WQ0022841_20030717_FTSEPERM

SOF WATF90 Michael F. Easley, Governor
,O G William G. Ross Jr., Secretary
2 � North Carolina Department of Environment and Natural Resources
O < Alan W. Klimek, P. E., Director
Division of Water Quality
Coleen H. Sullins, Deputy Director
Division of Water Quality
July 17, 2003
Mr. Herman Caulder, Town Manager
Town of Maiden
113 West Main Street
Maiden, North Carolina 28650
Subject: Permit No. WQ0022841
Town of Maiden
Clarks Creek Sewer Service
Wastewater Collection System Extension
Catawba County
Dear Mr. Caulder:
In accordance with your application received on June 24, 2003, we are forwarding herewith
Permit No. WQ0022841, dated July 17, 2003, to the Town of Maiden for the construction and operation
of the subject wastewater collection system extension. This permit shall be effective from the date of
issuance until rescinded, and shall be subject to the conditions and limitations as specified therein. This
cover letter shall be considered a part of this permit and is therefore incorporated therein by reference.
Please pay particular attention to Permit Condition 3 which requires that the wastewater
collection facilities be properly operated and maintained in accordance with 15A NCAC 2H .0227 or any
individual system -wide collection system permit issued to the Permittee.
Permitting of this project does not constitute an acceptance of any part of the project that does
not meet 1)15A NCAC 2H .0200; 2) the Division of Water Quality's (Division) Gravity Sewer Minimum
Design Criteria adopted February 12, 1996, as applicable; 3) and the Division's Minimum Design
Criteria for the Fast -Track Permitting of Pump Stations and Force Mains adopted June 1, 2000, as
applicable, unless specifically mentioned herein. Division approval is based on acceptance of the
certification provided by a North Carolina -licensed Professional Engineer in the application. It shall be
the Permittee's responsibility to ensure that the as -constructed project meets the appropriate design
criteria and rules. Failure to comply may result in penalties in accordance with North Carolina General
Statute §143-215.6A through §143-215.6C, construction of additional or replacement wastewater
collection facilities, and/or referral of the North Carolina -licensed Professional Engineer to the licensing
board.
Mooresville Regional Office
919 N. Main Street, Mooresville, NC 28115
Internet http://h2o.enr.state.nc.us/
Telephone [phone] Fax [phone]
DENR Customer Service Center Telephone [phone]

Mr. Herman Caulder
Page 2
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North
Carolina as amended, and other applicable Laws, Rules, and Regulations, permission is hereby
granted to the Town of Maiden for the construction and operation of approximately 4,300 linear feet of
18 -inch gravity sewer; approximately 3,200 linear feet of 12 -inch gravity sewer; and approximately
6,600 linear feet of 8 -inch gravity sewer to serve 50 homes as part of the Clarks Creek Sewer Service
project, and the discharge of 18,000 gallons per day of collected domestic wastewater into the Town of
Maiden's WWTP (NPDES No. NC0039594) existing sewerage system, pursuant to the application
received June 24, 2003 and in conformity with 15A NCAC 2H .0200; the Division's Gravity Sewer
Minimum Design Criteria adopted February 12, 1996, as applicable; the Division's Minimum Design
Criteria for the Fast -Track Permitting of Pump Stations and Force Mains adopted June 1, 2000, as
applicable; and other supporting data subsequently filed and approved by the Department of
Environment and Natural Resources and considered a part of this permit.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the
right to request an adjudicatory hearing upon written request within 30 days following receipt of this
permit. This request must be in the form of a written petition, conforming to Chapter 1506 of North
Carolina General Statutes, and filed with the Office of Administrative Hearings, 6714 Mail Service
Center, Raleigh, NC 27699-6714. Unless such demands are made, this permit shall be final and
binding.
If you need additional information concerning this matter, please contact Sonja Williams at (704)
663-1699.
Sincerely,
for Alan W. Klimek, P.E.
cc: Catawba County Health Department
Mooresville Regional Office, Water Quality Section (WWTF Permit No. NC0039594)
Douglas Chapman, McGill Associates, PA
Water Quality Central Files
NDPU Files

