WQ0034147_Regional Office Historical File Pre 2018

NCDENR
North Carolina Department of Environment and Natural Resources
Beverly Eaves Perdue
Governor
Ms. Marilyn H. Sellers, City Manager
City of Kings Mountain
Po Box 429
Kings Mountain, NC 28086
Dear Ms, Sellers,
Division of Water Quality
Coleen H, Sullins Dee Freeman
Director Secretary
June 23, 2009
Subject: Permit No. W00034147
David Baptist Church
Wastewater Collection System Extension
Cleveland County, North Carolina
In accordance with your complete application received on June 15, 2009, we are forwarding
herewith Permit No. WQ00334147 dated June 23, 2009, to the City of Kings Mountain 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effective from the date of issuance until rescinded and shall be subject to the conditions and limitations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 Condition 3 which requires that the wastewater
collection facilities be properly operated and maintained in accordance with 15A NCAC 2T .0403 or any
individual system -wide collection system permit issued to the Permittee.
Permitting of this project does not constitute an acceptance of any part of the project that does
not meet 1) 15A NCAC 2T; 2) the Division of Water Quality's (Division) Gravity Sewer Minimum Design
Criteria adopted February 12, 1996, as applicable; 3) 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. 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.
rylooresviille Regionai Office
Location: 610 East Center Ave:, Suite 301 Mooresviiie, NC 281'15
Phone: [phone]t,79.-;:i) Fax: [phone] \ Customer Service: 1-877-523.-6748
Interneit wwwncweriiaijtor
Ar Equal Opportunity \Aftr VE Action Employer 5Cb Recy.creilOO'h. Post Consisrrieli upper
on,
NoriliCarolina
NatiirailY

Ms, Sellers
Page 2
June 23, 2009
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 for the
construction and operation of approximately 265 linear feet of 8-inch gravity sewer and the discharge of
879 gallons per day of domestic wastewater in conformity with 15A NCAC 2T; the Division's Gravity
Sewer Minimum Design Criteria adopted February 12, 1996, as applicable; the Division's Minimum
Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains adopted June 1, 2000,
as applicable; and other supporting data subsequently filed and approved by the Department of
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 Kings
Mountain WWTP (NPDES Permit No. NC0020737) prior to being discharged into the receiving stream.
Assessing subsequent impacts to the downstream collection system and treatment
facility is the complete responsibility of the City of Kings Mountain. Kings Mountain must utilize
whatever tracking tools necessary for planning additions of sewer flow in order to maintain
compliance with the WWTP permitted limits and the collection system permit WQCS00036.
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 1508 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,
for Co en H. Sullins
cc: Mooresville Regional Office, Collection System Permit Files
Christopher Wood, Joel E. Wood & Assoc., PLLC
Surface Water Protection Central Files
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:
1. 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 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 2T .0403. If an individual
permit is not required, the following performance criteria shall be met as provided in 15A NCAC 2T
.0403:
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. Purnp 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.

This permit shall,no 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.
5 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.
Per 15A NCAC 2T .0116, 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 2T; the
Division's Gravity Sewer Design Criteria adopted February 12, 1996 as applicable; the Division's
Minimum Design Criteria for the Fast -Track Permitting of Pump Station and Force Mains adopted
June 1, 2000 as applicable; and other supporting materials may subject the Permittee to an
enforcement action by the Division, in accordance with North Carolina General Statutes §143-
215.6A through §143-215.6C.
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 mil messages or faxed inform Lion is permissible, but shall not be considered as the
irtl verbal report; Overflows and spills occurring outside normal business hours may also be
reported to the Division of Emergency Management at telephone number (800) - or
[phone] Persons reporting any of the above occurrences shall file a spill report by
completing Part 1 of Form CS- O (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 w O (or the most
current Division approved form) can also be completed to show that the SSO was beyond
control,
Per n-rit issued this the 23rd day of June,2009.
NORTH Cr ROLINA ENVIRONMENTAL NTALANAGE
ENT COM ISSliN
rar oleen H. Sullins, Director
Division of Water Quality
By Authority of the EnvironmentalManagement Coma tssion
Number WQ0034147

