WQ0040742_Regional Office Historical File Pre 2018

Division of Water
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15,A NCAC 02T . 1 0 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
ETA 04-16 & SUPPORTING DOCUMENTATION
Application N u in be r: iv completed by DWR
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
.Applicant's name: City of Hickory (company: municipality. lMA. utility,. etc.)
2, Applicant t. pe IndiIndividual corporation Lil General Pannership
0 Federal LStatei'Coutity L Municipal
Signature authority's name: Warren Wood per 15,A, NCI(' 02T .0106(b)
Title: City Manager
4, Applicant's rnaiting address: PO Rox 39.8
City: Hjekory State: N(2, Zip: 28603-03i,
5. Applicant's contact information.
Phone number: [phone] Email „reood(4,Thickin.ne.gov
11. PROJECT INFORMVUON:
1. Project name: The Lodge at Hickorx
2, Application/Project status:
LJ )rivately-Owned Public titility
Lul Other
t.osed (New Permit) El Existing Permit:Project
If a modification. provide the existing, permit number: WQ00 and issued date:
Ifnew construction but part of a master phin, provide the existing permit number: WQ00
County where project is located: judyyba
LI. Approximate Coordinates (Ike irriai Degrees): Latitude: 35,717310 Longitude: -A,708„..588'.
5. Parcel ID (if applicable): 370214246271
(or Parcel ID to clOSCS1 downstream sewer)
111, CONSULTANT INFORMATION:
Professional Engineer: Da\ id 1 Reese License Number: 0108163
Firm: CLSt
Mailing itddress: PQ
City csiticord State: NC Zip: 28026-0268
Phone number: [phone] Email ,Address: davidreeseeiiicesiw.com
IV, WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
I. Facility Name: FienrY Fork W\VIP Permit Number: NC0040797
Owner Name: Citv of Hickoil
V. RECEIVING DOWNSTREAM SEWER INFORMATION tit different than WWTF):
1, Permit Numiyer(s): WQ Downstream (Receiving) Sewer Size: j2 inch
Svidem Wick: Collection Sit, stem PermiL NuniberilsyfirafThcablo: WQ( S(RON
Owiler Nat -nets): City of Hickory
ORM: FTA 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 att. ed?
• Vc flNo NiA
lithe Applicant is a Developer of lots to be sold, has a DevelopeLs C)perational Agreement. (FORM: DEV been attached'?
• Yes E. No
N/A
lithe Applicant is a floneyrjjperp,,, owners" :Association, hits an Operational :Agreement. (FORM: II( )A) been attached?
E Yes EINo N/A
4. Origin of Nvastewater (check all that apply):
O Residential lOwned El Retail (stores. centers, malls)
Residential Leased El Retail with food preparationfservice
El School I preschool / day care El Medical /dental veterinary tiled it ies
111 Food and drink aiiI iflcs Chureh
• Businesses / offices factories L Nursing Horne
[1] Car Wash
0 Hotel. and/or Motels
0 Swimming :Pool /Clubhouse
LilS NV irnminu, Pool/Filter Backwash
Other ( Explain in ;Attachment)
5. Nature of wastewitter : I 00 % Domestic/Commercial 0 Conunercial
% Industrial (SC'i:" 1,5A NCAC (CT „O 103121)0
1 Is there a Pretreatment Program in effect? El Yes
6, ht a Flow reduction been approved under 15;:\ NC,AC 0.2T ft 1 14iii? E] Yes L].No
If ves, provide a copy of flow reduction approval letter
Summarize wastewater generated by project:
Eslablislimeni Type (see 02T.0 11V))
Dwelling Unit (2 Bedroom Multifamily
Facility)
Daily Design Flow
240
gal
gal'
No
N. of Linitsi Flow
80 1 19.200 (>PD
GPI)
GPD
gl (iPD
gal/ G PD
gal/ GPD
Thiel/ I 19,200 GPD
1
a Sec J NCAC 021 ,01 4(jYt, tc)11) andisj2): tOr caveats to wastewater design flow rates (i.e., minimum flow per
dwelling: proposed unknown non-residential development use; public access facilities located near high public use areas;
and residential :property located south or east (yfthe Atlantic Intracoastal Waterway to be used as vacation rentalsas defined
in US, 42.,A-4).
b Per I 5A NCAC 02:1.01 14(c), design flow ratestor establishments not identified In table 15A CAC 124„))111-] shall be
determined using availahle flow data, s aler using fixtures, occupaney. or operation patterns, and other measured data,
8. Wastewater generated by project: 19,200 CiPD (per 15,A NC,,NC 42 tit 14)
Do not include future flows or previou.sly permitted allocations
If permitted flow is :zero. indicate why:
El Pump Station or Gravity Sewer where flow —ill be permitted in subsequent permits that connect to this line
El Flow has already been allocated in Permit Number
El Rehabilitation or replacement of existing sewer with no new flow expected
El Other (Explain):
1ORM: FT,-> (4-16 Page 2 of

GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 021.0305 & .MDCfGravity Sewers.):
, Summarize gravity sewer to be permitted:
Size (inches)
8
Length (feet) Material
361 57
PVC
Section 11 & Ill oldie MDC for Pennitting of -Gravity Sewers contains information related to desitm criteria
Section 1 11 contains information related to minimum slopes for gravity smells)
Oversizing lines to nteet minimum slope requirement is not alloyed and a violation of the MI)(
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T *030:5 & MDC (Pump Stations/Foree Mains):
COMPLETE FOR EACH PIMP STATION INCLUDED IN THIS PROJECT
Pomp station number or name:
2, Approximate Coordinates (Decimal Degrees), Latitude: 1.ongitude:
E)esign flow of the pump station: millions gallons per day (firm capacity)
1.. Operational point(s) [tithe pumpts): gallons per minute at feet total dynamic head (TD11)
Summarize the force main to be permitted (for this Purnp Station):
Size
Length (Teel)
Material
1
6. Power reliability, in accordance with A .NCA(:' 02-1: ..0305A
El Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(h)( 1 )(By.
T.- Required for ilI 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 ayera.ge daily low less than 15.000 gallons per day:
El Portable power source with manual activatio)1. quick -connection receptacle and telemetry - ISA -NCAC 02!
.0305(h)( )(C )
or
E1 Portable pumping unit with plugged emergency pump connection and telemetry - 1.5A NCAC 02-f .0305(h)(
It shall be demonstrated to the Division that the portable source is owned ir contra.cted by the applicant ( draft eement
and is compatible with the station.
lithe portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule oldie portable power source or pump. including travel timeframes, shall he provided
in the case of a multiple station power outage.,
11RNI: ETA (14- I Page 3 of 5

