WQ0040408_Regional Office Historical File Pre 2018

1Y COOPER
M C 1.E.1 Sr REGA
h ;axr.
I„INDA CLLPEPPER
November 14, 2018
Warren Wood, City Manager
City of Hickory'
P.O. Box 389
Hickory, NC 28603
Subject; Permit No. WQ0040408
City of hickory
Frivium - Wavle Sewer L:xten
Wastewater Collection System l xtensi< to Pennit
Catawba, County
Lear Mr. Woods
Jn accordance with your application received Novetnher 4, 208, and additional infortttation receiv°ed oft
November 12, 2,018, with additional information received November 14, 2018, we are forwardingherewith
Permit No. WQ0040408 dated November 14, 2018 to the City of Hickory (Permittee) for the constniction
and operation upon certification of the subject wastewater collection system extension. 'Flits permit shall
he effective from the date of issuance until rescinded and shall be subject to the conditions and limitations
as specified. therein. This cover letter shall he considered a part of this permit and is therefore incorporated
therein by reference.
Please pay particular attention to the f
ditions cc'
ained within tlr
p.
Condition 11.1: This permit shall not be automatically transferable; a request must be made and approved.
Condition 11 4. Requires that the vvas'tewa.ter collection facilities be properly operated and maintained in
accordance with 1;�t` . NCAC 2T .0403 or an.y individual system -wide collection system
permit issued to the Pennittee.
Condition 11. . Upon completion of construction and prior to operatic n of these permitted facilities. the
completed Engineering Certification form with checklist attached to this permit sltttll he
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. [ I yA NCAC 02T.01 16]

It shall be the responsibility of the Permittee to ensure that the as -constructed project inects the appropriate
design criteria and rules. Failure to comply may result in penalties in accordance with North Carolina
General Statute §143-215.6A through § I 43-2 I 5,6C„ ermstruction of additional or replacement wastewater
collection tbcilities, and/or refenial of the North Carolinaslicensed Professional Engineer to the licensing
hoard,
If any parts. requirements, or limitations contained in this permit are unacceptable, you have the right to
request an adjudieatory hearing upon written request within 30 days fanning receipt of this permit This
request must he in the form of a written petition, conforming to Chapter 15013 of North Carolina General
Statutes, and filed sith the Office of Administrative 'Hearings, 6714 Mail Service Center, Raleigh,. NC
27699-6/1 4„ Unless such demands are made, this permit shall be final and binding.
If you need additional information concerning this matter, please contact On TU Via at [phone] or
via e-mail at orittiviinfilinidennhou
Sincerely.
DocuSigned by:
Al4CC81AF27425,
lbr Limb Culpepper
interim Director, Division or fijater Resources
by Wn Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources. NCDEQ
cc: Shad Walters (P,E) (Ty -copy
Mooresa ale Regional Office Files (1,aserfiche)
Water Resources Central Files (Laserfiche)
PERCS (1,,aserfiche
Page 2 of 10

v.: 11 VfI 9,0 infr't
OU firy
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 Hickory
Catawba County
for the construction and operation of approximately 1,412 linear feet of 8-inch public gravity
sewer. to serve 400 employees and 2,000 gallons a week of industrial process flow, as part of
Trivium - Wave Sewer Extension, and the discharge of 10,285 gallons per day of collected
wastewater into the City of Hickory existing sewerage system, pursuant to the application
received November 4, 2018., and additional information received on November 12, 2018, 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 East -
Track Permitting of Pump Stations and Force Mains adopted Rine 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 he effective from the date of issuance until rescinded and shall be subject to
the specified conditions and limitations contained therein.
DocuSigned by:
A14CC681AF27425
fbr Linda Culpepper
Interim Director, Division of Water Resources
by. W. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NCDEQ
By authority ofthe Environmental Management Commission
Permit Number: WQ0040408
Permit Issued: November 14, 2018
Page 3 of 10

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 Waste Water
Treatment Facility in accordance with Permit Number NC0040797.
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, 10,285 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)].
11. STANDARD CONDITIONS
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 ch.ang,e of the Permittee, a formal permit request shall be
submitted to, the Division accompanied by documentation from the parties inwilved, 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 021-.0104; G.S 143-21.5.103A
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 ,01 Oj
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 I 5A NCAC 2T *0403, If an individual
permit is not required, the following performance criteria shall be net: (15A .NCAC 02T .01.08(b)]:
Page 4 of 10

