WQ0040742_Application_20190328

( -"'I
.2"EST
Civil - Surveying- Geotechnical
PO Box 268
Concord, NC 28026
(45 Spring Street SW)
Phone: [phone]
Fax: [phone]
Web: www.cesilds.com
License No. C-0263
transmittal
To:
NCDEQ
From:
Mooresville Regional Office
Project
Name:
Address:
610 East Center Avenue
Project No.:
Suite 301
Mooresville, NC 28115
Date:
Phone:
Re:
Fax:
Cc:
® For Review and Comment
c.lV[-D/NCD F_ N R/DViR
R
Uvapos
CESI MJC'RFSVILLF RI, G!0NAL. OFFICE
David Reese, PE
The Lodge at Hickory
180457.000
3/27/2019
For Approval As Requested
For vour fiiP
Copies
Description
1 Fee Check
1 NCDEQ Cover Letter
2 Fast Track Sewer Systems Extension Application (FTA 04-16)
2 Flow Tracking for Sewer Extension Application (FTSE 10-18)
2 Specifications
2 24" x 36" Plans
2 USGS Topo and Aerial

March 27, 2019
NCDEQ
610 East Center Avenue
Suite 301
Mooresville, NC 28117
Re: Sewer Extension — The Lodge at Hickory
Enclosed, please find our Sewer Extension
submittal for proposed new sewer extension permit.
for the above referenced
needed, please don't hesitate to contact us. Inpsurnrt If have an project. Please review this
for you review. The sewer extension will serve a two b f the a y questions or additional items
The extension will consist of approximatelyPplication, the followin
lledr°°1n multifamil g items are enclosed
362 feet of 8"PVC designed or 240 consisting of 8o units.
Two (2) paper copies of the following: gal/day flow.
1 • Fast Track Sewer Systems Extension
2, Flow Tracking for Sewer Extension A Application(FTA 04-16)
ISpecifications pplicati ication 4. Sealed and signed plan drawings (FTSE 10-18)
5. USGS Topo and Aerial g with cover sheet
One (1) fee check.
Page 1 of 1

Division Of Water Resources
WR
State of North Carolina
Department of Environmental Quality
Division
15A NCAC 02T .0300 — FAST TRACK SEWER SYST MEXTEN I N APPLICATION
Resources
FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: ()C>'1L�(�
�`- to be completed by DWR)
All items must be com leted or the a lication will be returned
1. APPLICANT INFORMATION:
1
2
3.
4.
5.
Applicant's name: City of Hickory (company, municipality, HOA, utility, etc.)
Applicant type: El Individual
❑ Corporation ❑ General Partnership
❑ Federal ❑ State/Count
Signature authority's name: Warren Wood y ®Municipal
per l5A NCAC 02T .0106(b
Title: City—er
Applicant's mailing address: POD
City: Hicckor•y State: NC
Zip: 28603-0398
Applicant's contact information:
Phone number: [phone]
If. PROJECT INFORMATION:
Email Address: wwoodnhickorync ov
RECE!VED/NCDENR/DWR
MAR v 3 2019
WQI,OS
MOORFSVILLE RFG'IONAL OFFICE
❑ Privately -Owned Public Utility
❑ Other
I . Project name: The Lodge at Hickory
2. Application/Project status:
® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: W 00
If new construction but art of a master plan, � and issued date:
p p , provide the existing
3. County where project is located: Catawba Permit number: WQ00
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.7_ 173100 Longitude: --8.3_ 485880
5. Parcel ID (if applicable): 370214246271
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: David F. Reese License Number: 0108163
Firm: CESI
Mailing address: PO Box 268
City: Concord State: NC Zip: 28026-0268
Phone number: [phone] Email Address: davidreese@cest� 'ca�s com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
I. Facility Name: Henry Fork W WTP Permit Number: NCO040797
Owner Name: City o_ ferry
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
l . Permit Number(s): WQ Downstream (Receiving) Sewer Size: 12 inch
System Wide Collection System Permit Numbers if applicable): WQCS00020
Owner Name(s): City of Hickory
FORM: FTA 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 ®N/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 ®N/A
3. If the Applicant is a Home/Property Owners' Association has an Operational Agreement (FORM HOA) been attached?
❑ Yes ❑No ®N/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
❑ Businesses /offices /factories El Swimming Pool/Filter Backwash
❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: l 00 % Domestic/Commercial % Commercial
% Industrial (See 15A NCAC 02T 0103(20))
,Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T 0114(f)? ❑ Yes ® No
➢ If Yes, provide a copy of flow reduction approval letter
Summarize wastewater generated by project:
Establishment Type (see 02T.01140
Daily Design Flow a01h,
=0.EUni:tsE=Flow
Dwelling Unit (2 Bedroom Multifamily
Facility
240 gal/day
80
19,200 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
19,200 GPD
a See 15A NCAC 02T 0114(b) (d) (e)(1) 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: 19,200 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: FTA 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
8 +/- 361.57 PVC
➢ 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
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
l . Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: - °
3. Design flow of the pump station: millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): gallons per minute at feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
FSize (inches) Length (feet) Material
Power reliability in accordance with 15A NCAC 02T 0305(h
❑ 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 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T.0305(f)):
l . Does the project comply with all separations found in 15A NCAC 02T 0305(f) & ( )
➢ 15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer s stems: ® Yes ❑ No
Setback Parameter* Separation Required
Storm sewers and other utilities not listed below (vertical)
Water mains (vertical -water over sewer including in benched trenches) 24 inches
Water mains (horizontal) 18 inches
Reclaimed water lines (vertical - reclaimed over sewer) 10 feet
Reclaimed water lines (horizontal - reclaimed over sewer) 18 inches
**Any private or public water supply source, including any wells, WS-I waters of Class I or 2 feet
Class II impounded reservoirs used as a source of drinking water
**Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal 100 feet
high water (or tide elevation) and wetlands (see item IX.2)
**Any other stream, lake, impoundment, or ground water lowering and surface drainage 50 feet
ditches
Any building foundation SM36'
Any basement
Top slope of embankment or cuts of 2 feet or more vertical height
Drainage systems and interceptor drains
Any swimming pools
Final earth grade (vertical)
➢ 15A NCAC 02T 0305( ) contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications web a e
➢ If noncompliance with 02T.0305(f) or (g) see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation)
➢ See the Division's draft separation requirements for situations where separation cannot be meet Yes El No El N/A
➢ 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
individual permits or 401 Water Quality Certifications? ® Yes ❑ No
➢ Information can be obtained from the 401 & Buffer Permittiniz Branch
5. Does project comply with 15A NCAC 02T 0105(c)(6) (additional permits/certifications)?
Z Yes Per 15A NCAC 02T 0105(c)(6), directly related environmental permits or certification applications a being Iprepared, have
been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permi(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.
❑ 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

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Pump Stations
and Force Mains (latest version), and the Gravity Sewer Minimum Design Criteria (latest version,) as applicable?
® Yes ❑ No
If No, complete and submit the Variance/Alternative Design Request application (VADC 10-14) and supporting documents for
review. Approval of the request is required prior to submittal of the Fast Track Application and supporting documents
2. Professional Engineer's Certification:
V I � S g— + attest that this application for
(Professional Engineer's name from Application Item III.1.)
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans, specifications,
engineering calculations, and all other supporting documentation to the best of my knowledge. I further attest that to the best
of my knowledge the proposed design has been prepared in accordance with the applicable regulations, Gravity Sewer
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -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 143-215.613, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation. n
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I, W AQLL -Q U 0 o ['� , T t, ,40 A61 F k attest that this application for
(Signature Authority's name & title from Application Item I.3.)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required parts of
this application are not completed and that if all required supporting documentation and attachments are not included, this
application package is subject to being returned as incomplete. I understand that any discharge of wastewater from this non -
discharge system to surface waters or the land will result in an immediate enforcement action that may include civil penalties,
injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water Resources should a condition
of this permit be violated. I also understand that if all required parts of this application package are not completed and that if
all required supporting information and attachments are not included, this application package will be returned to me as
incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature:NN
iz, —
FORM: FTA 04-16 Page 5 of 5

, D-' W, R
aD vi,sloe of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: City of Hickory
Project Name for which flow is being requested: The Lodge at Hickory
More than one FTSE may be required for a single project if the owner of the WWTP is not responsible for all pump
stations along the route of the proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Henry Fork WWTP
b. WWTP Facility Permit #: NCO040797
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
All flows are in MGD
9.0
1.89077
2.98375
0.0192
4.88937
54.37%
II. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
List pump stations located between the project connection point and the WWTP:
(A)
(B)
(C)
(D)=(B+C) (E)=(A-D)
Design
Obligated,
Pump
Pump
Average
Approx.
Not Yet
Total Current
Station
Station
Firm Daily Flow**
Current
Tributary
Flow Plus
(Name or
Permit
Capacity, * (Firm / p f),
Avg. Daily
Daily Flow,
Obligated Available
Number)
No.
MGD MGD
Flow, MGD
MGD
Flow Capacity***
* The Firm Capacity (design flow) of any pump station is defined as the maximum pumped flow
that can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor
(pf) not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): Hickory Collection System
Downstream Permit Number: WQCS00020
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I Warren Wood certify to the best of my knowledge that the addition of
the volume of wastewater to be permitted in this project has been evaluated along the route to the receiving
wastewater treatment facility and that the flow from this project is not anticipated to cause any capacity
related sanitary sewer overflows or overburden any downstream pump station en route to the receiving
treatment plant under normal circumstances, given the implementation of the planned improvements
identified in the planning assessment where applicable. This analysis has been performed in accordance
with local established policies and procedures using the best available data. This certification applies to
those items listed above in Sections I and II plus all attached planning assessment addendums for which I
am the responsible party. Signature of this form certifies that the receiving collection system or treatment
works has adequate capacity to transport and treat the proposed new wastewater.
Signing Official Signature Date
City Manager
Title of Signing Official
Page 2 of 6
FTSE 10-18

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