WQ0023225_20031029_FTSEPERM

\ CF WA7F9,q Michael F. Easley, Governor
C
0 7 William G. Ross Jr., Secretary
r North Carolina Department of Environment and Natural Resources
ti
Y Alan W. Klimek, P.E., Director
Division of Water Quality
Coleen H. Sullins, Deputy Director
Division of Water Quality
October 29, 2003
Mr. Eddie Faulkner, Public Works Director
Town of Maiden
P.O. Box 125
Maiden, North Carolina 28650
Subject: Permit No. WQ0023225
Town of Maiden
Temple Heights Subdivision
Wastewater Collection System Extension
Catawba County
Dear Mr. Faulkner:
In accordance with your application received on October 14, 2003, and additional information
received on October 23, 2003, we are forwarding herewith Permit No. WQ0023225, dated October 29,
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 This permit shall be effective from the date of issuance until rescinded, and shall be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
Intemet http://h2o.enr.state.ne.usi
Telephone [phone] Fax [phone]
DENR Customer Service Center Telephone [phone]
*A
NUMR

Mr. Eddie faulkner
Page 2
October 29, 2003
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 1,874.6 linear feet of
8 -inch gravity sewer to serve 30 three-bedroom residences as part of the Temple Heights Subdivision
project, and the discharge of 10,800 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 October 14, 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)
R. Carroll Williams, P.E.
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 2B.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.
Overflows and bypasses shall be reported to the appropriate Division regional office in
accordance with 15A NCAC 2B .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 26 .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 29" day of October, 2003.
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
for Alan W. KlimeK P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission
Permit Number WQ0023225

Fast Track Engineering Certification
Permit No. W00023225
October 29, 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 dearly 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
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 Temple Heights
Subdivision, 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.

FAST-TRACK APPLICATION for GRAVITY SEWtk:P '1'.T1VIP`STATIONS, AND FORCE MAINS PAGE 1
t�li;r "
�pF W A TF90 State of North Carolina
\p G Department of Environment and Natural Resources
� OCT 2 3 2003 Division of Water Quality
o FAST-TRACK APPLICATION
for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
sytems are not to be included as part of this application package)
INSTRUCTIONS: Indicate that you have included the following list of F gwred application package items by checking the
space provided next to each item. Failure to submit all required items will lead to your application being returned as
incomplete or additional processing and review time. This form may be photocopied for use as an original.
I. Application Form - Submit one original and one copy of the completed and appropriately executed application
form. Any changes to this form will result in the application being returned. The Division of Water Quality
(Division) will only accept application packages that have been fully completed with all applicable items
addressed. You do not need to submit detailed Plans and specifications unless you respond NO to Item B(12).
EII. Application Fee - Submit a check in the amount of $400 made payable to: North Carolina Department of
Environment and Natural Resources (NCDENR).
E3 III. Certificates of Public Convenience and Necessity — If the application is being submitted in the name of a
privately -owned public utility, submit two copies of the Certificate of Public Convenience and Necessity (CPCN)
which demonstrates that the 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, provide two copies of a letter from the North Carolina Utilities
Commission's Public Staff that states that an application for a franchise has been received, that the service area
is contiguous to an existing franchised area, and/or that franchise approval is expected. The project name in the
CPCN or letter must match that provided in Item A(2a) of this application.
9/,V. Operational Agreements — Submit one original and two copies of a properly executed operational agreement if
the sewer extension is permitted by a private applicant and will be serving residential or commercial lots (e.g.,
houses, condominiums, townhomes, outparcels, etc.) that will be sold to another entity. If the applicant is a
homeowners' association, use Form HOA 02/03. If the applicant is a developer, use Form DEV 02/03. EVEN IF
THE PROJECT WILL BE TURNED OVER TO A MUNICIPALITY, FORM DEV 02/03 IS REQUIRED.
EI/V. Flow Acceptance Letters — If the owner of the downstream sewers and/or WWTF is different from the applicant,
submit two copies of a flow acceptance letter from the owner of the downstream sewers and WWTF, if different.
Flow acceptance letters must contain the following minimum information: applicant and project name, amount of
flow accepted, and name and permit number of the receiving sewers/WWTF. The flow acceptance must not
expire prior to permit issuance and must be dated less than a year prior to the application date.
Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific flow acceptance
letter.
VI. Map — Submit an 8.5 -inch by 11 -inch COLOR copy of the portion of a 7.5 -minute USGS Topographic Map along
with this form. The map should identify the entire project area location as well as the closest downslope surface
waters as clearly as possible. Each map portion must be labeled with the map name and number, the identified
location of the sewer line and pump stations, and be of clear and reproducible quality. For instance, if the project
involves 4 miles of interceptor sewer that traverses over or near several different waterbodies (or counties,
basins, etc.), the map should have location ID's shown for each different waterbody (where the sewer line is within
100 feet of such waterbody - see Instruction VII). This location ID is self chosen and used to cross reference the
location in Section C of the permit application.
Ir VII. Stream Classifications — Section C
• If any portion of the project is within 100 feet of any down slope surface water, Section C must be completed
for the pertinent sections.
• If the entire project area is a minimum of 100 feet away from any down slope surface waters BUT there is a
pump station involved where a history of power outage is to be used to provide adequate design storage
instead of dual feed or permanent or portable generator, Section C must be completed to demonstrate that
the closest down slope surface water is Class C (see 15A NCAC 2H .0219(h)(3)(D)).
• Use the guidance document entitled, "Determining Watershed Classifications for Form FTA 02/03 (Fast -Track
Sewer Systems)" available from http://h2o.enr.state.nc.us/ndpu or by contacting the appropriate regional
office.

