WQ0040567_Application (FTSE)_20190109

a McGH] - brvisi nrA wolor FlasouR.a9
A S S O C I A TES
S
W400405e7 ' JAN 7 2019
January 4, 2019 -- - ' I Water Ouallly naplonal opararons
Aahavlli _�2,1o,0 O/Aee�
Mr. Timothy Heim
Division of Water Resources — Asheville Regional Office
North Carolina Department of Enviromental Quality
2090 U.S. Highway 70
Swannanoa, NC 28778
RE: Fast -Track Permit Application
Burnsville OMC Pump Station and Water
Treatment Plant Improvements
SRP No. H-SRP-D-17-0095
SRP No. E-SRP-W-17-0063
Town of Burnsville, Yancey County, NC
Dear Mr. Heim:
On behalf of the Town of Burnsville please find enclosed one (1) original and one (1) copy of the
following for the above referenced project:
. • Executed Fast Track application form ETA 04-16
• Flow Tracking/Acceptance Form FTSE 10-18
• Check in the amount of $480 for the application fee
• An 8.5 by 11-inch portion of a USGS map showing the project area
• A street/location map showing the project area
The project generally consists of thereplacementof the existing water treatment plant sludge
- storage tank with an 80,000 gallon equalization tank, 1125 LF of 8-inch gravity sewer line,
- twelve (12) manholes, and appurtenances to connect the equalization tank to the existing
permitted sanitary sewer system. Also included is the replacement of the existing OMC wet
pit/dry pit sewage pump station with a new submersible pump station.
The Town of Burnsville will own and maintain the equalization tank, gravity sewer lines and the
pump station. The additional flow that will be generated by this project has been accounted for in
Flow Tracking/Acceptance Form FTSE 10-18.
55 Broad Soccr P.O. Box 2259 ph: 828.252.0575
Aelrevale, North Carolina 28801 Ashcvillo, North Carolina 28802 p 828.252.2518 ""'na,gillenglnoenxmn

" Mr. Timothy Heim
January 4, 2019
Page 2 of 2
Thank you for your timely review of this project. Please contact me if you have any questions.
Sincerely,
McGIL� TES, P.A.
IVAN MESSINA
Engineering Technician
Enclosures
cc: Mike Dowd, McGill Associates
Ronnie Tipton, Town of Burnsville
Theresa Coletta, Town of Burnsville
I:\Projects\2017\17.00352\Permits\DWR\FTA Cover Letter.docx

WR _ State of North Carolina
Department of Environmental Quality
W00040567 Division of Water Resources
15A h..no ur. ..'AST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources INSTRUCTIONS FOR FORM: ETA 04-16 & SUPPORTING DOCUMENTATION
This application is for sewer extensions involving gravity sewers, pump stations and force mains, or any combination that has been
certified by a professional engineer and the applicant that the project meets the requirements of 15A NCAC 02T and the Division's
Minimum Design Criteria and that plans, specifications and supporting documents have been prepared in accordance with, 15A
NCAC 02T, 15A NCAC 02T .0300, Division Policies and goad enuineerina 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 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): r"`'-"� r (=TO
➢ Projects that require an environmental assessment in accordance with 15A NCAC 1C .0100; tiv w c.:uumua
➢ Projects that do not meet any part of the minimum design criteria (MDC) document;
➢ Projects that involve a variance from the requirements of 15A NCAC 2T;
➢ Pressure sewer systems utilizing septic tank -effluent pumps (STEPs) or simplex grinder pumps, J A N - 7 2019
➢ STEP or simplex grinder pumps connecting to pressurized systems (e.g. force mains);
➢ Vacuum sewer systems.
Waf<tr l.J,uN!N Iirjumxi OAmatlana
_ 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 of Application and Supporting Documents
® Required unless otherwise noted
B. Cover Letter (Required for All Application Packages):
® List all items included in the application package, as well as a brief description of the requested permitting action.
__..::. _.. ➢.. Be specific as to the system type, number of homes served, flow allocation required, etc.
. __... ➢ If necessary for clarity, include attachments to the application form.
C. Application Fee (AR New and Major Modification Application Packages):
N Submit a check or money order in the amount of $480.00 dated within 90 days of application submittal.
➢ Payable to North Carolina Department of Environmental Quality (NCDEQ)
D. Fast Track (Form: FTA 04-16) Application (Required for All Application Packages):
® Submit the completed and appropriately executed application.
➢ If necessary for clarity or due to space restrictions, attachments to the application may be made.
❑ If the Applicant Type in Item 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 II.1 shall be consistent with the project time 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 Eneineer.
❑ The Applicant's Certification on Page 5 of the application shall be signed in accordance with 15A NCAC 02T .0106(b).
Per 15A NCAC 02T .0106(c), an alternate person may be designated as the signing official if a delegation letter is
provided from a person who meets the criteria in 15A NCAC 02T .0106(b).
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 1 of 3

