WQ0023063_Regional Office Historical File Pre 2018

7
-c
• . Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, R.E., Director
Division of Water Quality
Coieen H. Sullins, Deputy Director
Division of Water Quality
September 15, 2003
Mr. Jon Dyer, Director of Public Works
Union County ,
400 N. Church Street
Monroe, North Carolina 28112
Subject: Permit No. WQ0023063
Union County
Fincher Valley
Wastewater Collection System Extension
Union County
Dear Mr. Dyer:
1n accordance with your application received on September 12, 2003, we are forwarding
herewith Permit No. WQ0023063, dated September 15, 2003, to Union County for the construction and
operation 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date of issuance until rescinded, and shall be subject to the conditions and limitations as specified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 Permit Condition 3 which requires that the wastewater
collection' facilities be properly operated and maintained in accordance with 15A NCAC 2H .0227 or any
individual system wide collection system permit issued to the Permittee.
Permiftirig of this project does not constitute an acceptance of any part of the project that does
not meet 1)15A NCAC 2H .0200; 2) the Division of Water Quality's (Division) Gravity Sewer Minimum
Design Criteria adopted February 12, 1996, as applicable; 3) and the Division's Minimum Design
Criteria for the Fast -Track Permitting of Pump Stations and Force Mains adopted June 1, 2000, as
applicable, unless specifically mentioned herein. Division approval is based on acceptance of the
certification provided by a North Carolina -licensed Professional Engineer in the application. It shall be
the Permittee's responsibility to ensure that the as -constructed project meets the appropriate design
criteria and rules. Failure to comply may result in penalties in accordance with North Carolina General
Statute §143-215.6A through §143-215.6C, construction of additional or replacement wastewater
collection facilities, and/or referral of the North Carolina -licensed Professional Engineer to the licensing
board.
Mooresville Regional Office
919 N. Main Street, Mooresville, NC 28115
Internet http://h2o.enr.state.nc.us/
Telephone [phone] Fax [phone]
NCDENR
DENR Customer Service Center
Telephone [phone]

Mr.. Jon Dyer
Page 2
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 Union County for the construction and operation of approximately 9,598 linear feet of 8-inch
gravity sewer to serve 91 three -bedroom residences as part of the Fincher Valley project, and the
discharge of 32,760 gallons per day of collected domestic wastewater into Union County's Twelve Mile
Creek WWTP (NPDES No. NC0085359) existing sewerage system, pursuant to the application
received September 12, 2003 and in conformity with 15A NCAC 2H .0200; the Division's Gravity Sewer
Minimum Design Criteria adopted February 12, 1996, as applicable; the Division's Minimum Design
Criteria for the Fast: Track Permitting of Pump Stations and Force Mains adopted June 1, 2000, as
applicable; and other supporting data subsequently filed and approved by the Department of
Environment and Natural Resources and considered a part of this permit.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the
right to request an adjudicatory hearing upon written request within 30 days following receipt of this
permit. This request must be in the form of a written petition, conforming to Chapter 150B of North
Carolina General Statutes, and filed with the Office of Administrative Hearings, 6714 Mail Service, _,
Center, Raleigh, NC 27699-6714. Unless such demands are made, this permit shall be final and
binding.
if you need additional information concerning this matter, please contact Sonja Williams at (704)
663-1699.
Sincerely,
for Alan W. Klimek, P.E.
cc: Union County Health Department
Mooresville Regional Office, Water Quality Section (WVVTF Permit No. NC0085359)
Robert Davis, RD Davis Consulting Engineers, PLLC
Water Quality Central Files
NDPU Files