FAST-TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 2
E?vlll. Environmental Assessments — If this project is subject to an Environmental Assessment (EA) (15A NCAC
01C .05001, 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.
13� 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(1 b). 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
Avery, Buncombe, Burke, Caldwell,
59 Woodfin Place
Cherokee, Clay, Graham, Haywood,
Asheville, North Carolina 28801
Henderson, Jackson, Macon,
[phone]
Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania,
Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Fayetteville, North Carolina 28301
Anson, Bladen, Cumberland, Harnett,
[phone]
Hoke, Montgomery, Moore, Robeson,
[phone] Fax
Richmond, Sampson, Scotland
Mooresville Regional Office
919 N Main Street
Mooresville, North Carolina 28115
Alexander, Cabarrus, Catawba,
[phone]
Cleveland, Gaston, Iredell, Lincoln,
[phone] Fax
Mecklenburg, Rowan, Stanly, Union
Raleigh Regional Office
1628 Mail Service Center
Chatham, Durham, Edgecombe,
Raleigh, North Carolina 27699-1628
Franklin, Granville, Halifax, Johnston,
[phone]
Lee, Nash, Northampton, Orange,
[phone] Fax
Person, Vance, Wake, Warren,
Wilson
Washington Regional Office
Beaufort, Bertie, Camden, Chowan,
943 Washington Square Mall
Craven, Currituck, Dare, Gates,
Washington, North Carolina 27889
Greene, Hertford, Hyde, Jones,
[phone]
Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington,
Wayne
Wilmington Regional Office
Cardinal Drive Extension
Wilmington, North Carolina 28405
Brunswick, Carteret, Columbus,
[phone]
Duplin, New Hanover, Onslow,
[phone] Fax
Pender
Winston-Salem Regional Office
585 Waughtown Street
Alamance, Alleghany, Ashe, Caswell,
Winston-Salem, North Carolina 27107
Davidson, Davie, Forsyth, Guilford,
[phone]
Rockingham, Randolph, Stokes,
[phone] Fax
Surry, Watauga, Wilkes, Yadkin
For mone information, visit our web site at: http://h2o.enr.state.nc.uslndpu/

FAST-TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 3
USE THE TAB KEY TO MOVE FROM FIELD TO FIELDI j Application Number:
(to be completed by DWQ) wQ 8 23 225
11.
Owner., _ l c)WA( c)r, A4191dc Al Al, 01 .
1 a.
Full Legal Name (company, municipality, HOA, utility, etc.)
Z
1b.
iE f uaKV�2 piP6ClYoQ o 'C"'O C A/o S
O
Signing Official Name and Title (Please review 15A NCAC 2H .0206(b) for authorized signing officialsl)
1c.
The legal entity who will oo�wgg this system is:
Individual E] Federal EMunicipality
❑ State/County ❑ Private Partnership ❑ Corporation Q Other (specify):
1d.
P,o., Dext2tr le. Amen%
0
LL
Street Address City
Z
1f.NoR-ny
C4 PC/ 9
Z
State Zip Code
0
Q
Telephone Facsimile E-mail
() 2.
Project (Facility) Information:
J 2a.
IL
-TEMPAE RCIe 7-S ,$'upbi✓iS/o.�% 26. CA'TAa!(3A
IL
Brief Project Name (permit will refer to this name) County Where Project is Located
Q 3.
Contact Person:
Q 3a.
0ARRC44. A11c1_1.4,✓/S A6,
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b.
y2N-327-4697 3c. Cw�9ChgYfe
Phone Number E-mail
1.
Project is ew ❑ Modification (of an existing permit) If Modification, Permit No.:
For modifications, attach a separate sheet clearly explaining the reason for the modification (i.e. adding another
phase,
changing line size/length, etc.). Only include the modified information in this permit application - do not
duplicate project information in B(7) and B(10-11) that has already been included in the original permit.
2.
Owner is�j �ublic (skip to Item B(3)) ❑ Private (go to Item 2(a))
2a.
If private, applicant will be: 2b. If sold, facilities owned by a (must choose one
❑ Retaining Ownership (i.e. store, church, single office, etc.) or, ❑ Public Utility (Instruction III)
Z
❑ Leasing units (lots, townhomes, etc. - skip to Item B(3)) ❑ Homeowner Assoc./Developer (Instruction IV)
0
❑ Selling units (lots, townhomes, etc. - go to Item B(2b))
H
Q 3.
oWR o MHiO—rd Al, C .
Owner of Wastewater Treatment Facility (W WIF) Treating Wastewater From This Project
0 4a.
'Tc wV de "AWCk kVW7 r 4b. H C o o 3 S
LL
Name of WWTF WWTF Permit No.
Z 5a.
`7'4WM or MA/DEd
b. "
c. Mol K.10AVd
Receiving Sewer Size
Permit Number of Downstream Sewer (if known)
Owner of Downstream Sewer
6.
The origin of this wastewater is (check all that apply):
WB4esidential
Subdivision El Car Wash
IL
ElApartments/Condominiums El Institution % Domestic/Commerdal
_
❑ Mobile Home Park ❑ Hospital
m
❑ School ❑ Church _ % Industrial
❑ Restaurant ❑ Nursing Home
El Office [I, Other (specify): �� Other (specify):
7.
Volume of wastewater to be oermitted in this project: /o, 840 gallons per day
8.
If the permitted flow is zero, indicate why: N/A
❑ Interceptor 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 4
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).
30 .L67_S OTIOu5E5, A//7// 3 4W206N/SEAClY @ /20 GPO/134I%Nj..
/O Sao C, PD /
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches) Length (feet) Gravity or Force Main
(use the pull down menu)
_ g_ / 8 % �• � � Ga�rv.r
w
—1
Z
Z
O
Z ENTER TOTAL LINE LENGTH IN MILES' o • 3 zrs- n'rr.
O
11. Summary of Pump Stations to be Permitted (attach additional sheets as necessary)
Location ID Power Reliability Option
(self chosen -as shown on Design Flow Operational Point (1- dual line feed; 2- permanent generator w/ATS; 3-
0 _ plans for cross-reference) (MGD) GPM @ TDH portable generator w/telemetry; 4 -wet well storage)
Z
I
W
IL
m ( y ) comply
with
h the Minimum Design Criteria
for the Fast Track Permitting of Pump Stations and Force
12. Does the sewers stem co y Minimum Design Criteria
Mpins latest version), the y is (latest version) and 15A NCAC 2H .0200 as applicable?
LTJ 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 I
113. Have the following permits/certifications been submitted for approval?
Wetland/Stream
Crossings - General Permit or 401 Certification? ❑ Yes ❑ No
Sedimentation and Erosion Control Plan? ❑ Yes [:]No
,_,/N/A
63 N/A
Stormwater? El Yes [I No
[E/N/A

FAST-TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 5
1. Use the Division's guidance document entitled, "DETERMINING STREAM CLASSIFICATIONS FOR FORM FTA 02103
(FAST-TRACK SEWER SYSTEMS)" to collect and record the stream classification data below (attach additional sheets as
necessary). This document is available from our web site or by contacting the appropriate Division of Water Quality
Zregional office (see instructions for addresses) OR indicate the following:
O
❑ A Stream Classification is not needed because all parts of the project are at least 100 feet away from any down slope
Qwaterbody, AND,
V ❑ A Stream Classification is not needed because the design does not depend on wet well storage as a power reliability
LL p y C down slope waterbody.
—
option for an pump station near a lass
CO) Location ID on Mapif forcross-reference) aName of Waterbody Stream , Watefbody
( Waterbody County River Basin Index Classification
self ohosen-as shown ° uu KN wnr To 11 -12q -S -l-1 C._.
J s&wd As x
V SHADY /J4Aaerr CATAW BA 1
W ;
V I!
Submit the 8.5" x 11" COLOR topographic map as required in Instruction VI
regardless of whether a classification is providedl
1. Applicant's Certification:
1, SIGNING OFFICIAL NAME, attest that this application for PROJECT NAME I &A^4 %STs: Seh�er_ �K� En/sioA/
has been reviewed by me and is accurate and complete to the best of my knowledge. 1 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
[" Swell as civil penalties up to $25,000 per violation. ) //
07
Z
1-
0
LL
t`
W
0
6
la.
2. Professional Engineer's Certification:
Date /
1 attest that this application for lamp c Wrs• -S Wc2 C-XTE,dsian/ 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 143-215.68, 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 as civil penalties up to $25,000 per violation. .
2a. /' CARtrazZ AIII-41AM6 r '. ,,` N CARjJ
Professional Engineer Name : pc !/,y
pp _ a
2b. /j. CfIRROLL A111LIAMs. Pte. gia�, 9
Engineering Finn _I = S E A L
2c. 4 8 4•a N 6i;drE9 S'T X20
Address Al C 2f t
e.
City State Zip �RO
28.826'-3t'j•41v`j7 2h.828-32�.-6gq'L 2i. ew�eCchartrr-.ne
Telephone Facsimile E-malf Seal Signature 8 Date

oe