WQ0040682_Application (FTSE)_20190304

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Transmittal I FEB 18 2019
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Date: 2/18/2019
Project Name: Blue Ridge Elementary Sewer Improvements
CDC Project: 21743
To: Timothy Heim
Water Quality Regional Operations Engineer
NCDEQ-Asheville
2090 U.S.70 Highway
Swannanoa, NC 28778-8211
Via: ❑ Mail ❑ Overnight ® Hand Delivered ❑ Pick up @ CDC Office ❑ Digital
Remarks:
Date
Description
02/18/2019 Application Fee Check for $480.00
_..___.__..._- -
02/18/2019 Cover Letter
-------------
-- -
02/11/2019 Fast Track Sewer Application
---- ---------- — -
02/06/2019 Vicinity Map (8.5 x 11)
Ben Munn
Bmunn@,cdcgo.com
Mailing Address: P.O. Box 5432, Asheville, NC 28813
168 Patton Avenue Asheville, NC 28801 52 Walnut Street —Suite 9, Waynesville, NC 28786
Phone [phone] Fax [phone] Phone: [phone] Fax: [phone]

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February 18, 2019 Cwitire F.
1 8 p019
Timothy Helm WAtar Cln�np, goninesl Oprrz+!lons
Water Quality Regional Operations Engineer -
NCDEQ-Asheville
2090 U.S. 70 Highway
Swannanoa, NC 28778-8211
RE: Blue Ridge Elementary Sewer Improvements
CDC Project No.: 21743
Dear Mr. Heim,
On behalf the town of Burnsville, we are requesting your review and approval of a sewer fast
track application for the subject project. The proposed project consists of; pump stations to serve
the middle school & elementary school, approximately 6,500 linear feet of force main, and other
appurtenances located on Cane River Sc ool Road in the Town of Burnsville.
Please find enclosed the following items r your review and approval:
• Fast Track Sewer Application �> v`� I OU
If you should have any questions or need any additional information during your review, please
do not hesitate to call our office.
Sincerely,
Ben Munn, P.E.
Civil Design Concepts, P.A.
[e-mail]
Mailing Address: P.O. Box 5432, Asheville, NC 28813
168 Patton Avenue Asheville, NC 28801 52 Walnut Street — Suite 9, Waynesville, NC 28786
Phone [phone] Fax [phone] Phone: [phone] Fax: [phone]

e�&�Pis.M
February 18, 2019
Timothy Heim
Water Quality Regional Operations Engineer
NCDEQ-Asheville
2090 U.S. 70 Highway
Swannanoa, NC 28778-8211
RE: Blue Ridge Elementary Sewer Improvements
CDC Project No.: 21743
Dear Mr. Heim,
DI oict rflesaumos
FEB 1 B 9019�
Wsrter poPh2. P^';�'^I Onnrmlorr5
On behalf the town of Burnsville, we are requesting your review and approval of a sewer fast
track application for the subject project. The proposed project consists of; pump stations to serve
the middle school & elementary school, approximately 6,500 linear feet of force main, and other
appurtenances located on Cane River School Road in the Town of Burnsville.
Please find enclosed the following items for your review and approval:
• Fast Track Sewer Application
If you should have any questions or need any additional information during your review, please
do not hesitate to call our office.
Sincerely, / //��
%vim-^----
Ben Munn, P.E.
Civil Design Concepts, P.A.
[e-mail]
Mailing Address: P.O. Box 5432, Asheville, NC 28813
168 Patton Avenue Asheville, NC 28801 52 Walnut Street - Suite 9, Waynesville, NC 28786
Phone [phone] Fax [phone] Phone: [phone] Fax: [phone]

