WQ0041262_Regional Office Historical File Pre 2018

15A NCAC
Appticatioat Number:
APPLICANT INFORMATION:
Applicant's name: City Of Belmont
Applicant type:
Signature author
l itle: C itx \fang
Ej individual orporation
C, Federal
g•'s name: Adrian LMiller per
4. Applicant's maihnag address: P()Box 4 31
City: Belmont State: NC
+. Applicant's contact information:
Phone number: [phone] Email Address: amtll�t`cr=t
PROJECT INFORMATION:
1. Project name: Greenwood Avenue Sewer Line Extension
2, A'pplication/Protect status.
2. Ifa modification., provide the existing permit number: WQ00 and issued date:
4. If new construction but part of a master plan, provide the existing permit number: WOOD
State of North Carolina
Department of Environmental Quality
Division of Water Resources
.030I -- SEWER SYSTEM EXTENSION APPLICATION
SSEA 04-l6 & SUPPORTING DOCUMENTATION
mtriered by WR)
al Partnership Privalclx v°ncIPuhlt t
County
RECEIVED
OCT
^21 2O19
NCDEQIDYYR:! PDES
E Proposed (New Permit)
County where project is located: Gaston
Existing Penn
6. Approximate Coordinates (Decimal Degrees): l..atitu.de: a 22(i l : Longitude: 81.1)4082 >
CONSULTANT INFORMATION:
. Professional Engineer; Aaron C. Long l.ictnse Number: P 0129
Firm: Excel Civil and Environmental Associates
Mailing address: 625lnluntsman Court
City: (Gastonia State: NC lip: 28054-
Phone number (?041 853--0800 Email Add.ressa alone a excelengr,com
STEWATER)011 TREATMEN FACILITY (WWTF) INFORMLATION:
1. Facility Nance: (wit} Of Belmont WWTP Permit Number: NC 0021 181I
t)4sner Name: Cite Of Belmont
RECEIVING DOWNSTREAM SEWER INFORMATION:
I, Permit Ni.urtber(s ):
System Fide Collection System Permit Number(s).
Owner Na-le(s): _mm
SEA 04-16 Page 1 of6

VI. GENERAL REQUIREMENTS
1, lithe Applicant is. a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been submitted?
0 Yes ENo N/A
2, If the Applicant a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV been submitted?
0 Yes 0No N/A
3. If the Applicant is a. Home/Property Owners' Association, has an Operational Agreem,ent (FOR,M; HOA) been submitted?
0 Yes JN0 N/A
4, Origin of wastewater: (check ail that appl).):
Residential Owned
0 Residential Leased
0 School preschool / day care
El Food and drink 'facilities
LI Bu,sinesses. I offices / factories
Ej Retail (stores, centers, malls)
0 Retail with food preparation/service
El Medical / dental / veterinary facilities
0 Church
Nursing Horne
5. Is/was an Environmental Assessment required under 15A NC.AC 0 IC? U Yes
If yes, submit the appropriate final environmental document (FONSI, ROD, etc.)
6. Nature of wastewater : 100 (l/i Domestic/Commercial 0 ",",i) Other waste specify:
Q % Industrial (See I 5A NCAC 02T .0103(20j)
7. Wastewater generated by project: 1,920 GPD (per 15A NCAC 02T .011,4)
Has a flow reduction been approved under L5A NCAC 02T ;0114(f).? Yes
If yes, provide a copy of flow reduction approval letter
8. Summarize wastewater generated by project:
Establishment Type
Daily Design Flow
0 Car Wash
El Hotel and/or 'Motels
0 Swimming Pool /Clubhouse
0 Swimming Pool/Filter Backwash
El Other (Explain in Attachment),
No
No
single-family lot
480 gal/day
No. of Units
Flow
4 1,920 GPD
gal/
gal/
gal/
GPD
GPD
gal/
gal/
Tola1
GPD
GPD
GPD
1,920 GPD
a See 15A -NCAC 021 IA( b), (d.), (01) and .(e)(.1) for caveats to wastewater design flow rates (i..e,, minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use
areas; and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals
as defined in CI,S; 42A-4).
Per 15A NCAC 02T ,0114(c), design flow rates for establishments not identified below shall be determined using
available flow data, water using fixtures, occupancy or operation patterns, and other measured data,
FORM: SSEA 04-16 Pageof 6

