WQ0039998_Regional Office Historical File Pre 2018

Water Resources
LNIVIRONMENI AL QUAL,TV
May 17, 2018
Jason Wilson
Salisbury -Rowan Utilities
1. Water Street
Salisbury, North Carolina 28144
PER
Governor
MICHAEL S, REGAN
Secretary
LINDA CULPEPPER
Interim Director
Subject: Permit No, WQ0039998
Salisbury -Rowan Utilities
Poplar Street Force Main Relocation
Wastewater Collection System Extension Permit
Rowan County
Dear Mr. Wilson:
In accordance with your application received May 14, 2018, we are forwarding herewith Permit No.
WQ0039998 dated May 16, 2018 to the Salisbury -Rowan Utilities (Permittee) for the construction and
operation. upon certification 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effective from the date of issuance until rescinded and shall be subject to the conditions and limitations as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 following conditions contained within this permit:
Condition 11„ 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 NC.A.0 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 §143-215.6.A 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.
State of North Carolugt Etivirotunental Quality I Water Resources I Water Quality Regional Operations
Mooresville, Regional Office. I 610 East Center Av'enue, Suite 3P.I 1Mooresville, North Carolina. 2113. I 15
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 lonsnider nedenr,Loy,
Sincerely,
DocuSigned by:
P$14CC681AFZ7425_
by \\ Corey Basinger, Regional Supervisor
Water Quality Regional Operations Section
Division of Water Resources, NCDEQ
cc: Randall Hintz, PE (E-copy)
Mooresville Regional Office Fil
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
Salisbury -Rowan Utilities
Rowan County
for the construction and operation of approximately 1,850 linear feet of 3-inch HDPE force main
to the line relocation of the Poplar Street pump station, and the discharge of 0 gallons per day
of collected wastewater into the City of Salisbury existing sewerage system, pursuant to the
application received May 14, 2018, 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.
DocuSigned by:
A14f:f;FR1AF97495
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: WQ0039998
Permit Issued: May 16, 2018
Page 3 of 8

SUPPLEMENT TO PERMIT COVER SHEET
Salisbury -Rowan Utilities is hereby authorized to:
Construct, and then operate upon certification the aforementioned wastewater collection extension. The
sewage and wastewater collected by this system shall be treated in the City of Salisbury Waste Water
Treatment Facility in accordance with Permit Number NC0023884.
Permitting of this project does not constitute an acceptance of any part of the project that does not sweet
15A 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 C:r nditions and any Special
Conditions identified below.
1. SPECIAL CONDITIONS
1) No flow in excess of the quantity permitted herein, 0 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')j.
II. STANDARD CONDITIONS
'I`his 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 Perrnittee, 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)]
2. 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 lune 1, 2000, as
applicable; and other supporting materials unless specifically mentioned herein. [15A NCAC
02T_0110]
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 tunes. The
Permittee shall maintain compliance with an individual system -wide collection system permit for the
operation and maintenance of these facilities as required by 1 5A NCAC 2T .0403, If an individual
permit is not required, the following performance criteria shall be met: [15A NCAC 02T .0108(b)l:
Page 4 of 8

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 §143-215.1C.
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
Page 5 of 8

Voice mail messages or faxed information is permissible, but this shall not he 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 Lof 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 l7 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, I)eclarations/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 DV'D 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
timefrarnes, shall be provided.
c. Changes to the project that do not result in non-compliance with this permit, regulations, or the
Minimum Design Criteria should be clearly identified on the record drawings, on the certification
in the space provided, or in written summary form_
Prior, to Certification (Final or Partial): Permit modifications are required for any changes resulting
in non-compliance withthis permit (including pipe length increases of lff% or greater, increased
flow, pump station design capacity design increases of 5% or greater, and increases in the
nurnber./type of connections), regulations, or the Minimum Design Criteria. Requested modifications.
Page b 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 Minimutn 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 licensing board. [15A
NCAC 02T .0104; 15A NCAC 02T .0108(b-c)]
1 I. 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
PERMITTEE: SALISBURY-ROWAN UTILITES
PERMIT #: WQ0039998
PROJECT: POPLAR STREET FORCE MAIN RELOCATION
ISSUE DATE: MAY 16, 2018
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 ali 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 footen
Any wastewater flow made tributary to the wastewater collection system extension prior to completion
of this Certification shall be considered a violation of the permit and shall subject the Permittee to
appropriate enforcement actions. The Permittee 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.
PE TTEE'S CERTIFICATION
1, the undersigned agent for the .Peintittee, 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
ignature Date
ENGINEER'S CERTIFICATION
as a duly registered Professional Engineer in the State of North Carolina,
having been authorized to observe (I1periodicaily, PI weekly, full time) the construction of the
project name and location as referenced above for the above Permittee hereby state that, to the best of my
abilities, due care and diligence was used in the observation of the construction such that the construction
was observed to be built within substantial compliance of this permit; 1.5A NCAC 021; 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 .Pemiitting 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:
r Final
Partial (include description)
Certification Comments/Qualifiers (attach if necessary):
NC DWR — Water Quality Regional Operations Section 610 East Center Avenue, Suite 301, Mooresville, NC 28115
Mooresville Regional Office Phone: [phone] FAX: [phone]