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 sixmonths 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 NC.AC 2B .0506(a), and public notice shall he 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 usersand
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.
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.
Right-of-ways and easements shall be maintained iri the full easement width for .personnel and
equipment accessibility,
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 (704) 663-.1699, 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
Page 5 of 10

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 1 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 -lomt) can also be completed to show that the SSO was beyond control. G.S. 143-
215.1galt1
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 W ate r s of the State. 115A NCAC 021,0108(b)1
7. Upon completion of construction and prior to operation of these permitted facilities., the completed
Engineering Certification form 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 W a st e watt r 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 drawingsshould 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 aller construction information. and show requited 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 kW: points in
force mains ‘vitha pump cycle, and downstream sewer capacity analysis. If a portable power
source or pump is dedicated to multiple stations, an evaluation of alt the pump stationsstorage
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 surturiary 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
Page 6 of 10

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 .01-161
8. Gravity sewers installed greater than ten percent below the minimum required slope per the Division's
Gravity Sever Minimum Design Criteria shall not be acceptableand shall not he 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 02'T .01161
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
Tune 1, 2000, as applicable; and other supporting materials may subject the Permittee to an
enforcement a-ction by the Division, in accordance With North Carolina General Statutes §143-215.6A
through 043-21.5.6C, construction of additional or replacement wastewater collection facilities,
andlor referral of the North Carolina -licensed Professional Engineer to the licensing board. [15A
NCAC 02T .0104; 1 5A NCAC 02T ,0108(b-01
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 02'T .0110; 1.5A. NCAC 021 ,0108(b)1
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 jufisdiction or obtaining other permits which maybe required
by the Division or any other Federal, State, of Local governm.ent agencies. [Ci,'S. 143-21.5,1(b)1
Page 7 of 10

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 perrnit was issued (or -t modified): change of mailing address,
change of ownership, transfer from developer to HOA/P0A, etc. E Yes No
• Ifyes. please provide either a change of ownership form or new contact information. Note that transfer of
permits from the developer to the HOA/P0A must occur with the first certification.
2) Have the as -built drawings have been signed, sealed, and dated by an N.C. PE? Yes LI No
3) Final Engineering certification? L Yes E 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: 7 Yes No fl N/A
• "Three feet minimum cover has been provided for all sewers unless ferrous pipe as installed.
• Minimum diametersfor 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 he 4 feet. (48-inches).
5) Adequate information related to pump stations: Yes El No P N/A
• Ensure power reliability option was selected per 15A -NCAC 02'1 0305h.
6) Was project construction completed in accordance with. all of the following: Yes No LIJ NIA
• 15,A NCAC 021', Min' Desion Criteria (M DC) tor the2ermitting Seers latest version), and
ME)( for the Permitting of Puny. Stations and Force Mains (latest version)?
If not, a variance approval is required in accordance With 15A N(1°,,,,c.j,r21-t) N5j to, 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 perrnit with variance language or the variance letter must be maintained with the original documents.
7) Does the project .contains high priority lines (15.,), NC/N, C 021 .0402 )? 1 1 Yes Li No
• If yes, ensure that the permit already contains the necessary condition related to high priority lines 15A. NCAC
02T.0403 ta)(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 11.0% or geater, change in flow, pump station design capacity design change of 5% or
geater„ andlor change in the number/type of connections)? Yes r No
• If yes, a perrnit 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 HICKORY
PERMIT #: WQ0040408
PROJECT: TRIVIUM - WAVE SEWER EXTENSION
ISSUE DATE: NOVEMBER 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 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
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/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
. as a duly registered Professional Engmeer in the State of -North Carolina,.
having been authorized to observe ( periodically, L weekly. fuJi 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 construction 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.. 1.996, 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 wisignatu e & date:
E] Final Partial (include description)
Certification Comments/Qualifiers (attach if necessa
NC DWR — Water Quality Regional Operations Section 610 East Center Avenue, Suite 301, Mooresville, NC 28115
Mooresville Regional Office Phone: [phone] FAX: [phone]

