WQ0045489_Headwaters_Development_Sanitary_Sewer_Extension_FTSSE_Permit_App_2nd_Submission_20240628

State of North Carolina
Department of Environmental Quality
D-W,, R Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 10-23 & SUPPORTING DOCUMENTATION
Application Number: %�GllO�� d (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Town of Blowing Rock (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ® Municipal ❑ Other
3. Signature authority's name: Shane Fox per 15A NCAC 02T .0106(b)
Title: Town Manager
4. Applicant's mailing address: P.O. Box 47
City: Blowing Rock State: NC Zip: 28605-
5. Applicant's contact information:
Phone number: 828) 295-2020 Email Address: manager(attownofblowin rg ock.gov
II. PROJECT INFORMATION:
1. Project name: Headwaters Development Sanitary Sewer Extension
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project ❑ ARPA funded
If a modification, provide the existing permit number: WQ00 and issued date: ,
For modifications, also attach a detailed narrative description as described in Item G of the checklist.
If new construction, but part of a master plan, provide the existing permit number: WQ00
3. County where project is located: Watauga
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.145199' Longitude:-81.664192'
5. Parcel ID (if applicable): 2818-32-4159-000 (or Parcel ID to closest downstream sewer).
III. CONSULTANT INFO1MATION:
1. Professional Engineer: Alan J. Crees License Number: 27044
Firm: Municipal Engineering, Inc.
Mailing address: 820-B State Farm Road
City: Boone State: NC Zip: 28607-
Phone number: 828) 262-1767 Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Blowing Rock WWTP Permit Number: NCO027286
Owner Name: Town of Blowing Rock
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ0037025
2. Downstream (Receiving) Sewer Information: 8 inch ❑ Gravity ❑x Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS00142
Owner Name(s): Town of Blowing Rock
FORM: FTA 10-23 Page 1 of 5

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 HOA/POA Operational Agreement (FORM: HOA) and
supplementary documentation as required by 15A NCAC 02T.0I 15(c) been attached?
❑ Yes ❑ No ® N/A
4. Origin of wastewater: (check all that apply):
❑ Residential (Individually 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. Nature of wastewater: 53 % Domestic 47 % Commercial % Industrial (See 15A NCAC 02T .0103(20))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(fl? ❑ Yes ❑ No
➢ If yes, provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow 1,b
No. of Units
Flow
New Office Building
25 gal/employee/day/shift
15 emp.
375 GPD
Future Office Building
25 gal/employee/day/shift
20 emp.
500 GPD
(3) Future 2-Bedroom Residential Cottages
75 gal/bedroom/day
3 x 2 bed.
450 GPD
(1) Future 1-Bedroom Residential Cottage
75 gal/bedroom/day
1 x 1 bed.
75 GPD
(6) Future Tree Houses
75 gal/bedroom/day
6 x 1 bed.
450 GPD
gal/
GPD
Total
1,850 GPD
a See 15A NCAC 02T .0114(b), (d), (e)(1) and (e(2) for caveats to wastewater design flow rates (i.e. 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: 1,850 GPD (per 15A NCAC 02T .0114 and G.S. 143-215.1)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero, please indicate why:
❑ Pump Station/Force Main or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line.
Please provide supplementary information indicating the approximate timeframe for permitting upstream sewers with flow.
❑ Flow has already been allocated in Permit Number: Issuance Date:
❑ Rehabilitation or replacement of existing sewers with no new flow expected
❑ Other (Explain):
FORM: FTA 10-23 Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T.034 MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8
236
SDR 35 PVC
8
164
Cl. 350 Ductile Iron
➢ 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 requirements is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: 1
2. Approximate Coordinates (Decimal Degrees): Latitude: 36.145199' Longitude:-81.664192'
3. Total number of pumps at the pump station: 2
3. Design flow of the pump station: 0.11664 millions gallons per day (firm capacity)
➢ This should reflect the total GPM for the pump station with the largest pump out of service.
4. Operational point(s) per pump(s): 81 gallons per minute (GPM) at 50 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
2
114
IPS SDR 11
HDPE
If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.01C.l.b. ® Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(1):
❑ Standby power source or ❑ Standby pump
➢ Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(1)(B)_
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
➢ Must be permanent to facility and may not be portable
Or if the pump station has an average daily flow less than 15,000 gallons per day 15A NCACO2T.0305(h)(1)(C):
® Portable power source with manual activation, quick -connection receptacle and telemetry -
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry:
Include documentation that the portable source is owned or contracted by the applicant 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
as part of this permit application in the case of a multiple station power outage.
FORM: FTA 10-23 Page 3 of 5

