WQ0044365_Application (FTSE)_20230414

State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 06-21 &SUPPORTING DOCUMENTATION
Application Number: WQ(x)`t"` ,34 (to be completed by DWR) RECE ED NCDEQ/ WR
All items must be completed or the application will be returned AP 4 20 a
I. APPLICANT INFORMATION: W
1. Applicant's name: City of Kings Mountain(company,municipality, HOA,utility,etc.) MOORESVILLE GI NAL OFFICE
2. Applicant type: ❑ Individual ❑Corporation ❑General Partnership ❑ Privately-Owned Public Utility
❑ Federal ® State/County ❑ Municipal ❑Other
3. Signature authority's name: Ricky Duncan per 15A NCAC 02T.0106(b)
Title: Water Resources Director RECEIVED/NCDEQ/DWR
4. Applicant's mailing address: 1013 N. Piedmont Avenue
MAY - 3 ��?
City: Kings Mountain State:NC Zip:28086-
WOROS
5. Applicant's contact information: MOORESVILLE REGIONAL OFFICE
Phone number:[phone] Email Address: rickydacityofkm.com
11. PROJECT INFORMATION:
I. Project name: Cottages at Clovis Point
2. Application/Project status: ® Proposed(New Permit) ❑ Existing Permit/Project
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: Cleveland
4. Approximate Coordinates(Decimal Degrees): Latitude: 35.1350' Longitude: -81.2254'
5. Parcel ID(if applicable): 11912 (or Parcel ID to closest downstream sewer)
Ill. CONSULTANT INFORMATION:
1. Professional Engineer: Matthew C.Kirchner License Number:045509
Firm: Eagle Engineering Inc.
Mailing address:2013-A Van Buren Ave
City: Indian Trail State:NC Zip:28079-
Phone number:(704) 882 - 4222 Email Address:[e-mail]
IV. WASTEWATER TREATMENT FACILITY(WWTF) INFORMATION:
1. Facility Name: Pilot Creek WWTF Permit Number:NCO020737
Owner Name:Ci1y of Kings Mountain
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQNCO020737
2. Downstream (Receiving)Sewer Information: 8 inch ® Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s)(if applicable): WQCS00036
Owner Name(s):City of Kings Mountain
FORM: FTA 06-21 Page 1 of 5

