WQ0029808_Regional Office Historical File Pre 2018

Michael F. Easley, Governor
William G. Ross Jr, Secretary
North Carolina Department of Environment and Natural: Resources
.Alan W. 'Klimek, PT', Director
Division of Water Quality
February 9, 2006
Mr. Brad Cornwell, Assistant Utilities Director
City of Shelby
PO Box 207
Shelby, North Carolina 28151
Subject. Permit No, WQ0029808
Grey Fox Sewer Extension
City of Shelby
Wastewater Collection System Extension
Cleveland County, North Carolina
Dear Mr. Cornwell
In accordance with your application received on January 11, 2006, we are forwarding herewith
Permit No. VVQ0029808, dated February 9, 2006, to the City of Shelby for the construction and
operation of the subject wastewater collection system extension, This permit shall be effective from the
date of issuance until rescinded, and shall be subject to the conditions and limitations as specified
therein, This cover letter shall be considered a part of this permit and is therefore incorporated therein
by reference.
Please pay particular attention to Permit Condit on 3 which requires that the wastewater
collection facilities be properly operated and maintained in accordance with 15A NCAC 2H .0227 or any
individual system -wide collection system permit issued to the Permittee.
Permitting of this project does not constitute an acceptance of any part of the project that does
not meet 1) 15A NCAC 2H .0200: 2) the Division of Water Quality's (Division) Gravity Sewer Minimum
Design Criteria adopted February 12, 1996, as applicable, 3) arid 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, Failure to comply may result in penalties in accordance with North Carolina General
Statute §143-215.6A through §143-215.6C, construction of additional or replacement wastewater
collection facilities, and/or referral of the North Carolina -licensed Professional Engineer to the licensing
board.
ktuxiresville Regional Office MO East Center Ave., Suite 301 Mooresville, NC 28115
Internet h2o,enr:state.nc,us Customer Service: 1-877-623-6748
An Equal Opportunity/Affirmative Action Employer —50% Recycled/10% Post Consumer Paper
Phone: (704) 6(j3-1699 Fax: [phone]
NorthCarolina
;,Vaturally

Mr. Brad Cornwell
Page 2
February 8, 2006
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 Shelby for the construction and operation of approximately 572 linear feet of 8-
inch gravity sewer as part of the Grey Fox Sewer Extension project, and the discharge of 1,440 gallons
per day of collected domestic wastewater into the City of Shelby's existing sewerage system, pursuant
to the application received January 11, 2006, and in conformity with 15A NCAC 2H ,0200; the Division's
Gravity Sewer Minimum Design Criteria adopted February 12, 1996, as applicable, the Division's
Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains adopted
June 1, 2000, as applicable; and other supporting data subsequently filed and approved by the
Department of Environment and Natural Resources and considered a part of this permit.
The sewage and wastewater collected by this system shall be treated in the City of Shelby
WVVTP (NPDES No. NC0024538) prior to being discharged into the receiving stream,
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the
right to request an adjudicatory hearing upon written request within 30 days following receipt of this
permit. This request must be in the form of a written petition, conforming to Chapter 150B of North
Carolina General Statutes, and filed with the Office of Administrative Hearings, 6714 Mail Service
Center, Raleigh, NC 27699-6714, Unless such demands are made, this permit shall be final and
binding.
If you need additional information concerning this matter, please contact Dee Browder at (704)
663-1699.
Sincerely,
)
t„(,_
for Alan W. Klimek, P.E.
cc: Cleveland County Health Department
Mooresville Regional Office, Surface Water Protection (WVVTP Permit No. NC0024538)
David Odom, Odom, Hollifield & Associates
Surface Water Protection Central Files
Marie Doklovic, PERCS

