WQ0039603_Regional Office Historical File Pre 2018

Watery esacar
ENVIRONMENTAL Ai..ITV
December 4, 2017
W. Anthony Vann
Rowan -Salisbury Board of Education
500 N. Main Street
Salisbury, North Carolina 28144
Subject: Permit No. WQ0039603
Rowan -Salisbury Board of Education
Western Elementary School
Wastewater Collection System. Extension Permit
Rowan County
ROY COOPER
Governor
MICHAEL S. REGAN
.Secretary
LINDA CULPEPPER
Interim Director
Dear Mr. Vann:
In accordance with your application received November 3, 2017, with additional info received
November 27, 2017,.we are forwarding herewith Permit No. WQ0039556 dated December I, 2017 to the
Rowan -Salisbury Board of Education (Permittee) for the construction and operation upon c ification of
the subject wastewater collection system extension, This permit shall be effective from the date of
issuance until rescinded and shall be subject to the conditions and limitations as specified therein. This
cover letter shall be considered a part of this permit and is therefore incorporated therein by reference.
Please pay particular attention to the foliowing conditions contained within this permit:
Condition L1.1: This permit shall not be automatically transferable; a request must be made and approved.
Condition 11.4: 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.
It shall be the responsibility of the Permittee 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.
Suite. of North Carob x s tvir rlrKental Qua#ity ; Water Resources r Water Q dory Regs©saai Cpe
Mooresville Regional Office 61.0 East Center Avenue„ Suite 301 1 ivfooresvilie, North Cara
704 663 1699

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 Lon Snider at [phone] or
via e-mail at lon,sniderri4ncdenr., ov.
Sincerely,
by W. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NCDEQ
cc: Sam King, Jr, PE (E-copy)
Mooresville Regional Office Files
Water Resources Central Files
PERCS (E-copy)
Page 2 of 8

•
environmental
Quality
• STATE OF NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENTAL QUALITY
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
Rowan -Salisbury Board of Education
Rowan County
for the construction and operation of approximately 648 linear feet of 8-inch & 360 linear feet
of 6-inch public gravity sewer, to serve 628 students for the new Western Elementary School
project, and the discharge of 7536 gallons per day of collected wastewater into the Town of
Cleveland existing sewerage system, pursuant to the application received November 3, 2017,
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 shall be effective from the date of issuance until rescinded and shall be subject to
the specified conditions and limitations contained therein.
by W. Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NCDEQ
By authority of the Environmental Management Commission
Permit Number: WQ0039603
Permit Issued: December 1, 2017
Page 3 of 8

SUPPLEMENT TO PERMIT COVER SHEET
Rowan -Salisbury Board of Education 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 Town of Cleveland Waste Water
Treatment Facility in accordance with Permit Number NC0049867.
Permitting of this project does not constitute an acceptance of any part of the project that does not meet
15.A NCAC 2T; the Division's Gravity Sewer Minimum Design Criteria adopted February 12, 1996, as
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. 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.
Construction and operation is contingent upon compliance with the Standard Conditions and any Special
Conditions identified below.
SPECIAL CQ_NDI1'I©NS
1) No flow in excess of the quantity permitted herein, 7,536 GPD, shall be made tributary to the
subject sewer system until an application for permit modification for an increase in flow has been
submitted to and approved by the Division. [15A NCAC 02T.0304 (b)].
II. STANDARD CONDITIONS
This permit is not transferable. In the event there is a desire for the wastewater collection facilities
to change ownership, or there is a name change of the Pennittee, 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. [15A NCAC 02T.0104; G.S 143-215.i(d3)]
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'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 unless specifically mentioned herein. [15A NCAC
02T.01.10]
3. This permit shall be effective only with respect to the nature and volume of wastes described in the
application and other supporting data. [15A NCAC 02T .0110]
4. The wastewater collection facilities shall be properly maintained and operated at all times. The
Permitee 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: [15A NCAC 02T .0108(b)]:
Page 4of8

a. The sewer system shall be effectively maintained and operated at all times to prevent discharge
to land or 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 frequency, preventative
maintenance schedule, spare parts inventory and overflow response has been 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 months and inspections
documented.
f. A general observation of the entire sewer system shall be conducted at least once per year.
g.
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 § 143-215.1 C.
h. A Grease Control Program is in place as follows:
1. For public owned collection systems, the Grease Control Program shall include at least
biannual distribution of educational materials for both commercial and residential users and
the legal means to require grease interceptors at existing establishments. 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.
2. For privately owned collection systems, the Grease Control Program shall include at least bi-
annual distribution of grease education materials to users of the collection system by the
permittee or its representative.
3. Grease education materials shall be distributed more often than required in Parts (1) and (2)
of this Subparagraph if necessary to prevent grease -related sanitary sewer overflows.
i. Right-of-ways and easements shall be maintained in the full easement width for personnel and
equipment accessibility.
j. Documentation shall be kept for Subparagraphs (a) through (i) 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. The Permittee shall report by telephone to a water resources staff member at the Mooresville Regional
Office, telephone number [phone], as soon as possible, but in no case more than 24 hours
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 SSO and/or spill over 1,000 gallons; or
c. Any SSO and/or spill, regardless of volume, that reaches surface water
Page5of8

