WQ0039023_Application (FTSE)_20170202

Division of Water Resourc `" l" 1 7
Fast Track Application for Sewer Systems Revie Checklist
,y�, (pl -f x pp �. `` R J W_ Q0039023
Project Name: ii 4tki ;e�� �r(VL $i,/i2, �X'i. A rh��cation Number: :I
Application Completeness Review O�C 114 V (-� 34 Q 3
11v� Project is located in a County currently covered by the regional office es ❑No
Application and supporting documentation submitted in duplicate? J2Yr [-]No
One Original and One Copy
all Correct application fee. submitted? See G.S. 143-215.3D 12 es ❑No ❑N/A
Ensure that a check for $480 is submitted and made out to NC DEQ.
All new projects and major modifications to emsting projects require lication fee. A major modification
includes any changes to permitted flow volumes, changes in pipe di sages in pipe length greater than 10 %
of the originally permitted length, changes in operating points of a tion, are. If unclear, contact the Central
Office.
Application package is complete?
Current application version (See website) �Y.e []No
Brief project narrative (per Section B of FTA lions) as []No
Certification of Public Convenience and Nee provided Yes ❑No ❑N/A
(if applicable)
Operational Agreements, signed and dated ❑No ❑N/A
(if applicable)
Flow Tracking /Acceptance Form lived and da - Uws ❑No ❑N/A
Flow Tacking/ Acceptance Plarm tAddend ❑Yes ❑No ❑N/A
(if applicable)
Site Map and Street Level Map (per Se F o ctions es ❑No
PE Certification of is signed, d and C. P es No
Applicant Cert and dated cle rovi d) es ❑No -
If any. portion of the ap ' n is not Incta, or i equked insWction items have been omitted, and the
return of an application is' t, the wing steps s be taken:
C not ( ho emailfor-very minor completeness deficiencies,
e ap d co t) 48 he -
• e application p is to be incomp wring this completeness review, fill out a checklist that
r ' ies the deficien d re a application to the applicant with a copy to the consultant. If the
app n fee has not b posite it as well.
Any projects that be returned be returned prior to accepting the application (i.e, before logging in the
application and dep the chase fter a project has been accepted, any information that is found to be
incorrect and/or lackin be re d via an Additional Information Request in accordance with 15A NCAC
02T.0107.
Cam&= W I CAS IL

Permit Information
LyNaw Permit - ❑Permit Modification
If the project is a modification to an existing permit, be am to enter the application into RIMS as a permit
modification (i.e. "renew/modify application" and not `create new project"). BIMS will pull the previous signing
official and affiliations information. Modify all tabs and enter updated information.
Does the project require a permit for the activity? Eyes ON.
See Permitting by Regulation ((SA NCAC 02T 03031 for projects deemed permitted
If No, return fee and application package
Is the project eligible for the Fast Track Program? [3Y€s ❑No
Projects not permitted through the fast track program:
➢ Projects that require an environmental assessment in accordance with 15A NCAC 1C .0100;
➢ Projects that do not meet any part of the minimum design criteria (MDC) document;
D Projects that involve a variance from the requirements of 15A NCAC 2T;
➢ Pressure sewer systems utilizing septic tank -effluent pumps (STEPS) or simplex grinder pumps;
➢ STEP or simplex grinder pumps connecting to pressurized systems (e.g. force mains);
➢ Vacuum sewer systems.
If No, retain fee and application package and advise applicant what to do
Information entered into BIMS? (Project details, affiliations, etc)
ONO
Applicant (Owner/Permittee) signature meets requirement of 15A NCAC 0106(b)?
—�s
2Yes [IN.
If No, request revised application with an appropriate official, or a letter from an
appropriate official that indicates the person in question is delegated to sign the
application on the applicant's behalf. If a new delegated signing official is listed,
add the person to BIMS
Is the applicant is a public entity (county, city, sanitary district, etc.)?
`` //
Ny es ❑No
If Yes, move to Wastewater Flow Information Section
Is the applicant is a private entity and intends to retain ownership (store, church, etc.)?
Dyes []No
If Yes, move to Wastewater Flow Information Section
Is the applicant is a private entity (private utility)?
[]Yes . ❑No
If Yes, Applicant has been designated as a public utility by the NC Utilities Commission
❑Yes ❑No
Has submitted a Certificate of Public Convenience and Necessity (CPCN)
or Letter from the Public Staff of the NC Utilities Commission (contact Central Office)
The project name on the application and CPCN must match
Dyes ONO
Is the applicant is a private entity (Developer) that will be selling units?
❑Yes []No
If Yes, Applicant has submitted an executed Operational Agreement (DEV)
❑Yes []No
A developer may be responsible for the system for an interim period until the HOA is formed,
at which time a time chanee / chaoee ofOwnership form is required to transfer the permit to
HOA
The operational agreement should be attached to the peanut and incorporated into the Inagua
g
f the permit.
Is the applicant is a Homeowner's or Property Owner's Association selling units?
❑Yes ONO
If Yes, Applicant has submitted an executed Operational Agreement (HOA)
❑Yes ❑No
end, Copy of the Articles of Incorporation, Declarations and By-laws
❑Yes ONO
The operational agreement should be attached to the peanut and incorporated into the language
of the permit.