E. Flow Tracking/Acceptance Form (Form: FTSE 04-16) (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):
M Submit an 8.5-inch x 11-inch color copy of a USGS Topographic Map of sufficient scale to identify the entire project
area and closest surface waters.
➢ Location of the project (gravity sewer, pump stations & force main)
➢ Downstream connection points and permit number (if known) for the receiving sewer
M Include a street level map (aerial) showing general project area so that Division staff can easily locate it in the field.
G. Existing Permit (All Modification Packages):
❑ Submit the most recently issued existing permit.
❑ Provide a list of any items within the permit the Applicant would like the Division to address during the permit
modification (i.e., permit description, flow allocation, treatment facility, etc.).
H. Power Reliability Plan (Required if portable reliability option utilized for Pump Station):
❑ 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 genendiotr unit orportable, independently -powered pwnping 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 I SA NCAC 02T .0115(b), submit the properly executed Operational Agreement (FORM DEV).
For more information, visit the Division's collection systems ew bsite
INSTRUCTIONS FOR FORM: ETA 04-16 & SUPPORTING DOCUMENTATION Page 2 of 3

THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE:
REGIONALOFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional Office
2090 US Highway 70
Avery, Buncombe, Burke, Caldwell, Cherokee,
Water Quality Section
Swannanoa, North Carolina 28778
Clay, Graham, Haywood, Henderson, Jackson,
[phone]
Macon, Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Fayetteville Reaional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Harnett, Hoke,
Water Quality Section
Fayetteville, North Carolina 28301-5094
Montgomery, Moore, Robeson, Richmond,
[phone]
Sampson, Scotland
[phone] Fax
Mooresville Region al 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
Raleiah Regional Office
1628 Mail Service Center
Chatham, Durham, Edgecombe, Franklin,
Water Quality Section
Raleigh, North Carolina 27699-1628
Granville, Halifax, Johnston, Lee, Nash,
[phone]
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
Warren, Wilson
Washington Rectorial Office
943 Washington Square Mall
Beaufort, Barge, Camden, Chowan, Craven,
Water Quality Section
Washington, North Carolina 27889
Curriluck, Dare, Gates, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
Wilmington Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
Water Quality Section
Wilmington, North Carolina 28405
Hanover, Onslow, Pander
[phone]
[phone] Fax
Winston-Salem Reaional Office
450 W. Hanes Mill Road
Suite 300 -
Alamance, Alleghany, Ashe, Caswell, Davidson,
Davie, Forsyth, Guilford, Rockingham, Randolph,
Water Quality Section
Winston-Salem, North Carolina 27105
Stokes, Surry, Watauga, Wilkes, Yadkin
[phone]
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 3 of 3

State of North Carolina
DWR Department of Environmental Quality
Divisif——f'-xx'-ter ges4urces
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EX' __ kTION
Division of Water Resources FTA 04-16 & SUPPOR{ ATION
Application
WQ0040567
(to be oo upletol by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's time: Town of Burnsville (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 time: Theresa Coletta per 15A NCAC 02T .0106(b]
Title: Mayor
DMn IWpimaeeomoaA
4. Applicant's mailing address: 2 Town Square g
to
City: Burnsville State: NC Zip: 28714-_ - 7 2019'£'
5. Applicant's contact information: JAN
Phone number: [phone] Email Address: mayamZtownof aurnsville.ora Fodor Dua11W Npplonel open&lone
H. PROJECT INFORMATION:
1. Project time: Burnsville OMC Pump Station and Water Treatment Plant Improvements
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: W000 and issued date:
If new construction but part of a master plan, provide the existing permit number: W000
3. County where project is located: Yancey
4. _ Approximate Coordinates (Decimal Degrees): Latitude: 35.912810o Longitude:-82.295412°
5. Parcel ID (if applicable):
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Mike Dowd
Firm: McGill Associates PA
Mailing address: PO Box 2259
City: Asheville State: NC
Phone number: [phone]
License Number: 024487
Zip: 28802-_
Email Address: mike.dowd(tdmcgilleneineers cam
IV. WASTEWATER TREATMENT FACILITY(WWTF) INFORMATION:
1. Facility Name: Town ofBumsvilleWWTP Permit Number: NCO020290
Owner Name: Town of Burnsville
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Numbeds): WQ Downstream (Receiving) Sewer Size: _ inch
System Wide Collection System Permit Number(s) (if applicable): WQCS_
Owner Name(s):
FORM: ETA 04-16 Page 1 of 5