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH
WASTEWATER COLLECTION SYSTEM EXTENSION PERMIT
This permit shall be effective from the date of issuance until rescinded and shall be subject to the
following specified conditions and limitations:
This permit shall become voidable unless the wastewater collection facilities are constructed in
accordance with the conditions of this permit; 15A NCAC 2H .0200; the Division of Water Quality's
(Division) Gravity Sewer Minimum Design Criteria adopted February 12, 1996, as applicable; the
Division's Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force
Mains adopted June 1, 2000, as applicable; and other supporting materials unless specifically
mentioned herein.
2. This permit shall be effective only with respect to the nature and volume of wastes described in the
application and other supporting data.
3. The wastewater collection facilities shall be properly maintained and operated at all times. The
Permittee shall maintain compliance with an individual system -wide collection system permit for the
operation and maintenance of these facilities as required by 15A NCAC 2H .0227. If an individual
permit is not required, the following performance criteria shall be met as provided in 15A NCAC 2H
.0227:
a. The sewer system shall be effectively maintained and operated at all times to prevent
discharge to land or surface waters, and any contravention of the groundwater standards in
15A NCAC 2L.0200 or the surface water standards in 15A NCAC 213.0200.
b. A map of the sewer system shall be developed prior to January 1, 2004 and shall be actively
maintained.
c. An operation and maintenance plan shall be developed and implemented.
d. Pump stations that are not connected to a telemetry system shall be inspected every day (i.e.
365 days per year). Pump stations that are connected to a telemetry system shall be
inspected at least once per week.
e. High-priority sewer lines shall be inspected at least once per every six-month period of time.
f. A general observation of the entire sewer system shall be conducted at least once per year.
g. Inspection and maintenance records shall be maintained for a period of at least three years.
h. Overflows and bypasses shall be reported to the appropriate Division regional office in
accordance with 15A NCAC 26 .0506(a), and public notice shall be provided as required by
North Carolina General Statute §143-215.1C.

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

11. Noncompliance Notification:
The Permittee shall report by telephone to the Mooresville Regional Office, telephone number
[phone], as soon as possible, but in no case more than 24 hours or on the next working
day, following the occurrence or first knowledge of the occurrence of either of the following:
a. Any process unit failure, due to known or unknown reasons, that renders the facility incapable
of adequate wastewater transport, such as mechanical or electrical failures of pumps, line
blockage or breakage, etc.; or
b. Any failure of a pumping station or sewer line resulting in a by-pass directly to receiving waters
without treatment of all or any portion of the influent to such station or facility.
Persons reporting such occurrences by telephone shall also file a written report in letter form within
five days following first knowledge of the occurrence. This report must outline the actions taken or
proposed to be taken to ensure that the problem does not recur.
Permit issued this the 17th day of July, 2003.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
for Alan W. KlirO6k, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission
Permit Number WQ0022841

Fast Track Enaineerina Certification
Permit No. WQ0022841
July 17, 2003
Complete and submit this form to the permit issuing regional office with the following:
• One copy of the project record drawings (plan & profile views of sewer lines) of the wastewater collection
system extension
• supporting design calculations (selected pumps, system curve, operating point, available storage if portable
generator(s) or storage greater than longest past three year outage reliability option selected) for any pump
stations permitted as part of this project
• Changes to the project should be clearly identified on the record drawings or in written summary form. Permit
This project shall not be considered complete nor allowed to operate until this Engineer's Certification and all
required supporting documentation have been received by the Division. Therefore, it is highly recommended
that this certification be sent in a manner that provides proof of receipt by the Division.
ENGINEER'S CERTIFICATION
❑ Partial ❑ Final
I, , as a duly registered Professional Engineer in the State of North Carolina, having
been authorized to observe (❑ periodically, ❑ weekly, ❑ full time) the construction of the Clarks Creek Sewer
Service, Catawba County project for the Permittee hereby state that, to the best of my abilities, due care and
diligence was used in the observation of the construction such that the construction was observed to be built
within substantial compliance of this permit; 15A NCAC 2H .0200; the Division of Water Quality's (Division) .
Gravity Sewer Minimum Design Criteria adopted February 12, 1996 as applicable; the Division's Minimum Design
Criteria for the Fast -Track Permitting of Pump Stations and Force Mains adopted June 1, 2000 as applicable; and
other supporting materials.
North Carolina Professional Engineer's
seal, signature, and date:
SEND THIS FORM & SUPPORTING DOCUMENTATION
WITH REQUIRED ATTACHMENTS TO THE FOLLOWING ADDRESS
MOORESVILLE REGIONAL OFFICE
919 N. MAIN STREET
MOORESVILLE NC 28115
The Permittee is responsible for tracking all partial certifications up until a final certification is received. Any
wastewater flow made tributary to the wastewater collection system extension prior to completion of this
Engineer's Certification shall be considered a violation of the permit and shall subject the Permittee to appropriate
enforcement actions.