the sRavene[
May 11, 2018
North Carolina Department of Environmental Quality
Division of Water Resources
610 E. Center Avenue, Suite 301
Mooresville, NC 28115
Attn: Lon Snider
RE: WR Project #06170969.00
Fast Track Sewer System Extension Application
Salisbury -Rowan Utilities
Poplar Street Force Main Relocation
Dear Mr. Snider:
Please find enclosed a Fast Track Application for the Poplar Street Force Main Relocation project for
Salisbury -Rowan Utilities. The project consists of relocating an existing force main from the Poplar Street
pump station through the installation of approximately 1,850 LF of 3" HDPE (for use with grinder pumps). No
additional flow is requested with this application.
Items included in this submittal:
• Two copies of Fast Track Sewer System Extension Application
• Two copies of USGS and aerial site maps
• Two copies of the existing permit
• Application Fee (check in the amount of $480)
If you have any questions about this submittal, please do not hesitate to call me.
Sincerely,
ersRavenet
Jacob Gray, E.I.
Staff Professional - Utilities
WithersRavenel
828-255-0313
cc:
Jason Wilson, PE, Salisbury -Rowan Utilities

Division of Water Resources
State of North Carolina
nnevartrt ertt of Environmental Quality
l: i i ion of Water Resources
13A NC: AC O2`T.0300..R FAST TRACK SEWER SYSTEM F,N"FE SIGN APPLICATION
ETA. 04-16 & SLtic DOCUMENTATION
MEN' %TIO
\pphcati
1. Applicant's name: S al s u , - Rowan
.Appiieant ty
Title; 1 (
;\pp
ra address: 1 Wale
City: Salishur} State. NC,
Applicant's contact int3 rruation:
Phone numb r: (70:l) 216-7.353 .Era I Address: jasou
f
red or the application nil
icipal
per b rv" .';=rA ,1...d IN 6
PROJECT INFORMATION:
TION:
Zip: 28144
1. Project name: Poplar Street Force .e \mlain Relrrca
Application,'Prcricct status:
provide the e\rs
n but part of a maste
gated: Rowan
4. \pT>rcrsirt ate Coordinates {T ee retrat Degree~,]: lmat"tude:
5. Parcel ID
1-a. Parcel 1C) to c
3. County vv
l'CiNSI LI'ANT INFORMATION:
Processional Engineer' R adall I4irrt l$icr rase Number: 021337
Firm \4'ithets creel
Mailing address: 84C xe.,..:,\'oentie
C'it '; .F\.shes ille State: It€:".
Phone n'umlacr. l828 t1;,wl ;
Z Proposed
Permit)
Itsbur' uc,go\
p
t: nu.mher: \\'Q00 _ and issued date:
provide the, exrstina perrrtit. number: WQ0
ttrde: 80 O
I4. WASTEWATER T'.RT tTMEN°1 FACILx1"TN` tWNVI 1) INFCIR\1 t"TIC.b'
Facility Name. C.`itw' s ttl'bury \l' I PP Permit Number NC'002 bb4
C?cstrer° Name a C'�tom ofSalishtrr
NC; DO\%NSTI
unrber(s):
I SEWER INFCIR"1IATICJN fit°different than WW
Sewer Sic.
t't('Soup'19.
Downstream (Kee
ttrrut ^ unihert5) tlt`.App'1s_,
t"CtR1: 1°TA
Pa.ge 1 of 5