IX, SETBACKS & SEPARATIONS - (02B .0200 & 15A N(AC 02T .0305(f)):
„ Does the project comply with all separations found in 15A NC,A.0 0112"1 .030510 &.
I 5A NCAC 021.030510 contains minimum separations -that shall be ffovided for sewer systems:
Setback Parameter* Separation Required
1 Storm sewers and other utilities not fisted below (vertical) 24 inches
fal,Vater mains (vertical -water over sewer including in benched trenches) 18 inches
1 Water mains (horizontal) 11) feet
Reclaimed water lines (vertical - reclaimed over sewer) 18. incites
Reclaimed water lines (horizontal - reclaimed over sewer) 2 feet
* Any private or public water supply source, including any wells, WS-I waters of Class 1 or
Class 11 impounded reservoirs used as a source of drinking water
**Waters classified WS (except WS-1 or WS-V), SA„ ORW, HOW, or SU front normal
high water (or tide elevation) and Wet lands (see item 1X„2)
**Any other stream., lake, impoundment„ or ground water lowering and surface drainage
ditches
Any building foundation
An basement
Top slope of enlh3liknidnl or cuts of2 feet or more vertical height
Drainage s.stern s and interceptor drains
LAny swimming pools
LFinal earth grade (vertical)
Z Yes
1 00 feet
50 feet
10 feet
5 feet
10 feet
10 feet
5 feet
10 feet
36 inches
5A NC.A C 021',030 contains alternatives where separations in 014111.15tti cannot he achieved.
**Stream classifications can be identified using the Division's NC Surface Water Classifications W eklla
linoncompliance with 02 1 ,03050),or igh .see Section X of this application
.:,, Does the project comply with separation requirements for tvet lands? (50 feet of separation) . Yes No N/A
'. See the Division's draft separation requirements for situations where separation cannot be meet
. No variance is required if the alternative design criteria specified is utilized in design and construction
As built documents should reference the location of areas effected
Does the project comply with setbacks found in the river basin rules per 15A NC.A : 0213 0200? E yes Z No
1. This would include Trout Buffered Streams per I 5A NC,AC 213.0202
4. Does the project require coverage/authorization under a 404 Nation Wide or
individual permits or 401 Water -futility Certifications'?
Information can be obtained from the 401 & Buffer PermittineBranch
E Yes ENo
N/A
5. Does project comply with I 5A NCAC 021.O1(5(0(6) (additional permits/certifications)? E Yes EJ so
Per I 5 \ NCAC 02T„0 05Lc 10), directly related environmental permits or certification applications are being prepared, ha.ve
been applied lbr, or have been obtained, issuance of this permit is contingent on issuance of dependent permits (erosion and
sedimentation control plans, stormwater management plans, etc.),
0 Does this project include any sewer collection lines that are deemed "high -priority?"
Per 15A 'NCAC 021,0402, "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,
1] Yes Z 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 be inspected by the permittee or its representative at least once every six -months and inspections
documented per I5A NCAC 021%0403(05) or the permitee's individual System -Wide Collection permit.
FORM: FTA 04-10 Pate 4 of 5

X. CERTIFICATIONS:
Does the submitted system comply with 15,A NCAC 02T, the Minimum Design Criteria for Ole Permitting of Pump Stations
and FOrCe '.it version), and the Gravity SeweEMinimum Design Criteriathuest version) as applicable'?
E Yes Ei No
f No, complete and submit the Variance/Alternative Design Request application ( VADC 10-141and supporting documents for
review, Approval of the request is required prior to submittal of the Fast Track Application and supporting documents.
2. Professional Engineer's Certification:
-t---74v
(Professional Engineer's name from Application Item 111,)
attest that this application for
has been reviewed by me and is accurate, complete rind consistent with the information supplied in the plans, specifications,
engineering calcultitions, and all other supporting documentation to the best of my knowledt:te. 1 further attest that to the hest
of my k.DOWledge the proposed design 'has been prepared in ticcordance with the applicable regulations, GraVity Sewer
M n im um Design Criteria for Gravity Sewers (latest version). and the Minimum Design Criteria for the Fast -Track Permitting
of Pump Stations and Force Mains (latest versi)n). Although other professionals may have developed certain. portions of this
submittal package, inclusion of these materials under my signature and seal signifies that I have reviewed this material and
have judged it to he consistent with the proposed design,
NOD: In accordance ‘vith Genial Statutes 143-215.6,A and 143-215.6B. any person who knowingl\. makes any false
statement, representation, or certification in any application package shall he guilt\ of a Class 2 misdemeanor, which may
include a fine not to exceed S 1 0.000. as s ell as civil penalties up to $25,000 per violation.
North Carolina Professional Engineer's seal, signature, and date:
1 Applicant's Certification per 15A NCA( 02T .0106(b):
• \ \
A
V A \k) 0 t 4 \,/,1.(k attest that this application for
(Signature Authority's name & title from Application Item 1.3.)
has been re' es hy Inc and is accurate and complete to the best of my knowledge, 1 understand that Wall required parts of
this application are not completed and that if all required supporting documentation and attaclunents are not included, this
application package is. subject to being returned as irlcomp lete 1 understand that any discharge of wastewater front 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 he violated. I also understand that if all required parts of this application package are not completed and that if
ail required supporting; information and attachments are not included, this application package will be returned to me as
incomplete.
NOTE — In accordance vvith General Statutes 14.3-21.5.6,A and 143-215,6B, an v person who knowingly makes any false
statement, representation., or certification in any application package shall he guilty of a Class 2 misdemeanor, which may
include a .Etne not to exceed $10.000 as well as civil penalties up to $25,000 per violation.
Signature:
1ORM: 1 FA Page 5 of 5

