISA NCAC IC ,0100,
• Projects that do not meet any part of the minimum design criteria (MDC) document;
• Projects that involve a variance from the requirements of I 5A NCAC 2T;
• Pressure sewer systems utilizing septic tank -effluent pumps (STEPs) or simplex grinder pumps;
"?. STEP or simplex grinder pumps connecting to pressurized systems (e.gforce mains);
• Vacuum sewer systems.
C EEIEUE\i;.EDE N R/DWR
WO POE
MOO RESEf LE, E FE; Em AL oFPIcE
General- When submitting an application, please use the following instructions as a checklist in order to ensure all required items
are submitted. Adherence to these instructions and checking the provided boxes will help produce a quicker review time and
reduce the amount of requested additional information; Failure to submit all required items will necessitate additional
processing and review time, and may result in return of the application. Unless otherwise noted, the Applicant shall submit
one original and one copy of the application and supporting documentation.
A. One Original and One Copy of Application and Supporting Documents
Required unless otherwise noted
B. Cover Letter (Required for All Application Packages):
List all items included in the application package, as well as a brief description of the requested permitting action.
• Be specific as to the system type, number of homes served, flow allocation required, etc.
ie If necessary for clarity, include attachments to the application form.
C. Application Fee (All New and Major Modification Application Packages):
Submit a check or money order in the amount of S480.00 dated within 90 days of application submittal.
Payable to North Carolina Department of Environmental Quality (NCDEQ)
D. Fast Track (Form: FTA. 04-16) Application (Required for All Application Packages):
Submit the completed and appropriatelyexecuted application.
"ia If necessary for clarity or due to space restrictions, attachments to the application may be made..
O If the Applicant Type in Item 1.2 is a corporation or company, provide documentation it is registered for business with
the „
O if the Applicant Type in Item 1,2 is a partnership or clibla, enclose a copy of the certificate filedwith the Register of
Deeds in the county of business.
O The Project Name in hem 11.1 shall be consistent with the project name on the flow acceptance letters, agreements, etc.
The Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a
El The Applicant's Certification on Page 5 of the application shall be signed in accordance with
Per 15A NCAC 02T .0106(c), an alternate person may be designated as the signing official if a delegation letter is
provided from a person who meets the criteria in 1. SA NCAC 02T .0106(b).
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page -I of 3

E. Flow Tracking/.Acceptance Form (Form: FTSE 04-16) (If Applicable):
Submit the completed and executed FTSE form from the owners of the downstream sewers and treatment facility.
• Multiple forms maybe required where the downstream sewer owner and wastewater treatment..fact/4y are different.
The flow acceptance indicated in form FISE must not expire prior to permit issuance and must be dated less than one
year prior to the application date.
))... Submittal of this application and form FTSE indicates that owner has adequate capacity and will not tiolate ;
• Intergovernmental agreements or other Icontracts will not he accepted in Iicu of a project-specifie FTSE.
F. Site Maps (All Application Packages):
Submit an 8.5-inch x 1 1-inch color copy of a LSGS Topographic Map of sufficientscale to identify:- .the enureproject
area and closest surface waters,
Location of the project (gravity sewer, pump stations & force main)
Downstream connection .points and permit 'number (if known) for the receiving sewer
El -Include a street level map (aerial) showing general project area so that Division staff can easily locate it in the field,
G. Existing Permit (All Modification Packages):
O Submit the most recently' issued existing penult
El Provide a list of any items within the permit the Applicant would like the Division to address during the .permit
modification (i„e„, permit .deseription„ flow allocation, treatment facility, etc),
U..Power Reliability Plan (Required if portable reliability option utilized for Pump Station):
EJ Per I submit documentation of power reliability for pumping stations,
This alternative is only available for average daily flows less than 15,000 gallons per day
It shall be demonstrated to the Division that die portable source is owned or contracted hy the applicant and is compatible
with the station, The Division will accept a letter signed by the applicant (see 1.5A NCAC 02T .0106(b)) or proposed
contractor, stating that "the portable power generation unit or portable, independently -powered pumping units, associated
appurtenances and personnel are available .for distribution and operation of this pump station,"
If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump
stations' storage capacities and the rotation schedule of the portable power source or pump, including travel
timeframes, shall be provided in the case of a multiple station power outage, (Required at time of certification)
Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
D Per 5 provide the Certificate at Public Convenience and Necessity from the
demonstrating the Applicant is authorized to hold the utility franchise for the area to be served by
the sewer extension., or
0 Provide a letter from the ; „ ; "H ; - stating an
application for a franchise has been received and that the service area is contiguous to an existing franchisedarea or that
franchise approval is expected,
J. Operational Agreements (Applications from DOA/P.0A and Developers for lots to be sold):
florne/Property Owners' Associations
0 Per I.' submit the properly executed
El Per 15A NCAC 021 .0115(c), submit a copy of the Articles of 'incorporation. Declarations and By-laws.
O Developers of lots to he sold
El Per I 5A. NCAC 02T ,0115tb), submit the properly executed
in lion, visit the DiViSim'S COI leCtiOil ,Sy. 171,5 ,
INS ,JC la TS FOR FORM: FT. 04-1 & SUPPORTING DOCUMENTATION' 'Page. 2 of 3.