VIE GRAVITY SEWER DESIGN CRITERIA 15A NC:AC 02T .0305:
Summarize Gravity Sewer to be permitted:
Size (inches)
1,==centa•manwm."
Length (feet) Material
8 1.27
PVC
PUSIP• STATION DESIGN CRITERIA -- 02T M395 & NI DC (PUnifi Stations/Force .Mains;
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS P'ROJEC:T
I. Pump station number or name: NfA
2. Approximate Coordinates (Decimal Degrees): Latitude: . Longitude: -
What is the nearest 100-year flood elevation to the facility? 'feet mean sea. level„ Source.
Is any of th.e proposed project located within the 100-year flood plairi LI Yes LI No
4„ If Yes, are the following items provided per 15A NCAC 021
Water -tight seals on all station hatches and manholes; and
Control panels vents extend two feet above the100-year flood plain elevation?
II Yes
If No, what measures are being taken to protect them against flooding?
5„ Finish grade elevation of the pump station:
6. Design flow of the pump station:. millions gallons per day (firm capacity
7. Operational pointis) of the pump(s): gallons per minute at feet total dynamic head (TOFU)
8. Number of pumps provided:
9. Number of pump cycles at average daily 'flow": cycles per hour
10, Power reliability in accordance With 15A NC.AC 02.T „0,305(hy I):
Ei Standby power source or pump with automatic activation and telemetry - 15.A -NCAC 02T .0305(h)(1)(B):
Required for all pump stations with an average daily :flow greater than or equal to 1.5,000 gallons per day
.> Must be permanent to facility'
Or if the pump station has an average daily flow less than 15,000 gallons per day:
Portable power source with manual activation, quick -connection receptacle and telemetr 15A. NCAC 0.2T
.0305(h)( 1 )(C)
or
El Portable pumping unit with plugged emergency pump connection and telemetry - 15A NCAC 02T „0305(b)(1)(C):
lt shall be demonstrated to the Division that the portable source is owned or contracted by the applicant (draft agreement)
and is compatible with the station,
1)i> If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations'
storage capacities and the rotation schedule of the portable power source or pump, including, travel timeframes, shall be
provided in the case of a Multiple station power outa.ge,
FORM: SSEA 04-16 Page 3 of 6

.„PU P S4ATION C ,t"T` :1,1 tinned)
naniar€ c tl to pump station design elemettts:
Sit
Design Element
r Rellabilit ;otrrce and Assoc'ater Il lenents
t Wet Well Vent
Cheek Valves, gate V
Control Panel
Restricted Access F l rncttts i ettce. Wet
Audible and Vistaal Alt
'. D=
ttherpro
r llir t"W Ies
ain to be permitter
ze inch s) Length (feet)
Air t°nitaseI station location per l
[iischa re
eN ation (feet)
lVt_iaE . 04- I 6 Page 4 of

IX. SETBACKS & SEPARATIONS (02B .0200 & ISA NCAC 02T .0305(0):
Does the project comply with all separations found in 15A N('ACI 021 ,010511) k, (a)
15A NCAC 02T.0305(f) contains minimum separations that shall he provided for sewer systems:
Setback Parameter* Separation Required
rm sewers and other utilities not listed below (vertical)
'ater mains (vertical -water over sewer including in benched tre
/ater mains (horizontal)
Reclaimed water lines (vertical - reclaimed over seser)
Reclaimed water lines (horizon(al - reclaimed over sewer)
1 **Any private or public water supply source, including any Welk. WS-1 waters of Class 1 or
Class 11 irqounded reservoirs used as a source of drinking water
1 **Waters classified WS (except WS-1 or WS-V). B, SA, ORW, FIQW, or SB from normal
high water (or tide elevation) and wetlands (see item lX.2)
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches
Any building foundation
Any basement
Top slope of embankment or cuts of 2 feet orvertical height
Drainage systems and interceptor drains
imrning pools
Final earth grade (vertical)
El Yes ON
24 inches
18 inches
10 feet
18 inches
2 feet
100 feet
50 feet
10 feet
feet
I 0 -feet
10 feet
5 feet
10 feet
1 36 inches
• 15A NCAC 02T,0305(0 contains alternatives where separations in 0,2T,(305(t) cannot be achieved,
classifications can be identified using the Division's Nc. Surface \y,Itc!:(.1205:ifi,cgliqp; wel_2page
• If noncompliance with t),210305(j0or (g,, see Section X of this application
2, Does the project cornply with separation requirements for wetlands? (50 feet of separation) Yes El No LJ N/A
• See the Division's draft separation requirements for situations where separation cannot he meet
No variance is required if -the alternative design criteria specified is utilized in design and construction
• As built documents should reference the location of areas effected
3. Does the project comply kvith setbacks found in the river basin rules per 15A NCAC 0213 ,0200? E Yes No LJ Nt A
• This would include Trout Buffered Streams per 15A NCAC 213,0202
4, Does the project. require coveragelauthorintion under a 404 Nationwide or
individual permits or 401 Water Quality Certifications?
Information can be obtained 'from the 401 .1C Buffer Pei mittingBranch
IE Yes LI No
5., Does project comply with. 15,A NCAC o2:-.L01051.(40) (additional permitslcertitications? [2] Yes Lil No
Per 15A NCAC 021',0102ecl(61, directly related environmental permits. or certification applications are being prepared, have
been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion and
sedimentation control plans, stormwater management plans, etc„,).
6. Does this project include any sewer collection lines that are deemed -high-priority?"
Per 15ANCAc 02 1-,0402, -high-priority sewer" means -any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streamhanks that is subject to erosion that undermines or deteriorates the sewer.
C Yes
If yes, include an attachment with, details for each line, including t.:pe (aerial line, size, material, and location),
High priority lines shall. he inspected by the perniittee or its representative at least once every six -months and
inspections documented per I5A NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit.
FORM: SSEA 04-16 Page 5 of 6