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. [G.S. 143-
215.1C(a1)]
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. [15A NCAC 02T.0108(b)]
7. 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 is 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 applicable design calculations including pipe and pump sizing,
velocity, pump cycle times, and level control settings, pump station buoyancy, wet well storage,
surge protection, detention time in the wet well, and force main, ability to flush low points in
force mains with a pump cycle, and downstream sewer capacity analysis. If a portable power
source or pump is dedicated to multiple stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, include travel
timeframes, shall be provided.
c. Changes to the project that do not result in non-compliance with this permit, regulations, or the
Minim UM 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 10% or greater, increased
flow, pump station design capacity design increases of 5% or greater, and increases in the
number/type of connections), regulations, or the Minimum Design Criteria. Requested modifications
Page 6 of 8

or variances to the Minimum Design Criteria will be reviewed on a case -by -case basis and each on
its own merit. Please note that variances to the Minimum 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 be approved, thus requiring replacement or repair prior to
certification & activation. [15A NCAC 02T .0116]
8. 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 an 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. [ 15A NCAC 02T.0105(n)]
9. A copy of the construction record drawings shall be maintained on file by the Permittee for the life
of the wastewater collection facilities. [15A NCAC 02T .0116]
10. 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; construction of additional or replacement wastewater collection facilities,
and/or referral of the North Carolina -licensed Professional Engineer to the Iicensing board. [15A
NCAC 02T .0104; 15A NCAC 02T .0108(b-c)]
11. 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.
[15A NCAC 02T .0110; 15A NCAC 02T .0108(b)]
12. 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 the Division any other Federal, State, or
Local government agencies which have jurisdiction or obtaining other permits which maybe required
by the Division or any other Federal, State, of Local government agencies. [G.S. 143-215.1(b)]
Page 7 of 8

FAST TRACK SEWER ENGINEERING CERTIFICATION
PERIVIITTEE: ROWAN-SALISBURY BOARD OF EDUCATION
PERMIT #: WQ0039603
PROJECT: WESTERN ELEMENTARY SCHOOL
ISSUE DATE: DECEMBER 1, 2017
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 Perrnittee to
appropriate enforcement actions, The Pei mittee 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.
PERMITTEE'S CERTIFICATION
I, 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
I, , as a duly registered Professional Eineer in the State of North Carolina,
having been authorized to observe (0 periodically, 0 weekly, Li fiH time) the construction of the
project name and location as referenced above for the above Perrnittee 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 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 Ei Partial (include description)
Certification Comments/Qualifiers (attach if necessary):
NC DWR — Water Quality Regional Operations
Dorti,n-31 Chf-Fir,
610 East Center Avenue, Suite 301, Mooresville, NC 28115
Phrbnp- (7M F-1Q AX 17041-613-6040

State of North Carolina
Department of Environmental Quality
Division of Water Resources
1SA NCAC 02T.0300— FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number\;
(to be compketed by, f3
All items must be completed or the atm[rlicatitrn will be returned
APPLICANT INFORMATION:
1. Applicant's name: Rowan -Salisbury Board of.Fducation (ca mpany. municipality, HOA, utility. etc,)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately-f ed,Publir Utility e_
❑ Federal ❑ State/County [❑ Municipal t)tl
3. Signature authority's name: W. Anthony Vann per 15A. NCA
Title: Assistant Superintendent for Operations
4. Applicant's mailing address: Sot) N, Main St,
City: Salisbury; State: NC Zip: 28144-
5. Applicant's contact iinformation:
Phone number: [phone] Email Address: Anthonv.Vann;%i rss.'kI2.ne,us
PROJECT INFORMATION:
1. Project name: Western Elementary Sthool
2, ApplicationJProject status: ® Proposed (New Permit) ❑ Existing Perniitt"Project
If a modification, provide the existing pennit number: WQ00 and issued date:
if navy construction but part ot"a master plan. provide the existing penn.it number: WQ00
3. County where project is located: Rowan
4, A.pproximate Coordinates (Decimal Degrees): Latitude: 35:43'43." longitude: -8t1.4
5. Parcel II) (if applicable): 2520.31, 252042,
(or Parcel lD to closest downstream sewer)
111. CONSULTANT:INFORMAT1O.N:
1. Professional Engineer: Lesley R. 1:nelancl T icetts
F°irtn: Davis -Martin -Powell and Associates
Mailing address: 6415 Old Plank Rd
City: High Point State: NC Zit: 27265-.
Phone number; [phone] Entail Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Cleveland WW"I'P Permit Number: NC0049867
Owner Nante: Town of Cleveland NC
her. 02.7568
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
I. Permit Num.ber(s): WO
System Wide Collection System Permit +anrtl crO iik appli
(oner Name(s):
FORM: FTA 04-16
"S
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 ®N/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
❑ Residential Leased
® School / preschool / day care
❑ Food and drink facilities
❑ Businesses / offices / factories
❑ Retail (stores, centers, malls)
❑ Retail with food preparation/service
❑ Medical / dental / veterinary facilities
❑ Church
❑ Nursing Home
5. Nature of wastewater : 100 % Domestic/Commercial % Commercial
% Industrial (See 15A NCAC 02T .0103(20))
�Is there a Pretreatment Program in effect?
6. Has a flow reduction been approved under 15A NCAC 02T .0114(f)? ❑ Yes
➢ If ves, provide a copv of flow reduction approval letter
7. Summarize wastewater generated by project:
❑ Car Wash
❑ Hotel and/or Motels
❑ Swimming Pool /Clubhouse
❑ Swimming Pool/Filter Backwash
❑ Other (Explain in Attachment)
❑ Yes ® No
® No
Establishment Type (see 02T.0114(f))
Daily Design Flow 3'1'
No. of Units
Flow
Additional Students from Woodleaf ES
I0 gal/per day per student
347
3470 GPD
Existing Cleveland Elementary School
I0 gal/per day per student
281
2810 GPD
gal/
GPD
gall
GPD
gal/
GPD
gal/
GPD
Total
6280 GPD
a See I5A NCAC 02T .0114(b), (d). (e)(11 and (6(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: 3470 GPD (per I5A NCAC 02T .0114)
> Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
0 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:
❑ Rehabilitation or replacement of existing sewer with no new flow expected
® Other (Explain): THIS PROJECT WILL REPLACE THE EXISTING CLEVELAND ELEMENTARY SCHOOL
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
8
648
PVC
6
360
PVC
➢ 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.
4.
Design flow of the pump station: millions gallons per day (firm capacity)
Operational point(s) of the pump(s): gallons per minute at feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
6. Power reliability in accordance with 15A NCAC 02T .0305(hl(1):
❑ Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(h)(l)(B):
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
➢ Must he 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 ptunp 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 & 1SA NCAC 02T .0305(f)):
1. Does the project comply with all separations found in 15A NCAC 02T .0305(f) &_(g)
➢ 15A NCAC 02T.0305(fl contains minimum separations that shall be provided for sewer systems:
® Yes ❑ No
Setback. Parameter*
Separation Required
Stone 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(a) contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webpaae
➢ 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)
➢ 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
®Yes ❑No
3. Does the project comply with all setbacks found in the river basin rules per 15A NCAC 0213.0200? ® Yes ❑ No
➢ This would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Does the project comply with an individual 404 Permit or any 401 Certifications? ® Yes ❑ No
➢ Wetland -related permits shall be requested, obtained, and adhered to for projects that impact wetlands or surface waters
➢ Information can be obtained from the 401 & Buffer Permitting Branch
5. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T.0I05(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
➢ 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

