WQ0037191_Regional Office Historical File Pre 2018

ZIA
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Mr. I3rad Cornwell, Public Utilities Director
City of Shelby
824 West Grover Street
Shelby, NC 28151
Subject:
Dear Mr, Cornwell:
LUC 16,2014
Permit No. WQ00371.91.
Cleveland County Health Department
Wastewater Collection System Extension
Cleveland County
John aria, II
ecretary
In accordance with your complete application received June I I, 2014, we are forwarding herewith Permit
No. WQ0037191, dated June 16, 2014, to City of Shelby for the construction and operation of the subject
wastewater collection system extension. This permit shall he effective from the date of issuance until
rescinded, and shall be subject. to the conditions and limitations as specified therein. This cover letter and
supplement shall be considered a part of this permit and are therefore incorporated therein 'by reference.
Please pay particular attention to the following conditions .contained within this permit:
Condition I:4: Requires that the wastewater collection facilities be properly operated and maintained in
accordance with 15A NCAC 2i: .0403 or any individual system -wide collection system
permit issued to the Pei -mince.
It shall be responsibility of the City of Shelby 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 §14:3-215.6A through §1.4.3-21.5.6C, construction of additional or replacement
wastewater collection facilities, and/or referral of the North Carolina -licensed. Professional Engineer to
the licensing board.
if any parts, requirements, or limitations contained in this permit are unacceptable, you have the right to
request an adjudicatorhearing 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,
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location' 512 N. Saksbury 21 R.aleigh, North Carolina 27604
Phone: [phone](X)(, FAX: [phone]
Internet: ?.F.,ww.¢1tAtraif.rPesotirce5.gm
Opportuntty Affnnalive AcUon Employer

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NCDENR
STA.TF OF NORTH. CAROLINA
I.NVIR()NMI N CA[.. MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATt..IRAI, RESOURCES
WASTEWATER WATER COLLECTION ION SYS'IT.M EXTENSION PERM
in accordance with the provt ions ref Article ? 1 of Chap
amended, and other applicable i ass, Rules, and Regulations.
City of Shelby
Cleveland (.;onnty
h C'a
hereby granted to the
ei
a as
trr:etir: rt a�nt1 operation of appro. itnately 990 linear feet of i.neh gravity sewer to serve the
'ouDepartment, and the discharge of 2�0000 gallons per day of collected domestic
wastewater into the I first I3road River 1\V`\\ TP's existing sewerage system., pursuant to the application
ed May 6, 2014, and in eonfbrmity with 15A .NC AC 2°f; the Division's Gravity Sewer Minimum
.teria adopted February 12, 1996 as applicable; the Division's Minimum Design. Criteria for the
ek 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,
fhis permit shall be effective from the date of iss mice until rescinded and sha
specified conditions and limitations contained therein.
sued this the 16th day of iu.ne, 2014_
s Reeder, i)irector
Division of Water Resources
B Authority of The Environmental ;Management
Permit Number: WQ 003 2191

SUPPLEMENT TO PERMIT COVER SHEET
city of Shelby is hereby authorized t
Construct, and then operate upon certification the aforementioned wastewater collection extension. The
sewage and wastewater collected by, this system shall be treated in the First Broad River Wastewater
Treatment Facility prior to being discharged into the receiving stream.
Permitting of this project does not constitute an acceptance of any part of the project that does not meet
15A. NCAC 2T; the Division of Water Resource's (Division) Gravity Sewer Minimum Design Criteria
adopted February 12, 1996 as applicable; and the Division's Minimum Design Criteria for the Fast -Track
Permitting of Pump Stations and Force Mains adopted June 1, 2000 as applicable, unless specifically
mentioned herein, Division approval is based on acceptance of the certification provided by a North
Carolina -licensed Professional Engineer in the application. It shall be the 'Penriittee's responsibility to
ensure that the as -constructed project meets the appropriate design criteria and rules.
Construction and operation is continent upon compliance with the Standard Conditions and any Special
Conditions identified below,
SPECIAL CONDITIONS
at any time, the additional wastewater flow volume made tributary to this sewer extension is
believed to exceed the value permitted herein, a modification shall be requested for this permit from
the Division of Water Resources to properly allocate the subject wastewater flow„
No flow in excess of the quantity permitted herein, 20,000 GPD, shall be made tributary' to the .subject
sewer system until an application for permit modification for an increase in flow has been. submitted
to and approved by .the Division of Enviromnental Management,
II. 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 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.
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 Resource'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.
3. This permit shall be effective only with respect to the nature and volume of wastes described in the
application and other supporting data,

