WQ0036989_Regional Office Historical File Pre 2018

° ~~
NCDENR
North Carolina Department ofEnvironment and N8hnF@| ApuOU[C8S
Division OfWater R8S8urC83
Water Quality Programs
Pat McCrory Thomas A. Reeder
GOV8Dlo[ Director
March 6,Z0I4
Danny Jackson, City Manager
City ofMount Holly
4O8East Central Avenue, 2''~Floor
Mount Holly, N[2812O
Subject: Permit No. VV[K)Q96q89
{anoK8nntHealth-Freestanding Emergency Department
Wastewater Collection System Extension
Gaston County
Dear Mr, Jackson:
j0hOE. Skvarla, iU
Secretary
In accordance with your application received on February 28, 2014, we are forwarding herewith to
Permit No. VVQ0036989, dated March 6, 2014, to the City ofMount Holly for the construction and
operation ofthe subject wastewater collection system extension, This permit shall heeffective 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date of issuance until rescinded, and shall be subject to the conditions and limitations as specified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:
Condkion|i4L
Requires that the wastewater collection facilities beproperly operated and maintained
in accordance with 15A NCAC 2T.0403 or any individual system -wide collection system
permit issued tothe Permi1tee.
it shall be responsibility of the City of Mount Holly to ensure that the as -constructed project meetsthe
appropriate design criteria and rules. Failure 0ocomply may result inpenalties inaccordance with North
Carolina General Statute §143-215.6Athnough §143'215.6[, 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 adjudicatory hearing upon written request within 30 days following receipt of this permit,
This request must be in the form of written petition, conforming to Chapter 150B of North Carolina
General Statutes, and filed with the Office of Administrative Hearings, 6714 Mail Service Center, Raleigh,
NCZ7699'O714. Unless such demands are made, this permit shall befinal and binding.
Regionai Office
Locatiomie1UEast Comorm*`Suite o01 Mooresville, NC 28115
Phone: (704)60J-1699\Fax (J4)008-6V40\Customer Service: 1-877-623-6748
Internet: w^w,ncwmmq^n1iirorg

City of Mounty Holly
WQ0036989
If you need additional information concerning this matter, please contact u atha Na ulapally at 704)
663-1699 or via e-mail at ujatha.Na ulapallyi ncdenr. o .
for Thomas A. Reeder
Division of Water Resources
by Michael Parker
Regional Supervisor
Water Quality Regional Operations Section
Mooresville Regional Office
Cc. Mooresville Regional Office
Mark R. McAuley, P.E., Cole Jenes &Stone, P.A. (e-copy)
Water Resources Central Files
PERCS

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STATE OFNORTH CAROUNA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OFENVIRONMENT AND NATURAL RESOURCES
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 mfMount Hmdly
Gaston County
for the construction and operation of approximately 524 linear feet of8'inch gravity sewer to serve the
[ammK4ontHealth — Freestanding Emergency Department, project and the discharge of0gallons per day
of collected dnmcstic/connnmerCia| wastewater into the City of Mount Holly Wastewater Treatment
' ant to the application received February Z8, 2014and in
Facility existing sewerage sy�tcnn' pursuant ,
conformity with 15AN[4C2T; the Division's Gravity Sewer Minimum 0eoU8n Criteria adopted February
121996 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 bythe Dnpartnnen o � fEnvironment and Natural Resources and considered a part of
this permit.
This permitshall be effective from the date of issuance until rescinded and shall be subject to the
specified conditions and limitations contained therein.
Permit issued this 6' day ofMarch, 2Q14.
{
�
for Thomas A,Reeder
Division ofWater Resources
Permit Number: WQ0036989
'

