WQ0041842_Application (FTSE)_20200723

Baldwin Design
Consultmts^
ENGINEERING . SURVEYING - PLANNING
1700-D East Arlington Blvd • Greenville, NC 27858
252-756-1390 - 252-321-1412 (fax)
To: NCDEQ - Water Resources
943 Washington Square Mall
Washington, NC 27889
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Date: Job
07/16/2020 19-006 y�9jO��04�1pa ���p
Attention:
Sarah A. Toppen - Environmental Specialist�p�gro
Re:
Montevallo, Section 1 Phase 1
We are sending you: ❑ Attached ❑ Under separate cover via
Drawings ❑ Plans ❑ Prints
X Letter Package ❑z Other
2
1
2
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05/26/2020
05/14/2020
07/10/2020
06/17/2020
07/1612020
O5/27/2020
1010
the following:
❑ Pay Request/ Specifications
Invoice
Letters Referencing Fast Track Application
Check for $480.00 for Sewer Permit Fee
Fast Track Sewer Applications
Flow Tracking Application
Maps of Project Site (each one w/ markings)
Letter of Acceptance from Contentnea Metropolitan Sewerage District
for Additional Flow
Transmitted as checked below:
LX For approval ❑ Approved as noted
❑ For your use LJ Approved as submitted
E, As requested ❑ Returned for corrections
❑ For review Other
Remarks:
❑' Resubmit
❑ Submit
❑ Return
copies for approval
copies for distribution
corrected copies

MONTEVALLO CORPORATION
1700 TOTTENHAM CT
WINTERVILLE, NC 28590-9762
B0.4NCH OMKWGANOIW ST COMPANY
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66-11W531

BaldwinDesign Page 1 of 1
Consultants, Pa
ENGINEERING • SURVEYING PLANNING pti
'�CF�/NcoFN�o�k
May 26, 2020 JUC 2320?
Washington Regional OfficeA9pnssect
Water Quality Section ajohs°
943 Washington Square Mall
Washington, North Carolina 27889
REF: Fast Track Sewer Application Narrative for Montevallo, Section 1, Phase 1
To Whom It May Concern:
The project site is located off of the western right-of-way of NCSR 1723 - Ayden Golf
Club Road approximately 1,650 feet north of NCSR 1723 - Ayden Golf Club Road and
Country Club Drive intersection in Town of Ayden, Ayden Township, Pitt County, North
Carolina. The existing project site is currently undeveloped and consists of farmland.
The proposed sewer main extension project will consist of the installation of 8 new
manholes. The project needs to be permitted for the installation of 1,104 LF of 10" PVC
sanitary sewer main and 194 LF of 8" PVC sanitary sewer main.
Per 15A NCAC 02T.0114(b), the minimum daily design flow for one -bedroom dwelling
unit should be at least 240 gpd. The daily design flow for dwelling units with more than
two bedrooms should have the daily design flow increased by 120 gpd per each
additional bedroom. There will be 18 residential lots within this proposed subdivision
and the developer intends on building 3-bedroom houses in all residential lots.
Therefore, the daily design flow that needs to be permitted for this project is 360 gpd/lot
x 18 lots = 6,480 gpd.
If there are any questions or concerns please contact me at [phone] or email me
at [e-mail].
Sincerely,
Md W ,ISO
re ft !lialyvocla, PE
GPPoNt•AL
°rc 5FP LR°� �i
Z:o 0d3 4U:
Evk
1700-D EAST ARLINGTON BOULEVARD, GREENVILLE, NORTH CAROLINA 27858
NCBELS Lic. No. C-3498 TEL [phone]FAx[phone] www.BALDWINDESIGNCONSULTANTS.coM