of W ATF
Department of EnState of North Carolina
o Environment and Natural Resources
�
Division of Water Quality
for GRAVITY SEW FAST -TRACT{ APPLICATION
ERS, PUMP STATIONS, AND FORCE MAINS
INSTRUCTIONS: Indicate that you have included the following list of re
(Pressure sewers systems are not to be included as part of this application package)
space provided next to each item. Failure to submit all required items will lead to
incomplete or additional processin required application Package
g and review time. This form ca items in checking the
® I. may be Your application being returned as
Application Form - Y photocopied for use as an origins/.
form. Submit one Original and one co
Any changes to this form will result in the application
of the completed and appropriately
(Division) will only accept a vis executed application
addressed. application Packages pplication being returned. The Division of Water
You do not need to submit detailed glans and sat ave been full
Y completed with all applicable Quality
® II. Application Fee - ecifications unless ou res Ind NO 2items
Environment and Natural it a check
in the amount of 400
(NCDENR). $ made payable to: North Carolina Department of
13111. Certificates of Public Convenience and Necessity
privately -t es O public utility, y — If the application
which demonstrates that the submit two copies of the CertificateOf Publ c isbeing submitted in the name of a
Public utility is authorized to hold the utility franchise for the area to be served by the
sewer extension. If a CPCN has not been issued,
Commission's Public Staff that states that an a and Necessity (CPCN)
provide two copies Of a letter from the North Carolina Utilities
is contiguous to an existing franchised area, application for franchise has been received, that the service area
CPCN or letter must match that provided in Item A(2a)
franchise approval is expected. The project name in the
❑ IV. Operational Agreements — application.
the sewer extension will be serving one or, and two copies of a properly executed operational
homeownerstassocaGonilt bbe erving OA 02/0al or commercial lots e.
Form y a homeowners' association or developer (Item g(2bhe' agreement if
THE PROJECT WILL BE TURNED OVER TO A MUNICIPALITY, FORM DEV 02/03 IS REQUIRED.
townhomes,
If the applicant is a developer, use Form)DEVt02 applicant is a
❑ V. Flow P 02/03. EVEN IF
Acceptance Letters — If the owner of the downstream sewers and/or W WTF is different from the applicant
submit two copies of a flow acceptance letter from the owner of the downstream sewers and
Flow acceptance letters must contain the following
flow accepted, and name and 9 minimum information: applicant and project name
if different
expire p permit -SSUance Permit number of the receiving Intergovernmental agreements or other oontractsMust bwill not be accepted in lieu of a r . amount of
dated less WTF. The flow acceptance must not
letter. than a year prior to the a
Project -specific application date.
® VI. Map —Submit an 8.5 -inch b pecific flow acceptance
form. The Y 11 -inch copy of the portion of a 7.
map should identify the entire project area location as well as the closest downslope surface waters as
clearly as 5 -minute USGS Topographic Ma
and be possible. Each map portion must be labeled with the P along with this
of clear and reproducible quality. For instance, if the project involves 4
traverses over or near several different waterboinst (Or counties, basins, name and number, the identified location,
for each different waterbody (where the sewer line is within 100 feet of such waterb dales a interceptor sewer that
etc.), the map should have location ID's
® VII. Watershed Classifications —Section C
If an pro. Y see Instruction VII).
• Y portion of the ro'ect is within 100 feet of an
for the pertinent sections. y down slope surface water,
• If the entire project area is a minimum of 100 feet away from an Section C must be completed
PUMP station involved where a
instead of dual feed or history of power Outage is to y down slope surface waters B
Permanent or portable g be used to provide adequate des. ynUT hstoraga
the closest down slope surface water is Class Cgenerator,
• Use the Section C must )( completed to demonstrate that
guidance document entitled, ' (see 15A NCAC ZH .0219(h 3
Sewer Systemsy, Determining Watershed Classifications (forDF)o)rm FTA 02/03 (Fast -Track
office. ) available from http://h2o.enr.state.nc.us/ndpu or by contacting the appropriate regional
N