4
The wastewater collection facilities shall be properly maintained and operated at all times. The
Permittee shall maintain compliance with an individual .systern-wide collection system permit for the
operation and maintenance of these facilities as required by 15A NCAC 2T .0403, If an individual
pen -nit is not required, the following performance criteria shall be met as provided in 1.5.A NCAC 2T
.0403:
a. 'The sewer system shall he effectively maintained and operated at all times to prevent discharge to
land or surface waters, and to prevent any contravention of groundwater standards or surface
water standards.
b. A. map of the sewer system shall be developed and shall be actively maintained_
c. operation and maintenance plan including pump station inspection frequency, preventative
maintenance schedule, spare parts inventory and overflow response has been developed and
implemented.
d. Pu.mp stations that are not connected to a telemetry system shall he 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 -months and inspections are
documented.
A general observation of the entire sewer system shall be conducted at least once per year.
g. Overflows and bypasses shall be reported to the appropriate Division regional office in
accordance with 15A 'NCAC 2B .0506(a)„, and public notice shall he provided as required by
North Carolina General Statute §143-215„1C.
h. A Grease Control Program is in place as follows:
J
For public, owned collection systems, the Grease Controi Programshall 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 collectionsystems, the Grease Control Program shall include at least bi-
annual distribution of grease education materials to users of the collection system by the
pemiittee or its representative,
3, Grease education materials shall be distributed more often than required in Parts (I) and (2
of this Subparagraphif necessary to prevent grease -related sanitary sewer overflows.
Right-of-ways and easements shall he maintained in the full easement Nvidth for personnel and
equipment accessibility.
Documentation shall be kept for ." ibparagraphs (a) through (i) of this Rule for a minimum of
three years with exception of the map, which shall be maintained for the 1ife of the system,

5 Noneompliance Notification:
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 ca.se 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 fad ity
incapable of adequate wastewater transport, such as mechanical or lectrical failures ,of
pumps, line blockage or breakage, etce; or
b. Any SSO and/or spill over 1,000 gallons; or
c. An SSO and/or spill, regardless of volume, that eaches surface water
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 he 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 (S-SSO (or the most current Division approved form) within five days following first
knowledge of the occurrence. This report must outline the actions taken or proposed to be taken to
ensure that the problem does not recur. Part 11 of Form (S-SSO (or the most current Division
approved form.) can also be completed to show that the SSO was beyond control.
6. Construction of the gravity sewers, purnp 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.
'7„ Per I 5A NCAC 2T.011.6, 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 forrn is fully executed and the supporting documents are provided as applicable,
Any 'wastewater flow made tributary. to the ‘vastiewater collection system extension prior to
completionof this Engineer's Certification shall he considered a violation. of the permit and shall
sitbject the Permittee to appropriate enforcement actions.
If the permit is issued to a private entity with an Operational Agreement, then a copy of the
Articles of Incorporation, Declarations/Covenants/Restrictions, and Bylaws that have been
appropriately filed with the applicable County's Register of Deeds office shall be submitted
with the certification,.
A complete certification is one where the form is fully executed and the supporting documents are
provided as applicable, Supporting documentation shall include the following:
a. One copy of the project construction record drawings (plan & profile views of sewer lines &
force mains) of the .wastewater collection system extension. Final record 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 pump station design calculations :selected pumps, system curve,
operating point, buoyancy calculations, available storage if portable generator(s), or storage
greater than longest past three year outage relia.bility option selected) for any pump stations
permitted as part of this project.

c. Changes to the project that do not result in non-complia.nce 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
flow, pump station design ca.pa.city design. increases of 5% or greater, and increases in the
numbertype of connections), regulations, or the Minimum Design Criteria. Requested modifications
or variances to the Minimum Design Criteria will he reviewed on a case -by -case basis and each on its
own merit. Please note that variances to the. Minim.um Design Criteria should be requested and
approved during the permitting process prior to construction. After -construction requests are
discouraged by the Division and may not be approved, thus requiring replacement or repair prior to
certification & activation.
8,. A cop of the construction record drawings shall be maintained on file by the Perrnittee
the wastewater cotlection.facilities
9. 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 Perrnittee to an
enforcement action by the Division, in accordance with North Carolina General Statutes §143-21.5..6A
through §14,3-21.5.6C, construction of additional or .replacement wastewater collection facilities,
and/or referral of the North Carolina -licensed Professional Engineer to the. licensing board,
10. 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.
11, The issuance of this permit shall not exempt the Perrnittee 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 btiffer 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 15,A. NCAC
2B .0200 and 1..5A NCAC 2H. .0,500.