Wastewater Flow Information
Has submitted Flow Tracking/Acceptance Form (FTSE Form)
Des [-]No ❑N/A
Ensure form is complete with all required information and that the owner
has accepted the entire volume of flow listed
Proper certification per 15A NCAC 02T 0106 (b)
,�/
Ly]!ks ❑No
Form is dated within one year of receipt of application package
es ONO
Is FTSE Planning Assessment Addendum Required?
—/
Dyes ONO E94A
Required Only for projects where available pump station capacity is <0.
(Contact Central Office if needed)
Additional forms (FTSE 06-13) required?
��//
Dyes ❑No LyN/A
Required only if the owner of downstream sewer different then owner of W WTF
Receiving W WTF and downstream sewers have adequate capacity
/
Ensure no wmpliance issues (SSOs or W WTF compliance issues)
es ❑No
Wastewater domestic in nature DYes ONO
If item B.6 indicates industrial wastewater, notify the regional pretreatment coordinator or
- contact the Central Office to determine if a pretreatment permit is needed or if it is in place and compliant
Has the wastewater flow volume been calculated correctly (section 11.7 of FTA)? •Lly�7!'/es ONO
low is calculated per 15A NCAC 02T.0114
or
If daily design flow is not based on regulations ensure that the applicant has an approved flow reduction of daily
design flow rate on file with the Division.
Ile
If other than 2T.0114, values must be supported with flow data per 15A NCAC 02T 0114(f)
(Contact Central Office if this is the case)
Design Information ,—,C' Adequate information related to sewer lines (Section VII of FTA) U x es ❑No ❑N/A
Note that per the 2T and MDC, there is a minimum 8" for public gravity or
minimum 6" for private gravity
Adequate information related to pump stations (Section VIII of FTA) Dyes ❑No [X/A
Ensure power reliability option is selected (see 15A NCAC 02T 0305(h))
Has Setbacks & Separations Section been completed? Dyes ❑No */A
Required if any porth, of project is within 100 feet of any surface water or wetlands
Note, 15A NCAC 02T .0305 M contains minimum separations required for sewer
A variance is required if minimum separations cannot be attained (see below) //
Is Project design is in accordance with (see section X of FTA) ['es ❑No
15A NCAC 02T
Gravity Sewer Minimum Des'e Criteria (latest version)
Minimum Design Criteria for P rmittim off Pump St lion and Force Mains (latest version)
If no, a variance approval is required per the requirements of 15A NCAC 02T 0105(b)
• .Applicant must submit TWO copies of the plans, specifications, and calculations -
• Contact the Central Office to discuss the variance request to determine a course of action. The central
office will review the variance request, and if approvable, specific language regarding the variance will be
forwarded to the Regional Office reviewer to incorporate into the permit. A copy of the variance letter (or
email correspondence) should be kept with the application file. /
Project contains high priority lines (15A NCAC 02T 0402(2)). [-]Yes ONO
15A NCAC 02T 0403 (a)(5)
If Yes, insure that the permit contains the necessary condition related to high priority Imes