E:1 VIII. Environmental Assessments — If this project is subject to an Environmental Assessment (EA) ]15A NCAC
01C .0500], this application can not be used. Send the project application on Form PSFMGSA 10/99 to the
Non -Discharge Permitting Unit, 1617 Mail Service Center, Raleigh, NC 27699-1617. Applications can not be
processed until a Finding of No Significant Impact (FONSI) or Environmental Impact Statement (EIS) has been
issued. A copy is to be submitted with that permit application.
® IX. Certifications — Section D
The application must be certified by both the applicant and a North Carolina Registered Professional Engineer
(PE). The applicant signature must match the signing official listed in Item A(lb). The PE should NOT certify the
application if he/she is unfamiliar with 15A NCAC 2H .0200, the Gravity Sewer Minimum Design Criteria (most
recent version) and the Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains
(most recent version), as applicable to the project. Certification by a PE who is unfamiliar with these documents
is subject to NC Board referral.
THE COMPLETED FTA 02/03 APPLICATION PACKAGE, INCLUDING ALL SUPPORTING DOCUMENTS AND $400
FEE, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional Office
59 Woodfin Place
Avery, Buncombe, Burke, Caldwell,
Asheville, North Carolina 28801
Cherokee, Clay, Graham, Haywood,
[phone]
Henderson, Jackson, Macon, Madison,
[phone] Fax
McDowell, Mitchell, Polk, Rutherford, Swain,
Transylvania, Yancey
Fayetteville Regional Office
Anson, Bladen, Cumberland, Harnett, Hoke,
225 Green Street Suite 714
Montgomery, Moore, Robeson, Richmond,
Fayetteville, North Carolina 28301
Sampson, Scotland
[phone]
[phone] Fax
Mooresville Regional Office
919 N Main Street
Alexander, Cabarrus, Catawba, Cleveland,
Mooresville, North Carolina 28115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
Raleigh Regional Office
Chatham, Durham, Edgecombe, Franklin,
1628 Mail Service Center
Granville, Halifax, Johnston, Lee, Nash,
Raleigh, North Carolina 27699-1628
Northampton, Orange, Person, Vance, Wake,
[phone]
Warren, Wilson
[phone] Fax
Washington Regional Office
Beaufort, Bartle, Camden, Chowan, Craven,
943 Washington Square Mall
Currituck, Dare, Gates, Greene, Hertford,
Washington, North Carolina 27889
Hyde, Jones, Lenoir, Martin, Pamlico,
[phone]
Pasquotank, Perquimans, Pitt, Tyrrell,
[phone] Fax
Washington, Wayne
Wilmington Regional Office
Brunswick, Carteret, Columbus, Duplin, New
127 Cardinal Drive Extension
Hanover, Onslow, Pender
Wilmington, North Carolina 28405
[phone]
[phone] Fax
Winston-Salem Regional
585 Waughtown Street
Alamance, Alleghany, Ashe, Caswell,
Office
Winston-Salem, North Carolina
Davidson, David, Forsyth, Guilford,
27107
Rockingham, Randolph, Stokes, Surry,
[phone]
Watauga, Wilkes, Yadkin
[phone] Fax
For more information, visit our web site at: http://h2o.enr.state.nc.us/ndpu/
INSTRUCTIONS FOR FORM FTA 02/03