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH
WASTEWATER COLLECTION SYSTEM EXTENSION PERMIT
This permit shall be effective from the date of issuance until rescinded and shall be subject to the
_following specified conditions and limitations: .
1. ,This; permit shall become voidable unless the wastewater collection facilities are constructed in
accordance with the -conditions of this permit 15A NCAC 2H .0200; the Division of Water Quality's
(Division)' Gravity Sewer Minimum Design Criteria adopted February 12, 1996, as applicable; the
Division's Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force
Mains adopted June 1, 2000, as applicable; and other supporting materials unless specifically__
mentioned herein. -" . .
2. This permit shall be effective only with respect to the nature and volume of wastes described in the
application and other supporting data. •
3. The wastewater collection facilities shall be properly maintained and operated at all times. The
Permittee'shall maintain compliance with an individual system -wide collection system permit for the
operation and maintenance of these facilities as' required by 15A NCAC 2H..0227. If an individual
,perimt is not reqiure the following perforrnarice criteria shall be;met as provided sirI.15A NCAC 2H -
•
a. = The sewer system shall be effectively maintained and operated at all times to prevent
discharge to land or surface waters, and any contravention of the groundwater standards in
15A NCAC 2t..0200 or the surface water standards in 15A NCAC 2B .0200.
b. A map of the sewer system shall be developed prior to January 1, 2004 and shall be actively
maintained.
c. An operation and maintenance plan shall be developed and implemented.
d. Pump stations that are not connected to a telemetry system shall be inspected every day (i.e.
365 days per year). Pump stations that are connected to a telemetry system shall be
inspected at least once per week.
e. High -priority sewer lines shall be inspected at least once per every six-month period of time.
f. A general observation of the entire sewer system shall be conducted at least once per year.
g. Inspection and maintenance records shall be maintained for a period of at least three years.
h. Overflows and bypasses shall be reported to the appropriate Division regional office in
accordance with 15A NCAC 2B .0506(a), and public notice shall be provided as required by
North Carolina General Statute §143-215.1C.

4. This permit shall not be transferable. in the event there is a desire for the wastewater collection
facilities to change ownership, or there is a name change of the Permittee, a formal permit request
shall be submitted to the Division accompanied by documentation from the parties involved, and
other supporting materials as may be appropriate. The approval of this request shall be
considered on its merits and may or may not be approved.
5. Construction of the gravity sewers, pump stations, and force mains shall be scheduled so as not to
interrupt service by the existing utilities nor result in an overflow or bypass discharge of wastewater
to the surface waters of the State.
6. Upon completion of construction and prior to operation of these permitted facilities, a certification, a
copy of the construction record drawings, as well as supporting design calculations for any pump
stations permitted as part of this project shall be received from a North Carolina -licensed
Professional Engineer certifying that the facilities have been installed in accordance with this
permit; 15A NCAC 2H .0200; 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 Main adopted June 1, 2000 as applicable; and other supporting materials. If this
project is to be completed in phases and partially certified, you shall retain the responsibility to
track further construction approved under the same permit, and shall provide a final certificate of
completion. once the_ entire project has been - completed. A copy of the construction record
drawings, indicating the facilities constructed in the phase being certified, shall be submitted with
each partial certification. Mail the Engineer's Certification, one copy of the "Construction Record
Drawings," and one copy of the supporting design calculations to the Non -Discharge Permitting
Unit, 1617 Mail Service Center, Raleigh, NC 27699-1617.
7. A copy of the construction record drawings shall be maintained on file by the Permittee for the life
of the wastewater collection facilities. -
8. - Failure to abide by the_;conditigria_'and Timitatiorisncoritairied'in this'permrt, 15ANCAC 2the H :0200,
- Division's Gravity Sewer Design Criteria adopted February 12, 1996 as applicable; the Division's
Minirrium Design Criteria for. the Fast -Track Permitting of Pump Station and Force Mains adopted -
June 1, 2000 as applicable; -and other supporting materials may subject the Permittee to an
enforcement action by the Division, in accordance with North Carolina General Statutes §143-
215.6A through §143-215.6C.
9. In the event that the wastewater collection facilities fail to perform satisfactorily, including the
creation of nuisance conditions, the Permittee shall take immediate corrective action, including
those as may be required by this Division, such as the construction of additional or replacement
facilities. •
10. The issuance of this permit shall not exempt the Permittee from complying with any and all
statutes, rules, regulations, or ordinances that may be imposed by other government agencies
(local, state and federal) which have jurisdiction, including but not Iimited to applicable river buffer
rules in 15A NCAC 2B .0200, erosion and sedimentation control requirements in 15A NCAC Ch. 4
and under the Division's General Permit NCG010000, and any requirements pertaining to wetlands
under 15A NCAC 2B .0200 and 15A NCAC 2H .0500.

