WQ0038472_Application (FTSE)_20200213

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State of North Carolina
_�� JAN 0 6 2020 Department of Environmental Quality
Division of Water Resources
15A .0I300 —,FFAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resou"MVETTEVILI i_ IV/IOplgf ff 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
certified by 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 02T, 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 track 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 15A NCAC 02T.0303.
Projects not eligible for review via the fast track process (must be submitted for full technical review):
➢ Projects that require an environmental assessment in accordance with 15A NCAC 1C .0100;
➢ Projects that do not meet any part of the minimum design criteria (MDC) document;
➢ Projects that involve a variance from the requirements of 15A NCAC 2T;
➢ Pressure sewer systems utilizing septic tank -effluent pumps (STEPS) or simplex grinder pumps;
➢ STEP or simplex grinder pumps connecting to pressurized systems (e.g. force mains);
➢ Vacuum sewer systems.
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, as well as a brief description of the requested permitting action.
➢ Be specific as 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 (AR 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 name 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 Engineer.
❑ The Applicant's Certification on Page 5 of the application shall be signed in accordance with 15A NCAC 02T .0106(b).
Per 15A 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 known) 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)
I. 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
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]
Stanly, 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, Bertie, 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, Alleghany, Ashe, Caswell, Davidson,
Davie, Forsyth, Guilford, Rockingham, Randolph,
Water Quality Section
Winston-Salem, North Carolina 27105
Stokes, Surry, Watauga, Wilkes, Yadkin
[phone]
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 3 of 3

State of North Carolina
DWR Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Dlvlslon of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: J8tW (to be completed by DWR)
Ail items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Old North Utility Services, Inc. (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: Shay
Coombs per 15A NCAC 02T .0106(b)
Title: Senior Engineer
4. Applicant's mailing address: 903
Armistead Street
City: Fort Brag e State: NC
Zip: 28307-
5. Applicant's contact information:
Phone number: 910) 303-7348
Email Address: Shay.Coombs(a�asusinc.com
II. PROJECT INFORMATION:
1. Project name: ON-00018-5P Lift Stations C 1220 & C 1722 A&B
2. Application/Project status: ❑ Proposed (New Permit) ® Existing Permit/Project
If a modification, provide the existing permit number: W00038472 and issued date: June 2 2016
If new construction but part of a master plan, provide the existing permit number: W000
3. County where project is located: Cumberland County
4. Approximate Coordinates (Decimal Degrees): Latitude: 79.0332.° Longitude:-35.1437°
5. Parcel ID (if applicable):
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:.
1. Professional Engineer: Shay Coombs License Number: 048419
Firm: American States Utility Services, Inc.
Mailing address: 903 Armistead Street
City: Fort Brag e State: NC Zip: 28307-
Phone number: [phone] Email Address: Shay.Coombsoasusinc.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: South Harnett Regional W WTP
Owner Name: Harnett Countv
Permit Number:
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ_ Downstream (Receiving) Sewer Size: inch
System Wide Collection System Permit Number(s) (if applicable): WQCS00029
Owner Name(s): Old North Utilities Services
FORM: FTA 04-16 Page 1 of 5

VI. GENERAL REQUIREMENTS
1. 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 ❑ Swimming Pool/Filter Backwash
® Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 % Domestic/Commercial % Commercial
0 % 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(fl? ❑ Yes ®No
➢ If yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(fl)
Daily Design Flow a,n
No. of Units
Flow
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
0 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.0114] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 0 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: WO0038472
❑ Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain): _
FORM: FTA 04-16 Page 2 of 5

VH. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8
836
PVC
8
20
DIP
➢ 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
1. 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) 141
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):
Size (inches)
Length (feet)
Material
4
650
PVC
6. 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 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(t)):
1. Does the project comply with all separations found in 15A NCAC 02T.0305(f) & (g) ® Yes [—]No
➢ 15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below vertical
24 inches
Water mains vertical -water over sewer including in benched trenches)
18 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, WS-I waters of Class I or
Class II impounded reservoirs used as a source of drinking water
100 feet
**Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal
high water or tide 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 slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems 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(f) cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
➢ 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) ® 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 0213.0200? ❑ 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.
® 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

K1
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:
I Shay D. Coombs attest that this application for
(Professional Engineer's name from Application Item I1I.I.)
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.
North Carolina Professional Engineer's seal, signature, and date:
Digitally signed
d -- by Shay Coombs
Date:
a
/�— Date:2019.12.19
16:37:14-05'00'
3. Applicant's Certification per 15A NCAC 02T .0106(b):
CA
0
:a SEAL �.
048419 -
G
�i11111D.I CO1�0O
\���
I Shay D. Coombs 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:
6 ---- Designed by Shay Coombs
J�— Date:
: 201079.12.19 16:37:31-05'00'
Date:
FORM: FTA 04-16 Page 5 of 5