FAST-TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
USE THE TAB KEY To MOVE FROM FIELD TO FIELD! Application Number PAGE 1
-- -
1. Owner. ___------
(to be tom leted b
1a. Town of Maiden —�P Y DW —Q) W—_—Q00 -2-2 041
Full Legal Name (company,
Z
1b, Herman Caulder, Town Mana ericipality, HOA, utility, etc.)
QQ Signing Official Name and Title (Please review 15A NCAC 2H .0206(b) for authorized signing officials!
1c. The legal entity who will own this system is:
❑ Individual Q Federal )
X ®Municipality 0 1d. State/County E] private Partnership
Poration
O 113 West Main St. --___- ❑ Cor _
- _ Other (specify):
LL Street Address 1e. Maiden
Z 1f. NC City
OState 19. 28650
1h. 828-428-5000 ZIP Code
Q Telephone 1t. 828-428-5017
_V 2. Project (Facility) Information:Facsimile 1j' E-mail
Cd 2a. Clarks Creek Water and Sewer Service
CL
QBrief Project Name (permit will refer to this name) 2b. Catawba
3• Contact Person: County Where Project is Located
Q 3a. Dou las Cha man, McGill Associates, PA
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. 828-328-2024
Phone N_u_mber _ 3c. dcha man
1. Project is ---- --____ me illen ineers.com
— —
® New ❑ Modification (of an existin—mail
9 Permit
2. Owner is ) If Modification, Permit No.:
® Public (skip to Item B(3)) -- -
2a If private, applicant will be: -- I Private (go to Item 2(a))
- —_
2b. If sold, facilities owned by a (must choose one)
❑ Retaining Ownership (i.e. store, church, single office, etc.)
❑ Leasing units (lots, townhomes, etc. - skip to Item 8(3))
_ ❑ Selling units (lots, townhomes, etc. - go to t I t e 8(3 Public Utility (Instruction Itl)
Z _ _ El Homeowner Assoc./Developer (Instruction IV)
3• Town of Maiden --
(. Owner of Wastewater Treatment Facility (WWTF
4a. Maiden W WTp )Treating Wastewater From This Project
Name of WWTF 4b. NC0039594
LL 5a. Town Of Maiden ----- __WWTF permit No.
Z Owner of Downstream_Sewer 5b. 18 -,n -inch raviry --- -------_______ -
- ch 5c. Information not available
6• The origin of this wastewater is (check all that Receiving
Sewer Size
Permit Number of Downstream Sewer
----
apply): - - --- ---- — --
® Residential Subdivision
LU ❑ Apartments/Condominiums ❑ Car Wash
a ❑ Mobile Home Park ❑ Institution
❑ School ❑ Hospital 100 a
m
Cl 11 11Church �a Domestic/Commercial
❑ Office ❑ Nursing Home % Industrial
❑ Other (specify); _
7• Volume of wastewater to be o_ erg in this project: 18000 gallons per day %Other (specify);
8. If the permitted flow is
Interceptor zero, indicate ❑ Line - Flow will be permitted is subsequent permits that connect to this line
❑ Flow has already been allocated in Permit No.
_____ _ — ❑ Rehabilitation or replacement of existing sewer with no new flow expected

FAST-TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 2
9. Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2H
.0219(1) for Item 13(7) or the design Flow for line or pump station sizing if zero flow in the space below. Values other than
that in 15A NCAC 2H .0219(1)(1-2) must be approved prior to submittal of this application. Submit a separate request to
the Division of Water Quality, Non -Discharge Permitting Unit, 1617 Mail Service Center, Raleigh, NC 27699.1617 in
accordance with 15A NCAC 2H .0219(1)(3).
50 homes with 3 bedrooms at 120 gpd per bedroom
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
(inches) Length (feet) Gravity or Force Main
Size
( (pull down menu)
8 -inch 6600 Gravity
I
12 -inch 3200 Gravity
O 18 -inch 4300 Gravity
W- - - -- --
Gravity
Z - _ Gravity
Z Gravity
U Gravity
Z ENTER TOTAL LINE LENGTH IN MILES 2.67
Q11. Summary of Pump Stations to be Permitted (attach additional sheets as necessary)
Power Reliability Option
IX Location ID Design Flow Operational Point (dual line feed, permanent generator MATS,
0 (as shown on plans) (MGD) GPM @ TDH portable generator w/autodialer, wet well storage)
LL _ .- -
Z
F "
W
a -
12. Does the sewer system comply with the Minimum Design Criteria for the Fast Track Permitting of Pump Stations and Force
m Mains (latest version), the Gravity Sewer Minimum Design Criteria (latest version) and 15A NCAC 2H .0200 as applicable?
® Yes ❑ No If no, please reference the pertinent minimum design criteria or regulation and indicate why a
variance is requested:
SUBMIT TWO COPIES OF PLANS, SPECIFICATIONS OR CALCULATIONS PERTINENT TO THE VARIANCE WITH YOUR APPLICATION
13. Have the following permits/certifications been submitted for approval?
Wetland/Stream Crossings - General Permit or 401 Certification? ❑ Yes ❑ No ® N/A
Sedimentation and Erosion Control Plan? ❑ Yes ® No ❑ N/A
Stormwater? [-]Yes ❑ No ® N/A
FTA 02/03