THE COMPLETED APPLICATION PACKAGE INCLCiINC, ALL SI)PPORTING INFORMATION ANE)
MATERIALS, SHOULD BE SENT TO TIIF APPROPRIATE REGIONAL, OFFICE:
REGIONAL OFFICE
Astertlle R tonal
ut r Guaft Sect.
Fayettevi
Section
Office
aresvllte Re tana6 0
uat(fy Section
Raleigh Regional Office
Water Quality Sectionj
rhino
er
ADDRESS
2090 US Highway 70
Swannanoa, North Carolina 28778
[phone]
[phone] Fax
225 Green Street Suite 714
Fayetteville, North Carolina 28301-5094
[phone]
[phone] Fax
610E Center Avenue
Mooresville, North Carolina 28115
(704) 663-.1699
[phone] Fax
1628 Mail Service Center
Raleigh, North Carolina 27699-1628
[phone]
[phone] Fax
n Re banal Cfftr e 943 Washington Square Mall
iffy ection Washington, North Carolina 27889
[phone]
[phone] Fax
ton Regional Office
uatity Section
on -Sale m Regional 0
quality ect(on
27 Cardinal Drive Extension
riiornington, North Carolina 28405
)tl)) 796-7215
350-2.004 Fax
4
$ut
COUNTIES SERVED
Avery, Buncombe, Burke, Caldwell, Cherokee,
Clay, Graham, Haywood, Henderson, Jackson,
Macon, Madison, McDowell, Mitchell, Polk,
Rutherford, Swain, Transylvania, Yancey
Anson, Btaden, Cumberland, Harnett, Hoke,
Montgomery, Moore, Robeson, Richmond,
Sampson; Scotland
Alexander Cabarrus, Catawba Cleveland,
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
Stanly, Union
Chatham, Durham, Edgecornbe; Franklin,
Granville, Ha1'ifax,, Johnston, Lee, Nash,
Northampton, Orange, Person, Vance, Wake,
Warren„ Wilson
Beaufort, Bete, Camden, Chowan, Craven,
Currituck, Dare, Gates„ Greene, Hertford, Hyde,.
Jones, Lenoir, Martin, Pamlico, Pasquotank,
Perquimans, Pitt, Tyrrell, Washington, Wayne
Brunswick, Carteret, Columbus, Dublin, New
Hanover, Onslow, Pander
. Hanes Mill Road Al lance, Alleghany, Ashe, Caswell, Davidson,
e Davie, Forsyth, Guilford, Rockingham, Randolph,
,tor r-Salem, North Carolina 27105Stokes, Surry, Watauga, Wilkes, Yadkin
) 776-9800
INSTRUCTIONS FOR FORM: F l'.Fy 104-I6 & SI. PPOR"l l" Ci DOCUMENTATION

GENERAL, REQUIREMENTS
If the Applicant is a 0rivatelti-Ow ed Public t.itility, has tr (.'ertifcat
0 Yes ON°
li
a
lithe Applicant is a 1 uipe='Property
4. Origin of wastewater, {e•heck all tita
El Residential Owned
0 Residential L,ease.d.
El School a' preschool I day care
rood and drink facilities
0 Businesses / offices/ factories
Nature of NV tstewater : 1 Of
a.?
old, has a De,),,
0 Yes
0\es
)f Public.: Con
LI Retail (staers, malls
0 Retail with focrd preparation sc
0 Medical r' dental ;' veterinary ary faciliti
00 Church
Nursing Llonre
NIA
w;otn mercial
• Commercial
and 'Necessity been attached?
1 been attached?
een attached''
Wash
el and:or N�lo
lndustrittl (Sec G 1 \t tC 6t'?"1",• 0I0 3(20J)
i Is there a Pretreatment Program in effect'? LJ 'Yes El No
6. Has a flow reduction been approved under l s A \(„ C i 1. U 1 l4kfl? [l Yes ❑ No
w If yes, provide a copy of flow reduction apttrova tenet
7. Summarize wastewater generated by projects
lishnnent Type (see 02'I',011 4(0)
no wastewater is generated. by p
a
C,0
dwelling,. proposed un
and residential property 1
in („In,•,7. 42A.-1).
41bULI1,
'n no'n-re.
ted south or east of tl
h Per 15A NCA.C' 02'°f .01, I
determined using available flo
8. Wastewater generated by project
Do not include future flows or
Caveats tr
nt uses, public ne
rale Intracoastal \ "aterwa
design flow rates for establishments not identifies
uhht)use
ling Pool/1 filter Backwash
- (Explain in Attachment)
sign lost tatr
used as vacs
data, water using fixtures, occupancy or operation patterns, and
(iPE){lacrw1 A\!(,ra\.(mm021 .0lI4)
r°eviottsls aermitted allocations
GPD
GPI)
niniutttnt flow per
h public use areas;
as defined.
9 f permitted flow is zero, indicate why:
© Pump Station or (.gravity Sewer where flow will he permitted in subsequent, permits that connect to this line
El Flow has already been alto
Eg Rehab -I
tcd in Permit Nu her:
adorn or replacement of existing sessc 55 011 tto stew firs
El Other (Explain):
41 shall be
FORM: Im,.f1, 04- 16 Pa e. ? of 5