IX.
SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T.0305(f)):
1. Does the project comply with all separations/alternatives 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)
18 inches
'Water mains (vertical - water over sewer preferred, 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, and associated wetlands.
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 associated with these waters (see item IX.2)
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches, as well as wetlands associated with these waters or classified as WL.
10 feet
Any building foundation (horizontal)
5 feet
Any basement (horizontal)
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
➢ If noncompliance with 02T.0305(f) or (g), see Section X.1 of this application
* 15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(f) cannot be achieved. Please check "yes"
above if these alternatives are used and provide narrative information to explain.
**Stream classifications can be identified using the Division's NC Surface Water Classifications webpaQe
2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ N/A
➢ If no, please refer to 15A NCAC 18C.0906(f) for documentation requirements and submit a separate document,
signed/scaled by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? ® Yes ❑ No ❑ N/A
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ See the Division's draft separation requirements for situations where separation cannot be met.
➢ No variance is required if the alternative design criteria specified is utilized in design and construction.
i
® No
❑ Yes
4. Is the project located in a river basin subject to any State buffer rules? ❑ Yes Basin name:
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200?
➢ This includes Trout Buffered Streams per 15A NCAC 213.0202
❑ No
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ❑ Yes ® No
or 401 Water Quality Certifications?
➢ Please provide the permit number/permitting status in the cover letter if coverage/authorization is required.
6. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? ® '$es ❑ No
Per 15A NCAC 02T.0105(c)(6), directly related environmental permits or certification applications must be 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.).
7. Does this project include any sewer collection lines that are deemed "high -priority?" ❑ Yes ® No
Per 15A NCAC 02T.0402, "high -priority sewer" means any aerial sewer, sewer contacting surface waters,
siphon, or sewers positioned parallel to streambanks that are subject to erosion that undermines or deteriorates the sewer.
Siphons and sewers suspended through interference/conflict boxes require a variance approval.
➢ 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 Ieast once every six -months and
inspections documented per 15A NCAC 02T.0403(a)(5) or the permittee's individual System -Wide Collection permit.
FORM: FTA 10-23 Page 4 of 5

X. CERTIFICATIONS:
1. 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, for projects requiring a single variance, complete and submit the Variance/Alternative Design Request application
(VADC 10-14) and supporting documents for review to the Central Office. Approval of the request will be issued
concurrently with the approval of the permit, and projects requiring a variance approval may be subject to longer
review times. For projects requiring two or more variances or where the variance is determined by the Division to be a
significant portion of the project, the full technical review is required.
2. Professional Engineer's Certification:
Headwaters Development
I, Alan J. Crees , attest that this application for _ Sanitary Sewer Extension
(Professional Engineer's name from Application Item Ill.1.) (Project Name from Application Item H.1)
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans,
specifications, engineering calculations, and all other supporting documentation to the best of my knowledge. I further
attest that to the best of my knowledge the proposed design has been prepared in accordance with the applicable regulations,
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
have judged 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. Misrepresentation of the application
information, including failure to disclose any design non-compliance with the applicable Rules and design criteria, may subject
the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NCAC 56.0701)
North Carolina Professional Engineer's seal, signature, and date: C A R O��///�
O
2:o ti
SEAL 9�
27044 _
Dv/
xt
3. Applicant's Certification per 15A NCAC 02T .0106(b): S-3t 2.4
Headwaters Development
I, Shane Fox, Town Manager 61 , attest that this application for _ Sanitary Sewer Extension `
(Signature Authority Name from Application Item I.3.) (Project Name from Application Item II.1)
attest that this application 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.
c
Signature: Date: 5
FORM: FTA 10-23 Page 5 of 5

