WQ0041633_Application_20210727

DWR
Division of Water Resources
RECEIVED/NCDEQ/DWR
JUL 2 7 2021 State of North Carolina
Department of Environmental Quality
WQROS Division of Water Resources
MOORESVILLE REGIONAL OFFICE
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 04-16 & SUPPORTING DOCUMENTATION
O
Application Number: kk)(2(� C) 91633,o be "14completed DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: The Charlotte Mecklenburg Hospital Authority (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ® Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ❑ Municipal
3. Signature authority's name: Tom Washington per 15A NCAC 02T .0106(b)
Title: Director
4. Applicant's mailing address: 9401 Arrowpoint Blvd., Office 306
City: Charlotte State: NC Zip: 28273-8166
5. Applicant's contact information:
Phone number: [phone] Email Address: Tom.WashingtonAatriumhealth.org
❑ Other
II. PROJECT INFORMATION:
1. Project name: Atrium Union West - Private
2. Application/Project status: ❑ Proposed (New Permit) ® Existing Permit/Project
If a modification, provide the existing permit number: WQ0041633 and issued date: 12/15/2020
If new construction but part of a master plan, provide the existing permit number: WQ00
3. County where project is located: Union
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.083° Longitude: -80.667°
5. Parcel ID (if applicable): 071-020-23A
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Corey W. M. King License Number: 048981
Firm: Kimley-Hom and Associates, Inc.
Mailing address: 200 South Tryon Street, Suite 200
City: Charlotte State: NC Zip: 28202-0095
Phone number: [phone] Email Address: corey.king(ciikimley-horn.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Crooked Creek WRF Permit Number: NC0069841
Owner Name: Union County
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ0001158 Downstream (Receiving) Sewer Size: 8 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s): Union County
FORM: FTA 04-16 Page 1 of 5

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑No ZN/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached?
❑ Yes ❑No ®N/A
3. If the Applicant is a Home/Property Owners' Association, has an Operational Agreement (FORM: HOA) been attached?
❑ Yes ❑No ®N/A
4. Origin of wastewater: (check all that apply):
❑ Residential Owned ❑ Retail (stores, centers, malls)
0 Residential Leased ❑ Retail with food preparation/service
0 School / preschool / day care ® Medical / dental / veterinary facilities
® Food and drink facilities ❑ Church
❑ Businesses / offices / factories 0 Nursing Home
5. Nature of wastewater : 100 % Domestic/Commercial % Commercial
% Industrial (See 15A NCAC 02T .0103(20))
❑ Car Wash
❑ Hotel and/or Motels
0 Swimming Pool /Clubhouse
0 Swimming Pool/Filter Backwash
Z Other (Explain in Attachment)
>Is there a Pretreatment Program in effect? ® Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 02T .0114(fl? ❑ Yes ® No
)=. If yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow a,b
No. of Units
Flow
Hospitals, medical
300 gal/Bed
0 GPD
Central Energy Plant
8,760 gal/Building
0 GPD
Medical Office
250 gal/Practitioner-Shifts
0 GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
0 GPD
a See 15A NCAC 02T .0114(b), (d), (e)(1) and (e)(2) 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 G.S. 42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.0114] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 0 GPD (per 15A NCAC 02T .0114)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
❑ Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
® Flow has already been allocated in Permit Number: WQ0041633
O Rehabilitation or replacement of existing sewer with no new flow expected
O Other (Explain):
FORM: FTA 04-16
Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
6"
-1,089
PVC
6"
-182
DIP
8"
-149
PVC
8"
1
DIP
12"
36
DIP
> Section II & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section III contains information related to minimum slopes for gravity sewer(s)
> Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: . Longitude: - °
3. Design flow of the pump station:
4. Operational point(s) of the pump(s):
millions gallons per day (firm capacity)
gallons per minute at
5. Summarize the force main to be permitted (for this Pump Station):
feet total dynamic head (TDH)
Size (inches)
Length (feet)
Material
6. Power reliability in accordance with 15ANCAC 02T .0305(h)(1):
❑ Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(h)(1)(B):
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
➢ Must be permanent to facility
Or if the pump station has an average daily flow less than 15,000 gallons per day:
❑ Portable power source with manual activation, quick -connection receptacle and telemetry - 15A NCAC 02T
.0305(h)(1)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry - 15A NCAC 02T .0305(h)(1)(C):
➢ It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant (draft agreement)
and is compatible with the station.
➢ 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 outage.
FORM: FTA 04-16 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations found in 15A NCAC 02T .0305(f) & (g)
➢ 15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
® Yes ❑ No
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
24 inches
Water mains (vertical -water over sewer including in benched trenches)
18 inches
Water mains (horizontal)
10 feet
Reclaimed water lines (vertical - reclaimed over sewer)
18 inches
Reclaimed water lines (horizontal - reclaimed over sewer)
2 feet
**Any private or public water supply source, including any wells, WS-I waters of Class I or
Class II impounded reservoirs used as a source of drinking water
100 feet
**Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal
high water (or tide elevation) and wetlands (see item IX.2)
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches
10 feet
Any building foundation
5 feet
Any basement
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
> 15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(f) cannot be achieved.
> **Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
> If noncompliance with 02T.0305(f) or (g), see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ❑ Yes ❑ No ® N/A
➢ See the Division's draft separation requirements for situations where separation cannot be 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 with setbacks found in the river basin rules per 15A NCAC 02B .0200? ❑ Yes ❑ No ® N/A
> This would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Does the project require coverage/authorization under a 404 Nationwide or
individual permits or 401 Water Quality Certifications?
> Information can be obtained from the 401 & Buffer Permitting Branch
❑ Yes ® No
5. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T.0105(c)(6), 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 15A NCAC 02T.0402, "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes No ❑ N/A
> If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at least once every six -months and inspections
documented per 15A NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit.
FORM: FTA 04-16 Page 4 of 5