11. Noncompliance Notification:
The Permittee shall report by telephone to the Mooresville Regional Office, telephone number
[phone], as soon as possible, but in no case more than 24 hours or on the next working
day, following the occurrence or first knowledge of the occurrence of either of the following:
a. Any process unit failure, due to known or unknown reasons, that renders the facility incapable
of adequate wastewater transport, such as mechanical or electrical failures of pumps, line
blockage or breakage, etc.; or
b. Any failure of a pumping station or sewer line resulting in a by-pass directly to receiving waters
without treatment of all or any portion of the influent to such station or facility.
Persons reporting such occurrences by telephone shall also file a written report in letter 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.
Permit issued this the 15th day of September, 2003.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
for Alan W. mek, P.E., Director
Division of Water -Quality
By Authority of the Environmental Management Commission
•
Permit Number W00023063

Pril.
Fast Track Engineering Certification
Permit No. W00023063
September 15, 2003
Complete and submit this form to the permit issuing regional office with the following;
• One copy of the project record drawings (plan & profile views of sewer lines) of the wastewater collection
system extension
• supporting design calculations (selected pumps, system curve, operating point, available storage if portable
generator(s) or storage greater than longest past three year outage reliability option selected) for any pump
stations permitted as part of this project
• Changes to the project should be clearly identified on the record drawings or in written summary form_ Permit
modifications are required for any changes resulting in non-compliance with this permit, regulations or
minimum design criteria.
This project shall not be considered complete nor allowed to operate until this Engineer's Certification and all
required supporting documentation have been received by the Division. Therefore, it is highly recommended
that this certification be sent in a manner that provides proof of receipt by the Division.
1,
ENGINEER'S CERTIFICATION
❑ Partial ❑ Final
as a duly registered Professional Engineer in the State of North Carolina, having
been authorized to observe (1] periodically, El weekly, ❑ full time) the construction of the Fincher Valley, Union
County project for the Permittee hereby state that, to the best of my abilities, due care artd 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 2H .0200; the Division of Water Quality's (Division) Gravity Sewer Minimum
Design Criteria, adopted ..February112, 1996 as_applicable, the Division's Minimum, Design Criteria for ttie Fast- ,
Track Permitting of Pump Stations and Force Mains adopted June 1, 2000 as applicable; and other supporting
materials.
North Carolina Professional Engineer's
seal, signature, and date:
SEND THIS FORM & SUPPORTING DOCUMENTATION
WITH REQUIRED ATTACHMENTS TO THE FOLLOWING ADDRESS
MOORESVILLE REGIONAL OFFICE
919 N. MAIN STREET
MOORESVILLE NC 28115
The Permittee is responsible for tracking all partial certifications up until a final certification is received. Any
wastewater flow made tributary to the wastewater collection system extension prior to completion of this
Engineer's Certification shall be considered a violation of the permit and shall subject the Permittee to appropriate
enforcement actions.

rAPPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE I
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD!
1. Owner:
11 a. Union County Public Works
{ Full Legal Name (company, municipality, HOA, utility, etc.)
r • ib. Mr. Jon Dyer, Director Union County Public Works
1
0:
1 c. The legal entity who will own this system is:
0 Individual ❑ Federal ® Municipality ❑ State/County ❑ Private Partnership ❑ Corporation ❑ Other s eci
2. rfA
• jId. 400 N. Church Street
'2 Street Address
LL i ---
Z- 1f. North Carolina
State
2 Ii h. [phone] 1 i. [phone]
a I Telephone Facsimile
'Q F. Project (Facility) Information:
J '
:Ir].. a. Fincher Valley
'0_ Brief Project Name (permit will refer to this name)
Application Number:
(to be completed by DWQ) w6 230673
Signing Official Name and Title (Please review 15A NCAC 2H .0206(b) for authorized signing officials!)
'< ` 3. Contact Person:
13a. Charles P..O'Cain
le. Monroe
City
1 g.-281124804
Zip Code
! E-mail — -- -
2b. Union
County Where Project is Located
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. [phone]
Phone Number E-mail
€3c. o'[e-mail]
Project is ® New 0 Modification (of an existing permit) If Modification, Permit No.:
. Owner is ® Public (skip to Item B(3)) 0 Private (go to Item 2(a))
2a. if private, applicant will be:
2b. If sold, facilities owned by a (must choose one)
El Retaining Ownership (i.e. store, church, single office, etc.) } ❑ Public Utility (Instruction ill)
❑ Leasing units (lots, townhomes, etc. - skip to Item B(3)) € 0 Homeowner Assoc./Developer (instruction IV)
❑ Selling units (lots, townhomes, etc. - go to Item B(2b))
0 3. Union County Public Works
t Owner of Wastewater Treatment Facility (WVVf F) Treating Wastewater From This Project
Twelve Mile Creek 4b. NC0085359
14a.
ee
Name of WVVTF i WWTF Permit No.
0' '5a. Union County Public Works
-1L
Z.:
Owner of Downstream Sewer
5b. 8" 5c. WQ0022237
Receiving Sewer Size Permit Number of Downstream Sewer
The origin of this wastewater is (check all that apply):
E ® Residential Subdivision
WElApartments/Condominiums
0 Mobile Home Park
0 School
': 0 Restaurant
❑ Office
❑ Car Wash
❑ Institution
❑ Hospital
❑ Church
❑ Nursing Home
❑ Other (specify):
100 % DomesticlCommercial
% industrial
Other (specify):
7. Volume of wastewater to be permitted in this project: 32.760 gallons per day
8. If the permitted flow is zero, indicate why:
O Interceptor Line - Flow will be permitted is subsequent permits that connect to this line
❑ Flow has already been allocated in Permit No.
❑ Rehabilitation or replacement of existing sewer with no new flow expected
FTA fly./C

a
0
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`Z
CK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 2
9. Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2H
.0219(1) for Item B(7) or the design flow for line or pump station sizing if zero flow in the space below. Values other than
that in 15A NCAC 2H .0219(1)(1-2) must be approved prior to submittal of this application. Submit a separate request to
the Division of Water Quality, Non -Discharge Permitting Unit, 1617 Mail Service Center, Raleigh, NC 27699-1617 in
accordance with 15A NCAC 2H .0219(I)(3).
91 lots x 120 gallons per day x 3 bedrooms = 32,760
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches)
8"
Length (feet)
9598
Gravity or Force Main
(pull down menu)
Gravity
Gravity
Z
0
U
ENTER TOTAL LINE LENGTH IN MILES! 1.82 f H i11. Summary of Pump Stations to be Permitted (attach additional sheets as necessary)
Location ID i Design Flow
as shown on plans) (MGD)
Operational Point
GPM @ TDH
Gravity
Gravity
Gravity
Gravity
Gravity
Power Reliability Option
(dual line feed, permanent generator w/ATS,
portable generator w/autodialer, wet well storage)
/W 1 I
!12. Does the sewer system comply with the Minimum Design Criteria for the Fast Track Permitting of Pump Stations and Force
lb Mains (latest version), the Gravity Sewer Minimum Design Criteria (latest version) and 15A NCAC 2H .0200 as applicable?
® Yes ❑ No If no, please reference the pertinent minimum design criteria or regulation and indicate why a
variance is requested:
;SUBMIT TWO COPIES OF PLANS, SPECIFICATIONS OR CALCULATIONS PERTINENT TO THE VARIANCE WITH YOUR APPLICATION
13. Have the following permits/certifications been submitted for approval?
Wetland/Stream Crossings - General Permit or 401 Certification? ❑ Yes 0 No ® N/A
Sedimentation and Erosion Control Plan? ® Yes 0 No ❑ N/A
Stormwater? ® Yes D No 0 NIA
FTA 02/0;

