WQ0036280_Regional Office Historical File Pre 2018 (2)

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakiid, P. E. Dee Freeman
Governor Director Secretary
City of Belmont
Mr, Barry Webb, City Manager
P 0, Box 431
Belmont, NC 28012-3044
December 2012
Subject: Permit No. WQ0036280
Montcross Seniors
Wastevvater Collection System Extension
Gaston County, North Carolina
Dear Mr, Webb,
In accordance with your application received on ecernber 5, 2012, we are forwarding herewith
Permit No. WQ0036280 dated December 11, 2012, to the City of Belmont 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date of issuance until rescinded and shall be subject to the conditions and limitations as specified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,
Mooresville Regional Office
Location; 6'10 East Center Ave., Suite 301 Mooresville NC 28115
Phone; [phone] Fax: [phone] \ Customer Service 1-877-623-6748
Internet vwvw.ncwaterquatity,Org
An Equal Opportunity Affirmative Action Emptoyer 50% Recycledri10% Post Consumer paper
. one
NorthCaroi ina
,,Vaturally

Mr, VV,bb
Page "2
December 11, 2012
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 Belmont for the construction and operation of approximately 1,181 linear feet of 8-
inch gravity sewer, and the discharge of 17,280 gallons per day of domestic wastewater into the City of
Belmont existing sewerage system pursuant to the application received December 5, 2012 and 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 Belmont
VVVVTP (NPDES No NC0021181) 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 Belmont. The City of Belmont must utilize
whatever tracking tools necessary for planning additions of sewer flow in order to maintain
compliance with the WWTP permitted limits and their collection system permit WQCS00046.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the
right to request an adjudicatory hearing upon written request within 30 days following receipt of this
permit. This request must be in the form of a written petition, conforming to Chapter 150B of North
Carolina General Statutes, and filed with the Office of Administrative Hearings, 6714 Mail Service
Center, Raleigh, NC 27699-6714. Unless such demands are made, this permit shall be final and
binding,
If you need additional information concerning this matter, please contact Samar Bou-Ghazale at
[phone],
f or Charles Wakild, P.E., Director
cc Mooresville Regional Office, Collection System Permit Files
Surface Water Protection Central Files

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH
ASTEWATER COLLECTION SYSTEM EXTENSION PERMIT
This permit shall be effective from the date of issuance until rescinded and shall be subject to the
following specified conditions and limitations:
This permit shall become voidable unless the wastewater collection facilities are constructed in
accordance with the conditions of this permit; 15A NCAC 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 26 0200.
b, A map of the sewer system shall be developed and shall be actively maintained,
c. An operation and maintenance plan shall be developed and implemented.
d. Pump stations that are not connected to a telemetry system shall be inspected every day (Le.
365 days per year). Pump stations that are connected to a telemetry system shall be
inspected at least once per week
e. High -priority sewer lines shall be inspected at least once per every six-month period of time,
f A general observation of the entire sewer system shall be conducted at least once per year.
g. Inspection and maintenance records shall be maintained for a period of at least three years
h. Overflows and bypasses shall be reported to the appropriate Division regional office in
accordance with 15A NCAC 2B ,0506(a), and public notice shall be provided as required by
North Carolina General Statute §143-215.1C.

4 This permit shall nofbe transferable. in the event there is a desire for the wastewater collection-,
facilities to change ownership, or there is a name change of the Permittee, a formal permit request
shall be submitted to the Division accompanied by documentation from the parties involved, and
other supporting materials as may be appropriate. The approval of this request shall be
considered on its merits and may or may not be approved.
Construction of the gravity sewers, pump stations, and force mains shall be scheduled so as not to
interrupt service by the existing utilities nor result in an overflow or bypass discharge of wastewater
to the surface waters of the State,
6, Per 15A NCAC 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.
9. In the event that the wastewater collection facilities fail to perform satisfactorily, including the
creation of nuisance conditions, the Permittee shall take immediate corrective action, including
those as may be required by this Division, such as the construction of additional or replacement
facilities.
10, The issuance of this permit shall not exempt the Permittee from complying with any and all
statutes, rules, regulations, or ordinances that may be imposed by other government agencies
(local, state and federal) which have jurisdiction, including but not limited to applicable river buffer
rules in 15A NCAC 2B .0200, erosion and sedimentation control requirements in 15A NCAC Ch, 4
and under the Division's General Permit NCG010000 and any requirements pertaining to wetlands
under 15A NCAC 2B .0200 and 15A NCAC 2H .0500.
11 Noncompliance Notification:
The Permittee shall verbally report to a Division of Water Quality employee at the Mooresville
Regional Office, telephone number [phone], as soon as possible, but in no case more than
24 hours or on the next working day, following the occurrence or first knowledge of the occurrence
of either of the following:
a. Any process unit failure, due to known or unknown reasons, that renders the facility incapable
of adequate wastewater transport, such as mechanical or electrical failures of pumps, line
blockage or breakage, etc.; or
b Any failure of a pumping station or sewer line resulting in a by-pass directly to receiving waters
without treatment of all or any portion of the influent to such station or facility,

