WQ0029210_Application_20050822

A -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE I
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD! i
Application Number: (to be completed by DWQ) Wao0s2902t0
1.
Owner..1
a.
Moore County
Full Legal Name (company, municipality, HOA, utility, etc.)
`..1 b.
Phillip Boles, Director
Signing Official Name and Title (Please review 15A NCAC 2H .0206(b) for authorized signing officials!)
'1 c.
The legal entity who will own this system is:
0 Individual 0 Federal ❑ Municipality® State/County ❑. Private_ Partnership ❑Corporation ❑ Othe�cifyZ
1d.
Po Box 1927
1e. Carthage
Street Address
City
1f.
North Carolina
1g. 28327
State
Zip Code
1 h.
[phone] 1 i. [phone]
1 j.
Telephone Facsimile
E-mail
'2.
Project (Facility) Information:
2a.
Replace Lift Station 14-1
2b. Moore
Brief Project Name (permit will refer to this name)
_..------.._... . _.....
:..... County Where Project is Located
3.
_ .
Contact Person:
_._..__ _ _ _-_ --._ .___ ..._._.
HOBBS, UPCHURCH & ASSOCIATES, P.A. BB&T J�;942 4
CONSULTING ENGINEERS Branch Banking and Trust Company
" P.O. BOX 1737, 300 S.W. BROAD STREET 66-1121531
SOUTHERN PINES, NC 28388
[phone]
Exactly Four hundred and no / 100 Dollars
DATE
8/16/2005
PAY
TO THE
ORDER N . C. DENR VOID AFTER 90 DAYS
OF:
AMOUNT
$400.00
� ®Residential Subdivision Car Wash
W ❑ Hospital
[IApartments/Condominiums ❑ Institution o
❑ Mobile Home Park /o Domestic/Commercial
IL;
❑ School ( ❑ Church % Industrial
m ❑ Restaurant ❑ Nursing Home % Other
❑ Office El Other (specify): (specify):
7. Volume of wastewater to be permitted in this project: 0 gallons per day
8. If the permitted flow is zero, indicate why:
❑ Interceptor Line - Flow will be permitted is 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
FTA 02/03

OF W ATFR� gp_rit C®� State of North Carolina
R
Y Department of Environment and Natural Resources
cry r AUQ 2 z M. Division of Water Quality
o -mac nn``��gg�� FAST -TRACK APPLICATION
�id4- &VITY SEWERS, PUMP STATIONS, AND FORCE MAINS
(Pressure sewers systems are not to be included as part of this application package)
INSTRUCTIONS: Indicate that you have included the following list of required application package items by checking the
space provided next to each item. Failure to submit all required items will lead to your application being returned as
incomplete or additional processing and review time. This form may be photocopied for use as an original.
® I. Application Form - Submit one original and one copy of the completed and appropriately executed application
form. 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 B(12)
® II. Application Fee - Submit a check in the amount of $400 made payable to: North Carolina Department of
Environment and Natural Resources (NCDENR).
❑ Ill. 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(2a) of this application.
❑ IV. Operational Agreements — Submit one original and two copies of a properly executed operational agreement if
the sewer extension will be serving residential or commercial lots (e.g., houses, condominiums, townhomes,
outparcels, etc.) that will be owned by a homeowners' association or developer (Item B(2b)). If the applicant is a
homeowners' association, use Form HOA 02/03. If the applicant is a developer, use Form DEV 02/03. EVEN IF
THE PROJECT WILL BE TURNED OVER TO A MUNICIPALITY, FORM DEV 02/03 IS REQUIRED.
❑ V. Flow Acceptance Letters — If the owner of the downstream sewers and/or WWTF is different from the applicant,
submit two copies of a flow acceptance letter from the owner of the downstream sewers and WWTF, if different.
Flow acceptance letters must contain the following minimum information: applicant and project name, amount of
flow accepted, and name and permit number of the receiving sewersNVWTF. The flow acceptance must not
expire prior to permit issuance and must be dated less than a year prior to the application date.
Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific flow acceptance
letter.
® VI. Map — Submit an 8.5-inch by 11-inch copy of the portion of a 7.5-minute USGS Topographic Map along with this
form. The map should identify the entire project area location as well as the closest downslope surface waters as
clearly as possible. Each map portion must be labeled with the map name and number, the identified location,
and be of clear and reproducible quality. For instance, if the project involves 4 miles of interceptor sewer that
traverses over or near several different waterbodies (or counties, basins, etc.), the map should have location ID's
for each different waterbody (where the sewer line is within 100 feet of such waterbody - see Instruction VII).
® VII. Watershed Classifications — Section C
• If any portion of the project is within 100 feet of any down slope surface water, Section C must be completed
for the pertinent sections.
• If the entire project area is a minimum of 100 feet away from any down slope surface waters BUT there is a
pump station involved where a history of power outage is to be used to provide adequate design storage
instead of dual feed or permanent or portable generator, Section C must be completed to demonstrate that
the closest down slope surface water is Class C (see 15A NCAC 2H .0219(h)(3)(D)).
• Use the guidance document entitled, "Determining Watershed Classifications for Form FTA 02/03 (Fast -Track
Sewer Systems)" available from http://h2o.enr.state.nc.us/ndpu or by contacting the appropriate regional
office.
INSTRUCTIONS FOR FORM FTA 02/03