November 1, 2018
North Carolina Department of Enyilcnmeratal Quality (NCDEQ)
Division ol Resources
61.0 East. Center Avenue
Mooresville. North Carolina 28115
"l o whom it may concern:
Subject:
Fast Track Sewer System Application
Project Wave Sewer Extension
CEC Project 171-287
Civil & Environmental Co
Attached for your review and approval are the fallowing items for last Track Sewer System
Application permitting for Project. Wave Sewer Extension, located at 2461 Startown Rd, Newton,
NC:
One (I) check written to the amount of S480.00 for application fee. Check made payable
to North Carolina. Department of Environmental Quality (NCDEQ);
• One (1) original and one (1) copy of the completed and executed Fast Track Application;
• One (1) original and one (I) copy of the completed and executed 'Flow
Tracking/Acceptance Form;
• One (I) copy of an 8.5" x 11" US(S topography map; and
• One (I) aerial map of project, area.
project it elude s the installation of approximate
into a 12 inch diameter gravity sewer recently completed — WQ#0039791.
ear feet of gravity sewer that will
Should you have any questions or re )uire any additional information in support of this applicat
please do not hesitate to contact me at 980-237-0373.
Sincerely
CIVIL & ENVIRONMENTAL CONS I LTANTS, INC.
Naexi
Shad Walters, PE
Principal
CC: Kevin Greer, Citeoffliekory.
Attachments
190E Center Park Drive;, Stelte A 1 Charlotte, NC 28217 ;µsr 980-237-0373. f: 980-237-0372 l vvvdavJ

DIVIS1011. of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
I 5A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: )0
ro be corn fleted h' 1
All items must be completed or the application will he returned
I. APPLICANT INFORMATION:
1, Applicant's name: („Av of Hickory (company:, municipality, HOA, utility. etc.)
Applicant type: ID Individual
111 Corporation 0 General 'Partnership
Ej Federal 0 State/County
Mtinicipal
3. Signature authority's name: Warren Wood per I5A NCAC 02T .0106
'Title: City Manager
4. Applicant's mailing address: 76 N Center Street
City: Hickory State: INK Zip: 2869.
5. Applicant's contact in.formation:
Phone number: (82_8)323-7412 Email Address: wwood@hickorync„gov
11, PROJECT INFORMATION:
I. 'Project name: Trivium - Wave Sewer Extension
2. Application/Project status: Z Proposed (New Permit)
El Privately -Owned Public 1„.1tility
El ()tiler
[1] Existing Pe Project
If a modification, provide the existing .permit number: WQ00 and issued date:
Ilf new construction but part of a master plan, provide the existing permit number: 'WQ00
3. County where project is located: Catawba
4, Approximate Coordinates (Decimal Degrees): 11,,atitude: 36,681/1 ongitude: -$1,282/
5. P'arcel (if applicable): 372118311271
(or Parcel ID to closest downstream sewer)
111. CONSULTANT INFORMATION:
1. Professional Engineer: Shad Walters. P.E. License Number NC 1.L, 035796
Firm: Civil & Environmental Consultants, Inc.
Mailing address: 1900 Center Park Drive, Suite A
City: Charlotte State: NC Zip: 28117-__
Phone number: [phone] Ernail Address: swalters(Wcecinc.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1 Facility Name: Henry Fork WWTP Permit Number NC 0040797
Owner Name: City of Hickory
V. RECEIVING DOWNSTREAM SEWER INFORMATION Of different than WWTF):
I, Permit Number(s): WQ0039791 Downstream (Receiving) Sewer Size: l inch
System Wide Collection System .Permit NumberishilamlicablO: WQCS
Owner Narne(s): City of Hickory
FORM: PTA 04-16 Page 1 of 5