Voice mail messages or faxed information is permissible, but shall not be considered as the
initial verbal report. Overflows and spill§ occurring outsed 'normal business hours may also be
reported to the Division of Emergency Management at telephone number (800) - 36 or
[phone], Persons reporting any of the above occurrences shall file a spill report by
completing Part t of Form-c for 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 ti of Form CS-SSO (or the most
current Division approved form) can also be completed to show that the SSO was beyond
control.
Permit issued this the 'h1t` day of December 2012
NORTH CAROLINA ENVIRONIVENTAL MANAGE ENT COMM
for Charles VVakild, .P,, Director
Division of Water Quality
By Authority of the Environmental ManageManagement Cornrrr scion
SSION
Permit Nay
bee WQ0036280

Fast Track Engineering Certification
Permit No WQ0036280
December 11, 2012
OwnerNVQCS PE
Barry Webb Christopher Isaacs
City of Belmont The Isaacs Group, PC,
PO.Box 431 8720 Red Oak Blvd., Ste 420
Belmont, NC 28012-3044 Charlotte, NC 28217
Complete and s bmit 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 re uired for an chan resultin in non-com fiance with this ermit re ulations 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
L] Partial El Final
, as a duly registered Professional Engineer in the State of North Carolina, having been
authorized to observe (El periodically, Ei weekly, EI full time) the construction of Montcross Seniors Sewer Project, a
Gaston County project for the Permittee, hereby state that, to the best of my abilities, due care and diligence was
used in the observation of the construction such that the construction was observed to be built within substantial
compliance of this permit; 15A NCAC 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.

DSE'TFT TAB KEY TO MOVE FROM FIELD TO FIELD!
Owner/Permittee:
1 a City of 8e!mont
Full Legal Name (company, municipality, HOA, utility, etc.)
Application Number; \I,
(to be completed by DWQ) /
O lb„ Barry Webb — City Manager
Signing Official Name and Title (Please review 5A NCAC 2T .0106 (b
I--
4:( l c The legal entity who will own this system is:
E Ej individual 0 Federal El Municipality Ej State/County 0 Private Partnership 0 Corp
cc
O ld, P.0 Box 431
LL. Mailing Address
Z
z
0
f. North Carolina
State
lh. 704-825-5586
Telephone
704-825-0514
Facsimile
2 Project (Facility) information:
_j 2a. Montcross Seniors
CL
CL
Brief Project Name (permit will refer to this name)
3. Contact Person:
3a. Jerry Hatton, P.E.
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b, 704-557-7505
Phone Number
1, Project is New 0 Modification (of an existing permit)
2 Owner is Public (skip to Item 6(3))
2a, If private, applicant will be:
le, Belmont
or authorized signing officials!)
on Ej Other (specify):
City
lg. 28012-3044
Zip Code
lj [e-mail]
E-mail
2b Gaston
County Where Project is Located
3c. ihatton ofbelmantorg
E-mail
If Modification, Permit No,:
Ej Private (go to Item 2(a))
2b, If sold, facilities owned by a (must choose one)
0 Retaining Ownership (i.e store, church, single office, etc.) or
Ej Leasing units (lots, townhomes, etc. - skip to Item Bp)
Ej Selling units (lots, townhomes, etc - go to Item B(2b))
3, City of Belmont
Cij Public Utility (Instruction C)
0 Homeowner Assoc /Developer (Instruction D)
Z Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
O 4a. City of Belmont 4b, NC0021181
Name of WVVTF WWTF Permit No.
2 5a, City of Belmont 5b. 8 Z Gravity 5c,
Ce Owner of Downstream Sewer Receiving Sewer Size 0 Force Main Permit # of Downstream Sewer (Instruction E)
O 6. The origin of this wastewater is (check all that apply):
LL
th
0 Residential Subdivision
Z Apartments/Condominiums
0 Mobile Home Park
El School
0 Restaurant
0 Office
O Retail (Stores, shopping centers)
El Institution
0 Hospital
0 Church
Ej Nursing Home
O Other (specify):
7. Volume of wastewater to be allocated or permitted for this particular project:
*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
O Flow has already been allocated in Permit No.
0 Rehabilitation or replacement of existing sewer with no new flow expected (see 15A NCAC 02T .0303 to determine if a
permit is required)
100 % Domestic/Commercial
% Industrial (attach
description.)
(RO: contact your Regional Office
Pretreatment staff)
cl/o Other (specify):
17,280 gallons per day
FTA12,107