PermitNo. -WQ0034147
June 23,, 2009
Owner!WQCSWVVTP
Marilyn Sellers, City Manager
City of Kings Mountain
PO Box 429
Kings Mountain, NC 28086
PE
Christopher Wood
Jo& E. Wood & Associates, PLL
PO Box 296
Clover, SC 29745
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 Endineer's 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
Ei Partial 0 Final
, as a duly registered Professional Engineer in the State of North Carolina, having been
authorized to observe (0 periodically, 0 weekly, .0 full time) the construction of David Baptist Church, 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, 15,A NCAC 2T, 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
Engineer's Certification shall be considered a violation of the permit and shall subject the Permittee to appropriate
enforcement actions

JOEL E, WOOD & ASSOCIATES
I'I,ANNINC * ENGINE[ IiINC • MANAGEMENT
PROJECT NARRATIVE
DAVID BAPTIST CHURCH SJ
KINGS MOUNTAIN, NOR
David Baptist Church is located on David Baptist Church Road in Kings
Mounta n, North Carolina. The Church is currently served by a septic tank and
drain field that is beginning to fail. In order to provide a more reliable sewer
service and to protect the environment the City of Kings Mountain will extend an
Ii inch PVC gravity sewer line adjacent to the site. A new 6 inch sewer service
lateral will then be extended to the Church and the existing septic tank will be
abandoned. Ihe sewer extension will consist of 265 linear feet of 8 inch PVC
gravity sewer and 2 new rxaanholes. The utility excavations will be backfilled,
returned to the original line and grade, and re -vegetated. Best Management
Practices will be utilized during in tallation and trenches will be hackfilled, seeded,
and mulched immediately upon completion.

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
Flow Tracking/Acceptance for Sewer Extension Permit Applications
(FTSE -10/07)
Project Applicant Name: City of Kings Mountain
Project Name for which flow is being requested: _David Baptist Church Sewer
More than one F7SE-10/07 ma),., he requiredfir a single project if the owner of the WWTP is not responsible for all
pump stations along the route ofthe proposed wastewater flow
1. Complete this section only if you are the owner of the wastewater treatment plant.
WWTP Facility Name: Pilot Creek Wastewa Faci
b. WWTP Facility Permit #: NC0020737
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
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
All flows are in MGD
6.0
.266
0.0009
2.134
35.6%
11. 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 WWTP
Pump Station Name
N/A
Approx. Capacity, MGD Approx. Current Avg.
(Firm/Design) Daily Flow. .MGD
11 . Certification Statement:
Edg.ar, 0 Murphrey, Jr certify that, to the best of my knowledge, the addition of the ,olume
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 causeany capacity
related sanitary sewer overflows or overburden any downstream pump station en route to the receiving
treatment plant under normal circumstances. 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 for 'which I am the responsible party. Signature of this form indicates
accept a ..ce of this ,astewa iflq
C
<-77„„: •
ig Official 5
Date

