WQ0035539_Application_20110822

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USE THE TAB KEY TO MOVE FROM FIELD 10 rlEw'
(to be completed by DWQ)
i.
Owner/Permittee:
1a.
City of Laurinburg
Full Legal Name (company, municipality, HOA, utility, etc.)
O
Z
1 b.
Ed Burchins City Manager
--
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for officials!)
Signing Official Name and Title (Please review 15A NCAC 2T .0106 (b) authorized signing
H
Q
1 c.
The legal entity who will own this system is:
❑ Individual ❑ Federal X Municipality ❑ State/County ❑
Private Partnership ❑ Corporation ❑ Other (specify)-
0
1d.
P O Box 249
1a. Laurinburg
LL
Mailing Address
City
Z
1f.
North Carolina
1g. 28353
Z
State
Zip Code
O
1 h.
910-276-8324 1 i. 910-276-0354
1j. [e-mail]
QTelephone
Facsimile
E-mail
U
2.
Proiect (Facility) Information:
,J
2a.
Elm Ave. Sanitary Sewer
2b. Scotland
CL
Brief Project Name (permit will refer to this name)
County Where Project is Located
Q
3.
Contact Person:
3a.
Stacey McQuage Public Works Director
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b.
910-276-2364
3c. [e-mail]
Phone Number
E-mail
r
1
Prniant is x N,--w M Modification (of an existino permit)
If Modification, Permit No.:
2. Owner is X 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 (rnust choose one)
❑ Retaining Ownership (i.e. store, church, single office, etc.) or ❑ Public Utility (instruction C)
•--i „_,_ .._.. _1_.�_- ,.a.• . G;— *_ I*-- 0/121\ = . ­___ rn......1---. fl....•.....4:..n Ill
This disbursement has been approved as require by
RNC BANK the Local Government Budget and Fiscal con"CITY OF LAURINBURG LAURINBURGCHECK NO.6 3 3 6 f
GENERAL ACCOUNT e—A—r-
P.O. BOX 249
66-85/531 FINANCE DIRECTOR LAURINBURG, NC 28352 63367
VENDOR CHECK DATE CHECK AMOUNT
5340 08/17/2011 1 $480.00
********480 DOLLARS AND NO CENTS
PAY NCDENR
225 GREEN STREET
TO THE FAYETTEVILLE NC 283,01- •,,
ORDER
11 U SECURITY FEATURES INCLUDED. DETAILS ON BACK. n
II'0
OLltfall 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)

63367 CITY OF LAURINBURG 63367
08/17/11
INVOICE DATE
INVOICE NUMBER
INVOICE DESCRIPTION
NET INVOICE AMOUNT
PO NO.
VOUCHER
08/16/11
ELM AVE 8/11
480.00
66819