SUPPLEMENT T� �����U�� ��� ������
_ PERMIT ~,=°�~~"v .��vv~^~v
City of mount Holly is hereby authorized to.
Construct, and then operate upon certification the aforementioned wastewater collection extension,
The sewage and wastewater collected by this system shall be treated in the City of Mount Holly
VVastrwaterTreatment FaciNy(N[00ZI156)prior tnbeing discharged into the receiving stream,
/y
Permitting of 'this p '�c� does not constitute ../ an acceptance of any part of the project that does not
meet 15A N[A[ZT; the Division's Gravity Sewer Minimum Design Criteria adopted February I2I986as
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. Divisionapprova/ is based on acceptance mfthe certification provided by North [ero|hna'|/censed Professional
Engineer the application. It shall be the p*nnh�oe^s responsibility 0oensure that �heas-constructed
project meets the appropriate design criteria and rules.
Construction and operation is contingent upon Compliance with the Standard Conditions,
I. SPECIAL CONDITIONS
I. if, at any time, the additional wastewater flow volume made tributary tothis sewer extension is believed to
exceed the value permitted herein' a modification shall be requested for this permit from the D|wo|m f
VVaterResuu�extmproperly aUmcatethe su�ectwastewater Mnw/ no
2. No flow in excess of the quantity permitted herein, 0 GPD, shall be made tributary to the subject sewer system
until anapplication for permit modification for anincrease inflow has been submitted toand approvedb th
DowsionofV�aterResources, � e
11.ST&N0ARD CONDITIONS
l, This permit isnot transferable. |nthe event there isades�,efor the wastewater collection facilities zoch
ownership, or there is x name change o/ the Pe/m|�e� o fnmna| permit request shall be submitted to the
ed change
Division accompanied by documentation from the parties involved, and other supporting materials may be
as
appropriate. The approval o/this request shaUbeconsidered onits mnpri,sand may o/nnaynot heapproved.
'
2. This permit shall become voidable unless the wastewater collection facilities are constructed in accordance
with the conditions of this permit; 154 N[AC Z-� the Division's Gravity Seer Minimum Design Criteria
adopted February 12, I996asapplicable; the Division's Minimum Design Criteria for the Fast-Tracki
Of Pump Stations and Force Mains adopted June I, 2000 as applicable; and othersuppordn�materials
Permitting
sPeu�caUymentioned herein,
' /a/s unless
3. This permit shall be effective only with respect to the nature and volume of wastes described |n the
application and other supporting data,

~
4. The wastewater collection facilities shall beproperly maintained and operated at all times. The Pe/mioee
shall maintain compliance with an individual system -wide collection system permit for the operation and
maintenance of these facilities as required by lSA N[AC 2T �0403, If an individual permit is not required, the
following performance criteria shall bemet asprovided in1SAN[ACZT0403:
a. The sewer system shall beeffectively maintained and operated atall times toprevent discharge toland u/
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 An operation and maintenance plan including pump station inspection fnequrncy, preventative
maintenance schedule, spare parts inventory and overflow response has been developed and
implemented.
d, Pump stations that are not connected to etelemoetry system shall be inspected every day (i.e, 365 days
per year). Pump stations that are connected to otelemetry system shall he inspected atleast once per
week.
e. High -priority sewer Unp« shall be inspected at least once per every six'mo�nths and inspections are
documented,
A general observation of the entire sewer systern shall be conducted at least once per year.
�. Overflows and bypasses shall be reported tothe appropriate Division regional office in accordance with
16A NCAC 28 .0606<a\ and public notice shall be provided as required by North Carolina General Statute
§143-ZI5J[
h. A Grease Control Program is in place as follows�
L For public owned collection systems, the Grease Control Program shall include a, least biannual
distribution of educational materials for both commercial and residential users and the legal means to
require grease interceptors at existing estab|ishments. 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,
3. For privately owned collection systems, the Grease Control Program shall include at least bi-annual
distribution of grease education materials to users ofthe collection system by the permittee or its
representative,
3. Grease education materials shall be distributed more often than required in Ports (1) and (2) of this
Subparagraph if necessary to prevent grease -related sanitary sewer overflows,
Right-of-ways and easements shall bwmaintained inthe full easement width for personnel and equipment
accessibility,
Documentation shall be kept for Subparagraphs (a) through (V 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, Noncom 'once Notification:
The Permittee shall report by telephone to a water resources staff member at the Mooresville Regional Office,
telephone number 704 663 -1699, 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 ar unknown reasons, that renders the facility incapable of
adequate wastewater transport, such as mechanical or electrical failures of pumps, line blockage or
breakage, etc.; ar
b. Any SSO and/or spill over 1,000 gallons; or
c. Any SSO and/or spill, regardless of volume, that reaches 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 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 I of Form CS-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 II of Form
CS-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, 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,
7. 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. 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.
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 i5 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 reliability option selected) for any pump stations permitted as part of this project.