Application Certification
Has a N.C. PE stamped, signed, and dated the application?
^��-�+/� s ❑No
PE with active license in North Carolina?
Ls�yes ❑No
Check the NCBELS to ensure Engineer is currently registered to practice
NCBELS License Lookup
If the owner is a corporation, is the corporation registered in N.C.?❑yes
❑No
N C Secretary f State !C oo f on Searchl -
Applicant should be registered to conduct business as a corporation in NC (Private
If No, see return application guidance
Owners, Developers, HOAs, etc.)
Issuing a Permit
Most current version of the Fast -Track permit shell used?
Dyes ONO
Special conditions utilized within permit?
High Priority Lines (Aerials)
Dyes ❑No ❑N/A
Variance Language (Approved by the Central Office)
Regional Conditions (i.e. Stomrwater Plans for Coastal Counties)
Construction Only Language ("Dry Lines")
- -
Other instances (contact the central office if required)
Ifpermft modification:
Include Permit History
Dyes ❑No ❑N/A
Void Previously Issued Permit in language
Permit signed only by those delegated to sign for the Director
Dyes ❑No
Permit distributed as follows: ❑yes ❑No
• Original to Permittee
• Copy to Consulting Engineer
• Copy to CountyHealth Department (if applicable)
• Copy to Mecklenburg County Department of Environmental Protections
(Only for projects located in Mecklenburg County)
• Copy to the applicable Building Inspections Authority (if applicable)
• Copy(ies) to the owner of the W WTF and owner of the downstream sewers
(Only if different than the Permittee)
• Copy to Regional Office Files _ -
• Copy to Water Quality Central Files (see Central Files Permit Package below)
• Electronic copy to PERCS unit -
Electronic version shall preferably a signed, scanned copy of the permit in pdf format.
Haut, the electronic version can be a final version of the permit in word format. Regardless,
the permit should follow the naming convention of WQOOXXXXX - YY.MM,DD.
Electronic copies should be forwarded to the PERCS unit contact on a frequent basis (once a month is fine).
• Signed Operational Agreements should be distributed with the permit (if applicable)
Finalizing BIMS
Permit issued vtDate Dyes ❑No
All relevant Event Dates Entered? Dyes ❑No
(add info request, add info received, variance granted, variance denied, etc)
Central Files Permit Package
Complete package forwarded to Central Files ❑yes ❑No
• Finalized Tracking Slip (BIMS Report)
• Copy of signed, issued permit (with operational agreements, if applicable)
• Copy of pemtit application package (application, supporting documentation, etc.)
• Review comments, calculations, notes, review checklist, etc.
• All other correspondence (email phone logs, cover sheets, etc.)
All material in the permit package should be stapled together. Plans and specifications should not
be included in the permit package sent to central files.

�✓ ■ South Sterling Street, Morganton NC
8 8 286 t
CONSULTANTS o«< 2433 5661 / !ax 828 433 5662 /into®wes-consultants.com
January 25, 2017
Water Quality Section
Asheville Regional Office
NCDENR
2090 US 70 West
Swannanoa, NC 28115
Re: Mayfield Drive Sanitary Sewer Project
To Whom It May Concern; 17 Cx.,.atsft✓�/@.f
JAN 2 6 2017 I
The project will consist of the instiltifition of 1273 feet of 8-inch gravity sewer and 17 house
connections. The location is aloA Mayfield Drive and Stamey Road, in Sawmills. This area is
inside the town limits in the stern section of Sawmills. The project will provide public
sanitary sewer service to 17 omes and abandon the existing septic tank systems. Based on 120
gallons per bedroom per house, the allocated flow is 9,480 gallons per day. In the construction
phase of the project both concrete and asphalt driveways will be disturbed and will need to be
repaired. Included in this submittal is the Fast -Track Application, Flow Acceptance Application
for Sawmills and Lenoir, maps and a check for $480.00.
Thank you,
WEST CONSULTANTS, PLLC
�dPote'etdPE
/jc