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH
WASTEWATER COLLECTION SYSTEM EXTENSION PERMIT
This permit shall be effective from the date of issuance until rescinded and shall be subject to the
following specified conditions and limitations:
This permit shall become voidable unless the wastewater collection facilities are constructed in
accordance with the conditions of this permit; 15A NCAC 2H ,0200; the Division of Water Quality's
(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 unless specifically
mentioned herein.
2. This permit shall be effective only with respect to the nature and volume of wastes described in the
application and other supporting data,
3, The wastewater collection facilities shall be properly maintained and operated at all times. The
Permittee shall maintain compliance with an individual system -wide collection system permit for the
operation and maintenance of these facilities as required by 15A NCAC 2H .0227. If an individual
permit is not required, the following performance criteria shall be met as provided in 15A NCAC 2H
.0227:
a. The sewer system shall be effectively maintained and operated at all times to prevent
discharge to land or surface waters, and any contravention of the groundwater standards in
15A NCAC 2L ,0200 or the surface water standards in 15A NCAC 2B ,0200,
b. A map of the sewer system shall be developed and shall be actively maintained.
c, An operation and maintenance plan shall be 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-month period of time.
f. A general observation of the entire sewer system shall be conducted at least once per year.
g. Inspection and maintenance records shall be maintained for a period of at least three years.
h. Overflows and bypasses shall be reported to the appropriate Division regional office in
accordance with 15A NCAC 2B .0506(a), and public notice shall be provided as required by
North Carolina General Statute §143-215.1C,

4. This permit shall not be transferable. In the event there is a desire for the wastewater collection
facilities to change ownership, or there is a name change of the Permittee, a formal permit request
shall be submitted to the Division accompanied by documentation from the parties involved, and
other supporting materials as may be appropriate. The approval of this request shall be
considered on its merits and may or may not be approved.
Construction of the gravity sewers, pump stations, and force mains shall be scheduled so as not to
interrupt service by the existing utilities nor result in an overflow or bypass discharge of wastewater
to the surface waters of the State.
6, Per 15A NCAC 2H .0220, 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.
7. A copy of the construction record drawings shall be maintained on file by the Permittee for the life
of the wastewater collection facilities.
Failure to abide by the conditions and limitations contained in this permit; 15A NCAC 2H .0200; the
Division's Gravity Sewer Design Criteria adopted February 12, 1996 as applicable, the Division's
Minimum Design Criteria for the Fast -Track Permitting of Pump Station and Force Mains adopted
June 1, 2000 as applicable; and other supporting materials may subject the Permittee to an
enforcement action by the Division, in accordance with North Carolina General Statutes §143-
215.6A through §143-215,6C.
9. 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,
10. 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 other government agencies
(local, state and federal) which have jurisdiction, including but not limited to applicable river buffer
rules in 15A NCAC 2B .0200, erosion and sedimentation control requirements in 15A NCAC Ch. 4
and under the Division's General Permit NCG010000, and any requirements pertaining to wetlands
under 15A NCAC 2B .0200 and 15A NCAC 2H .0500.
11. Noncompliance Notification:
The Permittee shall verbally report to a Division of Water Quality employee at the Mooresville
Regional Office, telephone number [phone], as soon as possible, but in no case more than
24 hours or on the next working day, 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 failure of a pumping station or sewer line resulting in a by-pass directly to receiving waters
without treatment of all or any portion of the influent to such station or facility.

Voice mail messages or faxed information is permissible, but 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 Part 1 of Form CS-SSO (or the most current Division approved form), within five days
following first knowledge of the occurrence, This report shall outline the actions taken or
proposed to ensure that the problem does not recur. Part II of Form CS-SSO (or the most
current Division approved form) can also be completed to show that the SSO was beyond
control.
Permit issued this the 9th day of February, 2006,
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
for Alan VV. Kli 1,9k, P,E., Director
Division of Water Quality
By Authority of the Environmental Management Commission
Permit Number W00029808