OF WA 7FR p State of North Carolina
p DE —FRO Department of Environment and Natural Resources
Division of Water Quality
o �
FAST -TRACK APPLICATION
DWQ (FTA 12/07 ver5)
for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
(Pressure & Vacuum sewer systems are not to be included as part of this application package)
INSTRUCTIONS: Indicate that you have included/addressed the following list of required application package items by
checking the space provided next to each applicable item. Failure to submit all required items will lead to your application
being returned as incomplete. Forms are available from the web site or by calling the Regional Office serving your county:
http://h2o. enr. state. nc. us/peres/Collection % 20Systems/CollectionSystemApplications. html
X A. Application Form - Submit one original and one copy of the completed and appropriately executed application
form. The application should include a project narrative describing the final build -out design (i.e. system and/or
pump station to ultimately serve 500 homes, but flow for only 100 homes being requested now). For modifications,
clearly explain the reason for the modification (i.e. adding another phase, changing line size/length, etc.). Only
include the modified information in this permit application - do not duplicate project information that has already
been included in the original permit.
Any changes to this form will result in the application being returned. The Division of Water Quality (Division) will
only accept application packages that have been fully completed with all applicable items addressed. You do not
need to submit detailed plans and specifications unless you respond NO to Item B03).
Separate applications should be made for non-contiguous sewer systems.
X B. Application Fee - Submit a check in the amount of $480 made payable to: North Carolina Department of
Environment and Natural Resources (NCDENR). Checks shall be dated within 90 days of application submittal.
❑ C. Certificates of Public Convenience and Necessity — If the application is being submitted in the name of a
privately -owned public utility, submit two copies of the Certificate of Public Convenience and Necessity (CPCN)
which demonstrates that the public utility is authorized to hold the utility franchise for the area to be served by the
sewer extension. If a CPCN has not been issued, provide two copies of a letter from the North Carolina Utilities
Commission's Public Staff that states that an application for a franchise has been received, that the service area
is contiguous to an existing franchised area, and/or that franchise approval is expected. The project name in the
CPCN or letter must match that provided in Item A(2)a of this application.
❑ D. Operational Agreements — Submit one original and two copies of a properly executed operational agreement, as
per 15A NCAC 02T .0115, if the application is submitted by a private applicant and will be serving residential or
commercial lots (e.g., houses, condominiums, townhomes, outparcels, etc.) that will be sold to another entity. If
the applicant is a home or property owner's association, use Form HOA 02/03. If the applicant is a developer,
use Form DEV 02/03. EVEN IF THE PROJECT MAY BE TURNED OVER TO A MUNICIPALITY UPON
COMPLETION, FORM DEV 02/03 IS REQUIRED.
X E. Downstream Sewer, WWTF Capacity and Flow Tracking/Acceptance — FORM FTSE 10/07 (Flow
Tracking/Acceptance for Sewer Extension Permit Applications) is required with every application. The applicant
(and owners of downstream sewers, pump stations and/or treatment facilities submitting FORM FTSE-10/07)
certifies that the addition of the volume of wastewater to be permitted in this project has been evaluated along the
route to the receiving treatment plant, and that the flow from this project will not cause capacity related sanitary
sewer overflows or overburden any downstream pump station en route to the receiving wastewater treatment
plant. Where the applicant is not the owner of the downstream sewer, submit two copies of FORM FTSE 10/07
from the owner of the downstream sewer and owner of the WWTF, if different. The flow acceptance indicated in
FORM FTSE-10/07 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-10/07 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 project -specific FTSE 10/07.
X F Map — Submit an 8.5-inch by 11-inch COLOR copy of a USGS Topographic Map of sufficient scale to identify the
entire project area and the closest surface waters. Each map or maps must show the location of the sewer line
and pump stations and be of reproducible quality. Include a street level map showing the downstream connection
point, and the permit number for the downstream sewer, if known.

❑ G. Stream Classifications — Watershed Classification Attachment (Form WSCAS-12/07) If any portion of the
sewer system project is within 100 feet of any surface water or wetlands, the Watershed Classification Attachment
may need to be completed. A variance must be requested for encroachment within required setbacks or buffers
pursuant to 2T .0305 (f) and be indicated in Item B-13 with supporting documentationTustification provided.
❑ H Environmental Assessments — If this project is subject to an Environmental Assessment (EA) 115A NCAC
01C], this application cannot be used. Send the project application on the most current version of Form
PSFMGSA to the Design Management Unit, 1633 Mail Service Center, Raleigh, NC 27699-1633. Applications
cannot be accepted until a Finding of No Significant Impact (FONSI) or Environmental Impact Statement (EIS)
has been issued. A copy is to be submitted with that permit application.
❑ I. Flow Direction — Many wastewater treatment systems are entering into agreements for regionalization efforts
and emergency treatment capacity. Parts of the system are installed so that the wastewater flow can be directed
to more than one treatment facility. If this is the case with this project, please indicate in B(12) and give the permit
number of the second treatment facility.
X J. Certifications — Section C
The application must be certified by both the applicant and the design engineer who is a North Carolina
Registered Professional Engineer (PE). The applicant signature must match the signing official listed in Item
A(1 b). The PE should NOT certify the application if he/she is unfamiliar with 15A NCAC Chapter 2T, the Gravity
Sewer Minimum Design Criteria (most recent version) and the Minimum Design Criteria for the Fast -Track
Permitting of Pump Stations and Force Mains (most recent version), as applicable to the project.
THE COMPLETED FTA 12/07 APPLICATION PACKAGE, INCLUDING ALL SUPPORTING
DOCUMENTS AND $480 FEE, 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,
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,
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,
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,
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,
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
Wilmington, North Carolina 28405
Hanover, Onslow, Pender
[phone]
[phone] Fax
Winston-Salem Regional Office
585 Waughtown Street
Alamance, Alleghany, Ashe, Caswell, Davidson,
Winston-Salem, North Carolina 27107
Davie, Forsyth, Guilford, Rockingham, Randolph,
[phone]
Stokes, Surry, Watauga, Wilkes, Yadkin
(336) 7714630 Fax
For more information, please visit our web site at:
httpJ/h2o.enrstate.nc.us/peres✓Collection % 20Systems/CollectionSystemsHome.html
or contact the Regional Office serving your county.