THE COMPLETED APPLICATION PACKAGE INC LHING ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD BE SENT TO THE .,
REGIONAL OFFICE
ADDRESS
2090 US Highway 70
Swannanoa, North Carolina 28778
[phone]
[phone] Fax
COUNTIES SERVED
Avery, Buncombe, Burke, Caldwell, Cherokee,
Clay, Graham, Haywood, Henderson, Jackson,
Macon, Madison, McDowell, Mitchell, Polk,
Rutherford, Swain, Transylvania; Yancey
225 Green Street Suite 714
Fayetteville, North Carolina 28301-5094
[phone]
[phone] Fax
610 E. Center Avenue
Mooresville, North Carolina 28115
[phone]
[phone] Fax
Anson, Bladen, Cumberland, Harnett, Hoke,
Montgomery, Moore, Robeson, Richmond,
Sampson, Scotland
1628 Mail Service Center
Raleigh, North Carolina 27699-1628
[phone]
[phone] Fax
943 Washington Square Mall
Washington, North Carolina 27889
[phone]
[phone] Fax
Alexander, Cabarrus, Catawba, Cleveland,
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
Stanly, Union
Chatham, Durham, Edgecombe, Franklin,
Granville, Halifax, Johnston, Lee, Nash,
Northampton, Orange, Person, Vance, Wake,
Warren, Wilson
Beaufort, Bertie, Camden, Chowan, Craven,
Currituck, Dare, Gates, Greene, Hertford, Hyde,
Jones, Lenoir, Martin, Pamlico, Pasquotank„
Perquirnans, Pitt, Tyrrell, Washington, Wayne
127 Cardinal Drive Extension
Wilmington, North Carolina 28405
[phone]
[phone] Fax
450 W. Hanes Mill Road
Suite 300
Winston-Salem, North Carolina 27105
(3,36)776-9800
Brunswick, Carteret, Columbus„ Duplin, New
Hanover, Onslow, Pander
Alamance„ Alleghany, Ashe, Caswell, Davidson,,
Davie, Forsyth, Guilford, Rockingham, Randolph,
Stokes, Surry, Watauga, Wilkes, Yadkin
INSTRUCTIONS FOR FORT`vl. FTA 04-16 SUPPORTING DOCUMENTATION Page 3 of 3

