WQ0033912_Application (FTSE)_20090404

USE THE TAB KEY TO MOVE FROM FIELD TO FIELD! Application Number: _, (to be completed by DWO) 00, - J ;,2,_
1.
Owner/Permittee:
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--- Homes by Greg Johnson Inc -- - - - -- - - ---- --- - -- -
Full Legal Name (company, municipality, HOA, utility, etc.)
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1b.
Greg Johnson President
Signing Official Name and Title (Please review 15A NCAC 2T .0106 (b) for authorized signing officials!)
1 c.
The legal entity who will own this system is:
❑ Individual ❑ Federal ❑ Municipality ❑ State/County ❑ Private Partnership ® Corporation ❑ Other (specify):
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612 Powell St le. Smithfield
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Mailing Address
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-.. ..city
NC ':1g. 27577
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State Zip Code
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919-989-7236 :1i.
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Telephone Facsimile E-mail MAR
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2.
Project (Facility) Information:
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2a.
Dan Owen Drive Pri vic s¢C'&r 21b. Pender
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Brief Project Name (permit will refer to this name) County Where Project is Located
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3.
Contact Person:
Q3a.
Donnie Adams, PE
Name and Affiliation of Someone Who Can Answer Questions About this Application
31b.
910-270-8617 3c. [e-mail]
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Phone Number E-mail
1.
Project is ® New ❑ Modification (of an existing permit) If Modification, Permit No.:
2.
Owner is ❑ Public (skip to Item B(3)) ® Private (go to Item 2(a))
2a.
If private, applicant will be: 2b. If sold, facilities owned by a (must choose one)
❑ Retaining Ownership (i.e. store, church, single office, etc.) or ❑ Public Utility (Instruction C)
❑ Leasing units (lots, townhomes, etc. - skip to Item 8(3)) ® Homeowner Assoc./Developer (Instruction D) I
® Selling units (lots, townhomes, etc. - go to Item B(2b))
3.
Deuce Investments, LLC
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Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This, Project
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4a
Majestic Oaks Subdivision 4b. WO 0030088
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of WWTF WWTF Permit No.
5a.
Deuce Investments, LLC 51b. 4" ❑ Gravity 5c. WO 0030883
Owner of Downstream Sewer (Receiving Sewer Size Z Force Main ! Permit H of Downstream Sewer (Instruction E)
6.
The origin of this wastewater is (check all that. apply):
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® Residential Subdivision ❑ Retail (Stores, shopping centers) % Domestic/Commercial
❑ Apartments/Condominiums ❑ Institution %Industrial (attach
❑ Mobile Home Park ❑ Hospital description.)
❑ School ❑ Church
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❑ Restaurant ❑ Nursing Home (RO: contact your Regional Office
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❑ Pretreatment staff)
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% Other (specify):
7.
Volume of wastewater to be allocated or permitted for this particular project: 2160 gallons per day
*Do not include future flows or previously permitted allocations
8.
If the permitted flow is zero, indicate why:
❑ Pump Station, Outfall or Interceptor Line where flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit No.
❑ Rehabilitation or replacement of existing sewer with no new flow expected (see 15A NCAC 02T .0303 to determine if a
permit is required)
FfAl2/07

9. Provide thg wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2T .0114 for..
the value in Item B(7) AND/OR the design flow for line or pump station sizing if a reduced or zero flow is being requested in
'.. Item B(7). Values other than that in 15A NCAC 2T .0114 (b) and (c) must be supported with actual water or wastewater use
data in accordance with 15A NCAC 2T .0114 (1).
6 lots w/ 3 bedroom homes @ 120gpd/bdrm = 2160gpd '..
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size )
( inches
Length (feet) New Gravity or Additional
Force Main
8
_._ _..
1510 New gravity
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11. Summary of Pump Stations w/ associated Force Mains to be Permitted (attach additional sheets as necessary)
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Pump Station Location ID
Dan Owen Lift Station (self chosen - as shown on plans/map for reference)
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Design Flow
Operational Point Power Reliability Option
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(MGD)
GPM @TDH 1 - permanent generator w/ATS; Force Main Size Force Main Length
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2 - portable generator w/MTS
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0.018 '..
35GPM @ 55.3' 1 2 55'
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Q'Pump
Station Location ID
(self chosen - as shown on plans/map for reference)
Design Flow
Power Reliability Option
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OPGPM
0
(MGD)
@TDHerational
1 - permanent generator w/ATS; Force Main Size Force Main Length
2 - portable generator w/MTS
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WPump
Station Location ID
(self chosen - as shown on plans/map for reference)
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Design Flow
OeratiPower Reliability Option
ponal Point;
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(MGD)
1 - permanent generator w/ATS; Force Main Size Force Main Length;
GPM @TDH
2 - portable generator w/MTS;
'.12. Will the wastewater flow in the proposed sewer lines or pump stations be able to be directed to another treatment facility?
❑ Yes ® No If Yes, permit number of 2"d treatment facility
(RO — if "yes" to B,12 please contact the Central Office PERCS Unit)
13. Does the sewer system comply with the Minimum Design Criteria for the Fast Track Permitting of Pump Stations and Force
Mains (latest version), the Gravity Sewer Minimum Design Criteria (latest version) and 15A NCAC Chapter 2T as
applicable?
® Yes [:]No If No, please reference the pertinent minimum design criteria or regulation and indicate why a
variance is requested. SUBMIT TWO COPIES OF PLANS, SPECIFICATIONS OR CALCULATIONS
PERTINENT TO THE VARIANCE WITH YOUR APPLICATION
FTA12/07