Fast Track Engineering Certification
Permit No WQ0029808
February 9, 2006
Complete and submit this form to the permit issuing regional office with the following:
• One copy of the project record drawings (plan & profile views of sewer lines) of the wastewater collection
system extension
• Supporting design calculations (selected pumps, system curve, operating point, available storage if portable
generator(s) or storage greater than longest past three year outage reliability option selected) for any pump
stations permitted as part of this project
• Changes to the project should be clearly identified on the record drawings or in written summary form. Permit
modifications are required for any changes resulting in non-compliance with this permit, regulations or
minimum design criteria.
This project shall not be considered complete nor allowed to operate until this Engineers Certification and all
required supporting documentation have been received by the Division, Therefore, it is highly recommended
that this certification be sent in a manner that provides proof of receipt by the Division.
ENGINEER'S CERTIFICATION
E Partial 0 Final
as a duly registered Professional Engineer in the State of North Carolina, having
been authorized to observe (Ej periodically, E weekly, 1=1 full time) the construction of the Grey Fox Sewer
Extension, a Cleveland County project for the 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 2H .0200; the Division of Water Quality's (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, signature, and date:
SEND THIS FORM & SUPPORTING DOCUMENTATION
WITH REQUIRED ATTACHMENTS TO THE FOLLOWING ADDRESS
MOORESVILLE REGIONAL OFFICE
SURFACE WATER PROTECTION
610 EAST CENTER AVENUE, SUITE 301
MOORESVILLE NC 28115
The Permittee is responsible for tracking all partial certifications up until a final certification is received, 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 Permittee to appropriate
enforcement actions.

!FAST -TRACK APPLICATI+I N for GRAVITY SEWERS, PU °IP STt13C +(tN:S, AND FOR MAINS
PAGE 3
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD?
Owner:
City of Shelby
Full Legal Name (company, municipality,
1ity, HOA, utility, etc)
b, Brad Cornwell, Assistant Utilities Directo _
Signing Official Name and Title(Please review 15A NCAC 2H ,g2© 9 g 6(b) for authorized signing officials!)
Application Number:
(to be completed by D'WQ)
The legal entity who will own this system rs
❑ Individual El Federal ® Municipality ❑ State/County ❑ Private Partnership ❑ Corporation
1d. PO Box 207
Mailing Address
.............
NC
State
..................
1 h. 704-669-6575
Telephone Facsimile
2. Project (Facility) Information.'
2a, Grey Fox Sewer Extension
Brief Project Name (permit will refer to this n
Contact Person:
David W, Odom, P.E.
1 e, Shelby
City
lg. 28151
Zip Code
2b. Cleveland
County Where Project is Located.,
Name and Affiliation of Someone Who Can Answer Questions About this Application
82$_247 4495,_ 3c. davidodom©a odomengineering.com
Phone Number
Project is ❑ New ❑ Modification (of an existing permit) If Modification, Permit No,:
E-mail
For modifications, attach a separate sheet clearly explaining the reason for the modification (Le. adding another
phase, changing line size/length, etc.). Only include the modified information in this permit application - do not
duplicate project information in B(7) and B(10-11) that has already been included in the original permit.
2„ Owner is d Public (skip to item B(3)) ❑ Private (go to !tern 2(a))
"2a. If private, applicant will be: 2b, If sold, facilities owned by a (rriust choose one
Retaining Ownership (i,e, store, church, single office, etc.) or
❑ Leasing units (lots, townhomes, etc, - skip to Item B(3))
❑ Selling units (lots, townhomes, etc, - go to Item B(2b))
City of Shelby
❑ Public Utility (Instruction III)
❑ Homeowner AssociDeveloper (Instruction IV)
Owner of Wastewater Treatment Facility (1MNTF) Treating Wastewater From This Project
City of Shelt_y 4b. NC0024538
Name of WWTF WWTF Permit No.
a. City of Shelby t5b, 8'" ❑ Gravity ec.
Z Downstream Sewer Receiivin Sewer Size ❑ Force Main i Mmm Permit N o st Sewer (if known
Owner of Downstream µM„ �__.___....._ ._..._._. Permit Number of Downstream .., T_ The origin of this wastewater is (check all that apply):.
El Residential Subdivision
❑ Apartments/Condominiums
❑ Mobile Home Park
❑ School
❑ Restaurant
❑ Office
El Car Wash
❑ Institution
❑ Hospital
❑ Church
❑ Nursing Horne
El Other (specify):
00 % Domestic/Cornmercial
% Industrial
% Other (specify).
Volume of wastewater to be allocated for this particular project: 1440 gallons per day
*Do not include previously permitted allocations
If the permitted flow is zero, indicate why.
Interceptor Line - Flow will be permitted in subsequent permits that connect to this line
LI Flow has already been allocated in Permit No.
❑ Rehabilitation or replacement of existing sewer with no new flow expected
F"TA 02/03 - Re # 3 O 'O5

