WQ0043657_Application Attachment_20220909

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes No ®N/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached?
® Yes No ❑N/A
3. If the Applicant is a Home/Property Owners' Association, has an Operational Agreement (FORM: HOA) been attached?
❑ Yes No ®N/A
4. Origin of wastewater: (check all that apply):
® Residential Owned
❑ Residential Leased
❑ School / preschool / day care
❑ Food and drink facilities
❑ Businesses / offices / factories
❑ Retail (stores, centers, malls)
❑ Retail with food preparation/service
❑ Medical / dental / veterinary facilities
❑ Church
El Nursing Home
5. Nature of wastewater : 100 % Domestic/Commercial % Commercial
% Industrial (See 15A NCAC 02T .0103(20))
)Is there a Pretreatment Program in effect?
6. Has a flow reduction been approved under 15A NCAC 02T .0114(f)? ❑ Yes
> If yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
El Car Wash
❑ Hotel and/or Motels
® Swimming Pool /Clubhouse
El Swimming Pool/Filter Backwash
El Other (Explain in Attachment)
❑ Yes El No
® No
Establishment Type (see 02T.0114(f))
Daily Design Flow a,b
No. of Units
Flow
3 bedroom residential townhome
190 gal/townhome unit
63 units
11,970 GPD
Pool
10 gal/person (1 person / 15 sf)
400 people
(6,000 sf)
4,000 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
15,970 GPD
a See 15A NCAC 02T .0114(b), (d), (e)(1) and (e)(2) for caveats to wastewater design flow rates (i e , minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use areas;
and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in G.S. 42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.0114] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 15,979 GPD (per 15A NCAC 02T .0114)
➢ Do not include future flows or previously permitted 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 line
El Flow has already been allocated in Permit Number:
El Rehabilitation or replacement of existing sewer with no new flow expected
El Other (Explain):
FORM: FTA 04-16
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