WQ0029338_Regional Office Historical File Pre 2018

ich�ael FF. GovernorT Easley, V
'i North Carolina Department of Environment and Natural Resources
Mr. Robert Hites, Jr., City Manager
City of Statesville
P.O. Box 1111
Statesville, North Carolina 28687
Dear Mr. Hites:
William G. Ross Jr., Secretary
Alan W. Klimek, P.E. Director
Division of Water Quality
April 26, 2007
Subject: Permit No. WQ0029338 Modification
City of Statesville
Georgetown Place SID
Wastewater Collection System Extension
lredell County, North Carolina
in accordance with your application received on April 16, 2007, we are forwarding herewith
Permit No. WQ0029338, dated April 26, 2007, to the City of Statesville for the construction and
operation of the subject wastewater collection system extension. This permit shall be effective from the
date of issuance until rescinded, shall void Permit No. WQ0029338 issued September 22, 2005, and
shall be subject to the conditions and [imitations as specified therein. This cover letter shall be
considered a part of this permit and is therefore incorporated therein by reference. The modification
includes the addition of approximately 1,377 linear feet of 8-inch gravity sewer, and the addition of
10,200 gallons per day of wastewater flow.
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
610 East Center Avenue, Suite 301, Mooresville, NC 28115
Phone: [phone] Fax: [phone] / Internet: http://h2o.enr.state.nc.us
An Equal Opportunity/Affirmative Action Employer — 50% Recycled/10% Post Consumer Paper
One
North Carolina
Naturally

Robert Hites, Jr.
Page 2
April 26, 2007
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 Statesville for the construction and operation of approximately 1,377 linear feet of
8-inch gravity sewer to serve 10 four -bedroom and 15 three -bedroom residences as part of the
Georgetown Place SID project; and the discharge of 10,200 gallons per day of collected domestic
wastewater into the City of Statesville's existing sewerage system, pursuant to the application received
April 16, 2007, 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.
This permit also covers the continued operation of approximately 597 linear feet of 8-inch
gravity sewer as part of the Georgetown place S/D project, and the discharge of 1,800 gallons per day
of collected domestic wastewater into the City of Statesville's existing sewerage system, pursuant to
the application received, September 2, 2005, and in conformity with 15A NCAC .0200; 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 Statesville
Fourth Creek WWTP (NPDES No. NC0031836) prior to being discharged into the receiving stream.
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 Sonja Basinger at
[phone].
Sincerely,
-7 52 r (`
for Alan W. Klimek, P.E.
•
cc: Mooresville Regional Office, Surface Water Protection (Fast Track Sewer Ext Files)
R. Carroll Williams, P.E.
Surface Water Protection Central Files
PERCS Files

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH
WASTEWATER 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:
1. 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 2B .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 (i.e.
365 days per year). Pump stations that are connected to a telemetry system shall be
inspected at least once per week.
e. High -priority sewer lines shall be inspected at least once per every six-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.
1

4. This permit shall not be 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.
5. 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.
8. 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
(focal, 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.
2

Voice mail messages or faxed information is permissible, but 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 (919) 733-
3300. Persons reporting any of the above occurrences shall file a spill report by completing Part 1
of Form CS-SSO (or 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 II of Form CS-SSO (or the most current Division approved form)
can also be completed to show that the SSO was beyond control.
12. Gravity sewers installed greater than ten percent below the minimum required slope per the
Division's Gravity Sewer Minimum Design Criteria shall not be acceptable and shall not be certified
until corrected. If there is a unforeseen obstacle in the field where all viable solutions have been
examined, a slope variance can be requested from the Division with firm supporting
documentation. This shall be done through a permit modification with fee. Such variance requests
will be evaluated on a case by case basis. Resolution of such request shall be evident prior to
completing and submitting the construction certification.
Permit issued this the 26th day of April, 2007.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
IL+
for Alan W. Klimek, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission
Permit Number WQ0029338 Modification
3

Fast Track Engineering Certification
Permit No. WQ0029338 Modification
April 26, 2007
Robert Hites, Jr., City Manager
City of Statesville
P.O. Box 1111
Statesville, NC 28687
R. Carroll Williams, P.E.
4840 North Center Street
Hickory, NC 28601
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 changes 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 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.
ENG1NEER'S.CERTIFICATION
❑ Partial ❑ Final
, as a duly registered Professional Engineer in the State of North Carolina, having
been authorized to observe (❑ periodically, ❑ weekly, ❑ full time) the construction of the Georgetown Place
S/D, iredeil 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, NORTH CAROLINA 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.

1 b.
'AT 'ON fort G
SEWERS, PUMP' TATIONS, AND FORCE MAINS
USE THE TAB KEY TO MOVE FROM FIELD TO F1EIn0!
Owner: tom"
Full Legal Name (company,
ning Name and fj e (Ptea a review 1 aA NCAC 2H .02C r(b) for authorized signing o
Application Num
(to be competed by OWQ
e legal entity who will owr-this system is:
Individual 0 Federal 21Municipality 0 State/County Q Private Partnership 0 Corporation 0 Other (specify);
PAGE 3
0 1d. '')teLL
z
z
z
LL
Z
Mailing Address
1 f.
State
1h, ones;. -- `31? --4-
Telephone Facsimile
2. Project (Fecitify) Information:
2a, ea-0 12.6 t l 01.-A ae.
Brief Project Name (permit will refer to t
3. Contact Person.
3a.
3b.
Phone Number 1
1. Project is 0 New
City
1g.
Zip Code
t 1j
County Where Project is Located
his Application
E-mail
If Modification, Permit No.:
For modifications, attach a separate sheet clearly explaining the reason for the modification (i.e, adding another
phase, changing line size/length, etc.). Only Include the modified information in this permit application -do not
duplicate protect 'information in B(T) and B(10-11) that has already been included in the original permit.
2. Owner is d'F'ublrc (skip to Item B(3)) © Private (go to Item 2(a))
2a. If private, applicant will be:. 2b, If sold, facilities owned by a (must choos
Retaining Ownership (Le. store, church, single office, at
0 Leasing units (lots, townhomes, etc... skip to Item B(3))
❑ Selling units (lots, townhomes, etc. - go to stern B(2b))
Owner
Air
Trent Facility (1NVUTF) Treating
0 Public Utility (Instruction III)
❑ Homeowner Assoc/Developer (Instruction IV
tter From This Project
T rP 4b. l.t c; c, .°?) + "S ; cc
Name of WWTF
5a, t? er 1 tr r` A-r 5b. T rav'
owner of Downstream Sewer Receiving Sewer Size 0 Force
6. The origin of this wastewater is (check all that apply):
Residential Subdivision
Q Apartments/Condominiums
Mobile Home Park
❑ School
❑ Restaurant
❑ Office
Volume of wastewater to be
'Do not include previously perm
❑ Car Wash
❑ Institution
• Hospital
❑ Church
❑ Nursing Home
❑ Other (specify):
s particular project
ations.
the permitted flow is zero, indicate why: hr A
Interceptor Line - Flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit No,
❑ Rehabilitation or replacement of existing sewer with no new flow expected
WWTF Permit No.
Permit Number of Do nstre
' Domestic/Commercial
9b Industrial
96 Other (specify):
gallons per day (I'SOO

26 March 07
Re: Project Modification, Permit Information Item B I
Reference to Permit No. WQ0029338
Iredell County
This modification is the addition of phase 2 and phase 3.

z
0
2.
LICATION for GRA IT1i" SEWERS, I'UMP STATIONS, Ai'1ll FORCE MAINS PAGE 4
Provide tt a w st ter flour calculations used in determining the permitted flow in accordance with 15A NCAC 2H
.0219(I) for Item B(7) or the design flow for line or pump station sizing if zero flow in the space below. Values other than
that in 15A NCAC 2H .0219(l)(1-2) must be supported with actual water or wastewater use data in accordance with 15A
NCAC 2H ,0219(1)(3).
(o 4m00gs
��5 1 Zv
10. Summary of Sewer Lines to be Permitted (attach additional sheets .if necessary)
Size (inches)
ENTER TOTAL LINE LE N TH tN MILES
Length (feet)
1111 LIN Er
0
ummary of Pump Stations to be Permitted (attach additional sheets as n
Gravity or Force Matn
(use the pull down menu)
ocatton ID Power Reify
as shown on Design Flow Caper al Point (1- dual line teed; 2- permaneilrt generator %WATS; 3-
rence) (MOD) GPM TOM portable generator wftelemetrry; 4-wet well storage)
12. Does the .sewer s
Mai (latest version),
Qes Q No if no,
iimum Design Criteria for the Fast Track Permitting of Pump Stations and Force
Minimum sign Criteria (latest version) and 15A NCAC 214 x020C as applicable?
miniknum design criteria or regulatlan and tndIcabe why a
COPIES OF PLANS, SPECIFICATIONS OR CALCULATIONS
T TO Tl VARIANCE it3 YOUR APPLICATION
Have tttae followlrlg itsfcations tin submitted ferr aprotl?
Wetland/Stream Crossings - General Permit or 401 Certification? 0 Yes 0 No E A
EYYes 0No ON/A
0 Yes ©No Q'N/A
Sedimentation and Erosion Control Plan?
Stomwirater?
14. Does this pro)eot invatve aerial lines or siphons? Check if yes: 0
Thesis knes wit be considered hkit and rra 6e checked once ever six. months
15. Does this project have grrllty sewter lines designed at minimum slopes?0
Be wines that the Division will not accept " hoes more than 10% flatter than the minimum slope. Linea installed outside this tolerance should be
carreoted prior to submitting the final engineering sari...

D. CERTIFICATIONS
CATION I"ntr GRA4 'I' SEVERS, PUMP STATIONS ANI) FORCE MAINS PAGE 5
Use the Division's guidance document entitled, "DETERMINING STREAM CLASSIFICATIONS FOR FORM FTA 02103
(FAST -TRACK SEWER SYSTEMS)" to collect and record the stream classification data below (attach additional sheets as
necessary). This document is available from our web site or by contacting the appropriate Division of Water Quality
regional office (see instructions for addresses) OR indicate the following.
A Stream Classification is not needed because all parts of the project are at. Ieast 100 feet away from any down slope
waterbody AND,
Er/A Stream Classification is not needed buse the design does not depend on wet well Storage as a power reliability
option for any pump station near a Class C down slope waterbody.
Location ID on Map
(self chosen - as shown on
map for cross-reference)
la.
Name of
Waterbody
County
Waterbody Strew Waterbody
River Basin Index Ciassificaiian
Submit the 8.5" x 11" GOLOR topographic map as wired in Inistruction 'VI
regardless of whether a classification is provided!
Applicant's f t1tCtttion:
1, SIGNING OFFICIAL NAME, attest that this application for PROJECT NAME
has been reviewed by ore and is accurate and complete to the best of my knowledge. I undeand that if ail 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 143-215,68, any person who knowingly makes any false statement, representation, or
certification in any application shell be guilty of a Class 2 misdemeanor which may include a fine not to exceed $10 tom+'
as well as civil penalties up to $25 000 per violation.
Signing Official Signature
2, Professional Engineers
2a,
2b,
2c,
Dat
f attest that this application for has been reviewed by me and is accurate, complete
and consistent with the information in the engineering plans, calculations, and all other supporting documentation to the
best of my knowledge. I further attest that to the best of my knowledge the proposed design has been prepared in
accordance with the applicable regulations, Gravity Sewer Minimum Design Criteria for Gravity Sewers adopted February
12, 1996, and the Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains adopted June
1, 2000 and the watershed classification in accordance with Division guidance. Although certain portions of this submittal
package may have been developed by other professionals, 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 143-215.6A and 143-215, 68, 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.
s
Professional Engineer Name
icing Address
2d.
City
2g.TA. i,u m , .i 2h. -
Telephone Facsimile
E-mail
Seal, Snatui'e & pate_

vxue nusL livt J t vpu map
0.2 0.4 0.6 0.8
UTM 17 511756E 3963691N (NAD27)
USGS Statesville East (NC) Quadrangle
Projection is UTM Zone 17 NAD83 Datum
r'aa►bv A VA I
zone.com/print. asp?lat---35.8 i 909&tan=.8O,86986&size=1&u=4&iayer ►RG&datum... 3/26/2007

Central Files: APS SwP
04/25/07
Permit Number WQ0029338
Permit Tracking Slip
Program Category Status Project Type
Non -discharge In review Major modification
Permit Type Fast Track 'Version Permit Classification
Gravity Sewer Extension, Pump Stations, & Pressure Sewer B Individual
Extensions
Primary Reviewer Permit Contact Affiliation
sonja.basinger
Permitted Flow
1800
Facility
Facility Name
Georgetown Place S/D
Location Address
Owner
Major/Minor Region
Minor Mooresville
County
lredeli
Facility Contact Affiliation
Owner Name Owner Type
City of Statesville Government - Municipal
Owner Affiliation
Robert Hites, Jr
PO Box 1111
Statesville NC 286871111
Dates/Events
Orig Issue App Received
09/22/05 04/16/07
Draft Initiated
Scheduled
Issuance
Public Notice Issue Effective
o4/-24Ai
Regulated Activities Requested/Received Events
Subdivision
Wastewater collection
Outfall NULL
Additional information requested
Additional information received
Expiration
Waterbody Name Stream Index Number Current Class Subbasin

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Coleen Sullins, Director
Division of Water Quality
February 27, 2008
Robert Hites, City Manager
City of Statesville
P.O. Box 1111
.Statesville, North Carolina 28687
SUBJECT: Georgetown Place
Permit No. WQ0029338 Modification
Wastewater Collection System Extension
Final Engineering Certification
Dear Permittee:
The Division received a final engineering certification for the subject project on January 30, 2008. A
full review of the certification materials may or may not be conducted. It is assumed that receipt of
this certification indicates compliance with all regulations, design criteria and the permit. Please be
reminded that the Permittee is responsible for keeping a copy of the final record drawings'for the
life of the project. If you have not received a copy, please contact your consultant immediately to
obtain a copy.
You are receiving this letter because the Division has you listed as the responsible party. If this
permitted system is no longer owned by you, please complete Form PNOCF-S as this permit is not
automatically transferable. Form PNOCF-S can be downloaded from
httQ://h2o.enr.state.nc.us/ndriu/ndiouapps.html#Sewer.
If you have any question concerning this document or the completion of Form PNOCF-S (if
necessary), please contact Ms. Dee Browder at the letterhead address or via E-mail at
[e-mail].
ORobert Krebs
t) Surface Water Protection Regional Supervisor
Enclosure
Cc: R. Carroll Williams, PE 4840 North Center Street, Hickory NC 28601
Surface Water Protection Section Central Files (certification page only)
NorthCarolina
Naturally
Pretreatment, Emergency Response and Collection Systems Unit Internet httpi/h2o.enr.nc.state.us/ndpu
1617 Mail Service Center, Raleigh, NC 27699-1617 An Equal Opportunity Action Employer
Telephone [phone] Fax [phone]% recycled/10% post -consumer paper

Fast Track Engin
Permit No. WQ0029338 Modification
April 26, 2007
ring Certification
Robert Hite, Jr., City Manager
City of Statesville
P.O, Box 1111
Statesville, NC 28687
R. Carroll Williams, RE,
4840 North Center Street
Hickory, NC 28601
Complete and submit this form to the permit issuing regional office with the f
NC DEAR MRO
Surface Water Protection
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 ally changes resulting in non-compliance with this permit regulations or
minimum desictrrt 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.
been authorized to observe
ENGINEERS CERTIFICATION
[l Partial Final
as a duly registered Professional Engineer in the State of North Carolina, having
periodically, [] weekly, E full time) the construction of the Georgetown Place
SID, Iredell 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, NORTH CAROLINA 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.