DocuSign Envelope ID: 35AB5E2E-7517-4A98-8944-3DAE82B9E36B
X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Pump Stations
and Force Mains (latest version), and the Gravity Sewer Minimum Design Criteria (latest version) as applicable?
®Yes ❑No
If No, complete and submit the Variance/Alternative Design Request application (VADC 10-14) and supporting documents for
review. Approval of the request is required prior to submittal of the Fast Track Application and supporting documents.
2. Professional Engineer's Certification:
I,
Corey W. M. King
(Professional Engineer's name from Application Item III.1.)
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 the applicable regulations, Gravity Sewer
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track Permitting
of Pump Stations and Force Mains (latest version). Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that I have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation.
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I,
Toni Washington, Director
�ocISignesEAl {
e r
03448 y •
•
13QO 74194FD..„reel
*Zj' W� i�{ /„1C�3/2021
8alilIl 5
(Signature Authority's name & title from Application Item L3.)
attest that this application for
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required parts of
this application are not completed and that if all required supporting documentation and attachments are not included, this
application package is subject to being returned as incomplete. I understand that any discharge of wastewater from this non -
discharge system to surface waters or the land will result in an immediate enforcement action that may include civil penalties,
injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water Resources should a condition
of this permit be violated. I also understand that if all required parts of this application package are not completed and that if
all required supporting information and attachments are not included, this application package will be returned to me as
incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
DocuSigned by:
Signature: ` I Date: 7/26/2021
CF75A9AD530543E...
FORM: FTA 04-16 Page 5 of 5