t . CERTIFICATIONS:
IO\S:
I, Does the submitted system ctomply veith 25r
i to and the
1f No, con splcre and submit the Vdn m e/Altcrna
for review. Approval of the reque
documents.
Professional Firs„inccr's Ccititcatio
equired prior frs submittal
legsle „121°:raplasnd
1'tolessional Engineer's notate, atom Application.
'ADC 10-14) and supporting documents
Track ,Application and supporting
hat this a.pplfcat"son for
has lseera revievv°ed by me and is accurate, complete and consistent 'With the isupplied in the plans, specifications,
engineering calculations, and all other supporting documentation. to the best olmy 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 rn,w 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.
NO11., — In accordance Wit
statement, representation, or eel
include a fine not to exceed SIO,
North Carolina Profess
canes t'
143-215.6A and 143-215,6FL any perstart vs'ho know iaagly attakes any false
ation in any application package shall be guilty of a Class 2 misdemeanor, which may
as well as civil penalties up to S25,000 per violation,
Engineer's scat, signature, and date:
t\ \ CAU (12T .(t I 060):
Assist
io
applicanto
has been reviewed by me an is accurate and ct,aniplete to the best of my knowledge. l Lind- .a red parts of
this application are not completed and that if all required supporting deoa uttteratation and attachments are not t (chided, this
application package: is subject CO heing returned a.s inecanaplete. l understand that any discharge ot`wastewater 1
discharge system to surface waters or the land will result in an immediate enforcement action that may include civi
in tanekty zrltet, and/or eritt'aitaal Lea sec - °ill make no claims against the Division of Water (Resources slaotal
condition of this permit he violated, 1 also understand that if all required parts of this application package are not completed
and that Walt required supporting in fa rnteation and attachments are not included, this upplicatiton package Nvill be. returned to
me as incomplete:
NOTE — In atcc0rahnaCC '
statement, representation, or
include a line not to exceed $10.000 as vvel
Signature
t431.215_613. any person who knowingly makes any false.
ge shall he guilty of a ('lass 2 misdemeanor, which nt,ay
penalties up to S2Sfiiltl ltcr' violatiian.
Page 5 of 5

c. WWTP facility's permitted flow 0.270
d. Estimated obligated flow not yet tributary to the WWTP 0.102
e. WWTP facility's actual avg. flow 0.116
f. Total flow for this specific request 0.006
g. Total actual and obligated flows to the facility 0.224
h. Percent of permitted flow used 83.0
1-„
/
rn. rr of Water Rcsoutces
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow TrackinglAcceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: Salisbury Rowan Board of Education
Project Name for which flow is being requested: Western Elementary School
More than one AThE may be required for a single project if the owner of the WHIP is not responsible for all pump
stations along the route of the proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Cleveland WWTP
b. WWTP Facility Permit #: NC0049867
AlllTows are in MGD
H. Complete this section for each pump station you are responsible for along the route of this
proposed wastewater flow.
List pump stations located between the project connection point and the WWTP:
(A) (B) (C) (D)=(B ) (E)=(A-D)
Design Obligated,
Pump Average Daily Approx. Not Yet Total Current
Station Firm Flow** Current Avg. Tributary Flow Plus
(Name or Capacity, * (Firm / pf), Daily Flow, Daily Flow, Obligated Available
Number) MGD MGD MGD MGD Flow Capacity***
Hwy 70 0.26 0.104 0.023 0 0.023 0..081
* The Firm Capacity of any pump station is defined as the maximum pumped flow that
can be achieved with the largest pump taken out of service.
Design Average Daily Flow is the firm capacity of the pump station divided by a peaking
factor (p1) not less than 2.5.
f.x:. A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): Cleveland Wastewater Collection System
Downstream Permit Number: WQCS00231
Page 1 of 6
FTSE 04-1 ti

