WQ0043897_Application (FTSE)_20221018

kl Greenville
Utilities
October 7, 2022
Mr. Robert Tankard
Assistant Regional Supervisor
North Carolina Division of WaterQuality
943 Washington Square Mall Washington, NC 27889
Subject: Carolina Crofts.
Phase 1, Section 1
Sewer Main Extension
Dear Mr. Tankard:
We are submitting herewith one (1) original and one (1) copy of the executed Non -Discharge
Permit Application and Flow Tracking/Acceptance for Sewer Extension Permit Applications
along with a check for $480.00-for the subject project. We request your approval of the sewer"
improvements:
We trust that you will find this submittal to be in order and that your approval. Will be
forthcoming In the meantime, should you have any questions or require any additional "
information, please let us know.
Sincerely,
Clifton [1. Cahoon, PE
Construction / Contracts Engineer
Mr, Randall D. Emory, PE, Director Water Resources
Mr J. Stephen Janowski, PE, Rivers & Associates
Connected To You Post Office Box 1847 I Greenville, North Carolina 27835-1847 I guc.com .I 252-752-7166

Divislbn of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: Greenville Utilities Commission
Project Name for which flow is being requested Carolina Crofts Phase 1 Section 1
More than one P7bE may be required for a single project f `the owner of the WW7P not responsible for all pump
stations along the route of the proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Greenville Utilities Commission
b. WWTP Facility Permit #: NC0023931
All flows are in MGD
WWTP facility's permitted flow 17.5
d. Estimated obligated flow not yet tributary to the WWTP 2.646
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
II. Complete this section for each pump station you are responsible for along the route of this
proposed wastewater flow.
List pump stations located between the project connection point and the WWTP:
(A) (B) (C)
Design Obligated,
Pump . Average Daily Approx. Not Yet
Station 'Finn Flow** Current Avg. Tributary
(Name or Capacity, * (Firm / pf), Daily Flow, Daily Flow,
Number) MGD . MGD MGD MGD
Westside 4.971 1.988
(D)=(B+C)
(E)=(A-D)
Available
forty***
.58 .092 .672 . 1.316
Total Current
Flow Plus
Obligated
Flow
Ironwood .712 .284 ,183 .019 .202 .082
* 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 (pi) not less than 25.
*** 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): Unknown
Downstream Permit Number Unknown
Page 1 of 6
FTSE 04-16

III. Certification Statement:
I Clifton IL Cahoon, PE 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 addendnms for which I am theresponsible party.
Signature of this form indicates acceptance of this wastewater flow.
Page 2 of 6
FTSE 04-16

ENGINEERS PUNKAS
SURVEYORS LANDSCAPE ARCHITECTS
SANITARY SEWER NARRATIVE
CAROLINA CROFTS PHASE 1 SECTION 1
October 6, 2022
This sewerr system is to serve a portion of an 203.19 acre site to be developed in two phases and this
permit is for Phase 1 - Section 1 for the purpose of a single family residential neighborhood with farming
amenities. The calculated design flow is 19,140 gpd. The project is located south of Hwy 43 across from
the existing: Ironwood Golf and Country Club Development in Greenville, NC. This permit is for the
installation of 1503 if of new 8" sanitary sewer line, 534 if of 10" sanitary sewer line, 1216 if of 12"
sanitary sewer line and 53 if of 15" sanitary sewer line. All are measured from center line to centerline of
manholes. This project also includes a pump station and and 5340 if of 8 inch C900 force main The pump
station is a submersible duplex pump station with a flow of 344 gpm at 60 feet of total dynamic head. The
pump station will include an on -site generator with an automatic transfer switch for alternate source of
power.
107 E. Second Street, Greenville, NC 27858 r PO Box 929, Greenville, NC 27835 o Phone: [phone] • Fax: [phone]
NCBELS tic. No. F-0334 www.riversandassociates.corn NCBOLALIc. No. C-312