V1. 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 I�c�cloper's Uluigntl Atcem ntII. been attached?
[:]Yes [-] No ®N/A
3. If the Applicant is a Home/Property Owners'Association, has an IiOA/POA_O��e�aiton iJ_n rmeE�t-( ORM__1QA1 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)
S. Nature of wastewater: 100%Domestic 0%Commercial 0%industrial Scc 15A NCAC(l2T.0103 2U
If Industrial, is there a Pretreatment Program in effect?❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T__0 114(i)? [] 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 e,n No.of Units Flow
Residential Detached Homes(4BR/Unit) 480 gal/unit 80 38,400 GPD
7o1al 38,400 GPD
a See 1_5A_NCAC.02T .01,14(b),-_(c�,__(e)•(_I)_ 3u�_�)f2J 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. 2A_4),
b Per 15A NCAC 02T.0114(c),design flow rates for establishments not identified [in table:15_A_NCAC 02T,01-141 shall be
determined using available flow data,water using fixtures,occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 38,400 GPD(per:15A NCAC 02T :011-4)
➢ 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 06-21 Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA(I€Applicable) -02`I 0305&MDC:((ravil :Severs):
I. Summarize gravity sewer to be permitted:
Size(inches) Length(feet) Material
8 1,356 SDR-35
8 2,219 SDR-26
➢ 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�030+& MDC(Pyum Stations/Force]plains}:
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinates(Decimal Degrees): Latitude: Longitude:
3. Total number of pumps at the pump station:
3. Design flow of the pump station: 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): gallons per minute(GPM) at feet total dynamic head(TDH)
5. Summarize the force main to be permitted(for this Pump Station):
Size(inches) Length(feet) Material
If any portion of the force main is less than 4-niches in diameter,please identify the method of solids reduction per
MDCPSFM Section 2.01 C.Lb. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other(please specify)
6. Power reliability in accordance with 15A NCAC 02T .0305(fijf(L):
❑ 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 06-21 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 t 5ANCnC.02T.0305f 8:. ))? ®Yes ❑No
15A NCAC 02T.0305 f)contains minimum separations that shall be provided for sewers sterns:
Setback Parameter* Separation Required
Storm sewers and other utilities not listed below(vertical) v I8 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-1 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
y If noncompliance with 0210305(fj_gr_ ;),see Section X.I of this application
*I5A NCAC 02T,0305.U, contains alternatives where separations in 021',0305(i)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 Surlace Water Classifications webs?
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/sealed 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.
Seethe Division's drall_scimrattion requirements for situations where separation cannot be met.
Y No variance is required if the alternative design criteria specified is utilized in design and construction.
4. Is the project located in a river basin subject to any State buffer rules? ❑ Yes Basin name: ®No
If yes,does the project comply with setbacks found in the river basin rules per 15A NCAC 02B_.0200? ❑ Yes ❑No
T% This includes Trout Buffered Streams per 15A NCAC 213.0202
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 02;1'.01.05 c))(additional permits/certifications)? ® Yes ❑No
Per 15A NCAC 021'.0105(c 0J.,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 least 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 06-21 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with I SA NCAC 02:17,the Mininwm Desi_an Criteria for the Permittijig(If I?uinh Stations
and Force Mains Qatest yersign),and the Gravity Sewer Minimum I2esiU_Criterils_(latest vctsioi as applicable?
❑ Yes ❑No
1f 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 protects requiring two or more variances or where the variance is determined by the Division to be a
significant portion of the proiect,the full technical review is required.
2. Professional Engineer's Certification:
11 rkc�-1�e1�r W C. "nef 1 ,attest that this application for (^eA mes 061t- c6ts _
(Professional Engineer's name from Application Item 1I1.1.) (Project N%he from Application Item 1I.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,
Minim un DesiLn Criteria for Gravity Sewers(latest version), and the Minimum Design,Criteria for,the Fast-•Track Pernnitting
of PPump Stations and Force Mail sslatest 3 ersion 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 143-215.6B, 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.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 56A'lQP
North Carolina Professional Engineer's seal, signature,and date: ,CAR
4..VESs/o
0
SEAL
045509 . `
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3. Applicant's Certification per 15A NCAC 02T.0106(b):
I, t _ (�.���1e,�,ra,, ,attest that this application for f, g � �®�
(Signature A thority Name from Application Item 1.3.) (Project 1 me from Application Item 11.1)
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_2.15.6A 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.
Signature: Date:
FORM: FTA 06-21 Page 5 of 5

State of North Carolina
Department of Environmental Quality
Division of Water Resources
k.,y f r �,,.„ ",. Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: Clovis Point of KM, LLC
Project Name for which flow is being requested: Cottages at Clovis
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.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Pilot Creek Waste Water Treatment Plant
b. WWTP Facility Permit#: NC O020737
All flows are in MGD
c. WWTP facility's permitted flow 6.0
d. Estimated obligated flow not yet tributary to the WWTP 1,6800
e. WWTP facility's actual avg. flow 1.470
f. Total flow for this specific request 0.0384
g. Total actual and obligated flows to the facility 3.1.884
h. Percent of permitted flow used 53.14%
1I. 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/po, Avg. Daily Daily Flow, Obligated Available
Number) No. MGD MGD Flow,MGD MGD Flow Capacity***
Beason 2.3 0.92 0.176 0.188 0.3648 0.5552
*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): Pilot Creek Waste Water Treatment Plant
Downstream Permit Number: NC 0020737
Page 1 of 6
FI'SE 10-18

II1. Certification Statement:
1 Ricky Duncan _ 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 adequate capacity to transport and treat the proposed new wastewater.
2 �4-Z�-
Signing D.'icial Signature/ t Date
7ille of Signing Oficiul
Page 2 of 6
FTSI 10-18

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1 - THIS MAP MAY NOT BE A CERTIFIED SURVEY
r AND HAS NOT BEEN REVIEWED BYA LOCAL
GOVERNMENTAL AGENCY FOR COMPLIANCE
WITH ANY APPLICABLE LAND DEVELOPMENT
REGULATIONS AND HAS NOT BEEN REVIEWED
FOR COMPLIANCE WITH RECORDING
REQUIREMENTS FOR PLATS(G.S.47-30(n))
EAGLE ENGINEERING AERIAL EXHIBIT
LOCATED IN KINGS MOUNTAIN,NORTH CAROLINA
PIN:2-W874420
1 SCALE: I"=500'
FIRM LICEN SE# C-0873 JOB NAME: COTTAGES AT CLOVIS POINT
2013A Van Buren Avenue
CLIENT: CLOVIS POINT OF KM,LLC LOCATION: KINGS MOUNTAIN BLVD
Indian Trail, NC 28079 JOB NUMBER: 7554 KINGS MOUNTAIN,NC
[phone] DATE: 0312412023