'USE THE TAB KEY TO MOVE FROM FIELD TO FIELDI Application Number: J� J /��5✓2� (to be completed by DWQ) �v
1.
Owner/Permittee:
1 a.
Cit of Laurinbur
Full Legal Name (company, municipality, HOA, utility, etc.)
1 b.
Ed Burchins, City Manager
2T for authorized signing officials!)
Signing Official Name and Title (Please review 15A NCAC .0106 (b)
Q
1 c.
The legal entity who will own this system is:
❑ Individual ❑ Federal X Municipality E State/County ❑ Private Partnership ❑ Corporation ❑ Other (specify):
O
11d.
P O Box 249 1e. Laurinbur
I.L.
'
Mailing Address City
_
if.
North Carolina 1g. 28353
Z
State Zip Code
1h.
910-276-8324 1i. 910-276-0354 1j. [e-mail]
QTelephone
Facsimile E-mail
V
,2.
Project (Facility) Information: -
J
2a.
Elm Ave. Sanitary Sewer 2b. Scotland
IL
Brief Project Name (permit will refer to this name) County Where Project is Located
CL
Q
3.
Contact Person:
3a.
Stacey McQua e, Public Works Director
Q
Questions About this Application
Name and Affiliation of Someone Who Can Answer
i—
;3b.
910-276-2364 3c. [e-mail]
Phone Number E-mail
1.
Project is X New ❑ Modification (of an existing permit) If Modification, Permit No.:
2.
Owner is X 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 B(3)) ❑ Homeowner Assoc./Developer (Instruction D)
❑ Selling units (lots, townhomes, etc. - go to Item B(2b))
3.
City of Laurinbur
Z
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
0
4a.
Leith's Creek Wastewater Treatment Plant 4b. NCO020656
F'
Name of WWTF WWTF Permit No.
15a.
City of Laurinbur b. 15° X Gravity c. WQC S00062
Owner of Downstream Sewer Receiving Sewer Size ❑ Force Main Permit # of Downstream Sewer (Instruction E)
6_
The orb of this wastewater is (check all that apply):
LL
?
100 % Domestic/Commercial
ElResidential Subdivision ❑ Retail (Stores, shopping centers)
❑ Apartments/Condominiums ❑ Institution % Industrial (attach
❑ Mobile Home Park ❑ Hospital description.)
❑School X Church (RO: contact your Regional Office
W
d
❑ Restaurant ❑ Nursing Home Pretreatment staff)
❑ Office ❑ Other (specify):
%Other (specify):
7.
Volume of wastewater to be allocated or permitted for this particular project: 2000 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)

9. Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2T .0114 for
the value in Item 13(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 (f).
Church with kitchen —400 seats @ 5 gal per seat = 2,000 gal per day
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches) Length (feet) New Gravity or Additional
Force Main
8" SDR 35PVC 570 Gravity
0 11. Summary of Pump Stations w/ associated Force Mains to be Permitted (attach additional sheets as necessary)
W
Pump Station Location ID N/A (self chosen - as shown on plans/map for
Design Flow Operational Point Power Reliability Option
Z (MGD) GPM @TDH 1 - permanent generator w/ATS; Force Main Size Force Main Length
0 2 - portable generator w/MTS
Z
QPump Station Location ID WA (self chosen - as shown on plans/map for
Design Flow Operational PointPower Reliability Option
(MGD) GPM @TDH 1 - permanent generator w/ATS; Force Main Size Force Main Length
0 2 - portable generator w/MTS
LIL
Z
Pump Station Location ID N/A (self chosen - as shown on plans/map for
W Design Flow Power Reliability Option
0. (MGD) Operational Point 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 2nd treatment facility N/A
(RO — if "yes" to 13,12 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?
X 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

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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 X N/A
Sedimentation and Erosion Control Plan? ❑ Yes ❑ No X N/A
Stormwater? ❑ Yes ❑ No X 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 N/A
1. Owner/Permittee's Certification: (Signature of Signing Official and Project Name)
1, Ed Burchins, City Manager , attest that this application for Elm Ave. Sanitary Sewer has been
reviewed by me and is accurate and complete to the best of my knowledge. 1 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 143-215.6B, 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 pe up to $25, 000 per violation.
la. ,_
Signing Officia Signature
Date
ENGINEERING DESIGN DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL OF THIS
APPLICATION. THESE DOCUMENTS MUST INCLUDE PLAN AND PROFILE OF SEWERS, THEIR
TO OTHER UTILITIES, DESIGN CALCULATIONS. ETC. REFER TO 15A NCAC 02T .0305
2. Professional Engineer's Certification: (Signature of Design Engineer and Project Name)
1, _Joseph F. Wampler attest that this application for Elm Ave. Sanitary Sewer 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 I 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. Joseph F. Wampler
Professional Engineer Name
2b. J. F. Wampler Engineering, Inc.
Engineering Firm
2c. 604 Peden Street
Mailing Address
2d. Laurinburg 2e. NC 2f. 28352
City State Zip
2g. 910-276-8306 2h. 910-276-2440 2i. [e-mail]
E-mail
Telephone Facsimile
O�S%k CAROfv
e "00 , 0�
SEAL
�t 5364
NC PE
& Date

OF W ATF9 State of North Carolina
\O� QG Department of Environment and Natural Resources
CO
Division of Water Quality
Flow Tracking/Acceptance for Sewer Extension Permit Applications
(FTSE—10/07)
Project Applicant Name: _City of Laurinbur�
Project Name for which flow is being requested: Elm Ave. Sanit4U Sewer
More than one PTSE-10107 mqv 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: Leith's Creek Wastewater Treatment Plant
b. WWTP Facility Permit #: NCOO20656
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
4 , c,00
z .13s
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
_Pump Station # 19
Approx. Capacity, MGD
(Firm/Design)
1�•
Approx. Current Avg.
Daily Flow, MGD
III. Certification Statement:
I, Ed Burchins, City Manager , 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 i Se ons I and II for which I am the responsible parry. Signature of this form indicates
acceptanc f ewater flow. g5p//E/ //
Ofcial Signature Date