DW
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 - FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
INSTRUCTIONS FOR FORM: FTA 04-16& SUPPORTING DOCUMENTATION
This application is for sewer extensions involving gravity sewers, pump stations and force mains, or any combination that has been ..
certified by a professional engineer and the applicant that the project meets the requirements of 15A NCAC. 02T and the Division's
Minimum Design Criteria and that plans, specifications and supporting documents have beenprepared in accordance with, 15A.
NCAC 02T, 1.5A NCAC 02T..0300, Division policies and' good engineering practices.
While no upfront engineering design documents are requiredfor submittal, in accordance with 15A NCAC 02T .0305(b), design
documents must be prepared prior to submittal of a fast track: permit application to the Division. Thiswould include plans, design
.calculations, and project specifications referenced in 15A NCAC 02T .0305 and the applicable minimum design criteria. These
documents shall be available upon request by the Division.
Projects that are deemed permitted (do not require a permit from the Division) are explained in 15ANCAC 02T.0303.
Projects not eligible for review via the fast track process (must be submitted for fall technical review):
- ➢ 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;
• 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.
General -When submitting an application, please usethe following instructions as a checklist in order to ensure all required items
are submitted. Adherence to these instructions and .checking the provided boxes will help produce a quickerr review time and
reduce the amount of requested additional information.. Failure to submit all required items will necessitate additional
processing and review time, and may result in return of the application: Unless otherwise noted, the Applicant shall submit
one original and one copy of the application and supporting documentation. •
A, One Original and One Copy of Application and Supporting Documents
® Required unless otherwise noted
B. Cover Letter (Required for All Application Packages):
®: List all items included in the application package, as well as a brief description of the requested permitting action.
➢ Be specific as to the system type, number of homes served, flow allocation required, etc.
➢ If necessary for clarity, include attachments to the application form.
C. Application Fee (All New and Major Modification Application Packages):
El Submit a check or money order in the amount of $480.00 dated within 90 days of application submittal.
➢ Payable to North Carolina Department of Environmental Quality (NCDEQ)
D. Fast Track (Form: FTA 04-16) Application (Required for All Application Packages):
® Submit the completed and appropriately executed application
. If necessary for clarity or due to space restrictions, attachments to the application may be made.
• If the Applicant Type in Item 1.2 is a corporation or company, provide documentation it is registered for business with
the North Carolina Secretary. of State.
O If the Applicant Type in Item I.2 is a partnership or d/b/a, enclose a copy of the certificate filed with the Register of
Deeds in the county of business.
® The Project Name in Item 11.1 shall be consistent with the project name on the flow acceptance letters, agreements, etc.
® The Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a North
Carolina licensed Professional Engineer.
The Applicant's Certification on Page 5 of the application shall be signed in accordance with 15A NCAC 02T .0106(b).
Per 15A NCAC 02T .0106(c), an alternate person may be designated as the signing official if a delegation letter is
provided from a person who meets the criteria in 15A NCAC 02T .0106(b).
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 1 of 3

E. Flow Tracking/Acceptance Form (Form: VISE 0416) (If Applicable):
® Submit the completed and executed.FTSE form from the owners of the downstream sewers and treatment facility:
➢ Multiple forms maybe required where the downstream sewer ownerand wastewater treatment facility are different::
• The flow acceptance indicated in form FTSE must not expire prior to permit issuance and must be dated less than one
yearprior to the application date.
➢ Submittal of this application and form FTSE indicates that owner has adeqnnte capacity and will not violate G.S. 143-
215.67(a).
➢:: Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific FTSE.
F. Site Maps (All Application Packages):
® Submit an 8.5-inch x 11-inch color copy of a USGS Topographic Map of sufficient scale to identify the entire proJect
area and closest surface waters.
> , Location of the project (gravity sewer, pump stations & force main)
• Downstream' connection points and permit number (if known) for the receiving sewer
® Include a street level map (aerial) showing general project area so that Division staff can easily locate it in the field.
G. Existing Permit (All Modification Packages):
❑ . Submit the most recently issued existing permit.
❑ Provide a list of any items within the permit the Applicant would like the Division to address during the permit
modification (i.e., permit description, flow allocation, treatment facility, etc.).
H. Power Reliability Plan (Required if portable reliability option utilized for Pump: Station):
O Per 15A NCAC 02T .0305(h)(1), submit documentation of power reliability for pumping stations.:
➢ This alternative is only available for average daily flows less than 15,000 gallons per day •
• It shall be demonstrated to the Division that the portable source -is owned or contracted by the applicant and is compatible'
with the station. The Division will accept a letter signed by the applicant (see 15A NCAC 02T .0106(b)) or proposed
contractor, stating that "the portable power generation unit or portable, independently -powered pumping units, associated
appurtenances and personnel are available for distribution and operation of this pump station."
➢ If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump
stations' storage capacities and the rotation schedule of the portablepower source or pump, including travel
timeframes, shall be provided in the case of a multiple station power outage. (Required at time of certification)
L Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ , Per 15A NCAC 02T ,0115(a)(1) provide the Certificate of Public Convenience and Necessity from the North Carolina
Utilities Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served by
the sewer extension, or
❑ Provide a letter from the North Carolina Utilities Commission's Water and Sewer. Division Public Staff stating an
application for a franchise has been received and that the service area is contiguous to an existing franchised area or that
franchise approval is expected.
J. Operational Agreements (Applications from HOA/POA and Developers for lots to be sold):
❑ Home/Property Owners' Associations
O Per 15A NCAC 02T .0115(c), submit the properly executed Operational Agreement (FORM: HOA).
O Per 15A NCAC 02T..0115(c), submit a copy y of the Articles of Incorporation, Declarations and By -taws.
❑ Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(b), submit the properly executed Operational Agreement (FORK DEV).
For more information, visit the Division's collection systems website
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 2 of 3