2 t�j e
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water resources Flow Tracking for Sewer Extension Applications
(FTSE 10-23)
Entity Requesting Allocation: Town of Blowing Rock
Project Name for which flow is being requested: —Headwaters Development S.S. Extension
More than one FTSE maybe requiredfor a single project if the owner of the WWTP is 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: Blowing Rock WWTP
b. WWTP Facility Permit #: NCO027286
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
All flows are in MGD
0.800000
0.000000
0.313900
0.001850
0.315750
39.5%
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)
Design
Pump
Pump
Average
Approx.
Station
Station
Firm Daily Flow**
Current
(Name or
Permit
Capacity, * (Firm / pf),
Avg. Daily
Number)
No.
MGD MGD
Flow, MGD
(C)
(D)=(B+C) (E)=(A-D)
Obligated,
Not Yet
Total Current
Tributary
Flow Plus
Daily Flow,
Obligated Available
MGD
Flow Capacity***
* The Firm Capacity (design flow) 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, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** 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.
Downstream Facility Name (Sewer): Town of Blowing Rock
Downstream Permit Number: WQ0037025
Page 1 of 6
FTSE 10-23

- L Sw.� t�i1 i�5 i��• �C ^sue � ro. � �/ L� � 1
III. Certification Statement:
I Shane Fox, Town Manager 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 certifies that the receiving collection system or treatment
works has adee64e!�*pacity to transport and treat the proposed new wastewater.
Signing Official
Title of Signing Official
Date
Page 2 of 6
FTSE 10-23

LETTER OF TRANSMITTAL T u4,..._
DATE:
TO:
FROM
D� 0 ertrr,�,*
1ronrr� r�4al Liu
Receive(]
6-26-24 J U N 2 8 2001
Attn: Ronald Boone Winston -Sale
North Carolina Department of Environmental Qua4gional Office
Winston-Salem Regional Office
Water Quality Section
450 W. Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
Alan J. Crees, PE
RE: Fast Track Sewer System Extension Application
Headwaters Development Sanitary Sewer Extension
US Highway 321/221, Blowing Rock, NC
PROJECT No.: B18073
WE ARE SENDING YOU:
f
NE
Copies
Date
No.
Description
2
6-26-24
Repones Letter
2
--
Fast Track Permit Application (FTA 10-23 (Pages 1-3
2
6-26-24
Flow Tracking/Acceptance Form FTSE 10-23
2
6-26-24
Project Narrative
TRANSMITTED:
❑FOR
YOUR USE/FILE
❑FOR
APPROVAL
OAS
YOU REQUESTED
❑FOR
REVIEW/COMMENT
❑FOR
SIGNATURE
❑AS
REQUESTED BY:
❑FOR
YOUR INFORMATION
❑FOR
BIDDING
1;7:11M -1TVX►Ii
VIA: ®1ST CLASS MAIL ❑FAX ❑HAND DELIVERED ❑PICKUP ❑
COPY: Preston Spencer, 4 Forty Four
Transmitted from the Boone, NC Office of
Municipal Engineering, Inc.
820-B State Farm Road, Boone, North Carolina 28607
Phone [phone] — Fax [phone] - E-mail (general): mesco(@boone.net