❑ Vill. Environmental Assessments — If this project is subject to an Environmental Assessment (EA) ]15A NCAC
01C .0500], this application can not be used. Send the project application on Form PSFMGSA 10/99 to the
Non -Discharge Permitting Unit, 1617 Mail Service Center, Raleigh, NC 27699-1617. Applications can not be
processed 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.
❑ IX. Certifications —Section D
The application must be certified by both the applicant and a North Carolina Registered Professional Engineer
(PE). The applicant signature must match the signing official listed in Item A(1b). The PE should NOT certify the
application if he/she is unfamiliar with 15A NCAC 2H .0200, 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. Certification by a PE who is unfamiliar with these documents
is subject to NC Board referral.
THE COMPLETED FTA 02/03 APPLICATION PACKAGE, INCLUDING ALL SUPPORTING DOCUMENTS AND $400
FEE, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional Office
59 Woodfin Place
Avery, Buncombe, Burke, Caldwell,
Asheville, North Carolina 28801
Cherokee, Clay, Graham, Haywood,
(828) 251-6
Henderson, Jackson, Macon, Madison,
[phone] 52 Fax
McDowell, Mitchell, Polk, Rutherford, Swain,
Transylvania, Yancey
Fayetteville Regional Office
Anson, Bladen, Cumberland, Harnett, Hoke,
225 Green Street Suite 714
Montgomery, Moore, Robeson, Richmond,
Fayetteville, North Carolina 28301
Sampson, Scotland
[phone]
[phone] Fax
Mooresville Regional Office
919 N Main Street
Alexander, Cabarrus, Catawba, Cleveland,
Mooresville, North Carolina 28115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
Stanly, Union
[phone]
[phone] Fax
Raleigh Regional Office
Chatham, Durham, Edgecombe, Franklin,
1628 Mail Service Center
Granville, Halifax, Johnston, Lee, Nash,
Raleigh, North Carolina 27699-1628
Northampton, Orange, Person, Vance, Wake,
[phone]
Warren, Wilson
[phone] Fax
Washington Regional Office
Beaufort, Bertie, Camden, 2owan, Craven,
943 Washington Square Mail
Currituck, Dare, Gates, Gre, Hertford,
Washington, North Carolina 27889
Hyde, Jones, Lenoir, Martin, Pamlico,
[phone]
Pasquotank, Perquimans, Pitt, Tyrrell,
[phone] Fax
Washington, Wayne
Wilmington Regional Office
Brunswick, Carteret, Columbus, Duplin, New
127 Cardinal Drive Extension
Hanover, Onslow, Pender
Wilmington, North Carolina 28405
[phone]
[phone] Fax
Winston-Salem Regional
585 Waughtown Street
Alamance, Alleghany, Ashe, Caswell,
Office
Winston-Salem, North Carolina
Davidson, David, Forsyth, Guilford,
27107
Rockingham, Randolph, Stokes, Surry,
[phone]
Watauga, Wilkes, Yadkin
[phone] Fax
For more information, visit our web site at: http:11h2o.enr.state.nc.us/ndpu/
INSTRUCTIONS FOR FORM FTA 02/03