pIPPICK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PP'
PAGE 3
1. Use the Division's guidance document entitled, "DETERMINING STREAM CLASSIFICATIONS FOR FORM FTA 02103
(FAST -TRACK SEWER SYSTEMS)" to collect and record the stream classification data below (attach additional sheets as
necessary). This document is available from our web site or by contacting the appropriate Division of Water Quality
regional office (see instructions for addresses) OR indicate the following:
❑ A Watershed Classification is not needed because all parts of the project are at least 100 feet away from any down
slope waterbody; AND,
❑ A Watershed Classification is not needed because the design does not depend on wet well storage as a power
reliability option for any pump station near a Class C down slope waterbody.
Location ID Name of I ; Waterbody Stream
on Map Waterbody County. River Basin Index
See attached map Unnamed tributary to; Union Catawba 11-138-3-6 C
.--u+ifh cifa-Inratari Tarlrill Rranrh_ — _ _ _ _ -t _ _
_t
I
t--
Waterbody
Classification
--- j-------
Submit the 8.5" x 11" topographic map as required in Instruction VI regardless of whether a classification is provided!
cn
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1.
2.
Applicant's Certification:
1 attest that this application for Fincher Valley has been reviewed by me and is
accurate and complete to the best of my knowledge. 1 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. Note: In accordance with North Carolina General Statutes 143-215.6A and
143-215.6B, any person who knowingly makes any false statement, representation, or certification in any application
shall be guilty of a Class 2 misdemeanor which may inc,1 de a fine not to exceed $10,000 as well as civil penalties up to
000 per violation.
ti ing Official Signature
Professional Engineer's cation:
9//e o3
ate
1 attest that this application for Fincher Valley has been reviewed by me and is accurate,
complete and consistent with the information in the engineering plans, calculations, and all other supporting documentation
to the best of my knowledge. 1 further attest that to the best of my knowledge the proposed design has been prepared in
accordance with the applicable regulations, Gravity Sewer Minimum Design Criteria for Gravity Sewers adopted February
12, 1996, and the Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains adopted June
1, 2000 and the watershed classification in accordance with Division guidance. Although certain portions of this submittal
package may have been developed by other professionals, inclusion of these materials under my signature and seal
signifies that 1 have reviewed this material and have judged it to be consistent with the proposed design. Note: in
accordance with NC General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement,
representation, or certification in any application shall be guilty of a Class 2 misdemeanor which may include a fine not to
exceed $10,000 as well as civil penalties up to $25,000 per violation.
2a. Robert D. Davis, P.E.
Professional Engineer Name
2b. RD Davis Consulting Engineers, PLLC
Engineering Firm
2c. 323 Indian Trail Road, North
Address
2d. Indian Trail
City
2e. NC 2f. 28079
State Zip
2g. [phone] 2h. [phone] 2i. rddavis©carolina.rr.com
Telephone Facsimile E-mail
,01111111taryrf,
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i
Seal, Signature Dat
FTA (17./01

1450, : 2 050
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Name: LANCASTER
Date: 8/14/2003
Scale: 1 inch equals 1.578 miles
lit— i
ti —y
475
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Location: 034° 54' 48.3" N 080° 46' 04.8" W
Copyright (C) 1997, Maptech, Inc.
1 500: 12 100

09/12/03
Permit Number W00023063
Permit Tracking Slip -
Program Category Status Project Type
Non -discharge In review New Project
Permit Type Fast Track Version Permit Classification
Gravity Sewer Extension, Pump Stations, & Pressure Sewer individual
Extensions
Primary Reviewer Permit Contact Affiliation
sonja.williams
Permitted Flow
32760
Facility
Facility Name
Pincher Valley
Location Address
Owner
MajorfMInor Region
Minor Mooresville
County
Union
Facility Contact Affiliation
Owner Name Owner Type
Union County Government - County
Owner Affiliation
Jon Dyer
400 North Church Street
Monroe NC 28112
Dates/Events
Scheduled
Orig Issue App Received Draft Initiated Issuance
09/12/03
Public Notice Issue
Effective Expiration
Regulated Activities RequestedlReceived Events
Subdivision
Duffel! NULL
Additional information requested
Additional information received
Waterbody Name Stream Index Number
Current Class 5ubbasin