VII. GRAVITY SEWER I)ESIGN 'RI:"I'ERI.A (If Applicable _ 02T .0305 & ,M DC (Cray.
1. Summarize gravity sewer o he perm itted:
Size (ine.hes) Length (feet)
Material
Section 11 & 1• P
Section 111 contains informatisrn related to
avers lines 10 rtteet trtrnittturn sit)
VII1, PUMP STATION DESIGN CRITERIA (If
CCJ �11'Ix:EiT. FOR EACI1 PUMP STATION 1NC ,UDED IN THIS PROJECT
I . Pump station number or name: Pular Street
Approximate Coordinates (Decimal Degrees): Laatitttcle: 5.596' Longitude 80.=4 "
Design flow of the pump station: p,01.3 millions gallons per day (firm capacity')
4. Operational point(s) of the pump(s): 45 gallons per minute at 98 feet total dynamic head (TDI1)
5. Summarize the force main to be permitted (for this Pump Station):
nfa rt,a
,ers cona
es for era
is not allowed a
rrtation
o des tgrt criteria
iolation of the MD
Power reliability in accordanc
Standby power source or pump with
uti
()5 & ,ltt)( (Pump Stations/Force,Ma,ins):
nd telemetry - I5.A, NCAC 02$I' .0305(h)
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 artd telemetry - 15A NCAC! 02T
.030.509( I)(C)
or
❑ Portable pumping in with plugged emergency° pump connection and telemetry 15A NC A 02T .030.5(h)(I)(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 tag multiple pump stations, an evaluation of"all the pump stations' storage
capacities and the rotation schedule of the portable pawner source or pump, including travel timefrinnes, shall be provided
in the case of a multiple station power outage,
FORM: FTA 04- l6

\. SETBACKS & SEPARATIONS —(0213 .0200 & 15A \CA(` 02'1` .0305i(I",
C, 1^.0305 &..•
that slr,tlt be provided for sewer systems:
1" Does the project comply with all separations found in
I SA. NCAC 021,0305(0 contains minimum
Setback Pa'
t fisted below (vertical)
later rraains (httrizorttal;
Reclainted water lines (v
tteelainted water lines t h
including in benched trenet
tle�tl r elaimed over sew
"a a' reclaimed ever s"
*Any pri ate or public vv'ater supply source, including any wells, \\
lass It impounded reservoirs used as tr source of drinking water
*i 'aters cl.assilied. Vi S (except WS-t or WS-V), 13, SA, (TRW IIQW, or SB from normal
`g e tide elevation) and wetlands see item 1\.2)
Any other stream, lake, impoundment, or ground water lowln and trrfuae drain e
nv n 7 foundation
nemen.
al earth
bankntent or cuts rtf2 feet ttr tttt>re vertic<1 laea:
t:02'1'.0'tl5` x co
If noncompliance with 02"1,0
alternatives
be identified usin
..1i�s. see
vhere se anti
a
Yes
red
nches
nc he s
feet
nches
100 feet
5 feet
0 fee
10 feet
36 inches
red,
_ebpae
the project comply with se tt<trati art requircnaent- for wetlands? (50 feet ot`separai.i tn) El Yes
See the Division's draft separation requirements tear satttatataras wltere scpatration cannot be meet
No variance is required if the alternative design criteria specified is utilized in design and c c>rtstruction
As built documents should reference the location of areas effected
Does the projee
This would
PI),"
ide
ith setbacks tcruntt in the
out Buffered Streams pe.
.aver basin rules pe
4, Does the project require cc vc r agcr`authorization render a 404 Nationwide or
individual permits or 40- Quality Certifications`?'
lnformattoncan heobtained from the ,401 &Bufler.'ctrt)Ifait l3r a ,6
project comply with 150'1
02)3_,02001;"
ddit onal permits)""certitacattic
permits or certifrcati
have been obtained, Issuance of this permit is contingent on ass
ls,. stC7r`tr141'atel" nranacernerrt plans, ete,).
ta. Does this project in Jude any ses er clllc
Per 15 N( 1t t "2l t1w1(12, °`high-l'arioTit:
pclsitiuncd parallel to strearnhnnks that is
priority
t underniva s car deter'or
[Yes ONo
No
icat c ns are being prepared, have:
f dependent permits (crositttt and
elude an attachment with details for each line, anchiding type (aerial Inc.isize, material, and loeatiu
thigh pr inrity lines shall be inspected by the perrnittce or its representati
documented per l5A .NCAC 02'1.0,403(a)(5) or the permitee's int)ie°ideas
ys
ce every six -months and inspections
ETA 04-16
e4of5