, j
FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 1
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD!
Application Number:
(to be completed by DWQ) 04?a 10
1.
Owner: —
1 a.
Moore County
Full Legal Name (company, municipality, HOA, utility, etc.)
Z
1 b. Phillip Boles Director
0
Signing Official Name and Title (Please review 15A NCAC 2H .0206(b) for authorized signing officials!)
Q'
1c.
The legal enft who will own this system is:
-
i
❑ Individual Federal ❑ Municipality ® State/County ❑ Private Partnership ❑ Corporation ❑ Other (specify):
1 d.
Po Box 1927
1 e. Carthage
Street Address
City
LL
Z
11f.
North Carolina
1g. 28327
Z
State
Zip Code
............
._.... -............ —....... ..._.__.._......... __...... ......... __..._......--...... --- ..... .._...._.....__..._._.... -... -- ._....... - ..... .
1 h.
[phone] 1 i. [phone]
1 j.
QTelephone
Facsimile
E-mail
(�
2.
Project (Facility) Information:
--
J ,
a
2a.
Replace Lift Station 14-1
2b. Moore
a
Brief Project Name (permit will refer to this name)
County Where Project is Located
= Q
t ....-
3.
— ---- -- -------------_............... .........
Contact Person:
.__..._.. ---..._.....— ----- ---- - -- - ............... ----.-.._._._..._.._...._....... ----
3a.
Lee Humphrey, Project Manager, Hobbs Upchurch
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b.
910-692-5616
3c.lhum hre hobbsu church.com
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:
i 2b. If sold, facilities owned by a (must choose one
❑ Retaining Ownership (i.e. store, church, single office, etc.)
❑ Public Utility (Instruction III)
Leasing units urats (lots, townhomes, etc. - slop to Item B(3))
❑ Homeowner Assoc./Developer (Instruction IV)
❑ Selling units (lots, townhomes, etc. - go to Item B(2b))
O3.
Moore County
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
4a.
Moore County Pollution Control Plant
4b. NCO037508
Name of WWTF
WWTF Permit No.
0
5a.
Moore County
b. 24"
N/A
Z
Owner of Downstream Sewer
Receiving Sewer Size
Permit Number of Downstream Sewer
6.
The origin of this wastewater is (check all that apply):
® Residential Subdivision
❑ Car Wash
W❑
Apartments/Condominiums
❑ Institution
%Domestic/Commercial
IZ
❑ Mobile Home Park
❑ Hospital
❑ School
❑ Church
% Industrial
❑ Restaurant
❑ Nursing Home
;
I % Other (specify):
El office
❑ Other (specify):
7.
Volume of wastewater to be permitted in this project: 0 gallons per day
8.
If the permitted flow is zero, indicate why:
❑ Interceptor Line - Flow will be permitted is 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
FTA 02/03

r . . ,
FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 2
9. Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2H
.0219(I) for Item B(7) or the design flow for line or pump station sizing if zero flow in the space below. Values other than
that in 15A NCAC 2H .0219(I)(1-2) must be approved prior to submittal of this application. Submit a separate request to
the Division of Water Quality, Non -Discharge Permitting Unit, 1617 Mail Service Center, Raleigh, NC 27699-1617 in
accordance with 15A NCAC 2H .0219(1)(3).
....._......... ... ..._.—....._......_._._..__.................._..._..._._..._.........._............._................................ _....... --....._.---- ............................................................._.................._......_...................._..._......._._..._......._...._....__......._.__.._..._...__............
.... ....... ......._...._...__.._..........-........-....._..
N/A
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches)
Length (feet)
Gravity or Force Main
(pull down menu)
8"
44
Force Main
----- ... -----�....._. ._..................---._...._..__._._.--............_....---- -......-_..._._.........._...
......... _.....--.............. -._._......360.
..._......_.._.............._........_......._.....................__......._...-._.._..---...__.-............Grave
....................__......... ---._...._..._...
.Gravity
�^
^
j 8"
26
Gravity
G
...._..__...__.._..........
_.._.....---... -......_.._.......... _......... ---.-......_.._...... ........... -.............. ..... ......... _..... .._.
_..__._._._.._.._...... ... _.... ... _._._........... ............ .................. _......... _.._...... ......._...._._
W
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Oa
_._._...._._....._...._... — -- _-------. --._... ---- .._.....
— ..._...-- —---._..........__..__......_...__..._....._._.... — — —.
_....—.__... ___..__.._._..._......__..—_...._._...._ .._... — . ............
`-'
ENTER TOTAL LINE LENGTH IN MILE
.08
Z
0
d 1. Summary of Pump Stations to be Permitted (attach additional sheets as necessary)
C
Power Reliability Option
Location ID
Design Flow
Operational Point (dual line feed, permanent generator,
as shown on ans
MGD
GPM T........ portablegenerator,
.................__..._.-----..P...._..._.....-....._.._....._...._..__.__........__.._._.._..__.._.....-....._...._...9..._)__._._....
0_'
V-
1
.632
1,100 Q 160.53 Permanent Generator
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H
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12. 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 2H .0200 as applicable?
® Yes ❑ No If no, please reference the pertinent minimum design criteria or regulation and indicate why a
variance is requested:
i
'.9
I
SUBMIT TWO COPIES OF PLANS, SPECIFICATIONS OR CALCULATIONS PERTINENT TO THE VARIANCE WITH YOUR APPLICATION
13. Have the following permits/certifications been submitted for approval?
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
Vrr A M ins