AST -TRACK APPLICATION for GRAVITY'SE
'ERS, PUMP STATIONS, AND FORCE MAINS PAGE 4
nv.
9, Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2H
.0219(1) for Item B(7) or the design flow for line or pump station sizing if zero flow in the space below, Values other than
that in 15A NCAC 2H .0219(1)(1-2) must be supported with actual water or wastewater use data in accordance with 15A
NCAC 2H ,0219(1)(3).
4 homes * 3 bedrooms/ home * 120 gpd per bedroom = 1,440 gallons per day
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
I (feet) Gravity or Force Main
Size (inches) Length (use the pull down menu)
8 572 Gravity
ENTER TOTAL LINE LENGTH IN MILES 0,11
1 Summary of Pump Stations to be Permitted (attach additional sheets as necessary)
Location ID Power Reliability Option
(self chosen - as shown on Design Flow Operational Point (1- dual line feed; 2- permanent generator w/ATS; 3-
plans for cross-reference) (MGD) GPM @ TDH portable generator w/telemetry; 4-wet well storage)
u.
12. Does the sewer system comply with the Minimum Design Criteria for the Fast Track Permitting of Pump Stations and Force
Mains (latest version), the Gravity Sewer Minimum Design Criteria (latest version) and 15A NCAC 2H .0200 as applicable,
El Yes 0 No If no, please reference the pertinent minimum design criteria or regulation and indicate why a
variance is requested. SUBMIT TWO COPIES OF PLANS, SPECIFICATIONS OR CALCULATIONS
PERTINENT TO THE VARIANCE WITH YOUR APPLICATION
13. Have the following permits/certifications been submitted for approval?
Wetland/Stream Crossings - General Permit or 401 Certification? Ell Yes 0 No 0 N/A
0 Yes 0 No IA N/A
Stormwater? 0 Yes II] No IA N/A
14. Does this project involve aerial lines or siphons? Check if yes: LI
These Ines will be considered hioh oriodtv and, must be checked onceevery,six months
15. Does this project have gravity sewer lines designed at minimum slopes? 0
Be aware that the Division will not accept installed lines more than 10% flatter than the minimum slope, Lines installed outside this tolerance should he
corrected prior to Submitting the final engineering certification,.
Sedimentation and Erosion Control Plan?
VIA. 02/03 - Rev. 3 04105

AST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE 5
1. Use the Division's guidance document entitled, "DETERMINING STREAM CLASSIFICATIONS FOR FORM FTA 02/03
(FAST -TRACK SEWER SYSTEMS)" to collect and record the stream classification data below (attach additional sheets a
necessary): This document is available from our web site or by contacting the appropriate Division of Water Quality
Z regional office (see instructions for addresses) OR indicate the following:
Z A Stream Classification is not needed because all parts of the project are at least 100 feet away from any down slope
waterbody, AND,
El A Stream Classification is not needed because the design does not depend on wet well storage as a power reliability
option for any pump station near a Class C down slope waterbody.
Location ID on Map
(self chosen - as shown on Name of Waterbody Stream Waterbody
map for cross-reference) Waterbody County River Basin Index Classification
Submit the 8.5" x 11" COLOR topographic map as required in Instruction VI
regardless of whether a classification is provided!
1. Applicant's Certification:
1, Brad Cornwell, attest that this application for Grey Fox Sewer Extension has
been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required pads 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 n Note: In accordance with North Carolina General
Statutes 143-215,6A and 143-215.6B, any person who knowingly makes any false statement, representation, or
certification in any application shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed $10,000
as we?f,s civil pen up to $25, 000 per teflon.
Signing Official Signature
2. Professional Engineer's Certification:
0
I attest that this application for Grey Fox Sewer Extension has been reviewed by me and is
accurate, complete and consistent with the information in the engineering plans, calculations, and all other supporting
documentation to the best of my knowledge, I further attest that to the best ofmy knowledge the proposed design has
been prepared in accordance with the applicable regulations, Gravity Sewer Minimum Design Criteria for Gravity Sewers
adopted Febniary 12, 1996, and the Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force
Mains adopted June 1, 2000 and the watershed classification in accordance with Division guidance. Although certain
portions of this submittal package may have been developed by other professionals, inclusion of these materials under my
signature and seal signifies that I have reviewed this material and have judged it to be consistent with the proposed design.
Note: In accordance with NC General Statutes 143-215, 6A and 143-215.68, any person who knowingly makes any false
statement, representation, or certification in any application 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,
2a. David W. Odom
Professional Engineer Name
2b. Odom Hollifield & Associates En ineerin
Engineering Firm
2c. 152 East Main Street
Mailing Address
2d. Forest City 2e. NC 2f. 28043
City - State Zip
I2g. 828-247-4495 2h. 828-247-4498 2i.
Telephone Facsimile davidodom@odomengineering.
•
Seal, Signature & Date
PTA 02/03 - Rev. 3 04/05