State of North Carolina
Department ofEnvironmental Quality
Division of Water Resources
"gblvislon: of WaterResourcts 15A NCAC 02T.0300- FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
.. .. INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION
This application is for sewer extensions involving gravity sewers, pump stations and force mains, or any combination that has been
certifiedly 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 OET, 15A NCAC 02T .0300, Division Policies and good engineering practices.
While no upfront engineering design documents are required for submittal, in accordance with 15A NCAC 02T .0305(b), design
documents must be prepared prior to submittal of a fast truck 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 1
Projects not eligible for review via the fast track process (must be submitted for full technical revie ): e1O'y10° vo..ae Fouou, 1e4
➢ Projects that require an environmental assessment in accordance with 15A NCAC 1 C .010 ;
➢ Projects that do not meet any part of the minimum design criteria (MDC) document; F E B B 2019
➢ Projects that involve a variance from the requirements of 15A NCAC 2T;
➢ Pressure sewer systems utilizing septic tank -effluent pumps (STEPS) or simplex grinder p taps;
➢ STEP or simplex grinder pumps connecting to pressurized systems (e.g. force mains); Water porn;,, trsnt,Ual poerallons
➢ Vacuum sewer systems. Pip- . -n
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, a; well as a brief description of the requested permitting action.
➢ Be specific w 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 (All New and Major Modification Application Packages):
® 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 Eng' ee .
® The Applicant's Certification on Page 5 of the application shall be signed in accordance with 15A NCAC 02T 0106(b).
Per ISA 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):
® 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 (mown) for the receiving sewer
® 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 generation unit or portable, independently -powered pumping units, associated
appurtenances and personnel are available for distribution and operation of this pump station."
If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump
stations' storage capacities and the rotation schedule of the portable power source or pump, including travel
timeframes, shall be provided in the case of a multiple station power outage. (Required at time of certification)
1. Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per 15A NCAC 02T .0115(a)(1) provide the Certificate of Public Convenience and Necessity from the North Carolina
Utilities Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served by
the sewer extension, or
❑ Provide a letter from the North Carolina Utilities Commission's Water and Sewer Division Public Staff stating an
application for a franchise has been received and that the service area is contiguous to an existing franchised area or that
franchise approval is expected.
J. Operational Agreements (Applications from HOA/POA and Developers for lots to be sold):
❑ Home/Property Owners' Associations
❑ Per 15A NCAC 02T .0115(c), submit the properly executed Operational Agreement (FORM: HOA).
❑ Per 15A NCAC 02T .0115(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
❑ Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(b), submit the properly executed Operational Agreement (FORM: DEV).
For more information, visit the Division's collection systems website
INSTRUCTIONS FOR FORM: FTA 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:
REGIONAL OFFICE
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 Regional 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 Regional Office
610 E. Center Avenue
Alexander, Cabarrus, Catawba, Cleveland,
Water Quality Section
Mooresville, North Carolina 28115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stenly, Union
[phone] Fax
Raleigh 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 Regional Office
943 Washington Square Mall
Beaufort, Bartle, Camden, Chowan, Craven,
Water Quality Section
Washington, North Carolina 27889
Currituck, Dare, Gates, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
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 Regional Office
450 W. Hanes Mill Road
Suite 300
Alamance, Allegheny, Ashe, Caswell, Davidson,
Davie, Forsyth, Guilford, Rockingham, Randolph,
Water Quality Section
Winston-Salem, North Carolina 27105
Stokes, Burry, Watauga, Wilkes, Yadkin
[phone]
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 3 of 3

State of North Carolina
Department of Environmental Quality
Division of Water Resources
,v $v 15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
dtvlstoq of Water Resoarces. PTA 04-16 & SUPPORTING DOCUMENTATION
Application Number (to be completed by DWR)
All items must be completed or the application will be returned
L APPLICANT INFORMATION:
L 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 name: Ronnie Tipton per ISA NCAC 02T .0106(b)------
Title Public Works Director t d t D
loo. UveO1 V11101 ri..0 icls
4. Applicant's mailing address: PO Box 97.2 Town Square
City: Burnsville State: North Carolina Zip: 28814-_ FEB 18 2019 f '
5. Applicant's contact information: Phone number: 8( 28)682-2420 Email Address: rtintonAtownofburnsville.ore Water RvzPh R�. ;opal Obowations
11. PROJECT INFORMATION:
1. Project name: Blue Ridge Elementary Sewer 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: 35.91290 Longitude:.82.3732"
5. Parcel ID (if applicable):
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Benjamin Munn License Number: 045043
Firm: Civil Deal= Concepts
Mailing address: 168 Patton Avenue
City: Asheville State: NC Zip: 28801-_
Phone number: 828 252-5388 Email Address: Bmumplieccict o.com
IV. WASTEWATER TREATMENT FACILITY(WWTF) INFORMATION:
1. Facility Name: Burnsville Waste Water Plant Permit Number: NCO020290
Owner Name: Town of Burnsville
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ_ Downstream (Receiving) Sewer Size: _ inch
System Wide Collection System Permit Numbers) (if applicable): WQCS
Owner Name(s):
FORM: ETA 04-16 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 EN/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached?
❑ Yes [—]No EN/A
3. If the Applicant is a Home/Property
Owners' Association. has an Operational Agreement (FORM' HOA) been attached?
❑ Yes ❑No EN/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
E School / preschool / day care
❑ Medical / dental / veterinary facilities ❑ Swimming Pool /Clubhouse
❑ Food and drink facilities
❑ Church ❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories
❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 % Domestic/Commercial %Commercial
%Industrial (See 15A NCAC 02T .0103(20))
"Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 02T 0114(f)? ❑ Yes E No
➢ If yes. Provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.01140
Daily Design Flow'•^
No. of Units
Flow
Cane River Middle School
15 gallstudent
350
5,250 dPD
Blue Ridge Elementary School
12 gallstudent
406
4,872 =D
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
10,122 GPD
a See 15A NCAC 02T 0114(b)(d). (e)(1) mid (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 I5A NCAC 02T.0114] shall be
determined using available flow data, water /u�5hig fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 10 122 GPD jper 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

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T.0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
➢ Section 11 & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section III contains information related to minimum slopes for gravity sewer(s)
➢ Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
VIII. 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 01P 2
2. Approximate Coordinates (Decimal Degrees): Latitude: 35.9130° Longitude:-82.3768°
3. Design flow of the pump station: 0.00525 millions gallons per day (£um capacity)
4. Operational point(s) of the pump(s): 30 gallons per minute at 78 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
2
1645
PVC
Power reliability in accordance with 15A NCAC 02T .0305(h)(Il:
e>tandby 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 or pump is dedicated to multiple pump stations, an evaluation of all the pump stations'stmage
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.
FORM: FTA 04-16 Page 3 of

FEB 1 8 2019
VIII. 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: 2 d,�
2. Approximate Coordinates (Decimal Degrees): Latitude: 35.9128' Longitude:-82.3732°
3. Design flow of the pump station: 0.010122 millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): 170 gallons Der minute at 178 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
4
4565 7
PVC
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 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.
FORM: FTA 04-16 Page 3 of5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(Q):
1. Does the project comply with all separations found in 15A NCAC 02T 0305(f) & W ® eY s ❑ No
➢ 15A NCAC 02T.0305 contains minimum separations that shall be provided for sewers stems:
Setback Parameter*
Se aration Required
Storm sewers and other utilities not listed below vertical
24 inches
Water mains vertical -water over sewer including in benched trenches
IS 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, W S-1 waters of Class I or
Class 11 impounded reservoirs used as a source of drinking water
100 feet
**Waters classified WS (except WS-1 or WS-V), B, SA, ORW, HOW, or SB from normal
high water or fide 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
Drairm e s stems and interceptor drains
5 feet
Any swimming Pools
10 feet
Final earth grade vertical
36 inches
➢ 15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(fl cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications weboaee
➢ If noncompliance with 02T 0305(f) or (2), see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ❑ Yes [—]No ®N/A
➢ See the 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 rules per 15A NCAC 02B .0200? ®Yes No ❑ N/A
➢ This would include Trout Buffered Streams per 15A NCAC 213.0202
4. Does the project require coverage/authorization under a 404 Nationwide or ❑ Yes ® No
individual permits or 401 Water Quality Certifications?
➢ Information can be obtained from the 401 & Buffer Permitting Branch
5. Does project comply with 15A NCAC 02T 0105(c)(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 control plans, stormwater management plans, etc.).
6. Does this project include any sewer collection lines that are 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.
El Yes El 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 he inspected by the permitter 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