THE COMPLETED APPLICATION PACKAGE INCLDIN.G ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD BE SENT TO THE APPROPRIATE REGIONAL Ok'FICE:
•
REGIONAL OFFICE .
ADDRESS
COUNTIES SERVED . .
Asheville Realonat'Offlce .
2090 US Highway 70,
Swannanoa, North Carolina 28778
[phone] .
[phone]' Fax
Avery, Buncombe, Burke, Caldwell, Cherokee,
Clay, Graham, Haywood, Henderson,. Jackson,
Macon, Madison, McDowell, Mitchell, Polk,
Rutherford, Swain, Transylvania, Yancey
Water Quality Section
Fayetteville Regional Office
225 Green Street Suite 714 :.
Fayetteville, North Carolina 28301-5094.
[phone] :
[phone] Fax
Anson, Bladen, Cumberland, Harnett, Hoke;
Montgomery, Moore, Robeson, Richmond,
Sampson, Scotland .
Water Quality Section
Mooresville Regional Office -
610 E. Center Avenue
Mooresville, North Carolina 28115
[phone]
[phone] Fax
Alexander, Cabarrus, Catawba, Cleveland,
Gaston, Iredell, l_Incoln, Mecklenburg, Rowan,
Stanly, Union
Water Quality Seddon
'Raleigh Regional Office.
1628 Mao Service Center
Raleigh, North Carolina 27699=1628.
[phone]
[phone] Fax
Chatham, Durham, Edgecombe, Franklin,
Granville, Halifax, Johnston, Lee, Nash,
Northampton, Orange, Person, Vance, Wake
Warren, Wilson
.W$oy Quality Section
-Wasiliggton Regional Office
' 943 Washington Square Mall ...
Washington, North Carolina 27889
(252) '946-6481
[phone] Fax
Beaufort, Bertie, Camden, Chowan; Craven,
Currituck, Dare, Gates, Greene, ;Hertford, Hyde,
Jones, Lenoir, Martin, Pamlico Pasquotank, . ..
Perquimans, Pitt, Tyrrell, Washington, Wayne
Water Quality Section
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, North Carolina 28405
[phone]
[phone] Fax
Brunswick, Carteret, Columbus, Duplin, New
Hanover, Onslow, Pender
Water Quality Section
Winston-Salem Regional Office
450 W. Hanes Mill Road
Suite 300
Winston-Salem, North Carolina 27105
.[phone]
Alamance, Allegheny, Ashe, Caswell, Davidson,
Davie,, Forsyth, Guilford, Rockingham, Randolph,
Stokes,: Surly, Watauga, Wikes,'Yadkln
Water Quality Section
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 3 of 3

` Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of. Water Resources
15A NCAC 02T.0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 04-16 & SUPPORTING. DOCUMENTATION
Application Number (to be bompleted by DWR)
JJ items must lie, comnieted or the aanlicution will be returned
APPLICANT INFORMATION:
1.
Applicant's name: Greenville Utilities Commission (company, municipality, HOA, utility, etc.)
Applicant type: ❑ Individual
® Corporation Q General Partnership 0 Privately -Owned Public Utility
❑ Federal 0 State/County d Municipal 0 Other
Signature authority's name: Clifton H. Cahoon. PE per 15A NCAC 02T .0106(b'1
Title: Construction/Contracts Engineer
4. Applicant's mailing address: PO i3ox 1847
City: Greenville State: N Zip: 27835-
5. Applicant's contact information:
Phone number: (252) SS1-334$. Email Address: Cahoonch@a guc.com
II: PROJECT. INFORMATION:
1: Project name: Carolina Crofts Phase1.Section 1
2. Application/Project status: Proposed (New Permit)
❑ Existing Permit/Project
If a modification, provide the existing permit number. WQO( . and issued date:
If new construction but part of a master plan, provide the existing permit number. WW1
3. County where project is located: itt
4. Approximate Coordinates (Decimal Degrees); Latitude: ° 35.626697° Longitude: -77.437703°
5 Parcel ID (if applicable): 1867$
(or Patten -JD to closest downstream sewer)
111 CONSULTANT INFORMATION:
1. Professional Engineer. J. Stephen Janowski, PE
Firm: Rivers & Associates. Inca
Mailing address: 107 E. Second Street
City: Greenville State: NC Zip: 27858-
Phone number (252) 752-41 5 Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTP) INFORMATION:
1. Facility Name: GUC WWTP Permit Number. NC 0023931
Owner Name: Greenville Utilities Commission
License Number. 12324
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ not known Downstream (Receiving) Sewer Size: 12 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS NC 0023931
Owner Name(s): Greenville.11tilites Commission
FORM: FTA 0 -16 Page 1 of 5

GENERAL REQUIREMENTS
If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes "❑No ®N/A
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
If the Applicant is a Home/k3roperty.Owners' Association,has an Operational -Agreement (FORM: HOA) been attached?
❑ Yes ❑No " ®N/A
Origin of wastewater. (check all that apply):
X❑ Residential Owned
❑ Residential Leased
❑ School / preschool / day care
❑ Food and drink facilities
❑ Businesses /offices [factories
® Retail (stores, centers; malls)
Retail with food preparation/service
ID Medical / dental / veterinary facilities
▪ Church
❑ Nursing Home
Nature of wastewater : 100 % Domestic/Commercial % Commercial
% industrial (See 15A NCAC 02T :0iO3(20))
there a Pretreatment Program in effect? ❑ Yes ❑ No
Has a flow reduction been approved under 15A NCAC 02T .0114(fj? ❑'Yes ❑ No
> )fives, Provide a conv of flow reduction approval letter
7. Summarize wastewater generated by project
▪ Car • Wash
El Hotel and/or Motels
❑ Swimming Pool/Clubhouse
❑ Swimming Pool/Filter Backwash
▪ Other (Explain in Attachment)
Establishment Type (see 02T.01140))
Daily Design Flo
..b
No. of Units
Flow
Ph 1 Section 1 three bedroom single fatriily'
homes
:360 gal/unit,
49
17640 GPD
Farm Center
25 gal/employee
10
250; GPD
Event Barn
5 gal/seat
250
1250 GPD
gal/
GPD
gal/
GPD
GPD
Total
19140 GPD
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] shrill be
determined using available flow data, water using fixtures, occupancy or operation patterns, arid other measured data.
8. Wastewater generated .byproject: 19140 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
❑ Flow has already been allocated in Permit Number
❑ Rehabilitation or replacement of existing sewer with no new flow expected.
0 Other (Explain):
FORM: FTA 0416
Page 2 of 5