DiStsion of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: City of Hickory
Project 'Name for which flow is being requested: The Lodge at Hickory
More than one FTSE may be required for a single project if the owner of the R'14(TP is not responsible all pump
stations along the route of the proposed wastewater flow.
. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Ilear> Fork WWTP
b. WWIP Facility Permit NC0040797
All.flows are in MGD
c. WWTP facility's .permitted flow 9.0
d. Estimated obligated flow not yet tributary to the WWTP 1.89077
e. 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
2.98375
0.0192
4.88937
54.37°,4
II. Complete this section for each pump station you are responsible for along the route of
wastewater flow.
List pump stations located between the project connection point and the
Pump Pump
Station Station
(Name or Permit
Number) No,
Firm
Capacity. *
MGD
(A)
Design
Average
Daily Flow**
(Firm pf),
MOD
(13.) (C)
Obligated,
Approx. Not Yet
Current Tributary.
Avg. Daily Daily Flow,
Flow, MGD MGD
TP:
(D)----(B+C)
s proposed
Total Current
Flow Plus
Obligated
Flow
Available
Capacity***
* The Firm Capacity (design flow) of any pump station is defined as the maximum pumped flow
that can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor
(pf) not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** 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): Hickory Collection System
Downstream Permit Number: WQCS00020
Page 1 of 6
FTSE 10-18

HI. Certification Statement:
1 Warren Wood certify to the best of My knowledge that the addition of
the volume of wastewater to be permitted in this project has been evaluated along the route to the receiving
wastewater treatment facility and that the flow from this project is not anticipated to cause any capacity
related sanitary sewer overflow's or overburden any downstream pump station en route to the receiving
treatment plant under normal circumstances, given the implementation of the planned improvements
identified in the planning assessment where applicable. This analysis has been performed in accordance
with local established policies and procedures using the best available data. This certification applies to
those items listed above in Sections I and II plus all attached planning assessment addendurns for which I
am the responsible party. Signature of this form certifies that the receiving collection system or treatment
Works has adequate capacity to transport and treat the proposed new wastewater.
Signing Official Signature Date
City Manager
Title of Signing Official
Page 2 of 6
1TSE 10- 8

GS© m/ya
S T o
6TH AVE SW
4TH AVE5
NOS TO SC /E
/2
HtceoP, QuoRx.GLE

NCDEQ
10 East Center Avenue
Suite 301
Mooresville, 811
d. piease 1iic.t trrr°tr.itt�n
l mitt l 1br proposed new,t t.r. te
st t1 ort't lIesit t tt;
ie..
k.Sew r
Apt
PVC
NA. It11CO\ t'd"
t. ltts r°t� t
aCt1iitr�eil
ed
7 t0'„ti al;'`day iiaw,
(14