Division of Water Resources
State of North Carolina
Department of Enr, ironmental Quality
Division of Water Resources
I5A NC,AC 021' .0300 — FAST TRA.CK. SEWER SYSTEM EXTENSION APPLICATION
FTA 04-16 & SUPPORTING DOCUMENTATION
ANOr cr., A.
Application Number: Go be completed by DWR)
All items be completed or the application will be returned
L. APPLICANT INFORMATION:
1, Applicant's name: CITY OF HICKORY (company, munic,ipality, I-10A, utility, etc.)
2. Applicant type: Individual Corporation El General Partnership Priaieiy-0wned Public Utility
El Federal LJ State/County Z Municipal 11111 Other
3. Signature authority's narne: Warren Wood per
Title: City Manager
4. Applicant's mailing address: 1441 9'h :Ave
City: Hickory State: NC Zip: 28601-
Applicant's contact information:
Phone number: [phone] .Email Address: KGREERHICKGRYNC.GOV
H. PROJECT INFORMATION:
Project name: PEPPERSTONE APARTMENTS
2. Application/Project status: Z Proposed (New Permit) fl 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: ('ATAWBA
4. Approximate Coordinates (Decimal Degrees): Latitude: 35,45.00Longitude: -81.18,71'
5. Parcel ID (if applicable): 371'31(1359993
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: WILLIAM S. CLAYTON License Number: 040758
Firm: CLAYTON ENGINEERING & DESIGN, PLIC
Mailing address: P(..) BOX 2351
City: HICKORY State: NC Zip: 28603-
Phone number: [phone] Email Address: WCLAYTON(140.„ 'TON-ENGINEERING:NET
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: NORTHEAST WWIT Permit Number: NC0020401
Owner Name.: CITY OF HICKORY
V.'RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
L Permit Number(s): WQ Downstream (Receiving) Sewer Size: inch
WQCS
Owner Name(s): CITY OF :HICKORY
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 Pu.blic Convenience and Necessity been attached?
El] Yes EiNo N/A
2. If the Applicant is a Developer of lots to be sold, has a .2 0 0 / been attached?
Ej Yes LINo N/A
3, if the Applicant is a
E. Yes No N/A
4. Origin of wastewater: (check all that apply):
11 Residential Owned Ej Retail (stores, centers, malls)
Z Residential Leased
LI School / preschool 1 day care
Ej Food and drink .facilities
E1 Businesses I offices / factories
Ej Retail with food preparation/service
LI Medical dental veterinary facilities
Ei Church
Nursing Flome
5. Nature of wastewater 1001!/0 Domestic/Commercial % Commercial
Industrial (
s there a Pretreatment Program in effect?
6. Has a flow reduction been approved under 20. 20 021 .0. 20:2i? Ei Yes No
'!•> If yes., provide a copy of flow reductiopapproval letter
7. Summarize wastewater .generated by project:
Establishrnent Type (see
APARTMENTS (192 TOTAL ROOMS)
been attached?
[11 Car Wash
Hotel and or Motels
Ej Swimming Pool /Clubhouse
LI Swimming Pool/Filter Backwash
El Other (Explain in Attachment)
Ej No
Daily Design Flow a'h
120 gal/T).AY
gal/
gal,"
gal/
gal
No. of Units
192
Flow
23,040 GPD
GPD
GPD
GPD
GPI)
gal/
GPD
Total
23040 GPD
a See - .002 I20 201 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
b Per 15 NCAC 02T' .0114(c), design flow rates for establishments not identified [in table 00 021' .0 .1-1 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data..
8. Wastewater generated by project. 23,040 GPD (per
Do not include future flows or previously perrnitted allocations
If permitted flow is zero, indicate why;
LI Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
[1] Flow has already been allocated in Pet -hit No ber.
El Rehabilitation or replacement of existing sewer with no new flow expected
E] Other (Explain):
FORM: FTA 04-16 Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA Applicable) &
, Summarize gravity sewer to be permitted:
Size ,h
Length (feet) [Material
976 DIP
• Section II & 111 of the ;MC for Permitting of Gravity Sewers contains information related to design criteria
Section III contains information related -t.o minimum slopes for gravity sewer(s)
• Oversizing lines to meet minimum slope requirement is not allowed and a violation of the M DC
PUMP STATION DESIGN CRITERIA (If Applicable) — I & Pit rio4
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1, Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude:, Longitude: -
3.
.4.
Design flow of the pump station: millions gallons per day (firm capacity)
Operational point(s) of the pump(s): gallons per minute at feet total dynamic, head (Tall)
5, Summarize the force main to be permitted (for this Pump Station):
6. Power reliability in accordance with
Ej Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(101)(B):
Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
'2e? Mustbe permanent to facility
Or if the pump station has an average daily flow less than 15,000 gallons per day:
Ej Portable power source with manual activation, quick -connection receptacle and telemetry - I5A NCAC 02T
,0305(h)(1)(C)
or
Ei Portable pumping unit with plugged emergency pump connection and telemetry - 15A NCAC 02T .0305(h)(I)(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 die case of a multiple station power outage.
FORM: FTA 04-16
Page 3 of 5