FAST TRACK ENGINEERING CERTIFICATION
Permittee: City of Shelby
Project: Cleveland County Health Department
Permit No. WQ0037127
Issue Date: 06/16/2014
Complete and submit this form to the permit issuing regional office with the following:
• One copy. of the project record drawings (plan ,Sz, profile views and detail drawings of sewer lines) of the wastewater collection
system extension, Final record drawings shouldhe clear on the plans or on digital media (CD or DVL) dik n pdf format.
Record drawings should indicate the design and the marked up changes during construction.
• Supporting design calculations (selected pumps, system curve, operating point, availablestorage 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. Pernaitmodifications
are required for any changes resulting in noncompliance with this permit, regulations or .minimum design criteria..
Modifications should be submitted
'This project shall not be considered complete nor allowed to operate until the Division has received this Engineer's Certification
and all required supporting documentation. Th_. - " con 'Wed be sent in :-
that provides proof of receipt by the Division.
PERMITTEE'S CERTIF !CAT ION
the undersigned agent for the Permittec, 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 Sc maintain the wastewater
collection system permitted herein or portions thereof.
Printed .Name,1 ale
Signature Date
ENGINEER:S. CERTIFICATION
Partial. Ej Final.
1, as a duly registered Professional Engineer in the State of North Carolina, having been
authorized to observe Ej Weekly, [J fuU time) the construction of the subject project for the. Permittee
hereby state that, to the hest of my abilities, due care and diligence was used in the observation of the constructionsuch that
the construction was observedto be built within substantial compliance of this permit; 1 A 'NCAC 02'F; the Division of
Water Resources'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 lune 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:
WATER QUALITY REGIONAL OPERATIONS SUPERVISOR
MOORESVILLE REGIONAL OFFICE
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
t considered a violation of the permit and shall subject the Permittee to appropriate enforcement actions.
Oniy:
1rom this projoci is tributary to:

lippr
USE THE TAB KEY TO MOVE FRO ltlf FIELD TO FIELD
1 Owner/Permitt+ee:
1 a. City of Shelby ...................
Full Legai Name (company, municipality, HOA, utility, etc
lb.. E3rad Cornwell, Public tJtiIrt es Director
Signing Official Name and Title (Please review 15A NCAC 21 0
A. APPLICA
Application Number:
(to be completed by DWR)
sized signing of vials)
lc The legal entity who will own this system is:
P] Individual ❑ Federal [1 Municipality ❑ State/County L0 Private Partnership ❑ Corporation ❑ +
ld. 824 West Grover St 1e Shelby___
Mailing Address City
11 NC lg 28151
State Zip Code
th. 704 669-6575 1i. 704-484 6856 ij brad c nri we Iik "K ttyr45hr thy co
Telephone Facsimile
2, Project (Facility) information:
2a Cleveland County Health Department
Brief Project Name (permit will refer to this name
3. Contact Person;
3a. © Chad Houser, PE, PLS TGS Enrtrrac r t
Name and Affiliation of Someone Who Can Answer Questions About this Application
b 704-476-0003
Phone Number
Project is J New ❑ Modification
ther (specify);
2b. Cleveland
County Where Project is Located
bchouset hotmail corn
E-maid
existing permit) If Modification, Permit No.;
2. Owner is M. Public (skip to Ilea 8(3)) ❑ Private (go to !terry 2(a))
2:a. If private, applicant will be
Ownership (i.e. store, cur single office, etc.) or
(lots, townhomes, eta._ - skip to item 8(3))
ownhories, etc. - go to item B(2b))
3. City of Shell,
0
_... Owner of Wastewatr;r Treatment Facility
• 4a. First Broad River WWTF
5a. City of Shelby tab 5' jn] Gravity
Owner of Downstream Sewer iReceivtng Sewer Size j 1 Force Main
LL
Z 6. The origin of this wastewater is (check all that apply):
2h. if sold, facilities owned by
Name of GWVTF
❑ ,Residential Subdivision
Apartments/Condominiums
❑ Mobile Home Park
❑ School
❑ Restaurant
❑ Office
F) 'Tread
[_] Public Utility (Instruction D)
Homeowner Asscc./Develcpur (Instruction E)
ater From This Project
NC©924538
WNTF Permit No.
Permit fF of Downstream Sewer (Instruction F)
s, shopping centers)
iOQ°% Domestic/Commercial
% Industrial
(Attach Description)
% Other
(Attach Description)
7. Volume of wastewater to be allocated or permitted for this particular project. 17L125 gallons per day
'Do not include future flows or previously permitted allocations
9 r tnsnrutr0
❑ Hospital
❑ Church
❑' Nursing Home
E Other (specify);_
8. if the permute d flow is zero, indicate why:
❑ Purup Station, (Duffel) or interceptor Line where flow will be permitted in subsequent permits that connect to this line
❑ How has already been allocated in Permit No.
U Rehabilitation or replacement of existing sewer with no new flow expected
(see .15A_.NC.AC 07T,0303 to determine if a permit is required)
11A 08-I3 APPLICATION