L3 e
FAST -TRACK APPLIICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 3
1. Use the Division's guidance document entitled, "DETERMINING STREAM CLASSIFICATIONS FOR FORM FTA 02/03
Z
(FAST -TRACK SEWER SYSTEMS)" to collect and record the stream classification data below (attach additional sheets as
necessary). This document is available from our web site or by contacting the appropriate Division of Water Quality
h-
regional office (see instructions for addresses) OR indicate the following_
._........... _ .. ............... _.. _ ....
Q
❑ A Watershed Classification is not needed because all parts of the project are at least 100 feet away from any down
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slope waterbody; AND,
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❑ A Watershed Classification is not needed because the design does not depend on wet well storage as a power
reliability option for any pump station near a Class C down slope waterbody.
Vj.......
JLocation
_... _._.._...__......... -.......____ - ....--...__._...__..__.........
ID Name of Waterbody Stream Waterbody
V
on Map _ Waterbody - County River Basin Index _ Classification
.............
Q
1 Nick's Creek _—Moore Cape Fear 18-23-3-(3) WS-111
W
w
-- - _.......`... .................. _..... .... _ .....
W
_. ........ ........
Submit the 8.5" x 11" topographic map as required In Instruction VI regardless of whether a classification is provided
1. Applicant's Certification:
I attest that this application for Replace Lift Station 14-1 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 143-215.6B, 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.
.1 a.
igning mo Signature Date
2. Professional Engineer's Certification:
Z
0
I attest that this application for Replace Lift Station 14-1 has been reviewed by me and is
accurate, complete and consistent with the information in the engineering plans, calculations, and all other supporting
F—
documentation to the best of my knowledge. i further attest that to the best of my knowledge the proposed design has
Q
been prepared in accordance with the applicable regulations, Gravity Sewer Minimum Design Criteria for Gravity Sewers
V
adopted February 12, 1996, and the Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force
LL"
Mains adopted June 1, 2000 and the watershed classification in accordance with Division guidance. Although certain
f...
portions of this submittal package may have been developed by other professionals, 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.
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Note: In accordance with NC General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
L)
statement, representation, or certification in any application shall be guilty of a Class 2 misdemeanor which may include a
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fine not to exceed $10, 000 as well as civil penalties up to $25, 000 per violation.
.. ......... .. _.. .......... .................... ..._. _...... _....... _..... _.. _...... ...... _ _ ........
..... ...... .......
2a. David T. Upchurch
Professional Engineer Name
2b. Hobbs, Upchurch & Associates, PA ��at
Engineering Firm
2c. 300 SW Broad Street
Address
,.
2d Southern Pines 2e. NC 2f. 28388tr
'•.;.rMsar
City State Zip
2g. 910-692-5616 2h. 910-692-7342 2i.
Telephone Facsimile E-mail Seal, Signature &Date
FTA 0? /O'A

M-1-m"L4�1, P
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F/I
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08/23/2005 09:56 FAX [phone] HOBBS UPCHURCH L¢J001
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FACSIMILE
I
i Hobbs, Upchurch
i _ & Associates. P-4
Consulting 8n-ineers
P,O, Bar 1737
300 S. W Broad Street
Southern Pines, North Carolina 28388
[phone] FAX [phone]
TO: rA I KC L PkWgrza FAX NTJM13ER: q IO - 4SG - celo.7
1r%jy S'rrC- V 1 LL C 4FFIe6 PNftNO. OF PAGES: 2 (including cover)
FROM: 'DA V I p (J /C.0Ar—* RUA PROJECT #
Robbs, Upchurch A Associates, .P.A. HUA FILE NO. #
DATE: f Z3 / OC TIME: I .Ov R m
RE: rnaoze moo. A s. 14,1
MESSAGE:
ALSO Se6 SHEET— ,+ FOX 51TF4o PLAA1.

TRANSMITTAL
TO: NCDENR
225 Green Street, Suite 714
Fayetteville, NC 28301
Atten: Mike Lawyer
FROM: Lee Humphrey
Hobbs, Upchurch & Associates, P.A.
DATE: August 17, 2005
RE: Replace 14-1 Lift Station
Fast Track Permit Application
Hobbs, Upchurch
& Associates, P.A.
Consulting Engineers
P.O. Box 1737
290 S. W Broad Street
Southern Pines, North Carolina 28387
[phone] FAX [phone]
HUA PROJECT # M00411
HUA FILE NO. # M00411
MESSAGE:
If you have any questions or need any additional information, please contact this
office.
c: Imy documentslfast track, fay. trans.doc