USE THE TAB KEY TO MOVE FROM FIELD TO FIELD!
Owner/Pennittee:
1 a. City of Kings Mountain
Application Number:
(to be completed by IDWQ)
Full Legal Name (company, municipality, HOA, utility, etc.)
lb. yarilyn,H. Sellers, Cit Maria
Signing Official Name and Title (Please review 15A NCAC 2T .0 06 (b) for authorized signing officials!)
lc. The legal entity who will own this system is:
0 Individual 0 Federal Municipality 0 State/County Ej Private Partnership 0 Corporation 0 Other (specify):
ld, P.O. Box 429
Mailing Address
if. North Carolina
State
lh. 704-734-0333
Telephone
704-734-4615
Facsimile
2. Project (Facility) Information:
2a, David Baptist Church
Brief Project Name (per
3. Contact Person:
▪ 3a, Dennis Wells
refer to this name)
le, Kings Mountain
City
lg. 28086
Zip Code
1j. marilynsecityofkm.co
E-mail
2b. Cleveland
County Where Project is Located
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b, 704-734-4531
Phone Number
1. Project is P New
z
0
0
LL
ai
0 Modification (of an existing permit)
2. Owner is El Public (skip to Item B(3))
2a. If private, applicant will be:
El Retaining Ownership (Le. store, church, single office, etc.) or
O Leasing units (lots, townhomes, etc. - skip to item B(3))
O Selling units (lots, townhomes, elc - go to Item B(2b))
3. City of Kings Mountain
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
4a, Pilot Creek Wastewater Facility 4b. NC 0020737
Name of V)ANTF VWVTF Permit No,
5a. City of Kings Mountain 5b. Gravity 5c NC 0020737
Owner of Downstream Sewer Receiving Sewer Size 0 Force Main
6. The origin of this wastewater is (check all that apply):
O Residential Subdivision
0 Apartments/Condominiums
El Mobile Home Park
O School
0 Restaurant
O Office
3c. dennisw©cityofkm.com
E-mail
If Modification, Permit No.:
El Private (go to item 2(a))
2b. If sold, facilities owned by a (must choose one)
0 Public Utility (Instruction C)
Ej Homeowner Assoc./Developer (Instruction D)
Permit # of Downstream Sewer (Instruction E)
0 Retail (Stores, shopping centers)
El Institution
0 Hospital
Church
0 Nursing Home
El Other (specify):_
100 % Domestic/Commercial
% Industrial (attach
description.)
(RO: contact your Regional Office
Pretreatment staff)
% Other (specify):
7. Volume of wastewater to be allocated or permitted for this particular project. 879 gallons per day
*Do not include future flows or previously permitted allocations
8. If the permitted flow is zero, indicate why:
0 Pump Station, Outfall or Interceptor Line where flow will be permitted in subsequent permits that connect to this line
• Flow has already been allocated in Permit No,
El Rehabilitation or replacement of existing sewer with no new flow expected (see 15A NCAC 02T .0303 to determine if a
permit is required)

Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2T .0114 for
the value in item B(7) AND/OR the design flow for line or pump station sizing if a reduced or zero flow is being requested in
Item B(7). Values other than that in 15A NCAC 2T .0114 (b) and (c) must be supported with actual water or wastewater use;
data in accordance with 15A NCAC 2T 0114 (t).
293 seats x 3 gallons/day/seat = 879 gallons/day
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches)
8 inch PVC
Length (feet)
New Gravity or Add
Force Main.
265,00 New Gravity
Summary of Pump Stations w/ associated Force Mains to be Permitted (attach additional sheets as necessary)
Pump Station Location ID (self chosen - as shown on plans/map for reference)
Design Flow
(MGD)
Operational Point
GPM TDH
Power Reliability Option
1 permanent generator w/ATS;
2 - portable generator w/MTS
Force Main Size Force Main Length
Pump Station Location ID
Design Flow
(MGD)
Operational Point
GPM @TDH
elf chosen -
Power Reliability Option
1 - permanent generator w1ATS;
2 - portable generator w/MTS
as shown on plans/map for reference
Force Main Size Force Main Len
Pump Station Location ID
Design Flow
(MGD)
elf chosen - as
Operational Point Power Reliability Option
1
GPM @TDH - permanent generator w1A'TS;
2 - portable generator w/MTS
h+cwn on plans/map for reference)
Force Main Size Force Main Length
12. Will the wastewater flow in the proposed sewer lines or pump stations be able to be directed to another treatment facility?
© Yes No if Yes, permit number of 2nd treatment facility
(RO -t if "yes" to B,12 please contact the Central Office PERCS Unit)
13. 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 Chapter 2T as
applicable?
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