J.F. WAMPLER ENGINEERING, INC.
p`POST OFFICE BOX 1782 LAURIN BURG , N. C. 2 8 3 5 3
604 PEDEN STREET PHONE: OFFICE [phone]
HOME: [phone]
FAX [phone]
State of North Carolina Dept. of Environment August 16, 2011
And Natural Resources
Division of Water Quality
225 Green Street, Suite 714
Fayetteville, NC 28301-5043
Attn: Trent Allen, Environmental Engineer
Ref: New Project, "Elm Ave. Sanitary Sewer Extension", Owner: The City of Laurinburg,
Scotland Co., NC
Fast Track — Gravity Sanitary Sewer Extension
Dear Mr. Allen,
Please find enclosed (one original and one copy):
1. Fast Track Application for Gravity Sewer, completed and appropriately executed. (FTA
12/07 ver5)
2. Application Fee of $480.00 payable to NCDENR written by the City of Laurinburg
3. Project Narrative.
4. Color 7.5 minute USGS topographical Map with identification, map name, number,
project area location, and closest downslope surface water. Project is not located
within 100 feet of any surface water or wetlands.
5. Downstream sewer, WWTF capacity and flow tracking/acceptance for Sewer Extension
Permit Application (Form FTSE 10/07). Supplied by the City of Laurinburg.
6. Certification is executed by the City of Laurinburg, (owner) and myself.
Thank you for your consideration and review of this application. If you need more information
or have questions, please contact me at 910-276-8306.
Sincer
7ly,
Joseph F. Wampler, PE 5364
Cc: Ed Burchins, City of Laurinburg, City Manager
Stacey McQuage, City of Laurinburg, Public Works Director
Brandi Deese, City of Laurinburg, Planning and Zoning

J.F. WAMPLER ENGINEERING, INC.
p` POST OFFICE BOX 1782 L A U R I N B U R G,
tLLiru� �n�i,n,ee c 604 PEDEN STREET PHONE: OFFICE [phone]
HOME: [phone]
FAX [phone]
August 16, 2011
Elm Ave. Sanitary Sewer Extension
City of Laurinburg Project
In the city limits of Laurinburg, Scotland County, NC
PROJECT NARRATIVE
N.C. 2B353
This project consists of placing 570 L.F. of 8" SDR 35-PVC Gravity Flow Sanitary Sewer line along
Elm Ave. to serve Faith Presbyterian Church, consisting of 400 seats with kitchen facilities.
All flow will be 100% domestic wastewater, gravity flow.
r_,4/
�H CAR01
..... /
pFV-ssJoseph F. Wampler, PE SEAL
53f -
y F

UNITED STATES
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CITY OF LAURINBURG LAURINBURGRNCANK
GENERAL ACCOUNT 66-85/531
P.O. BOX 249
LAURINBURG, NC 28352
fi nis aisoursemen[ nas oeen approvea as
the Local Government Budget and Fiscal
e -rl 6. e-*,
FINANCE DIRECTOR
63367
CHECK NO. 63367
VENDOR
CHECK DATE
CHECK AMOUNT
1
5340
08/17/2011
$480.00
U ********480 DOLLARS
'AND NO CENTS
PAY NCDENR
225 GREEN STREET
FAYETTEVILLE
NC 2 8 3 01 ,,
TO THE
ORDER
-
LI SECURITY FEATURES INCLUDED. DETAILS ON BACK.-

63367
CITY OF LAURINBURG
08/17/11
63367
INVOICE DATE
INVOICE NUMBER
INVOICE DESCRIPTION
NET INVOICE AMOUNT
PO NO.
VOUCHER
08/16/11
ELM AVE 8/11
480.00
66819

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r�r O Department of Environment and Natural Resources
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Flow 7lrackiing/Acceptenee for Sewer Extension Permit Applications
(FTSE—10/07)
Project Applicant Name: _City of Laurinbur$
Project Name for which flow is being requested: Elm Ave. Sanitary Sewer
More than one ME-10107 maybe required for a single project if the owner of the 97WTP is not responsible for all
pump stations along the route gfthe proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Leith's Creek Wastewater Treatment Plant
b. WWTP Facility Permit #; NC0020656
All flows are in MGD
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow L • i3S 1.
f Total flow for this specific request DO1 �-
g. Total actual and obligated flows to the facility 1 4 $
h. Percent of permitted flow used S `t ?'. F— �
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.
(Firm/Design) Daily Flow, MGD
Pub Station #19 3,000 L . 3OD
III. Certification Statement:
I, Ed BurchinsLCity Manager , 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 vith local
established policies and procedures using the best available data. This certification applies to those items
listed above ' Se Mons land II for ii,hich I am the responsible party. Sign, ire of this form inddicates
acceptant ,/cwater flow.
Official Signature
Date