, 2006
Maria
Odom, r Holli.
Via: F
Associat
I" A 0 T TFHP P OP
tter of i ill
ey Fox Forest S rExtension
Permit No, NC0024538
Tin s sh
NC. The (i helby does hays
No: ` i i i to a pt the flow ol
the existing gag i r . this proposed ubdwision,
Should you have any er questions dire this motr, pl don't hs
t t 669-6575.,
ga C0111
ASSiStalit UWI
Cc:
or
proposed Grey Fox fewer Extonon M Shelby,
wopacity t its Waste Water Treattn;.wt Facility
ately 1,440 GPD fixon`th proposed extension of
tt t
PO 207 824 W Grover . I I , NC 28151
P/ 0 - -- - Fax [phone]
n i A q---n . n:: fl. s5 I T T)
" T t

Per rnit Number 002
Central Files APS SWP
02f0 /06
Permit Tracking Slip
Program Category
Non -discharge
Status Project Type
In review New Project
Permit Type Version Permit Classi
Gravity Sewer Extension„ Pump Stations & Pressure Sewer A Individual
Extensions
Primary Reviewer
dee,browder'
Permitted Flow
1440
Facility
Facility Name,
Grey Fox Sewer Extension
Location Address
Owner Name
City of Shelby
Dates/Events
Permit Contact Affiliation
cation
Major/Minor Region
Minor Mooresville
fie
Feed'
Contac
County
Cleveland
Affiliation
Owner Type
Government - Municipal
Owner Affiliation
Jay Stowe, PE
PO Box 207
Shelby
NC 281510207
Scheduled
©rig Issue App Rebel Draft Initiated Issuance Public Notice Issue Effective
t 1t'1110
Regulated Activities
Subdivision
Wastewater collection
Ouffall Nl1M..L
Waterbody Name
ReauestediReceived Events
Additional information requested
Additional information received
Stream Index Nur
Exp
Current Class Su basin
10

ZOO
7(7
?'?f Q 'CAI
-".i77—cfav
7 '0 na;_

2 `As t' ST. • ^ )REST ern', 2o f 4
ary 5, 2006
N1:
Division of Wa
1628 Mail Service ,e;trt
Raleigh, NC 27699-1628
RE: Fast Track Serer Application
Grey Fox Sewer Extension
To \ h It May Conc
24'7-4495 • 2 -2 7-
Please find the fast trek sewer annlieatic n.
$400 application I e, topo neap and letter
WW1").
David
doer:
.ton, Alsenclosed is tl:'
ity of l ell y veritYing the capacity of the

