WQ0040163_Regional Office Historical File Pre 2018

W11!3;.3r ReSOCII3L C35
4,,,,,ROwLN r
July 24, 2018
Rickillowell, City Manager.
City of Shelby
824 West Grover Street
Shelby, NC 2815.0
RC '1 COOPER
Governor
MICHA.EL S. REGAN
,5ecretary
LINDA CULPEPPER
Interim Director
Subject,: Penrfit No, WQ0040163
City of Shelby
Gidney Street.
Wastewater Collection System Extension Permit
Cleveland County
Dear .Mr.
In accordance with your application received July19, 2018,.we are forwarding herewith Permit No.
WQ0040163 dated July 24, 2018 to the City of Shelby (Permittee) for the construction and gperation
upon certification of the subject wastewater collection system. extension.. This permit shallbe 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from the date of issuance until rescinded and shall be subject to the conditions and limitations as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
incorporatedtherein by reference.
Please pay particular attention to the following conditions contained within this permit:
Condition This permit shall not he automatically transferable; a request must be made and
approved.
Condition 1L4: 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.
It shall be the responsibility of the Permittee to ensure that the as -constructed project meets the
appropriate design criteria and rules. Failure to comply rnay result in penalties in accordance with North
Carolina General Statute §143-215.6A through § 43-215.6C, construction of additional or replacement
wastewater collection facilities, andfor referral of the North Carolina -licensed Professional Engineer to
the licensing board.
State of-N:(10-th CarOala Envuonmental Quality Reauurees WakeT Quality Regional Operata3na
Slo.oreavii le Regt.onal Office io5 East Center AVerille, Suite 30 MOtinCS'I'111.e. Noah Carcairt:a 1.5
704 663.

If any parts, requirements rae limitations aantainn d in thispermit are unaee ptahle, you have the right to
request an adjudicatory r hearing upon written request within 0 days following receipt f 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 Se ice Center,
Raleigh, N( 76 9-6i'71 , 1 else such demands' are made, this permit shall be final and binding,
need additional
via e-mail at a a
D cuu ign d by;
cone ernin . this matter„ please a onta
? 61FE3 A2D84A3
r
by VVB C oref,, Basinger, Regional Supervise r
Water Duality Regional Operations Section
Division of Water Resources, NCDEQ
David Odom 1'l (1: -copy)
Regional Office Files, P1 R S it
704) 2
21 0
Page of

Ern, frorunenui
Quakty
STATE OF NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENTAL QUALITY
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 Shelby
Cleveland County
for the construction and operation of approximately 650 linear feet of 8-inch public gravity
sewer, to serve four 3-bedroom homes as part of the Gindey Street development project, and the
discharge of 1,440 gallons per day of collected wastewater into the City of Shelby existing
sewerage system, pursuant to the application received July 19, 2018, and in conformity with 15A.
NCAC 2T; the Division's Gravity Sewer Minimum Design Criteria adopted February 1.2, 1996,
as applicable; the Division's Minimum Design Criteria for the Fast -Track Permitting of Pump
Stations and Force Mains adopted June 1. 2000, as applicable; and other supporting data
subsequently filed and approved hy the Department of Environmental Quality and considered a.
part of this permit.
This permit shall be effective front the date of issuance until rescinded and shall be subject to
the specified conditions and limitations contained therein.
rA
' DocuSigned by:
' +41.1.1144/ 11 PZ1444
for
- F 16 FE369A2D84A3,.
by W. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NCDEQ
By authority of the Environmental Management Commission
Permit Number: .WQ0040163
Permit Issued: July 24,2018
Page 3 of 8