X. CERTIFICATIONS:
1. Does the submitted system comply with I 5A NCAC 02T, the Minimum Design Criteria for the Permitting of Pump Stations.
and Force Mains (latest version). and the Gravity Sewer Minimum Design Criteria (latest version) as applicable?
Yes LINO
If No, complete and submit the Variance/Alternative Design Request application (V ADC 10-14) and supporting documents for
review. Approval of the request is required_prior to submittal of the Fast Track Application 4jadlupporting documents.
Professional2. Engineer's Certification:
tAP. A L.L. D. at±est that this application for
(Professional Engineer's name from Application Item 111.1.)
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans, specifications,
engineering calculations, and all other supporting documentation to the best of my knowledge. I further attest that to the best
of my knowledge the proposed design has been prepared in accordance with the applicable regulations, Gravity Sewer
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track Perrnitting
of Pump Stations and Force Mains (latest version). Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that 1 have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any hilse
statement, representation, or certification in any application package shall be guilty of a Class 2 misdem r, which may
include a fine not to exceed S10,000, as well as civil penalties up to $25,000 per violation.
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
6tkss-ofv! Erfriv AtrogAv
(Signature Authority's name & title from Application Item 1.3.)
oo
at
is application for
has been reviewed by me and is accurate and complete to the best ofmy knowledge. I understand that if all required parts of
this application are not completed and that if all required supporting documentation and attachments are not included, this
application package is subject to being returned as incomplete. 1 understand that any discharge of wastewater from this non -
discharge system to surface waters or the land will result in an immediate enforcement action that may include civil penalties,
injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water Resources should a condition
of this permit be violated. I also understand that Wall required parts of this application package are not completed and that if
all required supporting information and attachments are not included, this application package will be returned to me as
incomplete.
NOTE — In accordance with General Statutes 143-2154A and 143-21,5,613, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Date:
FORM: FTA 04-16
Page 5 of 5

Division of Water ttcsosirccs Flo
State of North Caro
Department of Environmental Quality
Division of Water Resources
Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Alloca.tit
City of Salisbury
Project Name for which flow is being requested: Poplar St Lift, Station
More than one FTSE may he required for a single project f the owner of the WWTP is not responsible. all pump
stations along the route of the proposed wastewater low.
➢. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Citf Salisbury - Town Creek Train
b. WWTP Facility Permit #: NC 0023884
c. WWTP 'facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP 0.337
e. WWTP facility's actual avg. flow
( Total flow for this specific request
g. Total actual and obligated flows to the facility 2.427
h. Percent of permitted flow used
All flows are in
5,000
GD
2.089
0.Ot10
48%
I1. 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
Pump
Station
(Name or
Number)
Crane Crk
(A)
Design
Average Daily
Firm Flow**
Capacity, * (Firm / pi),
MGD MGD
0.914
2.286
Coley Rd 1.071 0.426
Approx,
Current Avg,.
Daily Flow,
MG
().865
0,205
(t3) (C)
Obligated,
Not Yet
Tributary
Daily Flow,
MOD
0.020
0.013
the W WTP::
(D)=(t3+C,j (E)--(A-D)
Total Current
Flow Plus
Obligated Available
Flow Capacity***
0.885 0,029
0.218 0.208
* 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 (pf) 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):
Downstream Permit Number:
Page 1 of 6
FTSE 04-16

Pr
III, Certification Statement:
1 Jeffrey Jones, PE PLS 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 1 and II
plus all attached planning assessment addendums for which i am the responsible party.
Signature of this form indicates acceptance of this wastewater flow.
Signi tix Signature
Date
Page 2 of 6
FTSE 04-16

POPLAR STREET F J N
R EEOCA $O
OCA'110 4AP

POPLAR S SET I
R. L C TIO