c Changes tothe project that dpnot result innon-compliance with this permit, regulations, orthe 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 lO% or greater, increased flow, pump station
design capacity design increases of 5% or greater' and increases in the number/type of connectionsL
regulations, or the Minimum Design Criteria, Requested modifications orvariances to the Minimum Design
Criteria will be reviewed on a case -by -case basis and each on its own mehc Please note that variances to the
K1ininnunn 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 beapproved, thus
requiring replacement nrrepair prior tncertification &activation.
8, A copy of the construction record drawings diaO be maintained on 0e by the Permittee for the life of the
wastewater collection facilities,
9, Failure $zabide bythe conditions and limitations contained |nthis permit; l5A N[AC2T;the Division's Gravity
Sewer Design Criteria adopted February 13,199basapplicable; the Division's Minimum Design Criteria for the
Fast -Track Permitting of Pump Station and Force [mains adopted June I, 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 043-215.6Ath/nugh y143-215.6[' 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 tpU to perform satisfactorily, including the creation of
nuisance conditions, the Permittee shall take immediate corrective action, including those asmay berequired
bythis Division, such as the construction ufadditional orreplacement facilities,
11. The issuance ofthis permit shall not exempt the Permittee from ommp�y|mg 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 NCA[ ZB 0200' erosion and
sedimentation control requirements in 15A NCA[[h 4and under the Division's General PermitN[G010OQO.
and any reqmirementspertaining twwetlands under 15A N[4[2B.0ZQ0and l5ANCAC 2H.0500.

FAST TRACK ENGINEERING CER I1FICATION
Permittee: City of Mount Holly Permit No. WQ0036989
Project: CaroMont Health — Freestanding Emergency Department Issue Date: 3/0612014
Complete and submit this form to the permit issuing regional office with the following:
• One copy of the project record drawings (plan & profile views and detail drawings of sewer lines) of the wastewater
collection system extension. Final record drawings should be clear on the plans or on digital media (CO or DVD
disk) in pdf format, Record drawings should indicate the design and the marked up changes during construction,
• 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, Perm41
modifications are required for any changes resulting in non-compliance with this permit, regulations or
minimum design criteria. Modifications should be submitted prior to certification.
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, Therefore, it is highly recommended that this certification
be sent in a manner that provides_proof of receipt by the Division.
PERMITTEE'S CERTIFICATION
the undersigned agent for the Permittee, 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
0 Partial 111 Final
as a duly registered Professional Engineer in the State of North Carolina,
having been authorized to observe periodically, 0 weekly, 0 full time) the construction of the subject 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 02T; 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 arid 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
DIVISION OF WATER RESOURCES
WATER QUALITY REGIONAL OPERATIONS SECTION
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 considered a violation of the permit and shall subject the Permittee to appropriate
enforcement actions.
DWR Use Oruire
Flow from this project is uilititary

USE THE TAB KEY TO MOVE FROM FIELD TO FIELD
f. Owner/Permittee:
la. City of Mount Holly
Full Legal Name (company, municipality, HOA, utility, etc)
Application Number:
(to be completed by DWR)
-'61s71S1
O lb. Danny Jackson, City Manager
Signing Official Name and Title (Please review 15A NCAC 2T 0186 (b) for authorized signing officials)
re
z
2
0
4:(
(.)
D.
O.
lc. The legal entity who will own this system is:
[1] Individual 0 Federal Municipality 0 State/County 0 Private Partnership 0 Corporation Other (speci
ld 400 East Central Avenue, 2ncl Floor
Mailing Address
if North Carolina
State,
1 h. 704-827-3931
Telephone
N/A
Facsimile
2. Project (Facility) Information:
2a CaroMont Health - Freestanding Emergency Dtpar
Brief Project Name (permit will refer to this name)
3. Contact Person:
3a. Mark R McAuley - Project Manager
men
le. Mount Holly
City
lg, 28120
Zip Code
1j. [e-mail]
E-mail
2b. Gaston
County Wher
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. 704-971-4533 i:: 3c. mmcaule
Phone Number E-mail
1. Project is El New 0 Modification (of an existing permit) If Modification, Permit No.:
Project is Located
coleieneststonecom
2. Owner is 4 Public (skip to Item B(3))
1111 Private (go to item 2(a))
2a, If private, applicant will be:
0 Retaining Ownership (i.e. store, church, single office, etc) or
D Leasing units (lots, townhomes, etc. - skip to item 8(3))
0 Selling units (lots, townhomes, etc. - go to Item B(2b))
2b. If sold facilities owned by a (must choose one)
0 Public Utility (Instruction D)
LI Homeowner Assoc /Developer (Instruction E)
2 3. City of Mount Holly
O Owner of Wastewater Treatment Facility (VVVVIT) Treating Wastewater From This Project
/7 4a. City of Mount HollyWastewater Treatement Plant 4b, NC0021156
2
X 5b. 8" Gravity
(Public)
O 5a City of Mount Holly 0 Force Main 5c
U. Owner of Downstream Sewer Receiving Sewer Size
Z 6. The origin of this wastewater is (check all that apply):
ni
D Residential Subdivision
D Apartments/Condominiums
0 Mobile Home Park
0 School
Li Restaurant
0 Office.
Name of VVWTF VWVTF Permit No.
NCCS00059
Permit # of Downstream Sewer
LI Retail (Stores, shopping centers)
O Institution
0 Hospital
O Church
Li Nursing Home
pli Other (specify).
(Instruction F)
% Domestic/Commercial
% Industrial
(Attach Description)
1)/0 Other
(Attach Description)
7. Volume of wastewater to be allocated or permitted for this particular project 0 gallons per day
*Do not include future flows or previously permitted allocations
8. If the permitted flow is zero, indicate why:
D Pump Station, Outfall or Interceptor Line where flow will be permitted in subsequent permits that connect to this line
LI Flow has already been allocated in Permit No.
Rehabilitation or replacement of existing sewer with no new flow expected
(see 15A NCAC 02T ,0303 to determine if a permit is required)
ETA 08-13 APPLICATION
Page 14 6