VI.• GENERAL REQUIREMENTS
I. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑No MN/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEVI been attached?
❑ Yes ❑No MN/A
3. If the Applicant is a Home/Property Owners'Association, has an Operational Agreement (FORM: HOA) been attached?
❑ Yes ❑No MN/A
4. Origin of wastewater: (check all that apply)
❑ Residential 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
M Other (Explain in Attachment)
5. Nature of wastewater: %Domestic/Commercial %Commercial
100 % Industrial (See 15A NCAC 02T .0103(20))
L-4-Is there a Pretreatment Program in effect? ❑ Yes M No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(fl? ❑ Yes M No
➢ If yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f)
Daily Design Flow °•^
No. of Units
Flow
Municipal Water Treatment Plant
5000 gal/day
1
5000 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gap
GPD
Total
I ggZMGPD
a -- See 15A NCAC-02T .0114(b). (& (e)(l) and (e)(2) for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use areas;
and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in G.S. 42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.01141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 5000 GPD (per 15A NCAC 02T 0114)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
❑ Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit Number:
❑ Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain):
FORM: ETA 04-16 Page 2 of 5

VH. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 1125 DIP
➢ Section II & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section III contains information related to minimum slopes for gravity sewer(s)
➢ Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
VIIL PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains:
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: OMC
2. Approximate Coordinates (Decimal Degrees): Latimde: 35.916189' Longitude:-82.279114°
3.. Design flow of the pump station: 1.008 millions gallons per day (fnm capacity)
4. Operational point(s) of the pump(s): 700 gallons per minute at 272 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
6.
Size (inches)
Length (feet)
Material
n/a
n/a
n/a
Power reliability in accordance with 15A NCAC 02T.0305(h)(1):
® Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(h)(1)(B).
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
➢ Must be permanent to facility
Or if the pump station has an average daily flow less than 15,000 gallons per day:
❑ Portable power source with manual activation, quick -connection receptacle and telemetry - 15A NCAC 02T
.0305(h)(1)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry - 15A NCAC 02T .0305(h)(1)(C):
➢ It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant (draft agreement)
and is compatible with the station.
➢ If the portable power source orpump 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 thneframes, shall be provided
in the case of a multiple station power outage.
FORM: FTA 04-16 Page 3 of 5

IX. 11 SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(t)):
1. Does the project comply with all separations found in 15A NCAC 02T 0305(f) & W ® Yes ❑ No
nMc/O......n,:..., « o r6er aHall Ho «.....idrA fnr carves evefame'
Setback Parameter
Separation Required
Storm sewers and other utilities not listed below vertical
24 inches
Water mains vertical -water over sewer including in benched trenches
18 inches
Water mains(horizontal)
10 feet
Reclaimed water lines vertical - reclaimed over sewer
1S inches
Reclaimed water lines horizontal - reclaimed over sewer
2 feet
**Any private or public water supply source, including any wells, W S-I waters of Class I or
Class II impounded reservoirs used as source of drinking water
100 feet
**Waters classified WS (except WS-I or WS-u), B, SA, ORW, HQW, or SB fium normal
hi@L water or tide elevation and wetlands see item IX.2
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches
10 feet
Any building foundation
5 feet
Any basement
10 feet
Top sloe 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 crude vertical
36 inches
- — ➢ 15A NCAC 02T.0305(e) contains alternatives where separations in 02T.0305(fl cannot be achieved.
➢ **Stream classifications can be identified using the Division's NCSurface Water Classifications weboaee
➢. If noncompliance with 02T 0305(f) or (a), see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ®Yes []No []N/A
➢ Seethe Division's draft separation requirements for situations where separation cannot be meet
➢ No variance is required if the alternative design criteria specified is utilized in design and construction
_.. _. ➢ As built documents should reference the location of areas effected
3. Does the project comply with setbacks Found in the river basin rates per 15A NCAC 02B .0200'? ® Yes ❑ No [:]N/A
➢ This would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Does the project require coverage/authorization under a 404 Nationwide or ❑ Yes ®No
individual permits or 401 Water Quality Certification?
➢ Information can be obtained from the 401 & Buffer Permitting Branch
5. Does project comply with 15A NCAC 02T 0105(e)(6) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T 0105(c)(6), directly related environmental permits or certification applications are being prepared, have
been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion and
sedimentation central plans, stormwater management plans, etc.).
6. Does this project include any sewer collection lines that me deemed "high -priority?"
Per 15A NCAC 02T.0402, "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes ® No ❑ N/A
➢ If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at least once every six -months and inspections
documented per 15A NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit.
FORM: FTA 04-16 Page 4 of 5