X. CERTIFICATIONS:..
I Does the submitted system comply with I5A N `A'. 02T,'the Minfifinglin .. DesianCrittlya &E the Parinittifint of'Pump Stations
Audi ams; (latest version), and the tphwity Sewer Min'm cot Design Ckitara (IAmstyen'on3 as upplicable'I
ID Yes No
IfNo; complem and submit the Varianag/AlternativeDe➢ignRequest application (YADC 10-14)and supporting documents for
review. Anorovglofther auestis reauired prior to submittot of the Fast Track Application And supporting documents.
2, Professional pollinates Certification: /n/ ,,rr
r^�4k-,'- '9 *LL ✓I✓1 attest that this application for
(PrpPesslpual Enguicer'Bname hem Application Item TILL)
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 bestof my knowledge, Tfimhai attest Nsat tb the bast
of my knowledge the proposed design has been prepared in Accordance with theapplicable regulations, Gravity Sewer
Minimum DosignCcitm'ia for Gravity Sewers (latest vetxmrdt and the Minimum Design Criteria for the past -Track Permitting
of Pump Stations and Force Maids (latest version) Although other professionals may have developed certain portions of this
submittal package,inclusion of these materials under my signature and seal sigmfics 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
stmemenk 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 par violation.
for
has been reviewed by me and is accluateand complete to the best of my knowledge. I understood that if all required parts of
this application are not completed and that if all required supporting documentation and attachments arc not included, this
include
of this pormil be violated.. I also understand. that if all required, pans of this applicatroh package are not completed and that it'
all required supporting information and atarchmenl; are not included,. this application package will be returned to me as
NOTE —.In accordance with Geneml Statutes 3-215-6 and 143 215 813,. 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
melnde afine not in exceed $10,000 as well as civil penalties up In $25,000 per violation.
FEB 18 2019
Page 5 of 5

0 tiVA7t; State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
s
Flow Tcncking/Acceptancefgr Sewer Extension Permit Applications
(FTSB--10/07)
Project Applicant Name:. Town of Burnsville
Project Name for which flow is being requested: Blue Ridge Elementary Sewer Improvements
More Ulan oneFTSE-10107 ouzo, be required jar a.single prolent j(the owner oflhe WWTP is not rerponaibfFJor all
pump stations along the route a,/'the proposed Ivasteiyatet'flow.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name:. Burnsville Waste Water Treatment Plant
b. WWTP Facility Permit#: NCO020290
All flows are in MGD
c. WWTP facility's permitted flow 0•8
d. Estimated obligated flow not yet tributary to the W WTP 610
e WWTP facility's actual avg. flow '0,6
f. Total flow for this specific request 0.01
g. Total actual and obligated flows to the facility 0. (D
h. Percent of permitted flow used�'8.
IL Complete this: section for each pump station you are responsible for along the mute of this
proposed wastewater flow. -
Listpump stations located between the project connection point and the WWTP
Pump Station Name Approx. Capacity, MGD Approx, Current Avg.
(Firm/Design) Daily Flow, MGD
;&-K t t^ r z k 0. ()23
1,n rdeu �1 e t ram_, certify that, to the best of my knowledge, the addition of the.
volmne of wastewater to�mu d 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 sanitarysewer overflows or overburden any downstream pump station cn routo to the receiving
treatment plant under normal circumstances. 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 l and 11 for which l am the responsible party. Signature of this form indicates