IX. SETBACKS & SEPARATIONS - (02B .0200 & 15A NCAC 02T .0305(0):
1. Does the project comply with all separations found in
Z Yes El No
• 15A. NCAC 02T,0305(1) contains minimum separationsthat shall be provided for sewerseei systems:
Setback Parameter* Separation Required
Storm sewers and other utilities not listed below (vertical) 24 inches
Water mains vertical -water over sewer including,in benched hen es)
Water mains (horizontal)
Reclaimed water lines (vertical - reclaimed over sewer)
18 inches
10 feet
18 inches
Reclaimed water lines (horizonta( reclaimed over sewer) 2 feet
**.Any private or public water supply source, including any Welk. WS-I waters of Class I or
Class 11 impounded reservoirs used as a source of drinking water
**Waters classified WS (except \\ or WS-V), B, SA, ORW. HQW, or SB from normal
high water (or tide elevation) and wetlands (see item IX 2}
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches '10 feet
100 feet
50 feet
Any building foundation 5 feet
Any basement
10 feet
Top slope of embankment or cuts of 2 feet or more vertical heieht 10 feet
Drainage systems and interceptor drains
Any swimming pools
Final earth grade (vertical)
5 feet
10 feet
36 inches
contains alternatives where separations in cannot he achieved,
**Stream classifications can be identified using the Division's
If noncompliance with see Section X of this application.
Does the project comply with separation requirements for wetlands? (50 feet of separation) 0 Yes J No N/A
• See the Division's. draft separation requirements .for situations where separation cannot be meet
No variance is required ifthe alternative design criteria specified is utilizedin 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 fl Yes No N/A
This would include Trout Buffered Streams per
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
Lil Yes
5. Does project comply with ; '' ',, ul' '', ' 1.i'l: .''', , i::,,) (additional pennitslcertifications)? [2] Yes No
Per !:: \ ''',,c ',.. • .'1....' o''',. ,, - ' directly related environmental permits or certification applications are being prepared, have
been applied. for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion and
sedimentation control plans, storrnwater mana.gement plans, etc,).
6, Does this project include any sewer collection lines that are deemed "high -priority?"
Per "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned paraliel to streambanks that is subject to erosion that undermines or deteriorates the sewer.
E Yes No N/A
• If yes, include an attachment .with details for each lin.e, including type (aerial line, size, material, and (ocation).
High priority lines shall be inspected by the permittee or its representative at east once every six -months and inspections
documented per 154 NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit.
FORM, FTA 04-16 Page 4 of 5

X. CERTIFI(kTIONS:
1, Does the submatted system compni tit olosi the et tificoi„ its -sotto ; ti co: ow iota toi uteri itiittaimisi,
ititiatt and the. Grit woo- too; to tapioca, Elliatur ciao:pi as applicable?
Fl yes El No
If No, complete' and solwrd ,he Variance A liernative I) Request application iNt.i,\ DC I fall ); and supporting documents for
review, Approval of the request is r oi red prior to ,submittal of the laast Track Applicrition and supporting doeuments,
2. Professional E10,-L011000, CelfirtiatIOW
4,0La- 0"1 "i 0
iProfessional Engineer s name from Application item
tines] that ibis application for
has been reviewed by ale and is aecurate„ complete imd consistent the information supplied in ihe plans, speeirications,
engineerina calculations. and all other supporting document:16bn to the best (fimy knowledge.. I further attest that to the best
of my knowled.ge the pro.posied design has heen prepared in accordance. with the applicablt regulations, Gravity Sewer
Minimum 11)271 Criteria1 Gravity Sewers, (latest version), iand the Minimuini Design Criteria liar Me Fast -Traci: Pennitting
or Pinup Stations and Force Mains (latest \ ersiont Although other professionals .flay have developed certam portions of this
submittal par Isaac. inclusion these materials tinder my signature and seal signifies that I have reviewed this material and
haveiudged lo lie consistent with The proposed design,
NOTE -lnaccordance with General Statutes 1 -2 I fiftkl.i. and 143-215.6B any person who knowangly malies any fake
statement repre.s.entarion, or certification in an) application paukage shall be guilty of a Cass 2 misdemeanor, whiah may
include a fine aim to e.xcl as well as civil penalties tip to ,S25,000 per violation,
North Carolina Professional Engineer's seat, litturc. and date:
Applicant's Certification poi 1 A NGAc 02T
fl$TiJDDcL
Iniao
'Sinitittaire yis name &ithk front Applicatilo.n Item 1t3,1
t.,
fittest that s ilppliL :1nin for
has been revictured by me rind is accurate and cotnplete to the best :Amy knowledge. I understimd that if all required pans of
this application uL not completed and that if all required supp.orting documentation a.nu atizichments are not included, this
application package is subject to being returned as incomplete. I understand that any discharge of wastewater fitom this non -
discharge system to surface waters or the iand \sill result tri an immediate erforcelM:Ilk U.6011 llil may include civil penalties.
injunctive relief', and riT" criminal pro:so:anion. makelIC:, claim agatnst the Division of Water Resources shiauld a condition
of this permit he violated. I also understand that if all requiredparts of this application packapc are not completed and that if
all required supportinl1 informatitin and attachments arc nor included, this applicaticm package will be rendrned to me as
incomplete,
NOTE. 111 aiattordance with General Statutes. totit and tin person who linongly makes iiny false
statement, representation. ot fertification in any app1ii! ie guilty of a Class .2 misdemeanor, \ditch ma.y
include a tine ncti to exceed S10.000 as well as civil penalties tip to 52.5.000 per sit-dation.
Signature:
Date:
EORM: r TA 04-m,
Pane c of .5