VI. GENERAL REQUIREMENTS
If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
Yes LJNo NIA
2. If the Applicant is a Developer of lots to be sold, has a Develpers, Operational AiTeement (FORM: DEV) been attached'?
El YesLINo N/A
3. If the Applicant is a Hon. //Property Owners' Association, has an Operational Agreement (FORM: FIGAJ been attached?
El Yes INo N/A
4, Origin of Wast e wat e r: (check all that apply):
Residential Owned Ej Retail (stores, centers, malls)
El Residential Leased Retail with food preparation/service
IIj School preschool day care LIJ Medical / dental / veterinary facilities
[I] Food and drink facilities D Church
Businesses I offices :" factories fl Nursing I tome
5., Nature of wastewater 93 % Domestic/Commercial 9/0 Commercial
3)/4i industrial (See I.5A NCA(. 021 ,0103120))
> IS there a Pretreatment Program in effect? Ye
6,, Has a flow reduction been approved under I5A 'INCAC 02 1 ,0 I !Yr El Yes No
If Yes, pro -vide a copy offlow reduction approval letter
7., Summarize wastewater generated by project:
Establishment Type (see 02T.011,1(f))
eral Business and Office Facilities
Industrial Process Flow
Daily Design F
2.5 gallemployee
285 galIday
al
galal
gal/
El Car Wash
El Hotel and or Motels
E Swimming Pool /Clubhouse
LI Swimming Pool/Filter Backwash
A Other (Explain in Attachment)
Ni
No. of Units
10,000 GPD
1 285 GPD
GPD
GPD
GPD
GP D
Teta/ 10,285 GPI)
a See l5A NCA( 021 .01 I4(b)„(d), (e)(1) and_felQ for caveats to wa,stewater 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 (3 S, 42A-4).
b Per I5A NCA( 021 .01114(e), design flow rates for establishments not identified Fin table 15ANCACL.02-1A 1j4] shall be
determined using available flow data, Water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 10,285 GPD (per I 5A NCA( 02.1,0114)
Do not include future flows or previously permitted allocations
if permitted flow is zero, indicate why:
[1 Pump Station or Gravity Sesser where tloss will be permitted in subsequent permits that connect to this line
Ej Flow has already been allocated in Permit Number:
[1] Rehabilitation or replacement of existing sewer with no new flow expected
E] Other (Explain):
FORM: FTA. 04- 16 Page 2 of 5

Vil, ckAvrry SEWER DESIGN CRITERIA (If Applicable) - 02'1 .(05
1, Summarize gravity sewer to be permitted:
Size Onehes)
8"
8 tt
Length (feet)
725
C ,:i"ravity
Material
1„187 PVC
Section 11 & 111 oldie MDC for Permitting of Gravity Sewers. contains information related to design criteria
Section 111 contains infOrmation related to ininimain slopes .for gravity sewer(s)
OversIting lines to meet n1'111111E1111 slope requirement is not allowed and a violation of the ME)U
VIII, PUMP STATION DESIGN CRITERIA (If Applicable) (12T .0305 &1+0,11)C (Primp Stations/force Mains):
cometETE.FoR EACH PUMP STATION INCLUDED IN THIS PROJECT
Pump station number or name: N/A
Approximate Coordinates (Decimal Degrees); Latitude: . Longitude;
3, Design row of the pump station: millions gallons per day (firm capacity)
4, Operational point(s) of the pomp(s): gallons per Ininute at feet total dynamic head (1 1)I1)
5. Summarize the 'force main to be permitted (for this Ptimp Stationy
Size inches)
N/A
Length (feet)
Material
t. Power reliability in accordance with 15A NCAC 021 .0305000:
ij Standby power source or pump with automatic rictivation and telemetry ISA NCAC 021 ,0305(h)(1)(By
3.- Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
- Must be permanent to .facility
Or if the pump station has an average daily flow less than 15,000 gallons per day:
El Portable power source with manual activation, quic,k-conneetion receptacle and tcicrnctry - ISA NCAC 02'1
;0305(100 W2)
or
D Portable pumping unit with plugged emergency pump connection and telemetry - I5A N(AC 021 ,0305(h)( )(C):
R. 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 ofall the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel timerrames„ shall be provided
in the Case of a multiple station power outage.,
FORM; PTA 01-16. Page 3 of