X. CERTIFICATIONS:
Does the submitted system comply with I 5A NCAC 021, the Minimum„Design Criteria or the Permitting of Pump Stations
aud"orceYlatu5 (latestyersionl and the Gravity Sewer Minimum 'Design Criteria tlinest version) as applicable?
Z Yes El No
If No, complete and submit the Variance/Alternative Design Request application (\ADC 10-14) and supporting documents
for review. Approval of the request is required prior to submittal of the Fast TrackApplieation and supporting
doeurnents,
Professional Engineer's (- cation.
LA
(Professional E.nairicer's name from Application Item 11
'acility ;name from Application Item ILI.)
attest that this application for
has been reviewed by me and. is accurate, complete and consistent with the information supplied in the plans, specifications,
engineering calculations, and all other supporting documentation to the best of my knowledge. I further attest that to the best
of my knowledge the proposed design has been prepared in accordance with this application package and its instructions, as
well as all applicable regulations and statutes. 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 he consistent W ith the proposed design.
NOTE - In accordance with General Statutes 143-215. A and 14321,5..6,13, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a tine not to exceed S10,000, as well as civil penalties up to $25,000 per violation,
North Carolina Professional Engineer's seal, signature, and date:
3. Applicants Certification per 15A NCAC 021 .010601
,
1, Ad ri r-sk/ C144-1 •
_jk 4 attest that this application for
t Signature Authority'sq.arne & tit e from Application Item LI)
-rc A Vt, e-L'Y
(Facility name from Application Item IL I.)
has been reviewed by me and is accurate and complete to the best of my' knowledge. I understand that any discharge of
Was tewater from this non -discharge system to surface waters or the land w••ill result in an inunediate enforcement action that
may include civil penalties, injunctive relief, and/or criminal prosecution. 1 will make no claim against the Division of Water
Resources should a condition of this permit be violated, I also understand that if all required parts of this application package
are not completed and that Wall required supporting i„nfor•mation and attachments are not included, this application package
will be returned to me as incomplete.
NOTE In accordance wityUeneral Statutes 143-2 I5.6A and l4.3z2156B, any: person who knowingly makes any false
statement, represcnlatiol certification in any application package shall he guilty of a Class 2 misdemeanor, which may
include a fine npt 0,000 as eIl asjcivil penalties up to $25,000 per• violation.
Signature:
Date:
FORM SSFA 04-16
Page 6 of 6

EXCEL CIVIL & ENVIRONMENTAL
ASSOCIATES, PLLC
625 HUNTSMAN COURT
GASTONIA, NC 28054
[phone]
Figure 1 -- Site Vicinity Map
Excel Project Number 2018101
Source; 1997 USGS Topographic Maps