CERTIFICATION CHECKLIST
To be completed. by the certifying en.gineer prior to operation of the permitted sewers, per
Certifying Engineer: DAVID F . REESE - CESI
Certification Review Date: 0 3 / 3 1 / 0,2 0
Project Name: THE LODGE AT HICKORY
wQ00 4 0 74 2 Project County: CATAWBA COUNTY
1) Has perinittee information changed since the permit was issued. (or last modified): change of mailing address,
change of ownership, transfer from developer to flOA/POA, etc, L Yes No
if yes, please provide either a change of ownership form or new contact information. Note that transfer of
permits from the developer to the .110A/P0A must occur with the first certification.
f`
WQROS
MOORESVILLE REGIONAL, OFFICE
2) Have the as -built drawings have been signed, sealed, and dated by an N.C. PE? J Yes
3) Final Engineering certification? Yes LJ No
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: .TC1 Ycs [1 No El N/A °
• Three feet minimum cover has been provided :for all sewers unless ferrous pipe was installed.
• Minim.um diameters for gravity sewers are 8-inches for public lines and 6-inches for private lines,
• Manholes have been installed: At the end of each line, at all changes in grade, size, or ahgnme.nt, at all
intersections„ and at distances not greater than 425 .feet; minimum diameter shall be 4 feet (48-inches),
5) Adequate information. related to pump stations: Yes No lj N/A
• Ensure power reliability option was selected per 15,A NCA 02T..030
6) Was project construction completed in accordance with all of the 'following: Yes Li No NA
• 15A NCAC 02 F, Minimum Design Criteria (MDC) for the pertnitting of Gravity Sewers (latest version), and
MDC for_ the.PermittinQ of PUITI„ Stations and Force Mains (latest version)"?
If not, a variance approval is required in accordance with 1.5A NCAC 02T.0105(b)„ prior to certification and
operation.
• Contact the Central Office to discuss the variance to determine a course of action.
• Applicant must submit two copies of the. variance request form, plans, specifications, calculations, and any other
pertinent information to the Central Office (one hard copy, one digital copy),
• The central office will review the variance request, and if a.pprovable, specific language regarding the variance
will be incorporated into the permit., either via a special condition or a supplementary letter..A copy of the
reissued permit with variance language or the variance letter must be maintainedwith the original documents,
7) Does the project contains. high priority lines (15.A NCA.0 0T .040.2(2))? P Ye FIJ No
• If yes, ensure that the permit already contains the necessarycondition related to high priority lines 1.5A NCAC
02T.0403 (a)(5). If the permit does not 'include this language, the Fast Track reviewer will reissue the permit with
the appropriate language.
81 Are Permit modifications are required for® any changes resulting in .nort-compliance With this permit (including but not
limited to pipe length changes of itri` or greater, change in flow, pump station design capacity design change of 5% or
greater, and or change in the number/type of connections)? El Yes FT No
• If yes, a permitmodification 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, Mooresvil e, NC 28115
Mooresville Regional Office Phone: [phone] FAX [phone]

FAST TRACK SEWER ENGINEERING CERTIFICATION
"CDENRIDVIIR
PERMITTEE: CITY OF HICKORY
PERMIT #: WQ0040742
PROJECT: THE LODGE AT HICKORY
ISSUE DATE: APRIL 1, 2019
WQkOS
MOORESV)L1.5 REGIONAL OFFICE
This project shall not he 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 Pennittee to
appropriate enforcement actions. The .Permittee is responsible for tracking all partial certifications up
until a final certification is received by the Division. A Final Certification shall be a complete set of
record drawings and design calculations regardless of whether partials have been submitted.
PERMITTEE'S CERTIFICATION
I, the -undersigned agent. for the Pennittee, 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 h rein or portionsthereof.
/41',
Printed Name, Title SigDate
ENGINEER'S CERTIFICATION
I, David E. Reese PE , as a duly registered Professional E
the State of North Carolina,
having been authorized to observe (g Jeriodieally, weekly, LJ full time) the construction of the
project name and location as referenced above for the above Pcrinittee hereby state that, to the best of my
abilities, due care and diligence was used in the obsen/ation of the construction such that the construction
was observed to be built within substantial compliance of this permit; 362 linear -feet of 8-inch public
gravity sewer 15A NCAC 02T; the Division of Water Resources' (Division) Gravity Sewer Minimum
Design Criteria adopted Febniary 12, 1996, as applicable; the Division's Miniminn 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 wisignature .& date:
El Final Partial (include description)
Certification Comments/Qualifiers (attach if necessary):
NC DWR — Water Quality Regional Operations Section 610 East Center Avenue, Suite 301, MooresvilIe, NC 28115
Mooresville Regional Office Phone: [phone] FAX [phone]