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 YN 4. Will this project have a private sewer lift station? YN 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 YN ii. Gym/Locker rooms YN 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? YN 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 F