BaldwinDesign Page 1 of 1
Consultants^
ENGINEERING • SURVEYING • PLANNING
May 26, 2020
w4hi�a �pol Q�eii 1p�0
�0 2�i ti
Washington Regional Office
Water Quality Section p��o
943 Washington Square Mall
Washington, North Carolina 27889
REF: Fast Track Sewer Application Narrative for Montevallo, Section 1, Phase 1
To Whom It May Concern:
The project site is located off of the western right-of-way of NCSR 1723 - Ayden Golf
Club Road approximately 1,650 feet north of NCSR 1723 - Ayden Golf Club Road and
Country Club Drive intersection in Town of Ayden, Ayden Township, Pitt County, North
Carolina. The existing project site is currently undeveloped and consists of farmland.
The proposed sewer main extension project will consist of the installation of 8 new
manholes. The project needs to be permitted for the installation of 1,104 LF of 10" PVC
sanitary sewer main and 194 LF of 8" PVC sanitary sewer main.
Per 15A NCAC 02T.0114(b), the minimum daily design flow for one -bedroom dwelling
unit should be at least 240 gpd. The daily design flow for dwelling units with more than
two bedrooms should have the daily design flow increased by 120 gpd per each
additional bedroom. There will be 18 residential lots within this proposed subdivision
and the developer intends on building 3-bedroom houses in all residential lots.
Therefore, the daily design flow that needs to be permitted for this project is 360 gpd/lot
x 18 lots = 6,480 gpd.
If there are any questions or concerns please contact me at [phone] or email me
at [e-mail].
Sincerely,
\ e,'OX7 [�,4
Igor T
lyvoda, PE
A
VPP•�pNAL��" �; ?: Al
ENCa.QPv:
iGOP
1700-D EAST ARLINGTON BOULEVARD, GREENVILLE, NORTH CAROLINA 27858
NCBELS Lio. No. C-3498 TEL [phone] FAx [phone] www.BALDWINDESIGNCONSULTANTS.com

DW R State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 - FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources INSTRUCTIONS FOR 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.
9
Projects that are deemed permitted (do not require a permit from the Division) are explained in 15A NCAC o2T o30RCF,
Projects not eligible for review via the fast track process (must be submitted for full technical review): (tQ��O�
i Projects that require an environmental assessment in accordance with 15A NCAC IC .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;oOa
Pressure sewer systems utilizing septic tank -effluent pumps (STEPS) or simplex grinder pumps;
STEP or simplex grinder pumps connecting to pressurized systems (e. force mains);
P' � P P � P' Y €
i 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
E Required unless otherwise noted
B. Cover Letter (Required for All Application Packages):
E List all items included in the application package, as well as a brief description of the requested permitting action.
�0 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 (All New and Major Modification Application Packages):
E 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):
E 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 1.2 is a corporation or company, provide documentation it is registered for business with
the North Carolina Secretary of State.
❑ It' 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.
E The Project Name in Item I1.1 shall be consistent with the project name on the flow acceptance letters, agreements, etc.
E The Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a North
Carolina licensed Professional Engineer.
E 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 I of 3

E. Flow Tracking/Acceptance Form (Form: FTSE 04.16) (If Applicable):
E 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-
2 15.67(a).
➢ Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific FTSE.
F. Site Maps (All Application Packages):
E Submit an 8.5-inch x I I -inch color copy of a USGS Topographic Map of sufficient scale to identify the entire project
area and closest surface waters.
i Location of the project (gravity sewer, pump stations & force main)
Downstream connection points and permit number (if known) for the receiving sewer
E 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 .01 I5(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 .01 15(c), submit the properly executed Operational Aereement (FORM: HOA).
❑ Per 15A NCAC 02T .01 15(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
❑ Developers of lots to be sold
❑ Per 15A NCAC 02T .01 15(b), submit the properly executed Operational Agreement (FORM: DEV).
For more information, visit the Division's collection systems trebsite
INSTRUCTIONS 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, Allegheny, 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