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EAGLE ENGINEERING A PORTION OF USGS TOPOGRAPHIC MAP
DSCALE: 1"--1,000'
JOB NAME: COTTAGES AT CLOVIS POINT
FIRM LICENSE# C-0873
2013A Van Buren Avenue CLIENT:COTTAGES OF KM LLC LOCATION: KINGS MOUNTAIN BLVD
Indian Trail, NC 28079 JOB NUMBER: 7554 KINGS MOUNTAIN,NC
[phone] DATE: 0312412023

U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id.SAW-2020-01154 County:Cleveland U.S.G.S.Quad:NC-Grover
GENERAL PERMIT (REGIONAL AND NATIONWIDE)VERIFICATION
Permittee: Clovis Point of KMLLC
Dean Harrell
Address: 5615 Potter Road
Matthews,NC 28104
Telephone Number: 704-807-4610
E-mail: rdeanna rdha rrellcompa ny.com
Size(acres) 28.9 Nearest Town Kings Mountain
Nearest Waterway Beason Creek River Basin Santee
USGS HUC 03050105 Coordinates Latitude:35.231904
Longitude:-81.382098
Location description:Project is an undeveloped forested parcel located Northwest of the intersection of Kings Mountain Blvd,
andKing_sRowDrive near the municipality of Kings Mountain Cleveland County North Carolina.PIN:2584874420
Description of projects area and activity:This verification authorizes:
1) Permanent impacts of 65 LinearFeet(0.004 acres)to Stream A for a Culvert.
2) Permanent impacts of83 Linear Feet(0.006 acres)to Stream C for a Culvert.
Applicable Law(s): ©Section 404(Clean WaterAct,33 USC 1344)
❑Section 10(Rivers and Harbors Act,33 USC 403)
Authorization: NWP 29:Residential Developments
SEE ATTACHED NWP GENERAL,REGIONAL,AND/OR SPECIAL CONDITIONS
Your work is authorized by the above referenced permit provided it is accomplished in strict accordance with the attached
Conditions,your application signed and dated 7/27/2022,and the enclosed plans Cottages at Clovis Point June 20,2022.Any
violation of the attached conditions or deviation from your submitted plans may subject the permittee to a stop work order,a
restoration order,a Class I administrative penalty,and/orappropriatelegal action.
This verification will remain valid until the expiration date identified below unless the nationwide and/or regional general pen-nit
authorization is modified,suspended or revoked. If,prior to the expiration date identified below,the nationwide and/or regional general
permit authorization is reissued and/ormodified,this verification will remain valid until the expiration date identified below,provided
it complies with all requirements of the modified nationwide permit. If the nationwide and/or regional general permit authorization
expires or is suspended,revoked,or is modified,such that the activity would no longer comply with the terms and conditions of the
nationwide permit,activities which have commenced(i.e.,are under construction)or are undercontract to commence in reliance upon
the nationwide and/or regional general permit,will remain authorized provided the activity is completedwithin twelve months of the
date of the nationwide and/or regional gen eral permit's expiration,modification orrevocation,unless discretionary authority has been
exercised on a case-by-case basis to modify,suspendorrevoke the authorization.
Activities subject to Section 404 (as indicated above)may also require an individual Section 401 Water Quality Certification. You
should contact the NC Division of Water Resources(telephone [phone])to determine Section401 requirements.
Foractivities occurringwithin the twenty coastalcounties subjectto regulation under the Coastal Area Management Act(CAMA),prior
to beginning work you must contactthe N.C.Division of Coastal Management Morehead City,NC,at(252)808-2808.
This Department of the Army verification does not relieve the permittee of the responsibility to obtain any other required Federal,State
or local approvals/permits.If there are any questions regarding this verification,any of the conditions of the Permit,or the Corps of
Engineers regulatory program,please contact Kr s nka B Sty2gir at 252-545-0507or krystynka.b.stYgarnu usace.arm yam il.
Corps Regulatory Official: &,6 Date: 10/5/2022
Expiration Date o f Verific ation: 3/14/202 6 ou