Provide the wastewater flow calculations used in determining the permitted flow in accordance with A NCAC 7T .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 (f),
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches)
8
Length (feet)
524
New Gravity or Additional
Force Main
Relocated Gravity
z
11 Summary of Pump Stations wt associated Force Mains to be Permitted (attach additional sheets as necessary)
Z
© Pump Station Location ID: NIA (self chosen - as shown on plans/map for reference)
V
z
0
Longitude: N/A Latitude: NIA
Design Flow Operational Point Power Reliability Option
(MGD) GPM @TDH 1 -permanent generator wIATS; Force Main Size Force Main Length
2 - portable generator w/MTS
O N/A N/A N/A N/A N/A
LL
Pump Station Location ID: N/A (self chosen - as shown on planslmap for reference)
2 Longitude: N/A Latitude: N/A
CZ
Ill
CL Design Flow Power Reliability Option
(MGD) Operational Point 1 _ permanent generator wIATS; Force Main Size Force Main Length
CO GPM @TDH 2 - portable generator wIMTS
N/A
N/A N/A N/A N/A
12. Will the waste
e
low in the proposed sewer lines or pump stations be able to be directed to another treatment facility?
[) Yes ® No If Yes, permit number of 2nd treatment facility
(RO — if "yes" to 8 12 please contact the Central Office PERCS Unit)
13. Does the sewer system comply with the Minimum Design Criteria for the Permitting of Pump Stations and F,©ice Mavins
(latest version), the Gravitv_Sewer Minirnum_rpesign Criteria (latest version) and 15A NC,AC_Chapter2T as applicable?
' Yes 1111 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 APPIIICA::ION Page 4 of6