SUPPLEMENT TO PERMIT COVER SHEET
City of Shelby is hereby authorized to:
Construct, and then t)perate upon certification the aforementioned wastewater collection extension. The
sewage and 'wastewater collected by this system shall he treated in the City of Shelby First Broad RiverWatewater Treatment Plant in accordance: with Permit Number NC0024538„
Permitting of this project does not constitute an acceptance of any part of the project that does not meet
15,A. 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 Rine 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 he 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
I.) No flow in excess of the quantity permitted herein., 1,440 GPD, shall be made tributary to the
subject sewer system until an application for permit, modification (Or an increase in flow has been
submitted to and approved by the Division. [1,5A NCAC 02T:0304 (b)[„
IL STANDARD CONDITIONS
1, 'This permit is not transferable. In the event there is a desire for the wastewater collection facilities
to change ownership, or there is a name change of the Permittee,a formal permit request shall he
submitted to the Division accompanied by documentation from the parties involved, and other
supporting materials as may he appropriate. The approval of this request shall be considered on its
merits and may or may not be approved. [15A NCAC 02'1,0'104; G.S 143-215.1(d3)i
'['his permit shall become voidable unless the wastewater collection facilities are constructed in
accordance with the conditions of this pertnin 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
021,0110]
3. This permit shall be effective only with respect to the nature and volume of wastes described in the
application and other supporting data. [I5A NCAC 02T .0110]
4. The wastewater collection facilities shall be properly maintained and operated at all nines. 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 .0401 If an individual
permit is not required, the following performance criteria shall be met: [15,A NCAC 02T ,0108(b)]:
Page 4 of 8

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 he 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). Rump stations that are connected to a telemetry system shall be inspected at least
once per week.
e. High -priority sewer lines shall be inspected at least once per every six months and inspections
documented.
f. A general observation. of the entire sewer system shall be conducted at least once per year.
Overflows and bypasses shall be reported to the appropriate Division regional office in
accordance with 15A NCAC 2B .0506(a), and public notice shall he provided as required by
North Carolina General Statute §143,-215.1C.
Li . A Grease Control Program is in place as follows:
1. For public owned collection systems, the Grease Control Program shall include at least.
biannual distribution of educational materials for both commercial and residential users and
the legal means to require grease interceptors at existing establishments. The plan shall also
include legal means for inspections of the grease interceptors, enforcement for violators and
the legal means to control grease entering the system -from other public and private satellite
sewer systems.
2. For privately owned collection systems, the Grease Control Program shall include at least bi-
annual distribution of grease education materials to users of the collection system by the
permittee or its representative.
3. 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 in the .full easement width for personnel and
equipment accessibility,
j. Documentation shall he 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 [phone], as soon as possible, but in no case nore than 24 hours.
following the occurrence or first knowledge of the occurrence of either of the following:
a, Any process unitfailure, 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
h. Any SS() andlor spill over 1,000 galkms; or
c. Any SS() and/or spin, regardless of volume, that reaches surface water
Page 5 of 8

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 fotm) within five days following first
knowledge of the occurrence. 'Ibis report must outline the actions taken or proposed to be taken 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 SS() was beyond control, [G S. 1,43-
215.1C(a1)]
6. Construction of the gravity sewers, puny 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. []5A NCAC 02T,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 providedon the form. A complete certification is one where the form is
fully executed and the supporting documents are provided as applicable. Any wastewater flow made
tributary to the wastewater collection system extension prior to completion of this Engineer's
Certification shall be considereda 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 I.n.corporation. Declarations/Covenants/Restrictions„ and Bylaws that have been
appropriately filed with the applicable Couris 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:
i. One copy of the project construction record drawings (plan & profile views of sewer lines &
force mains) of the wastewater collection system extension. Final record drawings should be
clear on the plans or on digital media (CD or DVD disk) and are defined as the design drawings
that are marked up or annotated with after construction information and show required buffers,
separation distances, material changes, etc.
b. One copy of the supporting applicable design calculations including pipe and pump sizing,
.vel.ocity, pump cycle times, and level control settings, pump station buoyancy, wet well storage,
surge protection, detention time in the wet well, and force main, ability to flush low points in
force mains with a pump cycle, and downstream sewer capacity analysis. If a portable power
source or pump is dedicated to multiple stations, an evaluation of all the pump stationsstorage
capacities and the rotation schedule of the portable power source or pump, include travel
timefrarnes, shall be provided.
Changes to the project that do not result in non-compliance with this permit, regulations, or the
Minimum Design Criteria should be clearly, identified on the record drawings, on the certification
in the space provided, or in .written summary form,.
Prior to Certification (Final or Partial): Permit modifications are required for any changes resulting
in non-compliance with this permit (including pipe length increases of 10% or greater, increased
llow„ pump station design capacity design increases of 5% or greater, and increases in the
number/type of connections), regulations, or the Minimum Design Criteria. Requested modifications
Page 6 of 8