l�py IVIUNIUIPAL tNUINLLH
�i�ineeru.� E,�ellence.•/�uiovative A�j�'out/..es/Sadtaiaa�le S@lutis�s
NC Department of
Environment i Quality
June 26, 2024
Jlul NN Z 8 2024
Ronald C. Boone, Environmental Program Consultant Winston-Salem
NCDEQ— Division of Water Resources Regional Office
450 West Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
RE: Fast Track Sewer System Extension Permit No. WQ0045489
Town of Blowing Rock, Watauga County
Headwaters Development Sanitary Sewer Extension
Dear Ron:
We received your review comments for the reference project in a June 6, 2024 email and have
addressed them as follows:
1. Please provide the permit number for the receiving wastewater collection system in
question V.3. of the application.
The receiving downstream sewer permit number has been added to V.1. and the
system wide collection system permit number has been added to V.3.
2. Please note that Session Law 2023-137, enacted October 10, 2023, establishes a
wastewater design flow rate of 75 gallons per day per bedroom (GPD/BR) for
wastewater systems serving two or more dwelling units. Accordingly, wastewater
collection system extension permits issued pursuant to 15A NCAC 02T, with
wastewater systems serving two or more dwelling units shall use a wastewater design
flow rate of 75 GPD/BR. Additionally, the project narrative indicates there will be three
2-bedroom cottages, but the flow table on page 2 of the application, question V1.7.,
indicates there are only two. Please revise the flow table in question V1.7. to accurately
reflect the future facilities and make the application match what the project narrative
describes. Then recalculate the total flow using the new 75 GPD/BR rate. You will also
need to change the answer to question V1.8. of the application and revise and re -
execute the FTSE 10-23 with the correct total flow number.
The daily design flow shown in the summary table under V1.7. for the future residential
cottages and tree houses has been revised to 75 gallons per day per bedroom. The
correct number of three (3) 2-bedroom cottages has been shown in the wastewater
flow summary table under V1.7. The revised total flow calculated in the summary table
i s

z``"k 'Sw >--V -is s ``�
under V1.7. has been shown on line V1.8 and is also shown in section I., line f. of the
FTSE 10-23.
3. The answers to the questions in section VII1. of the application need to be corrected.
The design flow of the pump station should reflect the total GPM for the pump station
with the largest pump out of service. Since you indicate there will be two 81 gallon per
minute (GPM) pumps in the station, then 1 * 81 GPM * 1,440 minutes per day (MPD) _
116,640 gallons / 1,000,000 = 0.11664 MGD. The answer to the 2nd question V111.3. is
NOT the total flow calculated in question VI.7.
The answer on line V111.3. has been revised to 0.11664 million gallons per day.
4. The FTSE 10-23 flow tracking form will need to be re -executed using the new
recalculated total flows as instructed above. Also, the arithmetic in the current flow
form is incorrect and the town needs to fully understand how to fill out the FTSE 10-23.
Line c. is the plant's permitted flow. Line d. should reflect any obligated but not yet
tributary flow to the plant. Line e. is the plant's current actual average flow. Line f. is
the total flow for this specific project. Line g. is the sum of the values entered on lines
d. through f. Line h. is line g. divided by line c. Please also be sure to answer the two
questions at the bottom of page 1 of the FTSE 10-23, which should be the same answer
as to the questions in section V. of the application.
Under section I., the Town of Blowing Rock has confirmed the answer to line d. should
be zero. The total flow shown in section V1.8. of the FTA 10-23 has been shown on line
f. Line g. now shows the sum of lines d. through f. and line h. shows line g. divided by
line c. Under section IL, the Downstream Facility Name and Permit Number that are
shown in section V. of the FTA 10-23 have been added. The form has been re -executed
by the Blowing Rock Town Manager.
If we can provide any additional information for review, please contact us.
Sincerely,
MUNICIPAL ENGINEERING, INC.
Alan J. Crees, PE

PROJECT NARRATIVE
Headwaters Development Sanitary Sewer Extension
US Highway 321/221
Town of Blowing Rock, Watauga County, NC
Rev 6-26-24
This Fast -Track Sewer Application is for a total of 400 linear feet of new 8-inch gravity sanitary
sewer main, a new duplex pump station and 114 linear feet of 2-inch sanitary sewer force main
to be installed for the Headwaters Development in the Town of Blowing Rock. The new duplex
pump station will be installed at the northeast corner of the site and will discharge into 114 linear
feet of 2-inch IPS SDR 11 HDPE force main that will be directionally drilled under the pavement
of US Highway 321/221 to connect to the existing 8-inch force main on the north side of the
highway. The new gravity sanitary sewer will consist of 236 linear feet of SDR 35 PVC sewer
pipe and 164 linear feet of Class 350 Ductile Iron sewer pipe and will run from the new pump
station at first parallel to the highway, then turning south to follow the driveway into the site.
The gravity sewer will cross over the Middle Fork New River in the ground above the existing
metal arch culvert bridge on the site. The new sanitary sewer extension will serve one (1) new
office building to be constructed on the north side of the river and the future development to be
constructed on the south side of the river. The future development includes one (1) office
building, three (3) 2-bedroom residential cottages, one (1) 1-bedroom residential cottage and six
(6) future tree houses.
The volume of wastewater calculated comes from a total of 15 employees for the new office
building, 20 employees for the future office building, 7 bedrooms for the future cottages and 6
bedrooms for the future tree houses on the site. The total wastewater flow will be 1,850 gallons
per day, based upon a rate of 25 gallons per day for 1 shift for the office building employees and
75 gallons per day per bedroom.