FAST-TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 3
1. Use the Division's guidance document entitled, "DETERMINING STREAM CLASSIFICATIONS FOR FORM FTA 02/03
Z (FAST-TRACK SEWER SYSTEMS)" to collect and record the stream classification data below (attach additional sheets as
O necessary). This document is available from our web site or by contacting the appropriate Division of Water Quality
F regional office (see instructions for addresses) OR indicate the following:
Q ❑ A Watershed Classification is not needed because all parts of the project are at least 100 feet away from any down
<.i slope waterbody; AND,
V' ❑ A Watershed Classification is not needed because the design does not depend on wet well storage as a power
Nreliability option for any pump station near a Class C down slope waterbody.
Q Location ID Name of Waterbody Stream Waterbody
JJU on Map Waterbody County River Basin Index Classification
Q N3530 -W8107.5 Clark Creek Catawba Catawba 11-129-5-(0.3) C
LU N3530 -W8107.5 Bills Branch Catawba Catawba 11-129-5-5 C
LU
Q
V Submit the 8.5" x 11" topographic map as required in Instruction VI regardless of whether a classification is provided!
1. Applicant's Certification:
W
I attest that this application for Clarks Creek Water and Sewer Service 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. Note: In accordance with North Carolina General
Statutes 143-215.6A and 143-215.68, any person who knowingly makes any false statement, representation, or
certification in any application shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed $10,000
as well a j civil pena#iQs up to $25,000 per violation.
la.
Signing OfliciN Signature
2. Professional Engineer's Certification:
nX
Date
1 attest that this application for Clarks Creek Water and Sewer Service has been
reviewed by me and is accurate, complete and consistent with the information in the engineering plans, calculations, and
all other supporting documentation to the best of my knowledge. I further attest that to the best of my knowledge the
proposed design has been prepared in accordance with the applicable regulations, Gravity Sewer Minimum Design Criteria'
for Gravity Sewers adopted February 12, 1996, and the Minimum Design Criteria for the Fast -Track Permitting of Pump
Stations and Force Mains adopted June 1, 2000 and the watershed classification in accordance with Division guidance.
Although certain portions of this submittal package may have been developed by other professionals, inclusion of these
materials under my signature and seal signifies that I have reviewed this material and have judged it to be consistent with
the proposed design. Note: In accordance with NC General Statutes 143-215.6A and 143-215.6B, any person who
knowingly makes any false statement, representation, or certification in any application shall be guilty of a Class 2
misdemeanor which may include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
2a.
Douglas G. Chapman
;O`, LM% L M01 "I
Professional Engineer Name
.•• �°�oEESSIQ
2b.
McGill Associates, PA
Engineering Firm
= SEAL
2c.
1236 19'h Street Lane NW
p : 20622
Address
2d.
Hickory 2e. NC 2f. 28p601sr
City State
r rCNP
2g.
828-328-2024 2h. 828-328-3870 2i.
Telephone Facsimile E-mail
Seal, Sig ature
FTA 02/03

ss UNITED STATES
o DEPARTMENT OF THE INTERIOR
GEOLOGICAL SURVEY
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