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 far 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 (f),
205 Employees x 25 gal/employee/shift =5125 gpd; 8 Physicians x 250 galipractifienerishift=2000 gpd;
1 Dentist x250 gal/practitioner/shift = 250 gpd; 4 Public Access Restrooms = 30 toilets x 325 gal/fixture = 9750 gpd
Total Estimated Flow = 20,000 gpd
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches) Length (feet)
8 990
New Gravity or Additional
Force Main
avily
z
ft— 11. Summary of Pump Stations w/ associated Force Mains to be Permitted (attach additional sheets as necessary)
0 Pump Station Location ID; (self chosen - as shown on plans/map for reference)
Longitude: Latitude:
z
0
Design Flow
Operational Point Power Reliability Option
(MGD)
GPM @TOI-1 1 - permanent generator MATS; Force Main Size Force Main Length
2 portable :.•,;t,,l,rierator wIMTS
Cr
0
LL.
Pump Station Location ID:
Longitude: Latitude:
(self chosen - as shown on plans/map for reference)
Design Flow Power Reliability Option
Operational Point
(MGD) GPM @TDH 1 - permanent generator w/ATS; Force Main Size Force Main Length
2 - portable generator wtMTS
12. Will the wastewater flow in the proposed sewer lines or pump stations be able to be directed to another treatment facility?
E] Yes cz No If Yes, permit number of 2r4 treatment facility
(RO — if "yes' to B,12 please contact the Central Office PERCS Unit)
13. Does the sewer system comply with the Minimum Desrgn Criteria for the Perrnittingpt Piinip 51 itiofls,71nd rome 1‘4,1ins
(latest version), the Gravity Sewer Minimum Design Criteria (latest version) and 15A NCAC Chapter 2T as applicable?
Ei 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
FTA 08-13 APPLICATION
Pacte 5 01'6