or variances to the Minimum Design Criteria will be reviewed on a case -by -case basis and each on
its own merit Please note that variances to the Minimum Design Criteria should be requested and
approved during the permitti g 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. [15,A NCAC 02T .0116]
8. Gravity sewers installed greater than ten percent 'below the minimum required slope per the Division's
Gravity Sewer Minimum. Design Criteria shall not be acceptable and shall not be certified until
corrected. If there is an unforeseen obstacle in the field where all viable solutions have been
examined, a slope variance can be requested from the Division with firm supporting documentation,
This shall be done through a permit modification with fee. Such variance requests will he evaluated
on a case -by -case basis. Resolution of such request shall be evident prior to completing and
submitting the construction certification. [ I5A NCAC 02T,01050)1
9, A copy of the construction record drawings shall be maintained an file by the Permittee for the life
of the wastewater collection facilities. [15A NCAC 02T .011611
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
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 043-21.5,6A.
through §143-2156C, construction of additional or replacement wastewater collection facilities,
and/or referral of the North Carolina -licensed Professional Engineer to the licensing board. [15A
NCAC 02T .0104; 15A. NCAC 02T ,0108(b-c)]
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 021 .0110; 15A NCAC 021 .0108(b)]
12. The issuance of this permit shall not exempt the Pennittee 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 jurisdiction or obtaining other permits 'which maybe required
by the Division or any other Federal. State, of Local government agencies. [G.S, 143-215.1(b)]
Page 7 of 8

FAST TRACK SEWER ENGINEERING CERTIFICATION
PERMITTEE: CITY OF SHELBY
PERMIT #: WQ0040163
PROJECT: GIDNEY STREET
ISSUE DATE: JULY 24, 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.
PERMIT-IF:CS CERTIFICATION
I, the undersigned agent for the Pemnttee, 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 Engineer in the State of North Carolina,
having been authorized to observe ( periodically, [1:1 weekly, 11 full 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; 1.5A NCAC 02T; the Division of
Water Resources' (Division) Gravity Sewer Minimum Design Criteria adopted February .12, 1996, as
applicable; the Division's Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and
Force 'Mains adopted June 1,. 2000, as applicable; and other supporting materials.
North Carolina .Professional Engineer's Seal w/signature & date:
Final Partial (include description)
Certification Comments/Qualifiers (attach if necessary):
NC DWR — Water Quality Regional Operations Section 610 East Center Avenue, Suite 301, Mooresville, NC 28115
Mooresville Regional Office Phone: [phone] FAX: [phone]

DivUlm of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
ISA NCAC 02T .0300 — VAST TRACK SEWER SYSTEM EXTENSION APPLICATION
IFTA 04-16 & SUPPORTING DOCUMENTATION
ff
Application Number: r qq(-)( k2,3 (to be completed by DWR)
All items must be conipeted ppliesition will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: City of Shelby (company, municipality, MA, utility, etc.)
2. Applicant type: Individual
0 Federal
Ej Corporation 0 General Partnership
0 State/County
0 Privately -Owned Public Utility
Municipal El Other
3. Signature authority's name: per . RECE,IVE.D.N":,DEN-":10wR
Title: City Manager
4. Applicant's mailing address: PO Box 707
City:, State: NC: Zip:28151-
mOOR \,,ELLE RE. tE, W31,4 AL OF:F IC E
5. Applicant's contact .information:
Phone number: (704),484-6840 Email Address: rick.howellgeitvofshel y.corn
II. PROJECT INFORMATION:
1 „Project name: City of Shelby Qidney Street
2, Application/Project status:
Proposed (New Permit) 0 Existing Permit/Project
If a modification, provide the existing permit number: WQOO and issued date:
If new construction but part of a master plan, provide the existing permit number: WQ 0_
3. County where project is located: Cleveland
4, Approximate Coordinates (Decimal Degrees): Latitude: 35,164 ILongitude: 315'
5, Parcel ID (if applicable): 23282
(or Parcel ID to closest downstream sewer)
DI. CONSULTANT INFORMATION:
1, Professional Engineer: David Odom License Number.Z1130
Firm: Odom Engineering,PUC
Mailing address: 169 OakStreet
City: Forest City State: NC Zip: 28043-
Phone number: (828) 24774495 Email Address: davidodomgodomengineering.coln
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
14. 1 Facility Name: .First Br o River Wastewater Trent:pig-it Plant Permit Number: N4_5:31,3
Owner Name: City of Shelby
V. RECEIVING DOWNSTREAM SEWILR NFORMATION (if different than WWTF):
1, Permit Number(s): WQ__ Downstream (Receiving) Sewer Size: inch
"..• "4: WOCS00037
Owner Name(s): Ci
FORM: ETA 04-16 Page 1 of 5

GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Pu
lftlae Applicant is a Developer of lots to be sot
If the Applicant is a
4. Origin of w tewater: (check all that
Residential Owned
0 Residential Leased
Q School / preschool / day care
Q Food and drink facilities
Q Businesses / offices / factories
ifity, has a Certificate of Public Convenience and Necessi
© Yes QNo % 'N/A
I„ has a
❑ Yes QNo ON/A
0 Yes QNa 11N/A.
pply)
Retail (stores, centers, real
Retail with food preparationt'se;
Medical / dental / veterinary .facilitie
Church
Nursing Home
Nature of wastewater : IQ©_% Domestic./Commercial % Commercial
G/ Industrial
Is there a Pretreatment Program in effect?
6Has a ow reduction been approved under
10 If tes,orgvidc a, ppy al,flow reduction approv
7. Summarize wastewater generated by project:
Establishment Type (see 2,?,,,1
Residental
Q Yes Q No
Daily Design Flow'''
120 gal/day/br
gal/
gab
gal/
gab!
gal/
beTn attached?
been attached?
n attached?
© CraWash
Q Hotel and/or Motels
Q Swimming Pool /Clubhouse
© Swimming Pool/Filter Backwash
Q Other (Explain in Attachment)
No
No. of Units
Total
stow
1440 GPD
GPD
GPI?
GPD
GPD
GP["
1440 GPD
a See for caveats to wastewater design Clow rates (Le., minimum flow per
dwelling, proposed unknown non-residential development uses; public access facilities located near high public use areas;
and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in)
b Per 15A NCAC 021 .0114(c), design flow rates for establishments trot identified [in table shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured d
Wastewater generated by project: 1440 GPD (per
Do not include future flows or previously permi
If permitted flow is zero, indicate why:
0 Pump Station or Gravity Sewer where flow will 1
Q Flow has already been allocated in Permit Number:
Q Rehabilitation or replacement of ex
Q Other (Explain):
d allocations
permitted i
ubsequent permits that connect to this line
ting sewer with no new flow expected
FORM: FTA 04-16
Page 2 of 5

VIL GRAVITY SEWER DESIGN CRITERIA (If Appliusble) &
1, Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 650
SDR-2I PVC
): Section II & III of the MDC for Permitting of Gravity Sewers contains infomiation related to design criteria
• Section III contains information related to minimum slopes for gravity sewer(s)
• Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
PUMP STATION DESIGN CRITERIA (1,1Applicable), &
ETE FO E CII U P T ON I PRO E
1, Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude:
3. Design tlow of the pump station: millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): gallons per minute at feet total dynamic head (MU)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
6. Power reliability in accordance with
El Standby power source or pump with automatic activation and telemetry - 15,A NCAC 02T .0305(hXIXB)
/0 Required for ail 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:
0 Portable power source with manual activation, quick -connection receptacle and telemetry 1 A NCAC 02T
.0305(h)( 1 XC)
or
E] Portable pumping unit with plu ed emergency pump connection and telemetry - 15A NCAC 02T .0305(h)(1)(C):
>. It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant (draft agreement)
and is compatible with the station,
ifthe portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel tirneframes, shall be provided
in the case of a multiple station power outage.
FORM.: PTA 4-16 Page 3 of 5

1X., SETBACKS & SEPARATIONS — (0211.0200 & 1.5A NCAC 02T .030
1. Does the project comply with all separations found in
• 15.A NCAC 021.0305(1) cotaains minimum separations that shall be provided for sewer sstems:
Setback Parameter* Separation Required
Storm sewers and other utilities not listed below (vertical) 24 inches
Water mains (vertical -water over sewer includintin. benched trenches) 18 inches
Water maina(horizontal) 10 feet
Reclaimed water lines (vertical reclaimed over sewer) 18 inches
Reclaimed water lines thorizontal - reclaimed over sewer 2 feet
**Any private or public water supply source, including any wells, WS-I waters of Class for
Class 11 impounded reservoirs used as a SOUree of drinking water
*Waters classified WS (except WS-1 or WS-V), B, SA, ORW, HQW, or SB from normal
high water (or tide elevation) and wetlands (see item IX.2) 50 feet
*Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches
Any building foundation
Any basement
Top slope ofembankment or cutscutsof2 feet or more vertieda height
100 feet
10 feet
5 feet
10 feet
10 feet
Drainage systems and interceptor drains 5 feet
Any swimmiwools 10feet
Final earthgraele (verticall 36 inches
contains alternatives where separations in cannot be achieved.
IA- **Stream classifications can be identified using the Division's
• linoneompliance with sec Section X of this application
Yes
2. Does the project comply with separation requirements for wetlands? (50 feet of separsition) Li Yes No
/A. See the Division's draft separation requirements for situations where separation cannot be meet
)0 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
)0. This would include Trout Buffered Streams per
No
N/A
DYesDNo N/A
4. Does the project require coverage/authorization under a 404 Nationwide or 0 Yes
individual permits or 401 Water Quality Certifications?
TA Information can be obtained from the
5. Does project comply with (additional permits/certifications)? 4 Yes U No
Per , directly related environmental permits or certification plications 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, stormwater management plans, etc.).
6. Does this project include any sewer collection lines that are deemed "high -priority?"
Per , "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to trearnbanks th t is subject to erosion that undermines or deteriorates the sewer.
0 Yes 0 No N/A
./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 15A NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit.
FORM: FTA 04-16
'Page 4 of 5

C.ERTIFIC :AT DNS:
n Does the submitted system comply with
and the
If No, complete and submit the Vari
review. Atatat"atvat of ti a re twee t is
Professional Engineer's Certification:
as applicable?
Yes ©No
ive Design Request application (VADC 10-14) anti supporting documents for
aaa to aabraaittul of the Fast "Track Application and supporttlttr docituverrts.
David W. Odom. P.E.
nal Enginee
arne from Application 1
attest that this application for
has been reviewed by me and is accurate, complete and consistent with the in nation supplied in. the plans, specifications,
engineering 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 (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 mat and
have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 1.43-215.6A and 143-215,.68, 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,
North Carolina Professional Engineer's seal, signature, and date:
Applicant's Certificatio per 15A NCAC 02T 0106(b):
Rick Nowell, C:aty Manager
(Signature Authority's name & title from Applicatio
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. I 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, I will make no claim against the Division of Water Resources should a condition
of this permit be violated. t also understand that 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 and > 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 $10,00.0 as well as civil penalties up to $25,000 per violation,
Signature,
Date:
FORM: ETA 04-16
Page 5 of 5

Tuvia, Ori A
From:
Sent:
To:
Subject:
David Odom <[e-mail]>
Tuesday, July 24, 2018 1:24 PM
Tuvia, Ori A
[External] Gidney Street Sewer Application Capacity - City of Shelby
Ono
ee f
achmen
Ori
Just to confirm the application is for four 3BR homes which results in the 12 bedrooms, Let me know if you need
anything else.
Dave

lyr partrnent of
IAivis;
if North rolina
rrnmental Quality
of Water Resources
acking/Aceeptancc for Sewer Extension Applications
(FTSE 04-16)
ntity Requesting Allocation City of Shelby
Project Name for which flow is being requested: Habitat - Ciidne v Street
me F"'ISL may be required for a single project r `the owner (.f'the lV "'"TP is plot responsible for all pump
route oaf than proposed 'w wastewater lok
1.
°c rnplate this section only if you are the owner of the wastewater ar ent plant.
a. WWTP Facility Name: First Broad 'WWTP
b. WWTP Facility Perrnit WC"0024538
c. W WF1"P facility's pet -nil tt d flow°
d. Estimated obligated flow not yet tributary to the, ''TP 4.60
are in MGD
e„ 'WWTP facility's actual avg. flow
f: 'fowl flow for this specific request
g. "Total actual and obligated flows to the facility
h. Percent of permitted flow used
0.00144
3,780
62.99% . .
Complete ttlis section for eaa ;h pump station you are responsible for along the route of this.
proposed 1,vastewater flow,
fist pump stations located between tite project eunnectic-rn point and the W ^FI P:
(A) (tt') (C) +C) C)-(A-D)
Design Obligated,
Pump Average Daily Approx, Not Yet l°c tal Current
Station FirmFlow** Current Avg, Tributary Flow Plus
aName or Capacity, * Firm f pi), Daily Flow, ]Daily Flow, t:l li ated Available
Number) MGD MGD MELD MUID How Capacity***
* The Firm Capacity of any pump static rr is defined pas the
can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking
factor (pi) not less than 2.5.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < O.
Downstre.am Facility Name (Sewe
Downstream Permit Number:
pumper
Page 1 of 6

Certification Statement:
I Rick Howell, City Manager 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 overflows or overburden any downstream pump station
en route to the receiving treatment plant under normal circumstances, given the implementation of
the planned improvements identified in the planning assessment where applicable. This analysis
has been performed in accordance with local established policies and procedures using the best
available data. This certification applies to those items listed above in Sections I and II plus all
attached planning assessment addendums for which I am the responsible party. Signature of this
form indicateacceptance of this wastewater flow.
Signing
Page2of6

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July 1 , 2018
Wes Bell
Mooresville Regional t ffic
Water Quality Section
610E. Center Avenue
Mooresville, NC 115
Subject: Fast Track Sewer System Extension Application
Gidney Street, City of Shelby, Cleveland County
Dear Mr.
169 Oak Street Forest City, ILK 28043
We are submitting a Fast Track Sewer System Extension Application for Gidney Street Project located in
Cleveland County, This submittal includes the following items:
Signed Fast Track Sewer Application (ETA 04-16)
Check for application fee _ 4 0. 0
Signed Flow Tracking/Acceptance Fora FTSE 04 6)
USGS Topographic Map
If you have any questions or need additional information, tlease contact me at 28 24 -44 5 or
1ciavidgclom(03000mengineexin Rc rn,
Sincerely,
David Odom P.E.