RECEIVED
DEQIDWR
JAN 0 6 2020
WQROS
AYETTc-vi U.T.T7C., 1 ONALOFF1 C50a
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Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number:
(to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Old North Utility Services, Inc. (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: Shay Coombs per 15A NCAC 02T .0106(b) RL V L I VE f
L Title: Senior Engineer ®EQIDW R
4. Applicant's mailing address: 903 Armistead Street 1�
City: Fort Bragg State: NC Zip: 28307-_
JAN 06 2020
5. Applicant's contact information:
Phone number: C�10) 303-7348 Email Address: Shay.Coombsaasusinc.com WOROSS
'AYETTEVILI_E F r-0!0NAL0rF1CC
II. PROJECT INFORMATION: I
1. Project name: ON-00018-5P Lift Stations C 1220 & C 1722 A&B / tpr\/
2. Application/Project status: ❑ Proposed (New Permit) ® Existing Permit/Project
If a modification, provide the existing permit number: W00038472 and issued date: June 2, 2016
If new construction but part of a master plan, provide the existing permit number: W000_
3. County where project is located: Cumberland County
4. Approximate Coordinates (Decimal Degrees): Latitude: 79.0332 ° Longitude:-35.1437°
5. Parcel ID (if applicable):
(or Parcel ID to closest downstream sewer)

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JAN ® 2 20XP
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FAYETTE'fLIJ:-r'-1-G1101:'A' 07rF1GF
December 19, 2019
Trent Allen
NCDEQ
Fayetteville Regional Office
225 Green Street, Suite 714
Fayetteville, NC 28301
CC: Nyle L Hothem
NCDEQ— Divison of Water Resources
1617 Mail Service Center, Room 925T
Raleigh, NC 27699-1617
RE: WQ0038472
Permit Modification
Cumberland County, North Carolina
040
ASUS
Fort Bragg
serving Those Wno serve.,
We are providing the enclosed information for the permit modification of permit No. WQ0038472.
This permit pertains to the existing sewer permitted for ON-00015-5P Lift Stations C1220 & C 1722
A&B at Fort Bragg, North Carolina. We are requesting a permit modification because the piping
diameters and quantities in the permit approved on June 2, 2016 vary from what has been installed
and reflected on the As -Built drawings dated October 7, 2019 and submitted to the State by Justin
Nyland with the Engineering Certification on October 8, 2019.
Approximately 167-If of 8-inch gravity sewer was laid at less than the minimum slope required by
NCDEQ Design Criteria and is deemed a "High Priority Sewer". The As -Built drawings show the
location and profile for this sewer line. After review of the as -built drawings, I have confirmed to the
best of my knowledge that no 4-in gravity sewer or 6-inch gravity sewer was installed. This permit
modification denotes the correct pipe diameters and lengths reflected on the as -built for this project.
The Final Engineer's Certification has already been submitted to NCDEQ by Justin Nyland on October
8, 2019.
Enclosed please find an original and one copy of the following:
• NCDEQ Fast Track Application
• NCDEQ Original Approval Letter
• Check for $480.00
• Copy of the Approved As -Built Drawings
• Revised Engineering Certification Form with Correct Permit No.
American States Utility Services, Inc.
P.O. Box 73316, Fort Bragg, NC 28307
Tel: [phone] Fax: [phone]

=..ASUS
Fort Gracio
S2rving Those who
Thank you for your consideration in this matter. If you require further information, please do not
hesitate to call me at [phone].
Sincerely,
V Date: lly 2019.nedby.481Coombz
Date: by She, Coombs
Shay Coombs, PE
Senior Engineer
American States Utility Services, Inc.
P.O. Box 73316, Fort Bragg, NC 28307
Tel: [phone] Fax: [phone]