IX. SETBACKS & SEPARATIONS (02B .0200 & I5A .NCAC 02T .0305(0):
1. Does the project comply with all separations found in 15A NeAC 0.2-1 .03051Q &
• 15A NCAC 02T.0305(f) contains minimum spations that tall be provided for sewer systems:
Setback Parameter* Sparation Recpired
24 inches
Storm sewers and other utilities not listed below (vertical)
Water mains (vertical -water over sewer including in benched trenci
I Water mains (horizontal)
Reclaimed water lines((vertical - reclaimed over sewer)
Reclaimed water lines (horizontal - reclaimed over sewer)
**Any private or public water supply source., including any wells, WS-I
Class II .impounded reservoirs used as a source of drinking water
**Waters classified WS (except WS-1 or WS-V), B, SA, ORW, HQW, or SB from normal
hioh water (or tide elevation) and ‘vetlands (see item IX 2)
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches
es
Any building foundation
Any basement
Top_slope of embankment or cuts of 2 feet or rnore vertical height
Drainage s stems and interceptor drains
Any swimming pools
trial earth oracle (vertical)
Waters of Classt or
18 inches
I 0 feet
18 inches
2 feet
100 feet
50 feet
-10 feet
5 feet
10 feet
10 feet
feet
0 :le
36 inches
j 5 A Ncy,w_ qp:,.olow contains alternatives where separations in 921'.03951.1) cannot be achieved:
r. **Stream classifications can he identified using the Division's NC Surface Water Classifications web a ie
if noncompliance With 921-,91Q5C(Lor GO, see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet ofseparation) El Ye jill No
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 rules per I.5A NCAC 02B ,0200? Yes
, -fills would include "[rout Buttered Streams per I,5A NCAC 2[3,02.02
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 &, .13uf6er PermittingBranch
Ej Yes No
No
N/A
IA
5. Does project comply with 15A NCA.(' 02T.0 10.51cR6) (additional permits/certifications)? [El Yes LI No
Per 15,A NCAc °Tun 0510116), 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 management plans, etc.).
6,, Does this project 'include any sewer .collection lines that are deemed "high -priority?"
Per 1,5,A 'NsAC,921T,c14(c)„ "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer.
Yes No El N/A
• -if yes, include an attachment with details for each line, including type (aerial line, size,material, and location).
High priority lines shall he inspected by the permittee or its representativeat least once every six -months and inspections
documented per 15A. NCA.0 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit.
FORM: FTA 04-16 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCA.c 02T, the Minimum Design Criteria for the PermittingPeriniUine. ol Pump_Stations
and l'orce Mains (latest version), and the Gravitv Sewer Minimum Design Criteria (latest version as applicable?
Z Yes D No
If No, complete and submit the Variance/Alternative Design Request application (VADC 10-14) and supporting documents for
review. Approval of the request is required prior to submittal of the East Track Application and supporting documents,
Professional Engineer's Certification.
1, c Z7X5 attest that this application for
(Professional. Engineers name from Application Item fit.1 )
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans, specifications,
engineering calculations, and all other supporting doctanentation to the best of my knowledge, 1 further attest that to the best
of my knowledge the proposed design has been prepared in accordance With the applicable regulations, Gravity Sewer
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track Permitting
of Pump Stations and Force Mains (latest version). Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that 1 have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215,6A and 143-215.613, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000„ as well as civil penalties up to $2.5,000 per violation.
North Carolina Professional Engineer's seak signature, and date:
3, Applicant's Certification per 1.5.A NCAC 02'T 6(b):
(Signature Authority's name
e from Application Item 1.3..)
: is application for
has been reviewed by inc and is accurate and complete to the best of my knowledge, 1 understand that if all required parts of
this application are not completed and that if all required supporting documentation and attachments are not included, this
application package is subject to being returned as incomplete, 1 understand that any discharge of wastewater from this non -
discharge system to surface waters or the land will result in an immediate enforcement action that may include civil penalties,
injunctive relief, and or criminal prosecution. 1 will make no claim against the Division of Water Resources should a condition
of this permit be violated. 1 also understandthat if all required parts of this application package are not completed and that if
all required supporting information and attachments are not included., this application package will be returned to me as
incomplete,
NOTE In accordance with General Statutes 143-215.6A and 143-215.60, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Date:
.FORM: PTA 04-16
Page 5 of 5