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow. Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requestinv. Allocation: CITY OF HICKORY
Project Name for which flow is being requested: PEPPER STONE APARTMENTS
Afore than one FISE may h required for a single projectt the owner of the 14/WrP i„5" oot esponsible for all pump
stations along the route o he proposed wastewater -flow.
I. Complete this section only if you are the owner of the Wastewater trea
a. WWTP Facility Name: Northeast WWTF
b. WWTP Facility Permit g: NC0020401
e
All flows are in MGD
c. WWTP facility's permitted flow 6.0
d. Estimated obligated flow not yet tributary to the WWTP 0.307149
e. WWTP facility's actual avg. flow 3.175
f.'fotal flow for this specific request 0.023
g. Total actual and obligated flows to the facility 3,505149
h. Percent of permitted flow used
11. Complete this section for each pump s a
proposed ‘vastewater flow,
are responsible for along the route of this
List pump stations located between the project connection point and the WWTP:
(A) (B) (C) (D)=(13+C) (E)=(A-D)
Design Obligated,
Pump Average Daily Approx. Not Yet Total Current
Station Firm Flow" Current Avg. Tributary Flow Plus
(Name or Capacity, * (Firm / pi), Daily Flow, Daily How, Obligated Available
:Number) MGD MGD MGD MGD Flow Capacity***
N/A
* The Firm Capacity of any pump station is defined as the - aximum 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 (pi) not less. than 2.5.
*** A Planning Assessment Addendum shall be attached for each pump station located
between. the project connection point and the WWTP where the Available Capacity is < O.
Downstream Facility Name (Sewer):
Downstream Permit Number:
Patte '1 of 6
04-1 6

Cei icatic
Sta
anvil Food
the o same ofwastewater to be permitted in tlr s project has been evaluated along the route to the
recei vastewater treatmnent facility' and that the flow fa this project is not anticipated to
cause any ca acit related sanitary setser- overflo sss or ovvverurden any downstream pump station
en route to the receia°inp treatment plant under normal circumstances, given the implementation of
the planned improvements identified in the planning assessment witere applicable. This analysis
has been performed in accordance with local established policies and procedures using the best
lailahle data. This certification applies to those items listed above in Sections I and II plus all
the best of my kno ledge that the addition
ached planning assessment addendurns for ssInch I am the responsibleparty. Signature of this
form indicates acceptance of Nsasteen°ater frts.
gnn r t" fritr' u � racrtuu. Dal
Page of 6

Owner
PEPPERSTONE
Droveng Titre
STREET VIEW
Project T tie
PEPPERSTONE
APARTMENTS
Prc
HICKORY,
Job NG,.
.7050

?3RD A
NE
21ST AVL
E
TH AVE
CLAYTON
19T
Owner
PEPPERSTONE
WE NE
Project Tptle
PEPPERSTONE
APARTMENTS
Nor TO SCALE
Date
12/18/17
Job No.
17050
ENGINEERING & DESIGN
Drawing Title
USGS MAP
Protect Locokiot
HICKORY, NC
C-001