UNION COUNTY PUBLIC WORKS
400 N. Church Street
Monroe, NC 28112-4804
704/296-4210
Fax [phone]
To: NC Department of Environment and Natural Resources
Mooresville Regional Office
919 North Main Street
Mooresville, N.C. 28115
Attention:
Regarding: Sanitary Sewer to serve Fincher Valley Subdivision
We are sending you: (1 Copy of letter [1 Plans © Prints El Shop Drawings
E Other
Description
TRANSMITTAL
Copies Date No.
8/14/03 Original Non Discharge Permit Application
8/14/03 Copy of Non Discharge Permit Application
8/19/03 2825 Check for $400.00 (Application Fee)
These are transmitted as checked below:
For approval El For your use [.l As requested
Re rr arks:
Signed:
Received by:
Date: 9/10/03
For review and comments
Date:

UNION COUNTY PUBLIC WORKS
400 N. Church Street
Monroe, NC 28112--4804
704/296-4210
ilkiX,704/296-4232
To: Mooresville Regional Office
Water Quality
610 East Center Ave. Suite 301
Mooresville NC 28115
Attention:
OCT
TRANSMITTAL
Date: 10/12/04
Regarding: Record Drawings and Engineer's Certification for Fincher Valley Subdivision (Final)
We are sending you:.
0 Copy of letter Plans Q Prints
Other
Description
Record Drawings
Engineer's Certification for Sewer (WQ0023063)
Shop Drawings
These are transmitted as checked below:
Q For approval For your use 0 As requested 0 For review and comments
Remarks:
Signed:
Received by: Date:

Track Enstineerinq Certification
ermit Not- -
September
Complete and submit this form to the permit issuing regional office with the following:
• One copy of the project record drawings (plan & profile views of sewer lines) of the wastewater collection
system extension
• supporting design calculations (selected pumps, system curve, operating point, available storage if portable
generator(s) or storage greater than longest past three year outage reliability option selected) for any pump
stations permitted as part of this project
• Changes to the project should be clearly identified on the record drawings or in written summary form. Permit
modifications are required for any changes resulting in non-compliance with this permit, regulations or
minimum design criteria.
This project shall not be considered complete nor allowed to operate until this Engineer's Certification and all
required supporting documentation have been received by the Division. Therefore, it is highly recommended
that this certification be sent In a manner that provides proof of receipt by the Division.
ENGINEER'S CERTIFICATION
El Partial E Final
1, Robert D. Davis , as a duly registered Professional Engineer in the State of North Carolina, having
been authorized to observe ( periodically, 0 weekly, 0 full time) the construction of the Fincher
*A'
County project for the Pen-nittee 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 2H .0200; the Division of Water Quality's (Division) Gravity Sewer Minimum
Design Criteria adopted February 12, 1996 as applicable; the Division's Minimum Design Criteria for the Fast -
Track Permitting of Pump Stations and Force Mains adopted June 1, 2000 as applic.able; and other supporting
materials.
North Carolina Professional Engineer's
seal, signature, and date:
SEND THIS FORM & SUPPORTING DOCUMENTATION
WITH REQUIRED ATTACHMENTS TO THE FOLLOWING ADDRESS
MOORESVILLE REGIONAL OFFICE
919 N. MAIN STREET
MOORESVILLE NC 28115
The Perrnittee is responsible for tracking all partial certifications up until a final certification is received. Any
wastewater flow made tributary to the wastewater collection system extension prior to completion of this
Engineer's Certification shall be considered a violation of the permit and shall subject the Permittee to appropriate
enforcement actions,