Kimley>»Horn
July 26, 2021
NCDEQ
Mooresville Regional Office
610 E. Center Avenue
Mooresville, NC 28115
RECEIVED/NCDEQ/DWR
JUL 2 7 2021
WQROS
MOORESVILLE REGIONAL OFFICE
Subject: Fast Track Sewer System Extension Permit Modification Application
Existing Permit No. WQ0041633 - Private
Atrium Union West
1459 Stallings Rd
Stallings, NC 28104
To Whom it May Concern,
Submitted is the fast track sewer system extension application for the modification of Existing Permit
No. WQ0041633 dated December 15, 2020 for the Atrium Union West hospital and associated
development located in Stallings, NC for your review and approval. The modification to the existing
permit includes changes to the sanitary sewer lengths based on as -built conditions and due to the
removal of sanitary sewer laterals from the NCDEQ Fast Track Sewer System Extension Permit.
The existing permit included a total of approximately 1,163 LF of 6" PVC, 182 LF of 6" DIP, 488 LF of
8" PVC, 1,218 LF of 8" DIP, and 13 LF of 12" DIP private sanitary sewer pipe designed to serve a 200-
bed hospital, a 40 practitioner -shift medical office building, and a central energy plant. The
modification requested for this permit includes the subtraction of 107 LF of 6" PVC, 17 LF of 6" DI, and
124 LF of 8" PVC as well as the addition of 1 LF of 8" DIP and 36 LF of 12" DIP private sanitary sewer
pipe based on as -built conditions. An additional subtraction of 982 LF of 6" PVC, 165 LF of 6" DIP, and
25 LF of 8" PVC is requested for the removal of sanitary sewer laterals from the NCDEQ Fast Track
Sewer System Extension Permit. This results in a net subtraction of 1,089 LF of 6" PVC, 182 LF of 6"
DI, and 149 LF of 8" PVC and net addition of 1 LF of 8" DIP and 36 LF of 12" DIP private sanitary
sewer pipe to the existing permit.
The included application is for a net total of approximately 74 LF of 6" PVC, 0 LF of 6" DIP, 339 LF of
8" PVC, 1,219 LF of 8" DIP, and 36 LF of 12" DIP private sanitary sewer pipe designed to serve a 200-
bed hospital, a 40 practitioner -shift medical office building, and a central energy plant. As in the
existing permit, these buildings will be serviced by a proposed 8" public sanitary sewer which
discharges to an existing 8" public sanitary sewer. Although the nature of all wastewater flows is
classified as domestic/commercial, Union County is requiring a private grinder station as pre-
treatment. These changes are summarized in the chart on the following page.
�r .. o
2000 South Boulevard, Suite 440, Charlotte, NC 28203
704 333 5131.

Kimley»>Horn
Page 2
Type
Description
Permit No.
WQ0041633
Quantity
Removal
of Laterals
Correction for
As-Builts
Total
Change
Net
Amount
Length (FT)
6" PVC
1,163
-982
-107
-1,089
74
Length (FT)
6" DIP
182
-165
-17
-182
0
Length (FT)
8" PVC
488
-25
-124
-149
339
Length (FT)
8" DIP
1,218
0
1
1
1,219
Length (FT)
12" DIP
13
0
36
36
49
This package includes the following:
• $480 Application Fee
• NCDEQ Fast Track Sewer System Extension Application (FTA 04-16), including
o Design flows per 15A NCAC 02T .0114(c)
• Flow Tracking/ Acceptance Form (FTSE 04-16) (Signed copy on file)
• Site Maps
• Existing Permit No. WQ0041633
• Onsite Water and Sewer Asbuilt Plans
Should you have any questions or comments, please do not hesitate to contact me by phone or by e-
mail at 704-954-7477 or [e-mail].
Sincerely,
KIMLEY-HORN AND ASSOCIATES, INC.
Corey King, PE
Project Engineer
Enclosure
le
horn.co
2000 South Boulevard, Suite 440, Charlotte, NC 28203
704 333 5131

Atrium Union West — Aerial Vicinity Map
Hospital Site
Proposed Private
Sanitary Sewer
Proposed Public
Sanitary Sewer
Tie -In Location
#Wg001158
i+a>irttiy
Forest Park Lift Station
:l.IQV+1:9. >31owj), ^`.fintar 0,:r•:!'yr.teOt'c-11,
97 tJ.5c .8,;lameMD, len, INiY3c31.0 i�0t4ir

Atrium Union West — Topo Quad Map
Proposed Public
Sanitary Sewer
'Proposed Private
Sanitary Sewer
Tie -In Location
I4W Q001158