9. ProVide tine -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 (fy
24 two bedrooms unit = 24 x 2 x 120gpd = 5,760 gpd 48 one bedroom unit = 48 x 240gpd(min,) = 11,520
5,760 gpd + 11,520 gpd = 17,280 gpd
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches) Length (feet)
8 S6i
New Gravity or Additional
Force Main
New Gravity
11 Summary of Pump Stations wl associated Force Mains to be Permitted (attach additional sheets as necessary)
p Pump Station Location ID (self chosen - as shown on plans/map for reference)
Z
I— Design Flow
Operational Point Power Reliability Option (MGD)
GPM @TON 1 - permanent generator MATS; Force Main Size Force Main Length
0 2 - portable generator w/MTS
0
NFORMATION
Pump Station Location ID (self chosen - as shown on plans/map for reference)
Design Flow Power Reliability Option
Operational Point (MGD) GPM @TDH . permanent generator MATS; Force Main Size Force Main Length
2 - portable generator w/MTS
ce Pump Station Location ID (self chosen - as shown on plans/map for reference)
LU
11. Design Flow
Operational Point Power Reliability Option
(MGD) 1 - permanent generator w/ATS; Force Main Size Force Main Length
GPM @TDH
2 - portable generator w/MTS
12. Will the wastewater flow in the proposed sewer lines or pump stations be able to be directed to another treatment facility?
[I] Yes [E1 No If Yes, permit number of 2rid treatment facility
(RO — 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?
(23 Yes L 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
FTA12/07

14. Have the following permits/certifications been submitted for approval for the system or project to be served?
Wetland4,Strearn Crossings - General Permit or 401Certification?
Sedimentation and Erosion Control Plan?
Stormwater?
El Yes Ej No
Z Yes El No
Yes LINo
Z NIA
LI N/A
El 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 hicih Drionty and must be checked once every six months
Check if Yes: LI and provide details
Owner/Permitteets Certification: (Signature of Signing Official and Project Name)
1, Barry Webb „ attest that This application for Montcross Seniors has been reviewed by me and is accurate and
complete to the best of my knowledge. I understand that if all required pads of this application are not completed and
that if all required supporting documentation and attachments are not included, this application package is subject to
being returned as incomplete, Note: In accordance with North Carolina General Statutes 143-215.6A and 143-215.6B,
any person who knowingly makes any false statement, representation, or certification in any application shall be guilty of
a Class 2 misdemeanor, which may include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per
ENGINEERING DESIGN DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMI I I AL OF THIS
APPLICATION, THESE DOCUMENTS MUST INCLUDE PLAN AND PROFILE OF SEWERS, THEIR PROXIMITY
01 TO OTHER UTILITIES, DESIGN CALCULATIONS, ETC. REFER TO 15A NCAC 02T .0305
0
1-- 2. Professional Engineer's Certification, (Signature of Design Engineer and Project Name)
0
1, Christopher N. Isaacs , attest that this application for Montcross Seniors 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 Ciiteria 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
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
I have reviewed this material and have judged it to be consistent with the proposed design. Note: In accordance with NC
General Statutes 143-215,6A and 143-215.6B, any person who knowingly makes any false statement, representation, or
certification in any application shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed $10,000 as
well as civil penalties up to $25, 000 per violation.
2a. Christopher N. lsaacs
Professional Engineer Name
2b The Isaacs Group, P.C.
Engineering Firm
2c. 8720 Red Oak Blvd., Ste. 420
Mailing Address
2d, Charlotte
City
29 704-227-9400 2h
Telephone
2e, NC 2f, 28217
State Zip
704-527-8335 2i. csaacsarpoom
Facsimile E-mail
!tit;
-TA 12/07