October 15, 2019 Excel Environmental Associates PL,I.h
Post Office Box 6172
Gastonia, NC 28056-6000
Telephone [phone]
Facsimile 704.853.3949
Cover
To: North Carolina RE: .97, 299. 301, 3(13
NCDEQ.'DWR Water Quality Pern fitting PER.CS linit Greenwood Averr
Department Of Environmental Qua:. ity Division of Sever Line Extension
Water Resources Belmont, Gaston Co., NC
161.7 Mail Service Center
Raleigh, North Carolina 27699
We are ,sending you: XX. Attached
EXCEL No. 2018101
Under Separate Cover via
NO. COPIES
DESCRIPTION
Hoy,' Traekinc 1'orsn
24" x 36" Construction Dra.wi
for Greenwood Avenue Sewer 1
Ext
Sewer S star Extetion
Application Fee C"heck
TI/ESE ARE TRANSr111TTEl_):
1'ot appreaacr
As requested
AX
'nts ,r.. tlrc proposed
Any questionl.s, please ea
Sincerely yours,

b
WORU,S,
MOO t'AES'yt. HF,.(2.,`,10N/k1„. Of
Oi%ision of W,114,,u
Flow Tra
State of North Carolina
Department of Environmental Quality
Division of Water Resources
ension Applications
(FIST 10-18)
Entity Requesting Allocation: City of Behnont
Project 'Name for which flow is being requested: (ireenwood AvenueAveriue Sewer Line Lxt
Afore than one E'ISE may he required fOr a single project fl the owner of the wow. is not responsible for allpzirnp
stations along the route ophe proposed .wastewater flo w.
Complete this section only if you are the owner of the wastewater treatment plant.
a. WWIP Facility Name: City ofBelmont WWTP
b. WWTP ,Facility Permit fi: NC0021181
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 facility
h.. Percent of permitted flow used
All flows are in MGD
5.0000
TTP 1.2359
1,7910 (2018 Average)
0.0019
3.0288
6
11. Complete this sect
Ixastewater flow.
ach pump station you are responsible for along the route of this proposed
List pump stations located between the project: connection point and the WWTP:
(A) (B) (C) (D)—(B+C) (E)----(A-D)
Design. Obligated,
Blimp Iklrnp Average Approx.. Not Yet Total Current
Station Station Finn Daily How" Current. 'Tributary How Plus
(Narne or .Permit Capacity, * (Finn / pt), Avg, -Dai)y Daily Flow, Obligated Available
Number) No, 'MGD MGD Flow, MGD MGD Flow Capacity***
Point Unknown 1.1520 0.4608 0.2919 0.0402 0.3321 0.0402
Crossing
* The Firm Capacity (design flow) of any pump station is defined as the maximum pumped tlow
that can be achieved with the largest punip taken out of service.
" Design Average Daily Flow is the firm capacity of the pump station divided by a peaki
(pt) not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessinent Addendum shall be attached for each pump station located
between the project connection point and the. WWTP where the Available. Capacity is < O.
Downstream .Facility Name (Sewer):
Downstream .Permit Number:
Page 1 of 6
FTSE 10-18

• III. Certification Statement:
1 Adrian T. Miller, C' Mana er certify to the best of my knowledge that the addition of
the volume of wastewater to be permitted in this project has been evaluated along the route to the receiving
wastewater treatment facility and that the flow from this project is not anticipated to cause any capacity
related sanitary sewer overflows or overburden any downstream pump station en route to the receiving
treatment plant under normal circumstances, given the implementation of the planned improvements
identified in the planning assessment where applicable. This analysis has been performed in accordance
with local established policies and procedures using the best available data. This certification applies to
those items listed above in Sections I and U plus all attached planning assessment addendums for which I
am the responsible arty. Signature of this form certifies that the receiving collection system or treatment
works has adeq a capacity to transport and treat the proposed new wastewater.
Signing 0fficial Signature Date
C4"
Title of Sigiling 0
Page 2 of 6
FTSE 10-18