0
14. Have the following permits/certifications been submitted for approval for the system or project to be served?
Wettand/Streare Crossings - Genera Permit or 401Certification? D Yes No
Sedimentation and Erosion Control Plan?
Trout Buffer Waiver?
Stormwater?
0 Yes 0 No
E] Yes D No
El Yes El No
El N/A
Eli N/A
El N/A
NtA
15. Does this project include any high priority lines 'ClA NCAC 02T „0402 (Z)) involve aerial lines, siphons, or interference
manholes)? These lines will be considered high priority_ and must be chocked once_every sex months
Check if Yes: 0 and provide details:
1. Owner/Permittee's Certification (Signature of Signing Official and Project Name)
/' ":1
attest that this application for
,
has been.
reviewed by me and is accurate and complete to the best of my knowledge, t utiderstand that if all oquired 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 143-275,68, any person who knowingly makes any false statement representation, or
certification in any applicahon 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 $5.000 per violation.
Signing Official Signature
ENGINEERING DESIGN DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL OF THIS
APPLICATION.. THESE DOCUMENTS MUST INCLUDE PLAN AND PROFILE OF SEWERS, THEIR PROXIM[FY
TO OTHER UTILITIES., DESIGN CALCULATIONS, ETC, REFER TO 15.A NCAC 02T .0,305
Professional Engineer's Certification. (Signature of Design Engineer and Project Name)
B, Chad Houser ,attest That this application for City of Shelby 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. Althoughother professionals may have developed certain portions of this submittal package, inclusion of these
materials under my signature and seal signifies that I have reviewed this material and have judged it to be consistent with
the proposed design, Note: In accordance with NC General Statutes 14,37215,JA and 143-215„68, any person who
knowingly makes any false staternent, representation, or certification in any application shall be guilty of a Class 2
misdemeanor which may include a fine not to exceed It 0,000 as well as civil penalties up to $25,000 per violation,
2a„ B. Chad Houser, PE, PLS.
Professional Engineer Name
2b, TGS Engineers
Engineering Firm
2c. 804-C North Lafayelk: St
Mailing Address
2d. Shelby 2e. NC 21 28150
City State Zip
2g, '704-476-0003 2h, 704-476-0024 Z. chouser@tgsengineers,com
Telephone Facsimile E-mail
•
C. 4O
11
No PE SeN40 Shp takire .8t Date
FT,\ 08-13 APPLICATION
Page 6 c -6

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 08-13)
Project Applicant Name: City Of Shelby
eet Name for which flow is being requested: ClevelandCounty tfealth 1)Lpu1ment
More than o7e FTSE may be required for vngle pr, oeet the owinfr (?It ihe 11°W7 Is not responsible fio- 411I pump
sfittbm6 along the botito b/ the ropoeci4%731,c:water lio
Complete this section only i 1.vou are the owner of the wastewater treatment plant.
a. WWTP Facility Nam. i First Broad Wastewater Treatment Plant
b„ WWTP Facility Permit 4: NC0024538
c, WWTP facility's permitted flow
d„ Estimated obligated flow not yet tributary to the WWI
e. WWII' facility's actual avg. flow
1. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent. of permitted flow used.
Allfloiiis are in MGD
6,0
0..580
3„58
4i6
69P
II. Complete this section for each purup station von are responsible for along the route of this
proposed ii:Vastewater flow"
List pump stations locitted between the project connection point and the WWII':
( A ) (IT) (.0 (0)=(13,4:) (F.,:).4A-D)
Design Obligated,
Pump Average .Daliy Appro., Not Yet Total Current
Station Firm Flow** Current Avg. 'Tributary Flow Plus
(Name or Ciapacity,* (Firm I piT Daily How, Daily HOW, Obligated Available
Number) MG.D MGD MGD MGD Flow Capacity*"
* The Firm Capacity of any pump station is defined as the niaxflftUflu pumped flow that
can be achieved with the largest pump taken out of service,
**.Design Average Daily Flow is the firm capacity of the pump station divided by a peaking
factor (p) 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.
Page 1 of 6
FIST 08-13

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analysis has been pert ttoned tat att
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Ind procedures using
ails and
}ponsible party,

Cleveland County Health Departmen
Proposed Building and Sewer Location

Waco Quadrang +e
Light
Holb o r Oak
Proposed Se w er
Cleveland Community Coll

Engineering Report for Sewer Extensions
On The City of Shelby System
Applicant Information:
Engineer:
City Of Shelby
PO Box 207
Shelby, NC 28151
Mr. B. Chad Houser, PE PLS
TGS Engineers
804-C North Lafayette Street
Shelby, NC 28150
Sewer Line Extension
Cleveland County Health Department
General Description
This project includes the construction of approximately 990 linear feet of 8-inch
gravity sewer pipe to serve the proposed Cleveland County Health Department
Building off of NC HWY 180. The majority of the proposed sewer crosses the
property owned by Cleveland County, NC. Only approximately 300 linear feet of
the proposed sewer is not on the subject property and this remainder will be
located in an existing utility easement dedicated to the City of Shelby. The new
sewer line will tie to an existing 8-inch sewer line located at the end of Arbor Way
Drive..
Applicant Information
City Of Shelby
Brad Cornwell, Public Utilities Director
PO Box 207
Shelby, NC 28151
For additional information concerning engineering, please ntac
B. Chad Houser, PE, PLS
TGS Engineers,
804-C North Lafayette St.
Shelby, NC 28150
Ph. [phone]
Fax [phone].
[e-mail]