'RACK AI ICAT Tf N for CRAii'IFY SEWS S, PUMP STATIONS, A, I'ORC,H; MAINS PAGE 3
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD!
Owner:
1 a. CJ_of Shelby
Application Number:
(to be completed by DWQ)
Full Legal Name (company, municipality, HOA, utility, etc,)
_ .Assistant Utilities recto
q1 b. Brad Cornwell, eDirector
...__
Signing Official Name and Title (Please review 15A NCAC 2H .0206(b) for authorized signing officials!)
Ice The legal entity who will own this system is:
❑ Individual ❑ Federal El Municipality ❑ State/County ❑ Private Partnership ❑ Corporation El Other (specify):
O ld. wPO Box 207
z
0
Shelby
Mailing Address City
f_ NC ..___. ._ :1g. 28151
State Zip Code
1 h. 704-669-6575
Telephone Facsimile
2. Project (Facility) Information.
2a, Grey Fox Sewer Extension
Brief Project Name (permit will refer to this name
Contact Person:
• 3a, David W. Odom, P.E.
Name and Affiliation of Someone
3b, 828-247-4495
Phone Number
Project is [3 New
E-mail
2b. Cleveland
County Where Project is Located
ho Can Answer Questions About this Application
3c. davidodom odomengineerinlcom
E-mail
If Modification, Permit No.:
odification (of an existing permit)
For modifications, attach a separate sheet clearly explaining the reason for the modification (Le. adding another
phase, changing line size/length, etc.). Only include the modified information in this permit application - do not.
duplicate project information in B(7) and B(10-11) that has already been included in the original permit.
2, Owner is Public (skip to Item B(3)) ❑ Private (go to Item 2(a))
2a, If private, applicant will be:
2b. If sold, facilities owned by a (must cnoce one
Retaining Ownership (Le. store, church, single office, etc.) or ❑ Public Utility (Instruction III)
�; ❑ Leasing units (lots, townhomes, etc. - skip to Item B(3)) ❑ Homeowner Assoc /Develope
El Selling units (lots, townhomes, etc. - go to Item B(2b))
City of Shelby
__.._.-�....._....�
Owner of Wastewater Treatment Facility (WWTF)
Treating Wastewat er From This Project
0.
4a. City of Shelby ..._. 4b. NG�O24538
Name of WWTF WWTF Permit No.
City of Shelby b 8 [3 Gravity 5c
Owner of Downstream Sewer Receiving Sewer Size Force Main Pen riit Number of Downstream Sewer (if known)
6. The origin of this wastewater is (check all that apply):
❑ Residential Subdivision
❑ Apartments/Condominiums
❑ Mobile Horne Park
El School
❑ Restaurant
❑ Office
Car Wash
❑ Institution
❑ Hospital
❑ Church
❑ Nursing Home
[11 Other (specify):.
nstrtaction IV)
100 % Domestic/Commercial
Industrial
% Other (specify):
Volume of wastewater to be allocated for this particular project: 1440 gallons per day
*Do not include previously permitted allocations
If the permitted flow is zero, indicate why;
El Interceptor Line - Flow will be permitted iri subsequent permits that connect to this line
❑ Flow has already been allocated in Permit No.
❑ Rehabilitation or replacement of existing sewer with no new flow expected
I"A t?2r"03 It.cv05

'AST -TRACK APPLJCATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE 4
Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2H
.0219(1) for Item B(7) or the design flow for line or pump station sizing if zero flow in the space below. Values other than
that in 15A NCAC 2H .0219(I)(1-2) must be supported with actual water or wastewater use data in accordance with 15A
NCAC 2H .0219(I)(3),
4 homes * 3 bedrooms/ home * 120 gpd per bedroom = 1,440 gallons per day
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches) Length (feet)
ENTER TOTAL LINE LENGTH IN MILES
0.11
Summary of Pump Stations to be Permitted (attach additional sheets as necessa
Gravity or Force Main
use the pull down menu)
Gravity
Location ID Power Reliability Option
elf chosen - as shown on Design Flow Operational Point (1- dual line feed; 2- permanent generator wfATS; 3-
plans for cross-reference) (MGD) GPM c2 TDH portable generator wftelemetry; 4-wet well storage)
12. Does the sewer system comply with the Minimum Design Criteria for the Fast Track Permitting of Pump Stations and Force
c
Mains (latest version), the Gravity Sewer Minimum Design Criteria (latest version) and 15A NCAC 2H .0200 as applicable?l
Yes ❑ No If no, please reference the pertinent minimum design criteria or regulation and indicate why a
variance is requested. SUBMIT TWO COPIES OF PLANS, SPECIFICATIONS OR CALCULATIONS
PERTINENT TO THE VARIANCE WITH YOUR APPLICATION
Have the following permits/certifications been submitted for approval?
Wetland/Stream Crossings - General Permit or 401 Certification? Yes ❑ No
❑ Yes ❑ No
El Yes ❑ No
Sedimentation and Erosion Control Plan?
Stormwater?
14, Does this project involve aerial lines or siphons? Check if yes: ❑
These. lines will be considered hi©,h oriorrily and must be checked_pnce every,$ix months
15. Does this project have gravity sewer lines designed at minimum slopes?
Be aware that the Division will not accept installed lines more than 1 G% flatter than the minimum slope. Lines installed outside this iolershould be
corrected prior to submitting the final engineering certtication..
❑ N/A
El N/A
E N/A
FTA 02/03 - Rev. 3 00

AST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 5
1, Use the Division's guidance document entitled, "DETERMINING STREAM CLASSIFICATIONS FOR FORM FTA 02/03
(FAST -TRACK SEWER SYSTEMS)" to collect and record the stream classification data below (attach additional sheets as
necessary). This document is available from our web site or by contacting the appropriate Division of Water Quality
regional office (see instructions for addresses) OR indicate the following:
A Stream Classification is not needed because all parts of the project are at least 100 feet away from any down slope
waterbody; AND,
A Stream Classification is not needed because the design does not depend on wet well storage as a power reliability
option for any pump station near a Class C down slope waterbody.
Location ID on Map
(self chosen - as shown o Name of Waterbody Stream Waterbody
map for cross-reference) Waterbody County River Basin Index Classification
Submit the 8.5" x 11" COLOR topographic map as required in instruction VI
regardless of whether a classification is provided!
1. Applicant's Certification:
1, Brad Cornwell, attest that this application for Grey Fox Sewer Extension has
been reviewed by me and is accurate and complete to the best of my knowledge, I understand that if all required parts of
this application are not completed and that if all required supporting documentation and attachments are not included,
this application package is subject to being returned as incomplete. Note: In accordance with North Carolina General
Statutes 143-215.6A and 143-215,6B, any person who knowingly makes any false statement, representation, or
certification in any application shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed $10, 000
as wellas civil pena s up to $25, 000 per iolation,
la,
Signing Official Signature
2. Professional Engineer's Certification:
I attest that this application for Grey Fox Sewer Extension has been reviewed by me and is
accurate, complete and consistent with the information in the engineering plans, calculations, and all other supporting
documentation to the best of my knowledge, I further attest that to the best of my knowledge the proposed design has
been prepared in accordance with the applicable regulations, Gravity Sewer Minimum Design Criteria for Gravity Sewers
adopted February 12, 1996, and the Minimum Design Criteria for the Fast -Track Pemlltting of Pump Stations and Force
Mains adopted June 1, 2000 and the watershed classification in accordance with Division guidance. Although certain
portions of this submittal package may have been developed by other professionals, inclusion of these materials under my
signature and seal signifies that I have reviewed this material and have judged it to be consistent with the proposed design.
Note: In accordance with NC General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application 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,
2a. David W. Odom
Professional Engineer Name
2b. Odom Hollifield & Associates Engineering
Engineering Firm
2c. 152 East Main Street
Mailing Address
2d. Forest City 2e. NC 2f. 28043
City State I Zip
: tiituauet
2g. 828-247-4495 2h. 828-247-4498 !2i.
; davidodom@odomengineering.,
Telephone Facsimile Seal, Signatur
& Date
'FTA 02/03 - Rev. 3 04/05

nary 5, 2006
Maria Hunnicutt
Odom, Holliield & Associates
Via: Facsimile
Re;. Letter of Willis gness
Grey Fox Forest Sewer Extension
WWTP Permit N©. NC0024538
Dear Ms. Hunnicutt:
This letter of willingness shall serve the proposed Grey Fox Forest Sewer Extension in Shelby,
NC. The City of Shelby does have the capacity at its Waste Water Treatment Facility (Permit
No, NC0024538) to accept the flow of approximately 1,440 GPD from the proposed extension of
the existing gravity sewer in this proposed subdivision.
Should you have any further questions regarding this matter, please don't hesitate to contact me
at [phone].
Assistant Utilities Director
Cc: Mrs. Julie McMurry, Utilities Director
PO Box 207 -w 824 VVW, Grover St. _. 9re1hy, NC 2815. 0207
Phone 7O4-484-684Q - Fax [phone]
T°l
77:hT gll[7/c0/Tn