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14. Have the following permits/certifications been submitted for approval for the system or project to be served?
Wetland/Stream Crossings - General Permit or 401 Certification? ® Yes ❑ No ❑ N/A
Sedimentation and Erosion Control Plan? ® Yes ❑ No ❑ N/A
'.. Stormwater? ® Yes ❑ No ❑ N/A
15. Does this project include any high priority lines, [see 15A NCAC 02T .0402 (2)] involve aerial lines, siphons, or interference
manholes)? These lines will be considered high priority and must be checked once every six months
Check if Yes: ❑ and provide details
Owner/Permittee's Certification: (Signature of Signing Official and Project Name)
1, Greg Johnson , attest that this application for Dan Owen Dr Ext 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. Note: In accordance with North Carolina General Statutes 143-
215.6A and 143-215.6t3, any person who knowingly makes any false statement, representation, or certification in any
application 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.
Signing Official Signature Date
ENGINEERING DESIGN DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL OF THIS
APPLICATION. THESE DOCUMENTS MUST INCLUDE PLAN AND PROFILE OF SEWERS, THEIR PROXIMITY
TO OTHER UTILITIES, DESIGN CALCULATIONS. ETC. REFER TO 15A NCAC 02T .0305
j2. Professional Engineer's Certification: (Signature of Design Engineer and Project Name)
1, Donald C. Adams. Jr attest that this application for _Great Oak Or Ext. has been reviewed by me
and is accurate, complete and consistent with the information in the engineering plans, 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 adopted February 12, 1996, and the Minimum Design Criteria for the Fast -Track Permitting of Pump
Stations and Force Mains adopted June 1, 2000 and the watershed classification in accordance with Division guidance.
Although other professionals may have developed certain portions of this submittal package, inclusion of these materials
under my signature and seal signifies that 1 have reviewed this material and have judged it to be consistent with the
proposed design. Note: In accordance with NC General Statutes 143-215.6A and 143-215.6B, any person who knowingly
makes any false statement, representation, or certification in any application 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.
2a.
Professional Engineer Name
2b. Southwind Surveying and Engineering
Engineering Firm
j2c. 95 Hampstead Village
Mailing Address
2d. Hampstead 2e. NC 2f. 28443
City State Zip
2g. 910-270-8617 2h. 910-270-8619 12i. [e-mail]'
Telephone Facsimile E-mail
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4 SEAL �€
� � 25469
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INF_�
nature & Date
FTA12/07

pF W ATF9 State of North Carolina
Department of Environment and Natural Resources
r? 7� Division of Water Quality
Y Flow Tracking/Acceptance for Sewer Extension Permit Applications
(FTSE—10/07)
Project Applicant Name: Homes by Greg Johnson, Inc.
Project Name for which flow is being requested: Dan Owen Dr Extension
More than one FTSE-10107 maybe 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: Majestic Oaks Subdivision
b. WWTP Facility Permit #: WQ 0030088
All flows are in MGD
c. WWTP facility's permitted flow 0.05972
d. Estimated obligated flow not yet tributary to the WWTP 0.0494
e. WWTP facility's actual avg. flow 0.0036
I. Total flow for this specific request 0.00216
g. Total actual and obligated flows to the facility 0.05516
h. Percent of permitted flow used 92.36%
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
Pump Station Name Approx. Capacity, MGD Approx. Current Avg.
(Finn/Design) Daily Flow, MGD
III. Certification Statement
I, Linwood Jones, Deuce Investments Inc, certify that, to the best of my knowledge, 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. 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 for which I am the responsible party. Signature of this form
indicates acceptance of this wastewater flo*—) _ (--,Y\ n
Signing Official Signature I ' � I �) Date

FORM W SCAS-12/07
A
WATERSHED CLASSIFICATION ATTACHMENT
FOR SEWER SYSTEMS
K.
A licant Name
Project Name
Homes by Greg Johnson, Inc
Dan Owen Dr Ext
Professional Engineer Name
Engineering Firm Name
Donald C. Adams, Jr.
Southwind Surveying and Engineering
Location
ID
Name of Waterbody'
County
River
Basin
Waterbody Stream
Index No.
Waterbody
Classification
UT to Mill
Creek
UT to Mill Creek
ee
Fender
Cape Fear
18-87-14
SA/HQW
' If unnamed, indicate "unnamed tributary to V, where X is the named waterbody to which the unnamed tributary joins.
I certify that as a Registered Professional Engineer in the State of
North Carolina that I have diligently followed the Division's instructionsd"""""""""'N" �w
for classifying waterbodies and that the above classifications are ,0� l CH GA1�p
inclusive of the stated project, complete and correct to the best of my
knowledge and belief.
PE Seal, Signature and Date � p n �j
25469
IN
C. AD m�
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*** END OF FORM WSCAS-12/07 ***
FORM: WSCAS-12/07 Page 1 of 1