DIVICAOn Of Water Res o urc s
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 08-13)
Project Applicant Name: City of Hickory
Project Name for which flow is being requested: Trivium - Wave Sever Extension
More than one FTSE may he required/6r a single project the owner of the WiliTi" is not re,sponsible /or all pump
stations along the route of the proposed wasunvater flow.
1. Complete this section only if you are the owner of the wastewater treattnen( plant.
a. WWTP Facility Name: Henry Fork WWII'
h. W W-11) Facility Permit 4: NC0040797
Akflows are in MGD
c. WWTP facility's permitted flow 9..
d. Estimated obligated flov,"' not yet tributary t.(.. 77
c. WWTP facility's actual avg. flow
f. Total 'flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
2.48
0.010285
4.314055
47.93(Y
II. Complete this section for each pump station you are responsible .for along the route of this
proposed wastewater flow,
List pump stations located between the project connection point and the -r P:
(A) (8) (C) tnr---(B+C) (0---(A-0)
.Design Obligated,
Pump Average Daily Approx. Not Yet Total Current
Station Firm Flow" Current Avu.. 'Tributary Flow Plus
(Name or Capacity,* (Firm l pl), Daily Flow„ Daily:Flow, Obligated Available,
Number) MGD MGD MG) NdlCiD Flow Capacity***
Clark. Creek. 3,5 I A 0.670 0.40291 1.07291 0.327090
Sandy Ford 4.32 1.728 0.930 0.41206 1 .35582 0.37218
* The Firm Capacity of any pump station is defined as the
can he achieved with the largest pump taken out of service.
** Design Average Daily How is the firm capacity of the pump station divided by a peaking
factor (pi) not less than 2.5.
*** A Planning Assessment Addendum shall he attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is <O.
um pumped flow that
Page 1 of 6
FTSE 08-13

Staters.)
nt
the vcalutrte of astea utet to lie
reeilta r°astaaatet iretatraaeaat
cause an ealaacityy ae.lated sataitra
era route to the aeceiving treartrtaet
tla,e I la nned irnprovettieaats idctat
per°aaitted in th
tact lit A and
se er overt taws
plant utader rte
ed in the plantg assessment
s beet) performed in accordataec with local established policies and procedures using the best
ailable data. This c rtilacatisata applies to those items listed above it) Sections 1 and II talus all
atinched planning assessmertt addendums for which I am the responsible party, ignatu e of'this
tarns itadieates acceptance ,caf this e 'aste vatea' now.
knowledge that
evaluated along the
aaeet is ratat aaticl
\ downstream pump
the implementation of
applicable. This analysis
fate `? at6
p"f" I', 0 -1

Tuvia, Ori A
From: Wafters, Shad <[e-mail]>
Sent: Monday, November 12, 2018 9 32 AM
To: Tuvia, On A
Cc: Caleb Bynum; Kevin Greer; Shawn Pennell
Subject: [External} FW: Wave Sewer Extension Revised FTA
Attachments: FTA Sewer Application_EXECUTED PDF
Follow Up Flag:
Flag Status:
Follow up
Flagged
Mr, Tuviai
Thanks for the cad on F"riday regarding the Project kiiVave FiTAi As requested, the Erich idiameter sewer services has
been removed from the generai project description on page 3 iof the application,
in regards to the industrial wastewater flow, the 285 gpd flow WaS determined based upon an average discharge of 2000
gallons per week, The process water is recycled through a pretreatment system and then discharged this information
is based Upon information provided by the site owner, The 5ite owner currently has an existing facility within the City
of Hickory and the City is ifamikar with their process and discharge,
Please review and let me know if you need any additional ilinformation,
Shad NV. Walters, P.E. Principal.
Civil & nvironnicntal G.„KistIltants„ Inc.
19,00 Ge.ntcr Park Dri-vc Suito A - Charloue, NC 28217
L.tg5.5) Fax: 80) 234iiii;c2
704)
Senior 1 1ership Servic('s Persorrdl RekrPorrillips

15 T!f AVE
LAZENBYST
SANDY FORD
airr've
CONOVER
•ata
Mem
Park
Project Location
Close up view of project location.
USGS Top© Map
Hickory Quadrangle
North Carolina - Catawba Co.
7.5 Minute Series
Dated 2016

APPROX9AMATE
LOCATION OF SPE
AERIAL IMAGERY TAKEN FROM GOOGLE
CART' I DATED 3/19/20 I 7