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
Flow Tracking/Acceptance for Sewer Extension Permit Applications
(FTSE-1O/O7)
Project Applicant Name: City of Belmont, NC
Project Name for which flow is being requested: Montcross Senior Housing
More than one FTSE-l0/07 may he required„fbr a single project if the owner f`the tt' ':P is not responsible fbr all
pump stations along the route of the proposed wastewater flow
I. Complete this section only if you are the owner of tyre wastewater treatment plant.
a. WWTP Facility Name: City of Belmont WWTP
b. WWTP FacilityPermit #: NC0021181
c. WWTP facility'"s permitted flow
d. Estimated obligated flow not yet tributary to tl
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
WWTP
All flows are in MGD
5.000
0.308
1.280 (2012 Ave.)
0.01728
1.605
32%
1. Com.plete this section for each pump station you are responsible for along the route of this
proposed wastewater flow.
Last pump stations located between the project connection point and the WWTP
Pump Station Name
None
Approx. Capacity, MGD Approx. Current Avg.
(FirmlDesign) Daily Flow, MGD
III, Certification Statement:
I, Barry L. Webb, City Manager, certify that, to the best of my knowledge, 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. 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 Sectioc s 1 and 'II f9s..xw,hich. I am the responsible party. Signature of this form indicates
acceptance of):his ei, tewt
Signing Official S
Date

Name: MT HOLLY
Date: 9/4/2012
Scale: 1 inch equals 2000 feet
Location 035' 15' 20,1" N 081° 01' 54,9" W
Caption; Montcross Senior Site
Belmont, NC
Copyright (C) 1997, Maptech, Inc.

FORM WSCAS-O3/2O12
WATERSHED CLASSIF
FOR SEWER SYSTEMS
'ATION ATTACHMENT
Applicant. Name _
City of Belmont
I Professional Engineer Name
F Christopher N. Isaacs, P.E..
Location
ID
Site
Name of Waterbody' Cou n
Unnamed tributary at
Belmont_
Project Name
Montcross Seniors
Engineering Firm Name
The Isaacs Group, P.C.
River
Basin
Waterbody Stream Waterbody
Index No. Classification
Gaston Catawba 11-123-{1)
4
S-IV
If unnamed, indicate "unnamed tributary to X", where X is the named waterbody to which the unnamed tributary oins.
l certify that as a Registered Professional Engineer in the State of
North Carolina that l have diligently followed the Division's instructions
for classifying waterbodies and that the above classifications are
inclusive of the stated project, complete and correct to the best of my
knowledge and belief
PE Seal, Signature and Date
*** END OFFORM
CAS-03/2012 ***
FORM: WSCAS-0312012
PagelofI

1
LJ
1SAACS
Cf)
ENGINEERtNO DESIGN & LAND SURVEYING
8720 RED ,DAX 3(:)L.ILEVARD, STE. 420
CHA.RIOTTE7, N.G. 28217
PHONE [phone]C1 FAX [phone]
TO NCDENR
—0
610 East Center Ave.
Mooresville, NC 28115
Attn: Dee Browder
WE ARE SENDING YOLU Attached
Shop drawings Ei Prints
El Copy of letter 11 Disk
LETTER OF TRANSMITTAL
DATE: 12/4(20 2 0 NUMBER: 121 13
ATTENTION:
Dee Browder
RE: Montcross Senior Living, Belmont, N.C.
0 Under Separate cover via
Plans
Li
El Applications
the following items:
0 Specifications
COPIES DATE NO
DESCRIPTION
1 12/4/2012 1 Completed Application and 1 Copy of FTA 12/07
1 12/4/2012 1 Compled Original and Copy of FTSE-1O/07
1 12/4/2012 1 Color and 1 copy of USGS Map
1 12/4/2012 1 original and 1 copy of Watershed Classification Attachment
Check for $480
THESE ARE TRANSMITTED as checked below:
Lil For approval
Li For your use
n As requested
For review and comment
REMARKS
LI Approved and submitted
El Approved as noted
Ei Returned for corrections
El Resubmit
LI Submit
LI Return
copies for approval
copies for distribution
corrected prints
Please contact me at 704-227-9400 if any additional infor
COPY TO
ation is required.
SIGNED Christopher Isaacs

