WQ0041825_Revision to correct project name (facility name)_20200721

State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources 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: ELEVATE HAW RIVER, LLC (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: Frank Auman per 15A NCAC 02T .0106(b)
Title: MANAGER
4. Applicant's mailing address: 305 Blandwood Ave.
City: Greensboro State: NC Zip: 27401-
5. Applicant's contact information:
Phone number: [phone] Email Address:
II. PROJECT INFORMATION:
1. Project name: Elevate Haw River
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ00 and issued date:
If new construction but part of a master plan, provide the existing permit number: WQ00
3. County where project is located: Alamance
4. Approximate Coordinates (Decimal Degrees): Latitude: 36°03'49.002" Longitude:-79°22'40.777"
5. Parcel ID (if applicable): 147616 and 147620
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Chuck Truby License Number: NC 14984
Firm: CPT En ing eering and Surveying Inc.
Mailing address: 4400 Tyning Street
City: Hi hg Point State: NC Zip: 27265-
Phone number: [phone] Email Address: chuckt@cpten in�g com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Graham Wastewater Treatment Plant Permit Number: NC 0021211
Owner Name: City of Graham
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ
System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s):
FORM: FTA 04-16 Page 1 of 5