III. Certification Statement:
I -31161 h`G D fi eJ 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 IT plus all
attached planning assessment addendums for which I am the responsible party. Signature of this
form indicates acceptance of this wastewater flow.
ger,/
Signing Official Sjiafure Date
Page 2 of 6
FTSE 04-16

PLANNING ASSESSMENT ADDENDUM (PAA)
Submit a planning assessment addendum for each pump station listed in Section II where Available
Capacity is c 0.
Pump Station (Name or Number):
Given that:
a. The proportion and amount of Obligated, Not Yet Tributary Daily Flow (C) accounts for
% and MGD of the Available Capacity (E) in Pump Station
; and that
b. The rate of activation of this obligated, not yet tributary capacity is currently approximately
MGD per year; and that
c. A funded Capital Project that will provide the required planned capacity, namely
is in design or under construction with
planned completion in ; and/or
d. The following applies:
Therefore:
Given reasonably expected conditions and planning information, there is sufficient justification to
allow this flow to be permitted, without a significant likelihood of over -allocating capacity in the
system infrastructure.
I understand that this does not relieve the collection system owner from complying with G.S. 143-
215.67(a) which prohibits the introduction of any waste in excess of the capacity of the waste
disposal system.
Signing Official Signature
Date
Page 3 of 6
FTSE 04-16

• Instreictions for Flow Tracking/Acceptance form (FTSE) and Planning Assessment Addendum (PAA)
Section I
a. WWTP Facility Name: Enter the name of the WWTP that will receive the wastewater flow.
b. WWTP Facility Permit 4: Enter the NPDES or Non -Discharge number for the WWTP receiving the
wastewater flow.
c. WWTP facility's permitted flow, MGD: From WWTP owner's NPDES or Non -Discharge permit.
d. Estimated obligated flow not yet tributary to the WWTP, MGD: This includes flows allocated to other
construction projects not yet contributing flow to the collection system. Flows allocated through
interlocal agreements or other contracts not yet contributing flow to the collection system are also
included. For POTWs that implement a pretreatment program, include flows allocated to industrial
users who may not be using all of their flow allocation. Please contact your Pretreatment Coordinator
for information on industrial flow tributary to your WWTP.
As of January 15, 2008 the POTW should have reviewed flow allocations made over the last two years
and reconciled their flow records, to the best of their ability, so it is known how much flow has been
obligated and is not yet been made tributary to the WWTP, in accordance with local policies and
procedures employed by the reporting entity.
e. WWTP facility's actual avg. flow, MGD: Previous 12 month average.
f. Total flow for this specific request, MGD: Enter the requested flow volume.
g. Total actual and obligated flows to the facility, MGD Equals [d + e + f]
h. Percent of permitted flow used: Equals [(g / c)* 100]
For example:
On January 15 a POTW with a permitted flow of 6.0 MGD, reported to the Regional Office that there
is 0.5 MGD of flow that is obligated but not yet tributary. The annual average flow for 2007 is 2.7
MGD. There is a proposed flow expansion of 0.015 MGD.
The first Form FTSE submitted after January 15, 2008 may have numbers like this:
c. = 6.0 MGD
d. = 0.5 MGD
e. = 2.7 MGD
f. = 0.015 MGD
g. = 3.215 MGD
h. = 53.6%
The next Form FTSE may be updated like this with a proposed flow expansion of 0.102 MGD:
c. = 6.0 MGD
d. = 0.515 MGD
e. = 2.73 MGD
f. = 0.102 MGD
g. = 3.349 MGD
h. = 55.8 %
Each subsequent FTSE form will be updated in the same manner.
Page 4 of 6
FTSE 04-16

• Section it
List the pump station name or number and approximate pump station firm capacity, approximate design
average daily flow (A) approximate current average daily flow (B), and the obligated, not yet tributary flow
through the pump station (C) for each pump station' that will be impacted by the proposed sewer extension
project. Calculate the total current flow plus obligated flow (D=B+C) and the available capacity (E=A-D).
Include the proposed flow for this project with other obligated flows that have been approved for the pump
station but are not yet tributary (C).
Firm capacity is the maximum pumped flow that can be achieved with the largest pump out of service as
per the Minimum Design Criteria.
Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor (pf) of not
less than 2.5.
If the available capacity (E) for any pump station is < 0, then prepare a planning assessment for that pump
station lithe system has future specific plans related to capacity that should be considered in the permitting
process.
(A) (B)
Design
Firm Average
Pump Station Capacity Daily Flow
(Name or Number) MGD (Firm / pf)
Kaw Creek PS 0.800 0320
Approx.
Current Avg.
Daily Flow,
MGD
0.252
Valley Road PS 1.895 0.758 0.472
(C) (D)=(B+C) (E)={A D)
Obligated,
Not Yet
Tributary
Daily Flow,
MGD
0.080
0.135
Total Current
Flow Plus
Obligated Available
Flow Capacity*
0.332 -0.012
0.607 0.151
Page 5 of 6
FTSE 04-16