State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T.0300—FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources ,Ir,. FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number)WQ00 9001 dbe completed
All items must be completed or the application will be returned
L APPLICANT INFORMATION:
1. Applicant's name: Town of Sawmills (company, municipality, FICA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ® Municipal ❑ Other
3. Signature authority's name: Christopher Todd per 15A NCAC 02T .0106(b)
Title: Town Administrator
4. Applicant's mailing address: 4076 US HWY 321-A
City: Granite Falls State: NC Zip: 28630-_
5. Applicant's contact information:
Phone number: [phone] Email Address: [e-mail]
II. PROJECT INFORMATION:
1. Project name: Mayfield Drive Sewer Extension
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: W000 and issued date:
If new construction but part of a master plan, provide the existing permit number: W000
3. County where project is located: Caldwell
4. Approximate Coordinates (Decimal Degrees): Latitude: 35,81976' Longitude:-81.488190
5. Parcel ID (if applicable): N/A— Street Right of Wav
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION: EAZ
1. Professional Engineer: Todd L Poteet License Number: 289062 6 2017Firm: West Consultants PLLCMailing address: 405 South Sterling StreCi[ Morganton State: NC Zi 28655 Y p: Ra, tonal ,
Phone number: [phone] Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY(WWTF) INFORMATION:
I. Facility Name: Gunpowder Creek W WTP Permit Number: NCO023736
Owner Name: City of Lenoir
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ Downstream (Receiving) Sewer Size: inch
System Wide Collection System Permit Numbers) (if applicable): WQCS
Owner Name(s):
FORM: FTA 04-16 Page 1 of 5

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-ENERAL REQUIREMENTS
I. 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. lithe Applicant is a Hopar/Property Owners' Association, has an Operational Agreement (FORM, HOA) been attached?
❑ Yes ❑No ®N/A
4. Origin of wastewater: (check all that apply)
® Residential Owned
❑ Retail (stores, centers, malls)
❑ Car Wash
❑ Residential Leased
❑ Retail with food preparation/service
❑ Hotel and/or Motels
❑ School / preschool / day care
❑ Medical / dental / veterinary facilities
❑ Swimming Pool /Clubhouse
❑ Food and drink facilities
❑ Church
❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories
❑ Nursing Home
❑ Other (Explain in Attachment)
5. Natureofwastewater: 100%Domestic/Commecial %Commercial
_ s Industrial (See 15A NCAC 02T 0103(20))
"Is there a Pretreatment Program in effect? ❑ 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 Flaw a"
No. of Units
Flow
Residential 2 Bedroom
120 gal/day/bedroom
15
3,600 GPD
Residential 3 Bedroom
120 gal/day/bedroom
15
5,400 GP
Residential Bedo mn
120 gal/day/bedroom
1
480 GPD
gal/
3
GPD
gal/
GPD
gal/
G O
9,480 PD
a See 15A NCAC 02T 0114(b) ofMill sad (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 .Ot 14(c), design flow rates for establishments not identified [in table 15A NCAC 02TOt 141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
S. Wastewater generated by project. 9 480 GPD (per t5A NCAC 02T 0114)
➢ Do not include future flows or previously pertained allocations
If permitted flow is zero, indicate why:
❑ Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this tine
❑ Flow has already been allocated in Permit Number:
❑ Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain);
FORM: FLA 04-16 Page 2 of 5

r it. GRAVITY SEWER DESIGN CRITERIA (If Applicable) .02T.0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 1,273 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 sewers)
➢ Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T m0305 & MDC fPumn Stations/Force Mainst:
I. Pump station number or name Im ndor d . trial Park Station]
2. Approximate Coordinates (Decimal Degrees): titu eQ 35 41646 Longitude:I-✓81.`147261°
�. Design flew of the pump station: 0.00375 m llhan§ lions p rdg (firm capacity)
4. Operational point(s) of the pum )% 60 gallons per all at 110 fact [ dynamic head (TDH)
5. Summarize the for 1c� n to be permitted (for this Pump Station): �
'a/ a
Size (inches) Length (feet) Material
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(D:
❑ Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T.0305(h)(1)(B)_
7 Required for all pump stations with an average daily flow greater than or equal to t5,000 gallons per day
➢ Must be permanent to facility
Or if the pump station has an average daily Row 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 plugger) 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 orpump is dedicated to multiple pump stations, an evaluation ofall the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel timetrames, shall be provided
in the case of a multiple station power outage.
FORM: FTA 04-16 Page 3 of 5