FAST TRACK SEWER ENGINEERING CERTIFICATION
PERMITTEE: CITY OF BELMONT
PERMIT #: WQ0041262
PROJECT: GREENWOOD SEWER LINE EXTENSION
ISSUE DATE: NOVEMBER 8, 2019
D: fifDINCDENRiD)NR:
WQr-U)8
PAOORESIILE RECOONAs;
This project shall not be considered complete nor allowed to operate in accordance with standard
Condition 7 of this permit until the Division has received this Certification and all required supporting
documentation, It should be submitted in a manner that documents the Division's receipt. Send the
required documentation to the Regional Supervisor, Water Quality Regional Operations Section at the
address noted in the page footer.
Any wastewater flow made tributary to the wastewater collection system extension prior to completion
of this Certification shall be considered a violation of the permit and shall subject the Permittee to
appropriate enforcement actions. The Perrnittee is responsible for tracking all partial certifications up
until a final certification is received by the Division. A Final Certification shall be a complete set of
record drawings and design calculations regardless of whether partials have been submitted,.
PERMITFEE'S CERTIFICATION
1, the undersigned agent for the Perrnittee, 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 th Permittee is prepared to operate & maintain the
wastewater col'lecti©n system permitted herein or ppftj6ns thereof.
Rzirm, /7/ ler Cif-7 makv,
Printed Name, Title Signaturc
ENGINEER CERTIFICATION
Date
, as a duly registered Professional Engineer in the State of North Carolina,
ving been authorized to observe (0 periodically, [1] weekly, full time) the construction of the
project name and location as referenced above for the above Permittee hereby state that, to the best of my
abilities, due care and diligence was used in the observation of the following construction:
127 linear feet of 8-inch gravity sewer,; such that the construction was observed to be built within
substantial compliance of this permit; 15A NCAC 02T; the Division of Water Resources' (Division)
Gravity Sewer Minimum Design Criteria adopted February 12, 1996 as applicable; the Division's
Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains adopted June
1, 2000 as applicable; and other supporting materials.
North Carolina Professional Engineer's Seal w/signature & date:
Final
L Partial (include description)
Certification Comments/Qualifiers (attach if necessary);
NC DWR Water Quality Regional OperationsSection 610 East Center Avenue, Suite 301, Mooresville, NC 28115
Mooresville Regional Office
Phone: [phone] FAX: [phone]

Certifying Engineer:
Certification Review Date:
Project Name: CO Et/Vida-9a
WQ00 Project County:
1) Has permittee information changed since the permit was issued (or ast modified): change of mailing address,
change of ownership, transfer from developer to HOA/POA, etc. Yes No
• If yes, please provide either a change of ownership form or new contact information. Note that transfer of
permits from the developer to the HOA/P0A. must occur with the first certification.
2) Have the as -built drawings have been signed, sealed, and dated by an N.C. PE? Yes [11 No
3) Final Engineering certification?
Yes
No
• If Partial Engineering certification, provide detailed narrative including what is being certified in the current
phase, what was previouslycertified (if applicable), and what is left to be certified.
4) Adequate information related to sewer lines: Ai, Yes E] No LI N/A
•
•
•
CERTIFICATION CHECKLIST
To be completed by the certifying engineer prior to operation of the permitted sewers, pe
9i2r\OV c. 1-01Y6'
AC 02T.0116.
.'—iVEDINICRENIVDWR
WQRON
MOORESVillt RENIONPN NriNIX
Three feet minimum cover has been provided for all sewers unless ferrous pipe was installed,
Minimum diameters for gravity sewers are 8-inches for public lines and 6-inches for private lines,
Manholes have been installed: At the end ofeach line, at all changes i.n grade, size, or alignment, at all
intersections, and at distances not greater than 425 feet, minimum diameter shall be 4 feet (48-inches)
5) Adequate information related to pump stations: Yes Lill No ERN/A
• Ensure power reliability option was selected. per ISA NCAC 02T.0305(h).
6) Was project construction completed in accordance with all of the fdlowin.g: J Yes Lil No Ej N/A
• 1.5A NCAC ozr, Minimum Design Criteria (MDC) for the permitting of (iravity' Sewers ilatest version), and
IvIDC._ for the Permitting. of Pump .Stations and Force Mains, (latest version)?
If not, a variance approval is required in accordance with SA NCAC 02T,010,ahl, prior to certification and
operation.
• Contact the Central Office to discuss the variance to determine a course of action.
• Applicant must. submit two copies of the variance request form, plans, specifications, calculations, and any other
pertinent information to the Central Office (one hard copy, one digital copy).
• The central office will review the variance request, and if approvable, specific language regarding the variance
will be incorporated into the permit., either via a special condition or a supplementary' letter. A copy of the
reissued pennit with variance language or the variance letter must be maintained with the original documents.
7) Does the project contains high priority lines (15A :NCAC 02T .0402(2))? Ej Yes Ea No
• if yes, ensure that the permit already contains the necessary condition related to high priority lines 15A NCAC
02T.0403 (a)(5). If the permit does not include this language, the Fast Track reviewer will reissue the permit with
the appropriate language.
8) Are Pennit modifications are required for any changes resulting in non-compliance with this permit (including. but not
limited to pipe length changes of10% or greater, change in flow, pumot.ation design capacity design change of 5% or
greater, and/or change in the number/type of connections)? [1 Yes No
• if yes, a permit modification request must be submitted to the appropriate Regional Office, and a modified
permit with revised certification must be issued prior to certification and operation..
NC DWR — Water Quality Regional Operations Section 610 East Center Avenue, Suite 301, Mooresville, NC 28115
Mooresville Regional Office Phone: [phone] FAX: [phone]