Holland and Hamrick Architects, P.A.
PO Box 1238
Shelby, NC 28150
Ph: 704-487-8578 Fax: [phone]
LETTER OF TRANSMITTAL
Date:
June 10, 2014
:Job Number:
2221
NC DENR/Div. of Water Resources
322 Chapanoke Road
Raleigh, NC 27603
We are sending you the following items via:
# of Copies
2
'Date
06/10/14
Re:
A New Health Center or Cleveland County
Attn:
Description
Sewer Extension Application
US Mail
Hand Delivered
Application Fee (Check#238767 $480,00)
Transmitted as described below:
Returned
Re ark :
For your use As requested
UPS
FedEx
Picked up
For review/comment
Copy to:
Signed:
Roger L Holland, AIA
If enclosures are not as noted, kindly notify us at once.

ntr t9 Files APPS
Sw
16/2014
Category
Non -discharge
Pursta`st Type
Of
Owr
Owner Name
City of ShWby
rr. Pump Stet ns. resstare
Permit Tracking Slip
Status
AL tiv
Persian
P r ct a
Project Typo
dew Project
Perm'E Clam
ftodifedual
tt
tAffili tcs
Op rret Type
Non-C vwarner
Owner Affiliation
Braid Cornered
824 del Grover St
Shelby
a
rt
Espy n
Mooresville
County
veiand
NC
Orag lseate
641642014
App Received
a=r111d 11
Craft initiated
Scheduled'
Issuance
POE
Reques
Additional
seal sr
t�.tla9{ Ittart.�(
Sews
Effe lve Expirati i
}14 hs"FEs 2t 14
EvetatA
Waderbr dy [Marne.
dax Numbe.
n

tue . Y. .ATu
DATE
PAY TO THE (I) DEF OF
7a- 44 ,41i(R r
` IGNATOR AND EMI CALVE ACTI E;PAPER
238767
PAYMENT isr Ti 'S (T( Z';a:i�
ITT AN Yh P ,[ I$T@r"L'7 it !GT L9spLY MADE, OR f3ONt C}P Nil Y CTi..rl_W' � 4T
l IF;SObal!7 ds t 0 L tL'n E';f?V1. WENT c,41DGFT AP ID IFiw+;;Al s.'t`5t 1"TTtL`5v �a
This Check Void ©gays Atte

Water Resources
ENVIRONMENTAL QUALITY
March 4, 2016
Mr. Rick Howell, City Manager
City of Shelby
824 West Grover Street
Shelby, NC 28151
PAT MCCRORY
Governor
DONALD R. VAN DER VAART
SUBJECT: Final Engineering Certification Acknowledgement
Cleveland County Health Department
Permit No. WQ0037191
Permittee: City of Shelby
County: Cleveland
Dear Mr, Hobe
Secretary
S. JAY ZIMMERMAN'
The Division of Water Resource's Mooresville Regional Office received the final engineering
certification with record drawings for the subject sewer extension project on 03/02/201, 6. Enclosed
is a certification page for your records. A review of the certification materials may or may not
be conducted. It is assumed that receipt of this certification indicates compliance with all
regulations, design criteria and the permit. However, if a full technical review is conducted, you
will be notified of any items of non-compliance.
Please be reminded that the Permittee is responsible for keeping a copy of the final record drawings
for the life of the project. If you have not received such copy from your consultant, please contact
them im:rnediately to obtain a copy.
Lastly, you are receiving this letter because the Division has you listed as the responsible party. If
this permitted system is no longer owned by you or your company, please complete Form PNOCF
e the permit is not automatically transferable. Form PNOCF can be downloaded from
h :l/ ortal.ncdenr.or web/e rsw l s/cs/ rnoc from the Collection Systems Applications page.
Should you have any questions, please do not hesitate to contact rune at [phone].
Sincerely,
Barry Love
Environmental Specialist
cc: Leonard G. Fletcher, P.E., (TGS Engineers, 804-C N. Lafayette St, Shelby, NC 28150)
Central Files
MRO
of North Carolina i l nviroamenta1 ua1 ty; aterResoatoes C ater
nesvalle Regional Office' 610 East Center Aveuue, Suite 301 1 Moores
704 663 1 699
aty Regiorsa1 Operations
, North Carolina 26115