�u'fBACKS & SEPARATIONS — (02B.0200 & 15A NCAC 02T.0305(f)):
I. Does the project comply with all separations found in 15A NCAC 02T 0305(f) & (gl ® Yes ❑ No
➢ 15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer svatems
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)
t8 inches
Water mains (horizontal)
10 feet
Reclaimed water lines (vertical - reclaimed over sewer)
IS 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 11 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 shown, lake, impoundment, or ground water lowering and surface drainage
ditches
10 feet
Any building foundation
5 feet
Any basement
to feet
Top sloe of embankment or cuts of 2 feet or more vertical height
t0 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
➢ 15A NCAC 02T.0305(e) contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ **Stream classifications can be identified using the Division's SIC Surface Water Classifications weboage
If noncompliance with 02T.0305(t) or (g)sec Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ❑ Yes ❑ No ®N/A
➢ See the Division's draft separation requirements for situations where separation cannot be meet
➢ No variance is required if the alternative design criteria specified is utilized in design and Construction
➢ As built documents should reference the location of areas effected
3. Does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .02009 ❑ Yes ❑ No ® N/A
➢ This would include Trout Buffered Streams per 15A NCAC 213.0202
4. Does the project require coverage/authorization under a 404 Nationwide or ❑ Yes ® No
individual permits or 401 Water Quality Certifications?
Information can he 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 0105(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. Dees this project include any sewer collection lines that are deemed "high -priority?"
Per 15A NCAC 02T.0402, "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes ® No ❑ N/A
➢ If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at least once every six -months and inspections
documented per 15A NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit.
FORM: FTA 04-16 Page 4 of 5

CERTIFICATIONS:
Does the submitted system comply with 15A NCAC 02T, the Minimum Desipa Criteria for the Permitting f Pump Stations
and Force Mains (latest version) and the Gravity Sewer Minimum Design Criteria (latest version) as applicable?
® Yes ❑ No
If No, complete and subntit the Variance/Alternative Design Request application (VADC 10-14) and supporting documents for
review. Approval ofth request is c ' d Prior to submittal ofth Fast Tk Application ande f documents.
2. Professional Engineer's Certification:
loteet attest that this application for
(Professional Engineer's name from Application Item 111. 1.)
Alexander Industrial Park Pun, Station Relocation has been reviewed by me and is accurate, complete and consistent with the
information supplied in the plans, specifications, engineering calculations, and all other supporting documentation to the best
of my knowledge. I further attest that to the best of my knowledge the proposed design has been prepared in accordance with
the applicable regulations, Gravity Sewer Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum
Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains (latest version). Although other professionals
may have developed certain portions of this submittal package, inclusion of these materials under my signature and seal
signifies that I have reviewed this material and havejudged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.613, 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.
North Carolina Professional Engineer's seal, signature, and dale:
3. Applicant's Certification per GA NCAC 01I .0106(b):
I, Christopher Todd Town Administrator attest that this application for
(Signature Authority's name & title from Application Item I.3.)
Alexander Industrial Park Pump Station Relocation has been reviewed by me and is accurate and complete to the best of my
knowledge. I understand that if all required parts of this application are not completed and that if all required supporting
documentation and attachments are not included, this application package is subject to being returned as incomplete. I
understand that any discharge of wastewater from this non -discharge system to surface waters or the land will result in an
immediate enforcement action that may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no
claim against the Division of Water Resources should a condition of this permit be violated. I also understand that if all required
parts of this application package are not completed and that if all required supporting information and attachments are not
included, this application package will be returned to me as incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.66, 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 S 10,000 as well as civil penalties up to $25,000 per violation.
Signature: /�f/'t— Date: / /0�/ZOl7
FORM: ETA 04-16 Page 5 of 5

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State of North Carolina
"'_r Department of Environment and Natural Resources
Division of Water Resources
oivisk,a of Mae, itenmoces Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 08-13)
Project Applicant Name: City of Lenoir
Project Name for which flow is being requested: Mayfield Drive Sewer Extension
More than one FTSE maybe requiredfor a single project if the owner ofthe WWTP is not responsible for all pump
stations along the route ofthe proposed wastewaterJlow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. W WTP Facility Name: Gunpowder Creek W WTP
b. W WTP Facility Permit #: NC0023736
All flows are in MGD
c. W WTP facility's permitted flow 2.0
d. Estimated obligated flow not yet tributary to the W WTP 0.0
e. W WTP facility's actual avg. flow 0.70
f. Total flow for this specific request .009
g. Total actual and obligated flows to the facility 0.709
h. Percent of permitted flow used 35.45
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 W WTP:
(A) (B) (C) (D)=(B+C) (E)=(A-D)
Design Obligated,
Pump Average Daily Approx. Not Yet Total Current
Station Finn Flow** Current Avg, Tributary Flow Plus
(Name or Capacity,* (Firm /pf), Daily Flow, Daily Flow, Obligated Available
Number) MGD MGD MGD MGD Flow Capacity***
N/A
* 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 W WTP where the Available Capacity is <0.
Page 1 of 6
FTSE 08-13

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III. Certification Statement:
I Radford L. Thomas 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 addendums for which I am the responsible party.
Signature of this form indicates acceptance of this wastewater flow.
Page 2 of 6
FTSE 08-13

FTSE PLANNING ASSESSMENT ADDENDUM (PAA)
Submit a planning assessment addendum for each pump station listed in Section II where Available
Capacity is <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
MOD 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 08-13

Instructions for: Flow Tracking/Acceptance for Sewer Extension Permit Applications (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 #: Enter the NPDES or Non -Discharge number for the WWTP receiving the
wastewater flow.
c. WWTP facility's permitted flow, MOD: From WWTP owner's NPDES or Non -Discharge permit.
d. Estimated obligated flow not vet tributary to the WWTP MOD: 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.
The obligated flow not yet tributary plus actual flow will be reconciled annually for systems at less
than 60% of permitted flow used. Annual updates shall be submitted to the appropriate Regional
Office by January 15 0£ each year and cover the previous calendar year.
Semi -Annual updates shall be required when the percent of permitted flow used reaches 60%. Semi-
annual time period are defined as January 1 through June 30 and July 1 through December 31. Semi-
annual updates shall be submitted to the appropriate Regional Office by July 15 and January 15 of
each year.
Quarterly updates shall be required when the percent of permitted flow used reaches 80%. Quarters
are defined as Qtrl (Jan -Feb -Mar); Qtr2 (Apr -May -Jun); Qtr3 (Jul -Aug -Sep); Qtr4 (Oct -Nov -Dec).
Quarterly updates shall be submitted to the appropriate Regional Office by April 15, July 15, October
15 and January 15 of each year.
e. WWTP facility's actual avd 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]
Page 4 of 6
FTSE 08-13

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 MOD
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 Form FTSE- will be updated in the same manner.
Section II
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 (pi) 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 if the system has future specific plans related to capacity that should be considered in the
permitting process.
(A)
(B)
Design
Approx.
Firm Average
Current Avg.
Pump Station Capacity Daily Flow
Daily Flow,
(Name or Number) MOD (Firm / pf)
MGD
(C) (D)=(B+C) (E)=(A-D)
Obligated,
Not Yet
Tributary
Daily Flow,
MGD
Kaw Creek PS 0.800 0.320 0.252 0.080
Valley Road PS 1.895 0.758 0.472
Total Current
Flow Plus
Obligated
Available
Flow
Capacity*
0.332
-0.012
0.135 0.607 0.151
Page 5 of 6
FTSE 08-13

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 Kew 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 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.
Page 6 of 6
FTSE 08-13

State of North Carolina
Department of Environment and Natural Resources
PW I R Division of Water Resources
Division of Water Resources Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 08-13)
Project Applicant Name: Town of Sawmils
Project Name for which flow is being requested: Mayfield Drive Sewer Extension
More than one FTSE maybe required fora single project ifthe owner of the WWTP is not responsible for all pomp
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: N/A
b. WWTP Facility Permit#:
All flows are in MGD
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
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) (DMB+C) (E)=(A-D)
Design Obligated,
Pump Average Daily Approx. Not Yet Total Current
Station Firm Flow** Current Avg. Tributary Flow Plus
(Nameor Capacity,* (Firm/pi), Daily Flow, Daily Flaw, Obligated Available
Number) MGD MGD MGD MGD Flow Capacity***
�siame Road 0.29 0.12 0.02 0 0.02 0.10
* 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 < 0.
Page t of 6
FTSE 08-13

1II. Certification Statement:
I Christopher Todd 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 addendums for which I am the responsible party.
Signature of this form indicates acceptance of this wastewater flow.
Page 2 of 6
Dare
FTSE 08-13

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