•
Planning Assessment Addendum Instructions
Submit a planning assessment addendum for each pump station listed in Section II where available capacity
is < 0.
A planning assessment for Kaw Creek PS (see example data above) may be performed to evaluate whether
there is significant likelihood that needed improvements or reductions in obligated flows will be in place
prior to activating the flows from the proposed sewer extension project.
If the system decides to accept the flow based on a planning assessment addendum, it is responsible to
manage the flow without capacity related sanitary overflows and must take all steps necessary to complete
the project or control the rate of flow to prevent sanitary sewer overflows. •
The planning assessment may identify a funded project currently in design or construction, or a planned
project in the future not yet funded but in a formal plan adopted by the system. The system should carefully
weigh the certainty of successful timely project completion for any expansion, flow management diversion
or infiltration and inflow elimination projects that are the foundation of a planned solution to capacity
tracking and acceptance compliance.
For example:
Given that:
a. The proportion and amount of obligated, not yet tributary flow accounts for 24 % and 0.080
MGD of the committed flow in Pump Station Kaw Creek; and that
b. The rate of activation of this obligated, not yet tributary capacity is currently approximately 0.01
MGD per year; and that
c. A funded capital project that wiII provide the required planned capacity, namely
is in design or under construction with
planned completion in • and/or
d. The following applies:
The master plan and ten year capital plan contain recommended scope and funding for a capital project
entitled Kaw Creek Pump Station upgrade with funding planned in July 2014. This project is planned to
add 0.100 MGD to the firm capacity of the pump station by October 2015. Inclusion of this proposed
capital project as a condition of this Flow Tracking/Acceptance for Sewer Extension Permit Application
elevates this project's priority for funding and construction to be implemented ahead of the activation of
obligated., not vet tributary flows in amounts that exceed the firm pump station capacities identified in
Section II above.
Therefore:
Given reasonably expected conditions and planning information, there is sufficient justification to allow
this flow to be permitted, without a significant Iikelihood of over -allocating capacity in the system
infrastructure.
Page 6 of 6
FTSE 04-16

State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 - FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION
This application is for sewer extensions involving+ gravity sewers, pump stations and force mains, or any ccmbination that has been
certified by a professional engineer and the applicant that the project meets The requirements of 15 \, lw(-yC ll':I and the Division.'s
Minimum Design Criteria and that. plans, specifications and supporting documents have been prepared in accordance with, 15A
NCAC 02'T, 15t NCAC 021' .0300, Division policies and Llood engineering practices.
While no upfront engineering design documents rare required for submittal, in accordance with I5A NCAC 02T .0305(b), design
documents must be prepared prior to submittal of a fast track permit application to tl'te Division. This would include plans, design
calculations, and prefect specifications referenced in 1€ vl_11,,,t) .r7.9, and the applicable minimum design criteria. 'These
documents shall be available upon request by the Division,
Projects that ate deemed permitted (do not
Projects not eii
• Projects that require an environmental assessment in accordance with 15A NCA.0 IC .01 00;
Projects that do not meet any part of the minimum design criteria, (MDC) document,
• Projects that involve a variance from the requirements of 15A NCAC 2Ti
r Pressure sewer systems utilizing septic tank -effluent pumps (STI'Ps) or simplex grinder puunps;
STEP or simplex grinder pumps connecting to pressurized systems (e.g. force mains);
Vacuum sewer systems,
permit irons
sion) are explained in ➢ 5
-ack process (must be submitted for hall technical revi
General - When submitting a.n application, pl.ea.se use the follow%ng i trite -titans as a checklist in order to ensure all required
items are submitted. Adherence to these instructions and checking the prcavidet• boxes will help produce a quicker review time
and reduce the amount of requested additional information, Failure to submit all required items will necessitate additional
processing and review time, and may result in return of the application. Unless otherwise noted, the Applicant shall submit
one original and one copy of the application and supporting documentation.
A. One Original and One Copy of Application and Supporting Documents
Required unless otherwise noted
R. Cover Letter (Required for All Application Packages):
items included in the application package. as well as a brief description of the requested permit
Be specific as to the system type, number of homes served, flow allocation required, etc-
➢ if necessary for clarity, include attachments to the application form,
C. Application Fee (All New and Major Modification Application Packages):
g Submit a check or money order in the amount of $480.00 dated within 90 days of application submittal,
• Payable to North Carolina Department of Environmental Quality (NCDFQ)
D. Fast Track (Form: FTA 04.16) Application (Required for MI Application Packages):
Submit the completed and appropriately executed application.
If necessary for clarity or due to space restrictions, attachments to the application may be made..
© if the Applicant Type in hem 1,2 is a corporation or company, provide documentation it is registered for business with
the North Carolina Secretary of Stutc-
10 If the Applicant Type in item 1,2 is a partnership or dib,!a, enclose a copy of the certificate filed with the Register of
Deeds in the county of business,
The Project Name in ]rein II, I shall he consistent with the propect narrae on. the flow acceptance letters, agreements, etc.
The Professional Engirt
s Certification on Page 5 of the application shall be signed, sealed and dated by a North
CAarc lira llicenscd Profess tcrr trl Eng nevi.
The; Applicant's Certification on Page 5 of the application shall be signed 't.n accordance with 1' \ NC"
Per iS,A NCAC 02T .0106(c), an alternate person may he designated as the signing official if a de
provided from a person who meets the criteria in 15A NCAC 02T .0106(b)-
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION
I .fjl(1(tl�]
aft letter is
Page 1 of3

1
E. Flow Trac1dng/Acceptance Form (Form: FTSE 04-16) (If Applicable):
El Submit the completed and executed FTSE form from the owners of the downstream sewers and treatment facility.
➢ Multiple forms maybe required where the downstream sewer owner and wastewater treatment facility are different.
➢ The flow acceptance indicated in form FTSE must not expire prior to permit issuance and must be dated less than one
year prior to the application date.
➢ Submittal of this application and form FTSE indicates that owner has adequate capacity and will not violate G.S. 143-
215.67(a).
➢ Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific FTSE.
F. Site Maps (All Application Packages):
® Submit an 8.5-inch x 11-inch color copy of a USGS Topographic Map of sufficient scale to identify the entire project
area and closest surface waters.
➢ Location of the project (gravity sewer, pump stations & force main)
➢ Downstream connection points and permit number (if known) for the receiving sewer
® Include a street level map showing general project area.
G. Existing Permit (AlI Modification Packages):
❑ Submit the most recently issued existing permit.
❑ Provide a list of any items within the permit the Applicant would like the Division to address during the permit
modification (i.e., permit description, flow allocation, treatment facility, etc.).
H. Power Reliability Plan (Required if portable reliability option utilized for Pump Station):
❑ Per 15A NCAC 02T .0305(h)(1), submit documentation of power reliability for pumping stations.
➢ This alternative is only available for average daily flows less than 15,000 gallons per day
➢ It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant and is
compatible with the station. The Division will accept a letter signed by the applicant (see 15A NCAC 02T .0106(b)) or
proposed contractor, stating that "the portable power generation unit or portable, independently -powered pumping
units, associated appurtenances and personnel are available for distribution and operation of this pump 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. (Required at time of certification)
I. Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per 15A NCAC 02T .0115(a)(1) provide the Certificate of Public Convenience and Necessity from the North Carolina
Utilities Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served by
the sewer extension, or
❑ Provide a Letter from the North Carolina Utilities Commission's Water and Sewer Division Public Staff stating an
application for a franchise has been received and that the service area is contiguous to an existing franchised area or
that franchise approval is expected.
J. Operational Agreements (Applications from HOAIPOA and Developers for Iots to be sold):
❑ Home/Property Owners' Associations
❑ Per 15A NCAC 02T .0115(c), submit the properly executed Operational Agreement (FORM: HOA).
❑ Per 15A NCAC 02T .0115(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
❑ Developers of lots to be sold
O Per 15A NCAC 02T .0115(b), submit the properly executed Operational Agreement (FORM: DEV).
For more information, visit the Division's collection systems website
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 2 of 3

1
THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional Office
2090 US Highway 70
Swannanoa, North Carolina 28778
[phone]
[phone] Fax
Avery, Buncombe, Burke, Caldwell, Cherokee,
Clay, Graham, Haywood, Henderson, Jackson,
Macon, Madison, McDowell, Mitchell, Polk,
Rutherford, Swain, Transylvania, Yancey
Water Quality Section
Fayetteville Regional Office
225 Green Street Suite 714 •
Fayetteville, North Carolina 28301-5094
[phone]
[phone] Fax
Anson, Bladen, Cumberland, Harnett, Hoke,
Montgomery, Moore, Robeson, Richmond,
Sampson, Scotland
Water Quality Section
Mooresville Regional Office
610 E. Center Avenue
Mooresville, North Carolina 28115
[phone]
[phone] Fax
Alexander, Cabarrus, Catawba, Cleveland,
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
Stanly, Union
Water Quality Section
Raleigh Regional Office
1628 Mail Service Center
Raleigh, North Carolina 27699-1628
[phone]
[phone] Fax
Chatham, Durham, Edgecombe, Franklin,
Granville, Halifax, Johnston, Lee, Nash,
Northampton, Orange, Person, Vance, Wake,
Warren, Wilson
Water Quality Section
Washington Regional Office
943 Washington Square Mall
Washington, North Carolina 27889
[phone]
[phone] Fax
Beaufort, Bertie, Camden, Chowan, Craven,
Currituck, Dare, Gates, Greene, Hertford, Hyde,
Jones, Lenoir, Martin, Pamlico, Pasquotank,
Perquimans, Pitt, Tyrrell, Washington, Wayne
Water Quality Section
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, North Carolina 28405
[phone]
[phone] Fax
Brunswick, Carteret, Columbus, Duplin, New
Hanover, Onslow, Pender
Water Quality Section
Winston-Salem Regional Office
450 W. Hanes Mill Road
Suite 300
Winston-Salem, North Carolina 27105
[phone]
Alamance, Allegheny, Ashe, Caswell, Davidson,
Davie, Forsyth, Guilford, Rockingham, Randolph,
Stokes, Surry, Watauga, Wilkes, Yadkin
Water Quality Section
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 3 of 3

State of North. Carolina
Department of Environmental Quality
Division of Water Resources
NCAC 02T .0300 — EAST TRACK SEWER SYSTEM EXTENSION APPLICATION
ETA 04-16 & SUPPORTING DOCUMENTATION
Applicatio
'umber.
be reympieted kyv DWtti
All items must be completed or the applicatio
eturned
APPLICANT INFORMATION.
1. Applicant's name I o aan Salisbp,r,v l3 ardof,Education [ctrtrupanyr, n°stuticipality. II( \, ata'lit . etc.)
2, Applicant type: Li Individual Corporation General Partners l'aip El Privately -Owned Public Utility
:Federal ❑ State/County Municipal X Other
Signature authority's name W. Anthony Vann per 15_y_"via_t,] krpltrit�'1
Title: AssistancSuperintenderrt kutr„Unerations
4. Applicant's mailing address: 1)(1' ,u,.'V1,sin,St
City: Salisbury State. NC Zip: 2Zi1,44-_..,
5. Applicant's contact information:
Phone number: (704) 0.6i0('L Email Address: Anthony ,'_annAr
IL PROJECT INFORM.A'TION:
L Project name, Western Elemenn School
Application/Project status: X Pn!posed (Ne
If a modification, provide the existing permit number: WQOO and issued date:
if new construction but part ofa nrtas er plan, provide the existing permit number: WQ:00_
3. County where project is'I°cated: Row°ap
4, Approximate Caordina
imal Degrees): Latitude:;
Parcel ID (ifapplieable): "5 t314 5 2042w,
Or Parcel ID to closest downstream sewer)
bit. CONSULTANT INFORMATION:
1. Professional Engineer; Lesley._.R England__
Firm: Davis-Mattin-,Powell. and Associates
Mailing address 6415 71d Plank,,-(cd
City: ,high Paint State: NC
Phone number: (3 F?) 8864821 Final l Address: l as )and66dmj
fl Existing FemiitfPropeet
Longitude: -940'5 C
' ASTEWATER TREATMENT FACILITY.° ('WW`TF) INFORMA"IION:
Facility Name: Cleveland, WW„iP Permit Number NC0049867
Owner ,Name, Town of Cleveland NC
er• 02756s
RECEiVI.NG DOWNSTREAM SEWER IN 'IATION (it different than WWII):
1. Permit Nutnber(s): AVQ
System Wide Collection Systent lc-rnrit Numbers) (if appliealalc):
Owner Natne(s):
A 04-16 Page I 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 ®NIA
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached?
❑ Yes ❑No ®NIA
3. If the Applicant is a Home/Propertv Owners' Association, has an Operational Agreement (FORM: HOA) been attached?
❑ Yes ❑No ®NIA
4. Origin of wastewater: (check all that apply):
0 Residential Owned ❑ Retail (stores, centers, malls)
❑ Residential Leased ❑ Retail with food preparation/service
® School / preschool / day care ❑ Medical / dental / veterinary facilities
❑ Food and drink facilities ❑ Church
❑ Businesses / offices / factories ❑ Nursing Home
Car Wash
❑ Hotel and/or Motels
❑ Swimming Pool /Clubhouse
❑ Swimming Pool/Filter Backwash
❑ Other (Explain in Attachment)
5. Nature of wastewater : 100 % Domestic/Commercial % Commercial
% Industrial (See l5A NCAC 02T .0103(20))
�Is there a Pretreatment Program in effect? 0 Yes ® No
6. Has a flow reduction been approved under 15A NCAC 02T .0114(f)? ❑ 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
Additional Students from Woodleaf ES
12 gal/per day per student
347
4164 GPD
Existing Cleveland Elementary School
12 gal/per day per student
281
3372 GPD
gal/
GPD
gal
GPD
gall
GPD
gal/
GPD
Total
7536 GPD
a See I5A 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 1SA 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: 4164 GPD (per I5A NCAC 02T .0114)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
0 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.
❑ Rehabilitation or replacement of existing sewer -with no new flow expected
® Other (Explain): THIS PROJECT WILL REPLACE THE EXISTING CLEVELAND ELEMENTARY SCHOOL
FORM: FTA 04-16
Page 2 of 5

1 •
VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8
648
PVC
6
360
PVC
➢ 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
VIH. 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: millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): gallons per minute at feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
6. Power reliability in accordance with 15A NCAC 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)):
I. " Does the project comply with all separations found in 15A NCAC 02T .0305(f) & (g)
➢ 15A NCAC 02T.0305(fl 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() or (g), see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation)
➢ 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
®Yes ❑No
3. Does the project comply with all setbacks found in the river basin rules per 15A NCAC 02B .0200? ® Yes ❑ No
> This would include Trout Buffered Streams per 15A NCAC 213.0202
4. Does the project comply with an individual 404 Permit or any 401 Certifications? ® Yes ❑ No
➢ Wetland -related permits shall be requested, obtained, and adhered to for projects that impact wetlands or surface waters
➢ Information can be obtained from the 401 & Buffer Permitting Branch
5. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T.Q105(c)(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 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
➢ 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

• , 1 •
1
CERTIFICATIONS:,
Does, the; submitted system comply with I SA.NCAC'02T, the Minimum Design Criteria for the Peronittink: of Pump Stations
and Force M"tiros {[atesf the Gravity Sevier Minimum Design 'Criteria (latest version) as applicable?
® Yes Ergo
If complete and submit,the•Variance/Altertiattve.Design Request a pp[icationl(VADG lq-14) andsupparfir g doetiments
for; review. Approval: of the request' is required: prior to submittal of`the Fast -Track Applicatiowand, supporting,
documents.
2: Professional Engineer's Certification;
I, Lesley R:.England,. attest that this:application ibr
(Professional Engineer's name.from AppiicatiotiItem 1_141)'
has been reviewed by me: and is accurate, ebrnp[ete and consistent with the information supplied, in. the, plans,. specifications,
engineering calculations, and all other supporting to:the best of My knowledge: I further attest that to the best;
of illy 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 Miriiinuns 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 signatdre and seal"signifies thatI hale reviewed this,
material andfhave judged it:to:6econsistentwith the proposeddesign:
NOTE — In accordance with General Statutes 143-215.6A and. 143-215.6B,:any,person who :i4o;ionri7gri:linlal:e"s,: any false
statement,-teprese`ptation, or, certification. in -any ,application,package;shall be'guilty-of a•.Class:memno, which may
include.a fine not:to,exceed$10,000,;as:well-as.civtbpenalties up to.$25;000:per'v_iolatton ,
��rau+r.,,4` ,�• 4, .11D j'G
Al:14 ,.: 's 11 0
i$r 56:L.
17. r' 1i1/2017 / Q
.,,,Fr..,
.,.......................
North CaroiinaProfessio`nal Engineer's seal signaturei,anddate:
3. Applicant's Certification:per 15A NCAC 02T'.0106(b)
I, \V Anthony Vann' Assistant Superintendent. for Operations
(Signature.Authority's name.&.title from Application:ltem 1;1.)
has been reviewed by me:and is:accurate' and complete-to:the best of my, know[edge. I understand that if all requited parts of
this:apphcation;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 ivastewater from this none
discharge system wa
ters aters or -the land will result inan immediate enforcement action that may include civil` penalties;:
m unctrve� relief andlar criminal j prosecution, I will' make no claim against the Division Of Water- Resources. should. a,
condition. of this permit be.violated; I. al so; understand that;if'ail requiredparts of this application. package are not completed
and'that•if all required-suppoiting,i tformation and attachments ante not-included,.this application package will .be returned to+
me as incomplete.
attest;that this" applieation.for
NQTE — In': accordance with -General' Statutes+ I43215:6A and 143-215:6B: arty person who 'kdowingly makes any- false
statement, representation; or certification in .` y application package:sha[I.be,guilty-ofa Class 2 misdemeanor, which m__ay
include a fine not to exceed $10,000 as'well , civ[I penalties up -to $25,000 per violation.,
Signature
FORM: -ETA 04=1b'
Date: ttP I,,,14I 11
Page 5_ of 5