CERTIFICATIONS!
I. Does the submitted system comply with 15A NCAC 02'P, the Minimum Design Criteria for the Permitting of Pump Stations
andForee Mains (latest version) and the Gravity Sewer Minimum D sho Criteria (latest version) as applicable?
E❑Yes ❑❑No
If No, complete and submit the VatdancOAltemative Design Request application (VADC 10-14) and supporting documents
for review. Approval of the request is reauired prior to submittal of the Fast Track Application and supporting
documents.
Z. Professional tgine. 's Ca f c ut
1, attest that this application for
(Pro ass onal Msiinwrls name from Application Item fit.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. 1 further attest that to the beat
of my knowledge the proposed design has been prepared in accordance with the applicable regulations, Gravity Sewer
Miniature Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Past -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 143-215.6B, any person who knowingly makes any false
statement, representation, at certification in any application package shall be guilty of a Class 2 misde a which may
Include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation. A — 7/1
North Carolina Professional Engineer's seal, signature, and date: -""'Ptt"9O
t° SEAL
'. ()24487
�: � FA'GINEE
3, ApplicatuKerlifrcalion per 15A NCAC 02T.0106(b): '1.017lil iiT
-- - -- — -- —has been revlieved by me and is accurate and complete to the best ofmy knowledge. I understand that if all required pars of
Us application we not completed and that if all attained supporting documentation and attachments are not included, this
application package is subject to being returned as incomplete. I understand that my discharge of wastewater from Ibis non,
discharge system to surface waters or the land will result in an immediate enforcement notion that troy 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, T also understand that if all required parts of this application package are not completed
and that If all required supporting Information and attachments are net Included, this application package will be returned (o
we as incomplete.
NOTE — In accordance with GownfilStatutes 143.215.fiA and 143-215.6E my person who knowingly makes any false
suntanned, reprmonerion, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000aass "it as
civil penalties lip
ptto'$$225,000 par violation.
Signatura,;Z—,Date:
FORM: PTA 04-16 Page 9 of 5

nmi� v,.,eodroes WQOG40567
R r 7 7019 Department
it nt Carolina
�nrlState of No
p Environmental Quality
,,,. WP1Gr n , , < not n, rmtlonsWater Resources
of Water Resource _! A', ae ing for Sewer Extension Applications
(FTSE 10.18)
Entity Requesting Allocation: Town of Burnsville
Project Name for which flow is being requested: OMC Pump Station/WTP Improvements
More than one FUE stay be required fora single project fthe owner of the WWTPis not responsible for all pump
atadons along the route of the proposed wastewaterflow.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a.
WWTP Facility Name: Burnsville WWTP
b.
WWTPFacility Permit #: NC0020290
All flows are to MGD
e.
WWTP facility's permitted flow
0.800
d.
Estimated obligated flow not yet tributary to the W WTP
0.000
e.
W WTP facility's actual avg. flow
0.546
f
Total flow for this specific request
0.005
g.
Total actual and obligated flows to the facility
-
h.
PercentIofpermitted flow used
68.88°°/—
U.81
IL. 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 W WTP:
-
- (A)
(B)
(C)
(D)gB+C)
(E)(A-D)
-
Design
Obligated,
Pump.
,`Pump
:..
Avenge
Approx.
Not Yet
Total Current
Station
Station
Firm
Daily Flow**
Curtest
Tributary
Flow Plan
(Nereor---Permit
-- Capacity,*.
(Firm/p0,
Avg. Daily
Daily Flow,
Obligated
Available
Number)
::.::No.
MOD -_.
,�=MOD
Flow, MOD
MGD
Plow
Capacity**
--OMC
- -°-
1.008--.0.356
0.328
0.005
0.333
0.023
- * The Firm Capacity (deaigo, flow) of aoy pump station ie defined as the maximum pumped Baw
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
(p0 not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shill be attached for each pump station located
between the project connection point and the W WTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): Bumsville WWTP
Downstream Permit Number: NC0020290
Page 1 of 6
FTSE IOd8

III. Certification Statement:
KO NN I C 7IP76N 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 (his 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
addendutns 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.
pkaa M)Orks l�irvr for
Title of Signing Official
Page 2 of 6
Date
FTSE 10.18

4
�a4{ v
•
I
fle�p
rJ�
'
r
i N "hPry'o��wfl
�•-
i
e
{1 �np
a
t
.
do`rid4d �
'
IZyit II I fOe •
'
it
Alp,
�6
..
" tis 4 �,i •� . .
e
LL v u
'e
.4
]Sfll yJ lr `l �w r Hs aN�
k
i. �a,�ipv�eg
I
o.0
� l f4k.j y 1 4`1r`1/�
.
1

.��==,w�.� rve�w�e,oz�zo,�ow�a�zroo.,,,�.®a�,��„�a,rom�=�o��,,,,ar=o��o,,