14. Have the following permits/certifications been submitted for approval for the system or project to be served?
VVetland/Stream Crossings - General Permit or 401Certification? El Yes Li No
Sedimentation and Erosion Control Plan? Xi Yes No
Trout Buffer Waiver? 0 Yes 0 No
Stormwater? Yes 0 No
15 Does this project include any high priority lines (15A NCAC 02T .0402 (2)) involve aerial lines, siphons, or interference
ma nholes)? These lines will be considered hie) priority and must be checke(1 once every six months
bheck if Yes: D and provide details
:1 Owner/Permiltee's Certification, (Signature of Signing Official and Project Name)
N/A
0 N/A
N/A
0 N/A
1, Danny Jackson, attest that this application for City of Mounty Holly has been reviewed by me and is accurate and
complete to the best of my knowledge! understand that if all required parts of this application are not completed and that
if all required supporting documentation and attachments are not included, this application package is subject to being
returned' as incomplete* Note: In accordance with North Carolina General Statutes 143-215,6A and 143-215,5p, any
person who knowingly makes any false statement, representation, or certification in any application shall be guilty of a
C/a 2 misdemeanor, fah rrjay ir4ude a fine not to exceed $10,000 as well as civil penalties up to $25,000 per
vio
Signing Offici
- a
Date
ENGINEE ING DESIGN DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL OF THIS
APPLICATION. THESE DOCUMENTS MUST INCLUDE PLAN AND PROFILE OF SEWERS, THEIR PROXIMITY
TO OTHER UTILITIES, DESIGN CALCULATIONS, ETC, REFER TO 15A NCAC 02T .0305
. Professional Engineer's Certific.ation: (Signature of Design Engineer and Project Name)
1, Mark. R. McAuley , attest that this application for The City of Mount ,Holly 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, 1 further attest that to the best of my knowledge the proposed design has
been prepared in accordance with the applicable regulations, Gravity Sewer Minimum Design Criteria for Gravity Sewers
adopted February 12, 1996, and the Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force
Mains adopted June 1, 2000 and the watershed classification in accordance with Division guidance. Although other
professionals may have developed certain portions of this submittal package, inclusion of These materials under my
signature and seal signifies that 1 have reviewed this material and have judged it to be consistent with the proposed
design. Note: In accordance with NC General Statutes 143-215,5A and 143-215.58 any person who knowingly makes
any false statement, representation, or certification in any applcation 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, Mark R. McAuley
Professional Engineer Name
a). ColeJenest & Stone, P.A.
Engineering Firm
2c. 200 South Tryon Street, Suite 1400
Mailing Address
2d. Charlotte 2e NC 2f. 28202
City State : Zip
2g 704-971-4533 2h, 704-376-7851
Telephone Facsimile mmcauley@coleieneststone co
l
FTA 08-13 APPLICATION
Page 5 of 6
NC PE Seal, Si nature a Date

arortacnt Mount holly ELF
cdo Cloelenest & Stone
,Attn: Mr. Mark R. McAuley, P
0 South Tryon Street, Suite 1400
Charlotte, NC 28202
February 2 , 2014
t ar tnont Mount dolly l rrc standing n$ergeney Dep ent
Mount Holly, NC
Lear Mr. McAuley:
ley
As you know, r, the above referenced project is located within the City of Mount Holly°s at
y"
se i c area. It is y imderstanding that based on NCDENR flow rates you have calculated the
above facility to use 4,200 gpd, As state The Mourn Dolly 'Wastewater Treatment Plant t has
snf% icnt capacity to serve the proposed facility.
If you should have y cluestion , please give

A
Flow Trael
Project Applican
Department of Envi.
Ac+ eptance for Sewer E
Project Name for which flow is being requested:
than one FTSE-1O/07 may ire required for a single
pump stations along the route of the proposed wastewater II
ct if the owner
State of North Carolina
nt and Natural Resources
Division of Water
I. Complete this section only if you are the owner of the wastewater tre
a. WWTP Facility Nam
b. WWTP Facility Permit
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary
e. WWTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the
h. Percent of permitted flow used
II. Complete this section for each pump station you are responsi
proposed wastewater flow.
List pump stations located between the project connection point
Pump Station Name
Approx.. Capacity, MGD
(Firm/Design)
io n Permit Applications
(FTSE -10/07)
I tent respor Bible for all
and the WWTP
Approx. Current Avg.
Daily Flow, MGD
III. Certification Statement:
I, e s ,c.., 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�ve in Sections I and II for which I am the responsible party. Signature of this form indicates
aka pta e o!f this want at r4 v:-.
Sing Official Signature

Nagulapally, Sujatha R
From: ColeJenest & Stone - Mark R, McAuley <mmcauley@colejeneststonecom>
Sent: Thursday, March 06, 2014 10:37 AM
To: Nagulapally, Sujatha R
Cc: ColeJenest & Stone R, Todd Fisher; david [e-mail];
[e-mail]; Browder, Dee
Subject: 4207 - Caromont Mt Holly ED - Fast Track Sewer Permit/WQ0036989
Sujatha,
Per our conversation, although in our submittal package we included for reference the Flow Tracking and Acceptance
Documents from the City of Mount Holly for 4,200 GPD for the new building, for the purpose of this permit it is for the
relocated existing public sewer. Accordingly, the additional permitted flow should be zero as indicated on the
application. For your files, please revise Flow Tracking documents as necessary for zero GPD for this project specifically.
As previously mentioned, a separate partof the overall project involves construction of a new sewer lateral connection
to serve the proposed building. The new building will contribute 4200 GPD of addition& flow to the Mt. Holly sewer
system, but because the sewer connection is a lateral serving a single building, permitted through the local building
department, no construction permit is needed from NCDENR.
As discussed, as soon as you have the permit, please send to me electronically, and we will send the final signed
certification and final as-builts back to you soon after.
Thank you for assistance, let us know if you have any questions or need any additional infortration from us.
Mark R. McAuley, PE, LEED AP
Project Manager
COLEJENEST & STONE, P.A.
D 704-971-4533 C 704-564-6896
www.coleieneststone.com
25 Years of Design Excellence
prohobited.
This email is for the recipient only. It may contain confidential intaimation. Unauthonzed use