LETTER OF TRANSMITTAL JNric�Aq
DATE: 6-3-24
TO: North Carolina Department of Environmental Quality ;77�
Winston-Salem Regional Office '�Water Quality Section AEms`
450 W. Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
Demo,
o�
FROM: Alan J. Crees, PE thvlrot'ilerlbo gaiil%y
RE: Fast Track Sewer System Extension Application €� r
24
Headwaters Development Sanitary Sewer Extension
US US Highway 321/221, Blowing Rock, NC Winston-Salem
Regional Office
PROJECT No.: B18073
wF ARF cFNn►Nr. vn►►-
Copies
Date
No,
Description
1
5-31-24
$600 Fee Check #2664
2
5-31-24
Fast Track Permit Application (FTA 10-23
2
5-9-24
Flow Tracking/Acceptance Form FTSE 10-23
2
5-31-24
Project Narrative
2
5-31-24
USGS Topographic Map with Site Identified
2
5-31-24
Aerial Location Map
TRd NSMITTFn
❑FOR
YOUR USE/FILE
❑FOR
APPROVAL
❑AS
YOU REQUESTED
❑FOR
REVIEW/COMMENT
❑FOR
SIGNATURE
❑AS
REQUESTED BY:
❑FOR
YOUR INFORMATION
❑FOR
BIDDING
REMARKS;
VIA: ®1ST CLASS MAIL ❑FAX ❑HAND DELIVERED ❑PICK UP ❑
COPY: Preston Spencer, 4 Forty Four
Transmitted from the Boone, NC Office of
Municipal Engineering, Inc.
820-B State Farm Road, Boone, North Carolina 28607
Phone [phone] — Fax [phone] - E-mail (general): mesco(a)boone.net

PROJECT NARRATIVE
Headwaters Development Sanitary Sewer Extension
US Highway 321/221
Town of Blowing Rock, Watauga County, NC
This Fast -Track Sewer Application is for a total of 400 linear feet of new 8-inch gravity sanitary
sewer main, a new duplex pump station and 114 linear feet of 2-inch sanitary sewer force main
to be installed for the Headwaters Development in the Town of Blowing Rock. The new duplex
pump station will be installed at the northeast corner of the site and will discharge into 114 linear
feet of 2-inch IPS SDR 11 HDPE force main that will be directionally drilled under the pavement
of US Highway 321/221 to connect to the existing 8-inch force main on the north side of the
highway. The new gravity sanitary sewer will consist of 236 linear feet of SDR 35 PVC sewer
pipe and 164 linear feet of Class 350 Ductile Iron sewer pipe and will run from the new pump
station at first parallel to the highway, then turning south to follow the driveway , ' to sitt-
The gravity sewer will cross over the Middle Fork New River in the groun `abov` the existing
metal arch culvert bridge on the site. The new sanitary sewer extension wil serve one (1) new
office building to be constructed on the north side of the river and the future development to be
constructed on the south side of the river. The future development includes one (1) office
building, three (3) 2-bedroom residential cottages, one (1) 1-bedroom residential cottage and six
(6) future tree houses.
The volume of wastewater calculated comes from a total of 15 employees for the new office
building, 20 employees for the future office building, 7 bedrooms for the future cottages and 6
bedrooms for the future tree houses on the site. The total wastewater flow will be 2,435 gallons
per day, based upon a rate of 25 gallons per day for 1 shift for the office building employees and
120 gallons per day per bedroom.