Pert
APS
Number 00 280 Perm' Tracking Slip
program
Norodischarge
Permit Type Fast Ira
(Brevity Sewer Extension, Pump Stations, Pressure Sewer
Extensions
Primary Reviewer
sarnar.beu-ghaal
Coastal SW Rule
Permitted FlOW
10
Facility Name
Mintcross SeriMrs
Location Address
Owner
Owner Name
City of Belmont
Dates/Events
Orig issue App Receive
1111i1 12/05/12
Regulated Activities
Apartment complex
Condominium
Wastewater coil ion
Outt NULL
Scheduled
natlated Issuance
Status Project Type
Active New Project
Version Permit Classificatiom
1,00 individual
Fe itContact Affiliation
Region
Mooresville
County
Gaston
Facility ontactAffiliation
Owner Type
Government Municipal:
Owner Affiliation
Barn L, Webb
PO Box 431
Belmont
Pubi Notice Issue
NC
Efiectiwe
1 /11i1 1 /11f12
euestedleeied Events
28 1 20431
Expiration
Additional intoatx i requested
Additional inf rrra a9 on received
Waterbody Name
rdes Number Cirri
met Cla
Subbasin

Fast Track Engineering C
Permit No, WQ0036280
December 11, 2012
OwnerNVQCS/WWTP
Barry Webb
City of Belmont
P.O. Box 431
Belmont, NC 28012-3044
edification
PE
Christopher Isaacs
The Isaacs Group, P.C.
8720 Red Oak Blvd., Ste. 420
Charlotte, NC 28217
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 change resulting in non-compliance with this permit, regulations or
minimum design criteria.
This project shall not be considered complete nor allowed to operate until this Engineers Certification and all
required supporting documentation have been received by the Division. Therefore, it is highly recommended
that this certification be sent In a manner that provides proof of receipt by the Division.
ENGINEER'S CERTIFICATION
E] Partial 4 Final
141005 r4.1-15 Ac5 , as a duly registered Professional Engineer in the State of North Carolina, having been
authorized to observe tJ periodically, Ej weekly, LI full time) the construction of Montcross Seniors Sewer Project, a
Gaston County project for the Permittee, hereby state that, to the best of my abilities, due care and diligence was
used in the observation of the construction such that the construction was observed to be built within substantial
compliance of this permit; 15A NCAC 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:
CAT?
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 systern 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.

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TO NCDENR - Surface Water Protection
610 East Center Ave , Suite 301
Mooresville, NC 28115
LETTER OF TRANSMITTAL
DATE1/30/2014 JOB NUMBER 12113
ATTENTION: Surface Water Protection
RE- Montcross Senior Living, Belmont, N.C.
WE ARE SENDING YOLLI Attached Under Separate cover via
El Plans
El Shop drawings
ED Copy of letter
Pnnts
EI Disk
FA Applications
the following items:
n Specifications
CORES DATE
DESCRIPTION
1/30/2014
1/30/2014
1 Completed FT Certifi
1 Copy of Completed RecordDrawin
on Form for Public Sewer Lire
Approved by City of Belmont
THESE ARE TRANSMITTED as checked below:
For approval
ID For your use
Li A• s requested
F• or review and comment
REMARKS
LI Approved and submitted
0 Approved as noted
0 Returned for corrections
n Resubmit
Li Submit
O Return
copies for approval
copies for distribution
corrected prints
Please contact Bob Spalding at 704-227-9424 if any additional information is required.
COPY TO
SIGNED Christopher Isaacs
14