r .1 •
Div(sten of Water Resources
State of North. Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: Salisbury Rowan Board of Education
Project Name for which flow is being requested: Western Elementary School
More than one FTSE may be required a single project if the owner of the WWTP is not responsible for all pump
stations along the route of the proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Cleveland WWTP
b. WWTP Facility Permit #: NC0049867
All flows are in MGD
c. WWTP facility's permitted flow 0.270
d. Estimated obligated flow not yet tributary to the. WWTP 0.102
e. WWTP facility's actual avg. flow 0.116
f. Total flow for thisspecific request 0.0075
g. Total actual and obligated flows to the facility 0.2255
h. Percent of permitted flow used 83.5
II. Complete this section for each pump station you are responsible for along the route of this
proposed wastewater flow.
List pump stations located between the project connection point and the WWTP:
(A) (B) (C) (D) +C) (E)=(A D)
' Design Obligated,
Pump Average Daily Approx. Not Yet Total Current
Station Firm Flow** Current Avg. Tributary Flow Phis
(Name or Capacity, * (Firm / pf), Daily Flow, Daily Flow, Obligated Available
Number). MGD MGD - MGD MGD Flow Capacity***
Hwy 70 0.26 0.104 0.023 0 0.023 0..081
* The Firm Capacity of any pump station is defined as the maximum pumped flow w that
can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pumpstation divided by a peaking
factor (pi) not less than 2.5.
*** A Planning Assessment 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): Cleveland Wastewater Collection System
Downstream Permit Number: WQCS00231
Page 1 of 6
FTSE 04-16

• .1
III. Certification Statement:,
I. Danny Gabriel _ 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 II plus all
attached planning assessment addendurns for which I am the responsible party. Signature of this
form indicates acceptance of s wastewater flow.
Signing OfficiaZgnature
Page 2 of 6
Date
FTSE 04-16

taw
reight ne T L. ck.
a ufacturing Plant
0

The National Map
UST©po
40

DAVIS • MARTIN • POWELL
ENGINEERS & SURVEYORS
TIANSMIT'TAL
�p
Date: November 1, 2017
To: State of North Carolina Re: Rowan County Schools
Department of Environmental Quality Western Elementary School
Division of Water Resources Job No. 140438(BF)
Mooresville Regional Office, Water Quality
Section
610E Center Avenue
Mooresville, NC 28115
re sending you attached the following items:
Shop Drawings Samples
Prints 0 Specifications
Plans Disk
# Copies
Drawing #
1
Remarks:
Description
L
L
Copy of Letter
Other
Change Order
Original and Signed Copy of the Fast Track Sewe
Application
Check in the amount of $480
Signed Flow Tracking/Acceptance Form
8 %2 x 11 USGS Map showing the project area
street Map Showing the project Imcaticrn
By:�,--
Eddie MacEldo +rne
c: File
T: 336-886-4821 • F: 336-885-4458 • License: F-0245
5415 Old Plank Road, High Point, NC 27265 • www.dmp-inc.corn
Disposition
For Review and
Approval
For Review and
Approval

Central Files: APS _ SWP _
12/1/2017
Permit Number WQ0039603 _-Permit Tracking Slip
Program Category Status Project Type
Non -discharge Active New Project
Permit Type Version Permit Classification
Gravity Sewer Extension, Pump Stations, & Pressure Sewer Extensions 1.00 - Individual
Primary Reviewer
lon.snider
Coastal SWRuIe
Permitted Flow
7,536
Facility
Permit Contact Affiliation
Facility Name
Western Elementary School
Location Address
Owner
MajorlMinor Region
Minor Mooresville
County
Rowan
Facility Contact Affiliation
Owner Name
Rowan -Salisbury Board of Education
DateslEvents
Owner Type
Nan -Government
Owner Affiliation
W Anthony Vann
500 N Main St
Salisbury
NC 28144
Orig Issue
12/1/2017
App Received Draft Initiated
11/3/2017
Scheduled
Issuance Public Notice Issue
12/1/2017
Regulated Activities Requested /Received Events
School
Wastewater collection
Outfall
Effective
12/1/2017
Expiration
Additional information requested 11/6/17
Additional information received 11/27/17
Waterbody Name Streamindex Number Current Class Subbasin