14, Have the following permits/certifications been submitted for approval for the system or project to be served?
Wetland/Stream Crossings - General Permit or 401Certification? El Yes 11 No N/A
Sedimentation and Erosion Control Plan? Yes 0 No
Stormwater? [l] Yes 0 No N/A
0 N/A
15. Does this project include any high priority lines, [see 15A NCAC 02T .0402 (2)] involve aerial lines, siphons, or interference
manholes)? These lines will be considered high priority and must be checked once every six months
Check if Yes: 0 and provide details
1.
la.
Owner/Permiftee's Certification: (Signature of Signing Official and Project Name)
1, Marilyn H. Sellers , attest that this application for Daivd Baptist Church 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 143-215,68, 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, ivil penalties up, to $25,000 per violation.
Signing Offida Sgnature
ENGINEERING DESIGN DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMII 1 AL OF THIS
APPLICATION. THESE DOCUMENTS MUST INCLUDE PLAN AND PROFILE OF SEWERS, THEIR PROXIMITY
co TO OTHER UTILITIES, DESIGN CALCULATIONS. ETC. REFER TO 15A NCAC 02T .0305
z
2. Professional Engineer's Certification: (Signature of Design Engineer and Project Name)
1, _Christopher E. Woad attest that this application for David Baptist Church 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 Permitting of Pump
Stations and Force Mains adopted June 1, 2000 and the watershed classification in accordance with Division guidance.
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 NC General Statutes 143-215.6A and 143-215.68, any person who kno
makes any false statement, representation, or certification in any application shall be guilty of a Class 2 misdemeaq
which may include a fine not to exceed $10,000 as well as civil penalties up to $25, 000 per violation.
2a, Christopher E. Wood
Professional Engineer Name
2b. Joel E Wood & Assoc., PLLC
Engineering Firm
2c. P.O. Box 296
Mailing Address
2d. Clover
City
2g. 803-684-3390
2h, 803-628-2891
Telephone Facsimile
2e. SC 2f. 29745
State Zip
2i. [e-mail]
SEAL
028617
E-mail NC PE Sear, Signature & Date
ingly

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DAVID BAPTISTCHURCH, INC.
2300 David i Baptist Church Road
Kings Mountainv PAC 28086
PAY TO THE NODENR
ORDER OF
red Eigetyand 00 ° 00
NCDENR
Perniit
0000 2 I:0S 000 0
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28

P rrriit Ntiniber
00 4147
Para. it Tracking Slip
06/22/09
Program Category
Non -discharge
Permit Tyne:#<
Gravity Sewer Extension, Pump Stations, Pressure Sewer
Extensions
Primary Reviewer
dee.brawder
oa a W Pule
Permute Flow
879
Fsc,lity
Facility Name
David Baptist Church
Location Addre
Own
Owner Name
City of Kings Moun
/ants
n
Orig App Received Dra
06/23/09 06/15/09
Regulated cti rrtie
Chu
colle lined
t utfi
claeduled-
d Issuance
Status
In review
Version
A
Project Type
New Project
Permit Classific on
Individual
Per Contact Affiliation
ly#jttri inch Region
Minor Mooresville
County
Cleveland
Facility Coc t et Affiliation
Owner Type
Non-overnrnent
Owner Affiliation
NrEyn Sellers
PO Box 429
Kings Mountain
NC 280860429
Public Notice issue Effective
06/23/09 06/23/09
Al
Addition
Expiration,
rbody Nam
Strn Index Nur
basin

Permit No. WQ0034147
June 23, 2009
Owner/WQCSNWVTP
Marilyn Sellers, City Manager
City of Kings Mountain
PO Box 429
Kings Mountain, NC 28086
PE
Christopher Wood
Joel E. Wood & Associates, PLL
PO Box 296
Clover, SC 29745
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 Engineer's 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
El Partial 4 Final
I, c 1/4..112.35-1-0? AEe 14002 , as a duly registered Professional Engineer in the State of North Carolina, having been
authorized to observe ( periodically, El weekly, 0 full time) the construction of David Baptist Church, a Cleveland
County project for the ermittee, 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 2T; 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.