•ColeJenest
& Stone
1014
PROPOSED PRIVATE
SAN. SWR. LATERAL
EXISTING PUBLIC SAN
SWR. SYSTEM
CaroMont Health Freestanding ED USGS Topographic Map
CaroMont Regional Proj, No. 4207 SCALE: 1'" =150'
Medical Center Issued 02,26.14 FTniii
0 75' 150' 300'

Shaping the Envira 1
Realizing the Possibi
panning
200 South Tryon reet, Suit+
p+ 704 376 1555 f+ 70e+ 376 7�
February 27, 2014'
400 Charl
1 hity vww
otte, NC 0
ww.colejeneststone:rams
North Carolina Department of Environment and Natural Resources
610 East Center Avenue, Suite 301
Mooresville, North Carolina 28115
Re 7 - Caromont Mt. Holly Freestanding Emergency Department
Dear Ms, Browder
Chariot
Raleigh
Per direction from the City of Mt. Holly, we are submitting the Fast -Track Sewer
Application for the relocation of 524 linear feet of 8" public sewer on the proposed
Caromont Freestanding Emergency Department Building site in Mt. Holly, North
Carolina.
Landscape Arohitert
Civil Engineering
Urban
The public sewer relocation is required due to the location of the proposed building, and
the sewer Will be owned and maintained by the City of Mt Holly, This permit only covers
the relocated public sewer, as the proposed building sewer flow is not a NCEIR-
permitted"'line as it is a lateral serving a single building. Therefore, the attached
Application notes permitting of zero gallons per day. However for your reference, we
have included the Flow Tracking and Acceptance Documents from the City of Mt. Holly
for the proposed building.
Please let us know if you require any additional information.
Best regards,
COLEJENEST & STONE, P.A.
Mark R. cAuley, PE, L. AP BD+C
krnm
R. Todd Fisher, PE — CdS
Casey P. Werner, El — CJ

c
rIeJnest
Ston
'ZOO ':')Co„d'il. 40() Chanont. Nu," 2.8202
TRANSMITTAL
Date: November 27, 2014
Reference: 4207 — Caromont Mount Holly Freestanding Emergency Department
Attention: Ms. Dee Browder
Company: North Carolina Department of Environment and
Natural Resources
610 East Center Avenue, Suite 301
Mooresville, North Carolina 28115
We Are
Transmitting:
Transmitted
Via:
Tel:
704-663-1699
Copies
LJ Mail
0 For Approval
Dated
02/27/14
02/27/14
02/26/14
02/25/14
02/26/14
02/26/14
Herewith 0 Under Separate Cover
Description
Cover Lette
Fast -Track Application
Check #15529 for $480.00
Flow Acceptance Letter
Flow Tracking Form
USGS Map
Overnight 0 Courier
Hand Delivery 0 Pick -Up
0 For Your Use 0 As Requested
For Review
Remarks: Please see the attached submitted for your review and approval.
As soon as the permit number is available, please let us know.
Please contact us if there are any questions.
Thank you,
By:
cc:
Mark F. McAuley, PP,LEED AP D+C
Project Manager
krm
Mr. R. Todd Fisher, PE, LEED Green Associate - CJS
Mr, Casey P. Werner, El - CJS
P : \SDSKPROMAYA _Corre4)-andences':10.14,,Ttan%\0227 Brov,oler Sewer Pemliudoc

Prmagrartr Category
Non -discharge
Permit Type
Gravrty Sewer Extension,, Pump Staboos,
Primary Revievr
sujatha;nagulapally
Coastal MAW.
Facility
Pressure
r Extensions
Central Files APS WP
3/6/2014
p Tracking Slip
tat:
Active
Version
I.g0
PermitCont
Prolmmct Type
New Project
Permit Classificaton
Individual
fflliacln
Facility Name
CaroMont - Freestanding Emergerrny Departme
Location Address
Owns
City of P Count Holly
tang issue
31612014
.4Pp Received
2/2812014
t fated ActivMes
Aewater collethon
Draft tnitiated
Scheduled
Issuance
Public Notice
h inor
Facility
nor
nta
Afflllat+oia
Owner Type
Government - Munlclpad
w er Affiliation
Danny Jackson
City Manager
PC Box 4(38
Mt Holly
U.
t2014
Request d 1Peceivet E
Additional information re ived
AthAtiona0 oformaticn requested
Index tali
R g)on
Mooresville
bounty
Gaston
NC 28120
Effective ENO'
3/612014
4a t4
t urrent Class 8ubba!

EAST TRACK ENGINEERING CERTIFICATION
Permittee: City of Mount Hotly Permit No. WQ0036989
Project: CaroMont Health — Freestanding Emergency Department Issue Date: 3/06/2014
Complete and submit this form to the permit issuing regional office with the following.
• One copy of the project record drawings (plan & profile views and detail drawings of sewer lines) of the wastewater
collection system extension. Final record drawings should be clear on the plans or on digital media (CD or DVD
disk) in pdf format. Record drawings should indicate the design and the marked up changes during construction.
Supporting design calculations (selected pumps, system curve, operating pointn 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, Pannit
modifications are required for any changes resulting in non-compliance with this permit, regulations or
minimum design critoria. Modifications should be submitted prior to certification.
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. Therefore, it is higbly recommended that thls certification
be sent In a manner that Provides proof of receipt by the Division.
PERMITTEE'q CERTIFICATION
, the undersigned agent for the Permittee, hereby state that this project has
been constructed pursuant to the applicable standards & requirements, the Professional Engineer below has
provided applicable design/construction nformat o the Permittee, and th ermittee is prepared to operate &
maintain the wastewater collection system perm erein or port n
OINPV rAG44.0: 3 7 / Li
bANoki 4,01-.1tki
Printed Name, Title
ENGINEER'S CETWlCATlON
Date
Ej Partial Final
ricAL44-0Y as a duly regi§rtered Professional Engineer in the State of North Carolina,
having been authorized to observe (i periodically, Li weekly, Li full time) the construction of the subject 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 02T; 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
North Carolina Professional Engineer's
Seal, sIgnatiatm date:
r 0 CA fr/
r 0486.67 a'
037925
(Z.1
'• • Glisie ..•
•.
R. tkA
WITH
SEND THIS FORM & SUPPORTING DOCUMENTATION
REQUIRED ATTACHMENTS TO THE FOLLOWING ADDRESS
DIVISION OF WATER RESOURCES
WATER QUALITY REGIONAL OPERATIONS SECTION
MOORESVILLE REGIONAL OFFICE
610 EAST CENTER AVENUE, SUITE 301
MOORESVILLE, NC 28115
The Permittee is responsib e 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.
DWR Use Only
Flow front this project is tributary to.

TRANSMITTAL
Date: March 12, 2014
Reference: 4207 — Caromont Mt Holly Freestanding Emergency Department
Attention: Ms. Sujatha Nagulapally
Company: North Carolina Department of Environmental
Natural Resources
Mooresville Regional Office
Surface Water Protection Supervisor
610 East Center Avenue
Mooresville, North Carolina 28115
We Are
Transmitting:
Tel:.
704-432-5141
Copies
Dated
03/07/14
031671'14
Herewith ❑ Under Separate Cover
Description
Sewer As -Built Plans
Engineering Certification
Transmitted EJ Mail ❑ overnight Courier
Via: ❑ Hand Delivery ❑ Pick -Up
❑ For Approval ill For Your Use ❑ As Requested
❑ For Review
Remarks: Per our email correspondence, please see the attached hardcopies of
the documents you previously approved electronically.
Let us know if anything additional is needed for your files.
By:
Thank you.
Mark R. McAuley, PE, LEED AP BIiiS C
Project Manager
krm
Mr. R. Todd Fisher, PE, LEED Green Associate — CJS
Mr. Casey P, Werner, El - GJS