NC D � �I
EnVir r t�, State of North Carolina
Department of Environmental Quality
JUN 0 2624 Division of Water Resources
DWR.11--
FACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources INSTRU T �t��il� 8%- FTA 10-23 & SUPPORTING DOCUMENTATION
Regional Office
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 (Gravity Sewer & Pump Stations/Force Mains) and that plans, specifications and supporting documents
have been prepared in accordance with 15A NCAC 02T, 15A NCAC 02T .0300, Division policies, and good engineering practices.
While no upfront engineering design documents are required for 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. This would include plans, design
calculations, and project specifications referenced in 15A NCAC 02T .0305 and the applicable minimum design criteria. These
documents shall be immediately available upon request by the Division.
Projects that are deemed permitted (do not require a permit from the Division) are explained in 15A NCAC 02T.0303.
Projects not eligible for review via the fast track process (must be submitted for full technical review):
➢ Projects that do not meet any part of the minimum design criteria (MDC) documents;
➢ Projects that involve more than one variance from the requirements of 15A NCAC 02T;
➢ Pressure sewer systems utilizing simplex septic tank -effluent pumps (STEPS) or simplex grinder pumps;
➢ Simplex STEP or simplex grinder pumps connecting to pressurized systems (e.g. force mains);
➢ Vacuum sewer systems.
General — When submitting an application, please use the 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 quicker 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 (second copy may be digital) of Application and Supporting Documents
E Required unless otherwise noted. Signatures on original must be "wet ink" or secure digital signatures.
Please do not submit engineering design plans with the application unless specifically requested.
B. Cover Letter/Narrative Description (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.
➢ Include the permit number/status of any other required sewer permits (downstream/upstream)
➢ If necessary for clarity, include attachments to the application form.
➢ If the project is funded by American Rescue Plan Act (ARPA) funds, please include the ARPA project number in the cover
letter and in parentheses under Project Name (Section II.1. of the application).
C. Application Fee (All New and Modification Application Packages):
® Submit a check or money order in the amount of $600.00, dated no more than 90 days prior to application submittal.
➢ Payable to North Carolina Department of Environmental Quality (NCDEQ)
D. Fast Track Application (Required for All Application Packages, Form FTA 10-23):
® 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 I.2 is a corporation or company, provide documentation it is registered for business with the
North Carolina Secretary of State.
❑ 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 III 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.
INSTRUCTIONS FOR FORM: FTA 10-23 & SUPPORTING DOCUMENTATION Pagel of 3

® 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).
E. Flow Tracking/Acceptance Form (Form: FTSE 10-23) (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 owner and 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 year
prior to the application date.
➢ Submittal of this application and form FTSE indicates that owner has adequate 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,
including the closest surface waters.
➢ General location of the project components (gravity sewer, pump stations, & force main)
➢ Downstream connection points and permit number (if known) for the receiving sewer
® Include an aerial location map showing general project area (such as street names or latitude/longitude) so that Division staff
can easily locate it in the field.
G. Existing Permit (Application Packages for Modifications to an Existing Permit):
❑ Submit a copy of the most recently issued existing permit.
❑ Include a descriptive and clear narrative identifying the previously permitted items to remain in the permit, items to be
added, and/or items to be modified (the application form itself should include only include items to be added/modified). The
narrative should also include whether any previously permitted items have been certified.
❑ The narrative should clearly identify the requested permitting action and accurately describe the sewers to be listed in
the final permit.
H. Power Reliability Plan (Required if portable reliability option utilized for Pump Station):
® 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 portable power source or pump, including travel timeframes, shall
be. provided in the case of a multiple station power outage. (Required at time of certification)
I. 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
❑ Per 15A NCAC 02T .0115(c), submit the properly executed Operational Agreement (FORM: HOA).
❑ Per 15A NCAC 02T .0115(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
❑ Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(b), submit the properly executed Operational Agreement (FORM: DEV).
For more information, visit the Division's collection systems website
INSTRUCTIONS FOR FORM: FTA 10-23 & SUPPORTING DOCUMENTATION Page 2 of 3

THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional Office
2090 US Highway 70
Avery, Buncombe, Burke, Caldwell, Cherokee,
Water Quality Section
Swannanoa, North Carolina 28778-8211
Clay, Graham, Haywood, Henderson, Jackson,
[phone]
Macon, Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Harnett, Hoke,
Water Quality Section
Fayetteville, North Carolina 28301-5095
Montgomery, Moore, Robeson, Richmond,
[phone]
Sampson, Scotland
[phone] Fax
Mooresville Regional Office
610 E. Center Avenue
Alexander, Cabarrus, Catawba, Cleveland,
Water Quality Section
Mooresville, North Carolina 28115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
Raleigh Regional Office
3800 Barrett Drive
Chatham, Durham, Edgecombe, Franklin,
Water Quality Section
Raleigh, North Carolina 27609
Granville, Halifax, Johnston, Lee, Nash,
[phone]
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
Warren, Wilson
Washington Regional Office
943 Washington Square Mall
Beaufort, Bertie, Camden, Chowan, Craven,
Water Quality Section
Washington, North Carolina 27889
Currituck, Dare, Gates, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
Wilminqton Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
Water Quality Section
Wilmington, North Carolina 28405
Hanover, Onslow, Pender
[phone]
[phone] Fax
Winston-Salem Regional Office
450 W. Hanes Mill Road
Alamance, Alleghany, Ashe, Caswell, Davidson,
Water Quality Section
Suite 300
Davie, Forsyth, Guilford, Rockingham, Randolph,
Winston-Salem, North Carolina 27105
Stokes, Surry, Watauga, Wilkes, Yadkin
[phone]
[phone] Fax
INSTRUCTIONS FOR FORM: FTA 10-23 & SUPPORTING DOCUMENTATION Page 3 of 3

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State of North Carolina
Department of Environmental Quality
DWR z �� ) � Division of Water Resources
1
rl FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resource FTA 10-23 & SUPPORTING DOCUMENTATION
Application Number: 4-6654 K" (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Town of Blowing Rock (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ® Municipal— ❑ Other
3. Signature authority's name: Shane Fox per 15A NCAC 02T .0106(b)
r
Title: Town Manager
4. Applicant's mailing address: P.O. Box 47 `
City: Blowing Rock State: NC Zip: 28605-
5. Applicant's contact information:
Phone number: 828) 295-2020 Email Address: manager@townofblowin rg ock.gov
II. PROJECT INFORMATION:
1. Project name: Headwaters Development Sanitary Sewer Extension
2. Application/Project status: ® Proposed (New Permit)/ ❑ Existing Permit/Project ❑ ARPA funded
If a modification, provide the existing permit number: WQ00 and issued date: ,
For modifications, also attach a detailed narrative description as described in Item G of the checklist.
If new construction, but part of a master plan, provide the existing permit number: WQ00
3. County where project is located: Watauga
I
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.145199' Longitude:-81.6641920
5. Parcel ID (if applicable): 2818-32-4159-000 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Alan J. Crees License Number: 27044
Firm: Municipal Engineering,Inc'
Mailing address: 820-B State Farm Road
City: Boone` State: Ne Zip: 28607-
Phone number: 828) 262-1767�/ Email Address:[e-mail] /
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Blowing Rock WWTP/ Permit Number: NC002728d
Owner Name: Town of Blowing Rock
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ
2. Downstream (Receiving) Sewer Information: 8 inch./ ❑ Gravity ® Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS&/_i�z
4
Owner Name(s): Town of Blowing Rock
FORM: FTA 10-23 Page 1 of 5