FAST 'MACK ENGINEERING CERTIFICATION
Permittee: City of Shelby Permit m 0 0 R WQ0033Ale
Project: Cleveland County Health Department TSsue Date: 06116r2014
C0111pk:10iI M 1A.1Ieperirni Lmiregional. 'office twAth the ihikrwing:
One coit. of the project record drawings (plan & profile icIA s. and detail drAwings ,;ewer lines; oldie w“stcwat,LT coktction
iy,dient ewtcrPston, Fin.11 record drawing, dlould 1;)0 ckiiiir UE le phins or an digital media i(.J.) or DVD chs;kr pat' l'Ornvii,
Rc.cord ,-;ttonld indicate' thc ;:tesign and the inarked Up changesLCuiaconsirccuon
• Supporpng dc.ingo. calcnhtions ptiinps. :.tystr.nri. curve, onerhing point. availahic itorze ir pt rtable. generaions)
sthrtigc: grearcr than prh4 threc ontagc reliability option selected) ratanpump stations permittedh plio. ihis
project
• 'tiange TO tAti' project ihauld be ,2:far dentified on w drak6t1gN 01" ut writtcn 4:001iTlar rt)11ermtmodificatiolis
are required for 311V ChallgCSresuhin ill nonscompliance VVith this permit, regulations or minimum design criteria,
shottid he subillitted.prior to certification.
Thr, pornectIinot be considered coinplete flat 01101Ved t hlale Wild the haS reeek'ed this Ltigineer's Ceritficatic.)n
And all rcidt.nrcd ,,upl:.torting documentation, Therefore it is highly recommended that thiscertification hesientin a manner
that provides proof' of receipt by the Divisioa.
PERM' " N
I f („„„ in•Okt„ffli,f, __ _ . the 'undersigned agein for the Pennittce. hereby .!qate that this protect has been
1 consiructed initsmiiii to the applicable stamihr6 S...'. requirctucnis% the Prorei:sianal En:4irteer belinN has pro \ kfed applicithle
;. itcsigii cihistruoori information to hi,: Ponnittce, ,and the/Pertnittce t:i PrePar0 Patite & maintain the wa.steNater 1,
'collection .:;:citchh permitted herein or portions thereof:. /
t
,
«1/
Syr, ure Date ,
Printed Name. lane
ENGINEER'S CERTIFICATION
Parual 0 Final
_LEON.'1Rr.) a duty regis,sered !'rofessional Engin.ea in the State or Noah Citrolina: having been
authorized to observe tZpc odi. llv E VCCell. h.111 L1l310 he constriction of the subject priejeci ler the Penninee
hereby mine chat to the best (1" Fry 41)6 tik.S. due care and di ligetice was used in the observation of' the citrichen such that
iliconstrwtion 0.' observed to be built within substantial compliance of this permit, NC.AC 02"1: the 'Division of
Water Resources's. DO. islet)) Gravity Sewer Aliliam)); Design Criteria tidopted February 1.1,, 1996 tis
Division's \linkmen Design Criteria For lite Fastiiirack Permitting, of Pump Stanons and Force Mains adopted June 1
its applicable: ',Ind lii supporting materials.
North Carolina Professional Engineer's
Seal, siguature, and date:
‘‘kklittii
SEND IDES FORM & St PPORIING DO( ( ,NIENTA LION
\ 1111 REQL MED A IT 1,CHMENTS FO THE FOLI OWING ADDRESS:
'41t ATER QUAL' ry REGIONAL OPERATIONS SUPERVISOR
.7sIOORESVII,LE RECilONAL OFFICE
610 EAST CENTER AN ESTE, St TEE 301
:11100RESVII LE, NC 21E3
The Permaiete I. responsible for tracking all partial cerittictuions up omit a final certification is received. .Aityo astewater
(IOW Ma& l(iblataiS (la he o:eat:wilier collection ,systeinextension prior to completion of this Finittiineer's Cern ficatiollShall be I
considered1 vielittion of the permit and shall sUbe. 1 tle Pil`rmiltee 1 tppropriate enforcement aC60,1,S,
t ;sal' hal%
prtaiaa„al laThlakarY tO: