CAPACITY ASSURANCE REVIEW APPLICATION
(FLOW ACCEPTANCE & WILLINGNESS TO SERVE)
All requests require a drawing indicating proposed water/sewer connection point(s)
REQUESTED
BY
1
___________________________ _________________________________
First Name
Last Name
______
MI
__________________________________________
Company (if applicable)
_________________________________________________________________________________ __________________________
Address
e-mail
_______________________________________________
City
____________
State
__________________
Zip
_________________________
Phone
PROJECT
LOCATION
2
3
____________________________________________________________________________________
Project Name
____________________________________________________________________________________
Site Address
_______________________________________________
City
____________
State
* Complete the following:
1. Project is:  new;  modification
PROJECT INFO
Residential, apartment
_______units
b.
Residential, townhome/condominium
_______units
c.
Amenity Center (sf)/Pool (people)
_______sf/persons
d.
Residential, single-family
_______lots
YN
4. Will this project have a private sewer lift station?
YN
5. Total wastewater flow requested (average daily flow in gpd,
show calculations)
________________________________________
6. Commercial only: Peak wastewater flow requested
e.
Restaurant
_______seats
f.
Retail/Retail with food prep
_______sf
g.
Office
_______#emp/shift
h.
Warehouse
____#loading bays
i.
Hotel
_______rooms
8. Peak Water Demand (GPM): __________________
j.
School
_______students
9. Will you be submitting this project to NCDENR for
sewer permitting?
Y  N
k.
OFFICE USE
ONLY
 Y*  N
*if yes, pool must have a 4-inch drain line
a.
Public Roads?
_________________________
Tax Parcel Number
3. Will this project have a pool?
2. Type of development? (15A NCAC 02T.0114 Wastewater Design Flow Rates)
i.
__________________
Zip
i.
Cafeteria
YN
ii.
Gym/Locker rooms
YN
Other (provide flow calculations) _______________________
(peak hourly flow in gph, show calculations)
________________________________________
7. Average Daily Water Demand: _________________
10. Does this project include a 2-inch or larger private water
line providing service to multiple buildings?
YN
CLTWater Tracking #: _____________________________
Map #: _____________________________________
Does the flow transmit through a CMUD lift station?  Y  N
If yes, which station? ________________________
WWTF: McAlpine / McDowell / Irwin / Sugar / Mallard / Rocky River
Flow amount (gpd): __________________________
Basin: __________________________________________
Mail, deliver or fax this application to:
CHARLOTTE WATER
Installation & Development Services
5100 Brookshire Blvd
Charlotte, NC 28216
e-mail: bgross@charlottenc.gov
Fax: (704) 432-5804
Updated October 2015
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