VIL GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T•.0305 & MDC (Gravity Sewers):
Summarize gravity sewer to be permitted:
Size (inches
Length (feet)
Material
1483
PVC
8"
20
- DIP
10
534
PVC
1
1216
PVC
15"
53
PVC
Section II & III of the MDC for Permitting of Gravity Sewers: contains information related to design criteria
Section III contains information related to minimum slopes for gravity sewer(s)
Oversizing lines to meet minimum slope requirement is not allowed and a violation of the11DC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) -,, 02T..0305 & MDC (Punin Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION -INCLUDED IN THIS PROJECT
Pump station number or name:. Caroliina Crofts.
Approximate Coordinates (Decimal Degrees): Latitude: 35.6364° Longitude: -77.455334°
3: Design flow of the pump station: 0.038 millions gallons per day (firm capacity)
4. Operational.point(s) of the pump(s): 344 gallons per minute at ¢Q feet total dynamic head (TDH)
5. Summarize the force main to be permitted (fot this Pump Station):
Size (inches)
Length (feet)
Material
8"
5125
PVC
8"
215
DIP
Power reliability in accordance with 15A NCAC 02T .0305(h)(1):
Ej Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(h)(1)(B);
• Required for all pump stations with an average daily flow greaterthan or equal to 15,000 gallons per day
• Must be permanent to facility
Or if the pump station has an average daily flow less than 15,000 gallons per day:
❑ Portable power source with manual activation, quick -connection receptacle and telemetry- 15A NCAC 02T
.0305(h)(1)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry - 15A NCAC 02T .0305(h)(1)(C):
> It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant (draft agreement)
and is compatible with the station.
> If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel timeframes, shall be provided
in the case of a multiple station power outage,
FORM: FTA 04-16
Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(1)):
1. Does the project comply with all separations found in 15A NCAC 02T .0305(f) & (g)
➢ 15A NCAC 02T 0305(f) contains minimum separations that shall be provided for sewer systems:
Yes ❑ No
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
24 inches
Water mains (vertical -water over sewer including in benched trenches)
18 inches
Water mains (horizontal)
10 feet
Reclaimed water lines (vertical - reclaimed over sewer)
18 inches
Reclaimed water lines (horizontal - reclaimed over sewer)
2 feet
**Any private or public water supply source, including any wells, WS-I waters of Class I or
Class 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 stream, lake, impoundment, or ground water lowering and surface drainage
ditches
10 feet
Any building foundation
5 feet
Any basement
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
> 15A NCAC 02T.030$(g) contains alternatives where separations in 02T.0305(f) cannot be achieved.
> **Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
➢ If noncompliance with 02T.0305(f) or (g)., see 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
. Does the project comply with setbacks found in the river basin rules per 15A NCAC 02)3 .0200? ® Yes ❑ No ❑ N/A
> This would include Trout Suffered Streams per 15A NCAC 2)3.0202
4. Does the project require coverage/authorization under a 404 Nationwide or
individual permits or 401 Water Quality Certifications?
> Information can be obtained from the 401 & Buffer. Permitting Branch
® Yes ❑ No
5. Does project comply with 15A NCAC 02T,0105(c)(6) (additional permits/certifications)? ® Yes D No
Per 15A NCAC 02T.0105(c)(6), directly related environmental permits or certification applications are being prepared, have
been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion and
sedimentation control plans, stormwater management plans, etc.).
6. Does this project include any sewer collection lines that are deemed "high -priority?"
Per 15A NCAC 02T.0402, "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes ® No ❑ 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 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 ❑ No
If No, complete and submit the Variance/Alternative Design Request application (VADC 10-14) and supporting documents for
review. Approval of the request is required prior to submittal of the Fast Track Application and supporting documents.
Professional Engineer's Certification:
J. STEPHEN JANOWSKI, PE attest that this application for
(Professional Engineer's name. from Application Item III.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 id 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 mysignature and seal signifies that I have reviewed this material and
have judgedit 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 false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fne not to exceed $10,000, as well as civil penalties up to $25,000 per violation.
North Carolina Professional Engineer's seal, signature, and date:
Applicant's Certification per 15A NCAC 02T .0106(b):
I,0/7401 lil, ahwt firrf� 4 f/„r !i�etsr
(Signature Authority's name & title from Application Item I.3.)
AL
1132411
IN.
attest that this application for
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 143-215.6B, 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: /a O'% �o.2 Z.
FORM: FTA 04-16
Page 5 of 5

USGS MAP

Average Yearly Flow for:
Facility name, Permit # GUC, NC0023931
Jan.2021 13.774194
Feb.2021 17.764286
Mar.2021 12.9193548
Apr.2021 11.0066667
May2021 9.2225807
Jun2021 14.2433333
Ju12021 12.0258065
Aug2021 14.2419355
5ept2021 10.5466667
Oct2021 9.6870968
Nov2021 9.26
Dec2021 9.0709677
11.98024073 Avg. Flow
Permitted Flow: 17.50
2021 % of Permitted Flow:
68.45851843
(< 80% / 90% OK)