ENGINEER'S CERTIFICATION (MODIFIED FOR WQ0038472 in place of WQ0033337)
I, Justin Nyland, as a duly registered Professional Engineer in the State of North Carolina, attest that this
certification application for:
Gruber Road Pump Station (Old North Utility Services Project #PN-58708)
has been reviewed by me. In my review of information provided by the utility owner (American States
Utility Services (ASUS) / Old North Utility Services (ONUS)), there are a series of background points that
need to be considered as part of this certification:
- The initial project, permitted under WQ0033337 on September 16, 2008, was in support of an
upgrade to the Robinson Health Clinic at Ft. Bragg, NC. As part of this overall project, sanitary
sewer infrastructure was installed in an area adjacent to the intersection of Gruber Road and
Longstreet Road (approximately 49' of 6-inch gravity sewer, 191' of 8-inch gravity sewer, a
duplex lift station (later to be called C-17226) with a duty point of 100 gpm at 36' TDH, and
approximately 666' of 3-inch force main. Cromwell Architects and Engineers was the designer
for this United Stated Army Corps of Engineers project, and a set of PE stamped and signed set
of Plans dated May 5, 2008, is in the record file. ONUS GIS indicates that past infrastructure in
this area is very similarto that shown in the Plans from Cromwell Architects and Engineers.
Lift Stations C-1220 and C-1722 A &B (Project ON-00018-513)
- In the first half of 2016, ONUS planned a lift station consolidation project (ONUS Project #ON-
00018-513) in this same area, with three lift stations being consolidated into one renovated single
station that could handle the flow of all three. This scope of work called for the demolishing of
Lift Stations C-1722A and C-1220, and routing their influent flows via new gravity line to Lift
Station C-1722B, which was to be upgraded with new pumps, rails, bases, and valve
vault/piping. The discharge from this station was also upsized by replacing the existing 3-inch
force main (abandonment via flowable fill) with a new 4-inch force main in the same general
alignment and point of connection to the existing gravity system. This project was permitted
under W00038472. ASUS has been able to collect recently updated GIS and work with the ONUS
Capital Inspector to generate as -built drawings which will be routed to NC DEQ. It is ONUS'
position that the information covered in the Engineering Certification for WQ0038472 will be
the most updated information for both permits, as this submittal will include:
1. All the new gravity sewer installed for taking 2 of the 3 lift stations offline,
2. indicate what existing gravity sewer that did not change from the original project to the new
consolidation project (6-inch gravity sewer and 8-inch gravity sewer between an existing
building and Lift Station C-1722 B), and
3. include information on upgraded Lift Station C-1722B and the new 4-inch force main that
replaced the 3-inch force main that was abandoned via Plowable fill.
Although this project was not inspected by me personally, I was kept aware of its status throughout
construction, and the establishment of the as -built condition of this sewer infrastructure has been

performed by the utility owner (American States Utility Services / Old North Utility Services, Inc.)
through their GIS Infrastructure review and survey information transmitted to the record file. To the
best of my knowledge, this information is accurate, complete, and reflective of the installation work for
this project.
The design for this project was prepared by the ASUS Engineering Design Center, and was signed and
stamped by a North Carolina Professional Engineer on June 9, 2016. There is no indication that the
design was not prepared in accordance with all applicable regulations and statutes.
Notes / Qualifiers: Sheet C-02 of the Record Drawings indicates that an 8" sewer main was installed
below the minimum slope required per NC DENR Minimum Design Criteria. This run of sewer main is
identified as such in the Record Drawings and annotated with the following:
"High -priority sewer with slope laid less than NC DENR MDC requirements. Periodic inspection (once per
6-month minimum) and documentation per the System -Wide Collection Permit required. Periodic
flushing may be required per inspection findings."
Justin Nyland, Senior Engineer, American States Utility Services
...........
SEAL
33767
,,,,T� I l tally signed
_ by Justin Nyland
Date:2019.10.08
15:06:11-04'00'

Permit Number WQ0038472
Program Category
Non -discharge
Permit Type
Gravity Sewer Extension, Pump Stations, & Pressure Sewer Extensions
Primary Reviewer
trentallen
Coastal SWRuIe
Permitted Flow
0
Facility
Central Files: APS _ SWP _
2/13/2020
Permit Tracking Slip
Status
Project Type
Active
Major modification
Version
Permit Classification
1.10
Individual
Permit Contact Affiliation
Facility Name Major/Minor Region
ON-00018-5P Lift Stations C1220 & C1722 A&B Minor Fayetteville
Location Address County
Cumberland
Facility Contact Affiliation
Owner
Owner Name Owner Type
Old North Utility Services Inc Non -Government
Owner Affiliation
Shay Coombs
903 Armistead St
Dates/Events Fort Bragg NC 28307
Scheduled
Orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
6/2/2016 1/7/2020 2/13/2020 2/13/2020
Regulated Activities Requested /Received Events
Wastewater collection Additional information requested .
Additional information received
Outfall
Waterbody Name Streamindex Number Current Class Subbasin