V1. GENERAL REQUIREMENTS .`
1. If the Applicant is a Privately -Owned Public Utility, hasYCertifrcate 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 HOA/POA Operational Agreement (FORM: HOA) and
supplementary documentation as required by 15A NCAC 02T.0115(c) been attached?
❑ Yes ❑ No ® N/A
4. Origin of wastewater: (check all that apply):
❑ Residential (Individually 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. Nature of wastewater: 64 %Domestic 36 %`Commercial % Industrial (See 15A NCAC 02T .0103(20))
If Industrial, 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 with this application
Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow a,b
No. of Units
Flow
New Office Building '
25 gal/employee/day/shift"e
15 emp.
375 GPD
Future Office Building
25 gal/employee/day/shift'
20 emp
500 GP6
(3) Future 2-Bedroom Residential Cottages
120 gal bedroom/day
2 x 2 bed.
480 GPD
(1) Future 1-Bedroom Residential Cottage
120 gal/bedroom/day
1 x 1 bed.
120 GPD
(6) Future Tree Houses
120 gal/bedroom/day
6 x 1 bed.
720 GPD
gal/
GPD
Total
2,435 GPD
a See 15A NCAC 02T .0 1 14(b), (d), (e)(1) and (e)(2) for caveats to wastewater design flow rates (i.e. 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: 2,435 GPD (per 15A NCAC 02T .0114 and G.S. 143-215.1)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero, please indicate why:
❑ Pump Station/Force Main or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line.
Please provide supplementary information indicating the approximate timeframe for permitting upstream sewers with flow.
❑ Flow has already been allocated in Permit Number: Issuance Date:
❑ Rehabilitation or replacement of existing sewers with no new flow expected ✓�
❑ Other (Explain):
FORM: FTA 10-23 Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA f Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8
236
SDR 35 PVC
8
164
Cl. 350 Ductile Iron
➢ Section 11 & 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 requirements is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: 1
2. Approximate Coordinates (Decimal Degrees): Latitude: 36.145199' Longitude:-81.664192'
3. Total number of pumps at the pump station: 2
3. Design flow of the pump station: 0.002435 millions gallons per day (firm capacity)
➢ This should reflect the total GPM for the pump station with the largest pump out of service.
4. Operational point(s) per pump(s): 81 gallons per minute (GPM) at 50 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
2
114
IPS SDR 11­�
HDPE
If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.01C.l.b. ® Grinder Pump/❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(1):
❑ Standby power source or ❑ Standby pump
➢ Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(1)(B)_
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
➢ Must be permanent to facility and may not be portable
Or if the pump station has an average daily flow less than 15,000 gallons per day 15A NCACO2T.0305(h)(1)(C):
® Portable power source with manual activation, quick -connection receptacle and telemetry -''
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry:
➢ Include documentation that the portable source is owned or contracted by the applicant 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
as part of this permit application in the case of a multiple station power outage.
FORM: FTA 10-23 Page 3 of 5

State of North Carolina
Department of Environmental Quality
,''WRDivision of Water Resources
Mvi�sdons of Water s rfrr N Flow Tracking for Sewer Extension Applications
(FTSE 10-23)
Entity Requesting Allocation: Town of Blowing Rock -
Project Name for which flow is being requested: Headwaters Development S.S. Extension E
More than one FTSE may be required for a single project if the owner of the WWTP is 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: Blowing Rock WWTP
b. WWTP Facility Permit #: NCO027286
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
All flows are in MGD
0.800000
0.000000
0.313900 ,
0.002435 47
0.000000
0.39
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) (D)=(B+C)
(E)=(A-D)
Design
Obligated,
Pump Pump Average
Approx. Not Yet Total Current
Station Station Firm Daily Flow* *
Current Tributary Flow Plus
(Name or Permit Capacity, * (Firm / pf),
Avg. Daily Daily Flow, Obligated
Available
Number) No. MGD MGD
Flow, MGD MGD Flow
Capacity***
* The Firm Capacity (design flow) 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, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** 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.
Downstream Facility Name (Sewer):
Downstream Permit Number:
Page 1 of 6
FTSE 10-23

III. Certification Statement:
K-LIy4 1� A --
I Shane Fox, Town Manager 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 parry. Signature of this form certifies that the receiving collection system or treatment
works has adequate capacity to transport and treat the proposed new wastewater.
Signing Official Signature
d�
Title of Signing Official
Date
Page 2 of 6
FTSE 10-23