1 '
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
ETA 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:
I. Applicant's name: Town of Ayden (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State/County ® Municipal
3. Signature authority's name: Steven L. Harrell per 15A NCAC 021'.0106(b)
Title: Town Manager
4. Applicant's mailing address: 4144 N West Ave
City: Auden State: NC Zip: 28513-
5. Applicant's contact information:
Phone number: [phone] Email Address: [e-mail]
II. PROJECT INFORMATION:
F
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JG! 2 v�0Ak
0
❑ Private �8�'yblic Utility
❑ Other ai iY,
c�
I. Project name: Montevallo. Section I. Phase 1
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: W000 and issued date:
If new construction but part of a master plan, provide the existing permit number: W000
3. County where project is located: Pitt
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.464394` Longitude:-77.389853-
5. Parcel ID (if applicable): 04933
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
I. Professional Engineer: Izor Palyvoda License Number: 043249
Firm: Baldwin Design Consultants PA
Mailing address: 1700-D East Arlington Boulevard
City: Greenville State: NC Zip: 27858-
Phone number: [phone] Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (W WTF) INFORMATION:
I. Facility Name: Contentnea Metropolitan Sewer District Permit Number: NCO032077
Owner Name: Contentnea Metropolitan Sewer District
V. RECEIVING DOWNSTREAM[ SEWER INFORMATION (if different than WWTF):
I. Permit Number(s): WQ Downstream (Receiving) Sewer Size: 10 inch
System Wide Collection Svstem Permit Numbers) (if applicable): WQCS00269
Owner Name(s): Town of Auden
FORM: ETA 04-16 Page I of 5

VI. GENERAL REQUIRENIENTS
I. 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: FICA) 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 17c Domestic/Commercial 9c Commercial
_ % Industrial (See 15A NCAC 02T .0103(20))
),Is there a Pretreatment Program in effect'? [—]Yes ❑ No
6. Has a flow reduction been approved under I SA NCAC 02T .01 I4(f)? ❑ Yes ® No
i If Yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow ° °
No. of Units
Flow
Residential
360 gal/4-bedroom house
18
6,480 GPD
gal/
GPD
gal/
GPD
gal/
GPD
eal/
GPD
gal/
GPD
Total
6,480 GPD
a See 15A NCAC 02"f .01 14(b). (d), le)(I) and (e)('_1 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: 6 480 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 bus already been allocated in Permit Number:
❑ Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain):
FORM: FTA 04-16 Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
10
1,104
PVC
8
194
PVC
> 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)
4. Operational point(s) of the pump(s): --allons 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
6. Power reliability in accordance with I5A NCAC 02T .0305(h)( I):
❑ 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
i 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(f)):
1. Does the project comply with all separations found in 15A NCAC 02T .0305d) & (g)
> 15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
® Yes [-]No
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 11 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 _round 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
Drainages stems and interceptor drains
5 feet
Any swimming pools
10 feel
Final earth grade (vertical)
36 inches
i 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 webpave
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 ISA NCAC 02B .0200'? ❑ Yes ❑ No ® N/A
> This would include Trout Buffered Sueams per 15A NCAC 28.0202
4. Does the project require coverage/authorization under a 404 Nationwide or [-]Yes ® No
individual permits or 401 Water Quality Certifications'?
i 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, 'Ugh -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

K1t 810111406W(N11I18W&T
I. Does the submitted system comply with 15A NCAC 02T, the Minimum Desil?n 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, 1 1 Vt V V V V- attest that this application for
(Professiona Engin er's name from Application Item 111.1.)
Mon eYo,lly, SeC+(oh it ptiaSe 9
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 143-215.6B, 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.
North Carolina Professional Engineer's seal, signature, and date:
�: OP,.••pNAL�
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0 io:
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..................:' .,,.. .lGOP,.,,`.................
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I, �JCQ Uk L , rl ^ rytll /069n / FLOW"ef- attest that this application for
(Signature A thority's name & title from ApplicatioY Item I.3.)
%1)vf)�kBVo.lLOP S-eC+i0A 41 Phas2 A
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 143-215.613, 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.
Signature: nt�l "' tl L • / Date: I U 2�
FORM: FTA 04-16 Page 5 of 5

DWR State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources INSTRUCTIONS FOR 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 or I5A 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). desivl
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 I5.-A NCAC 0=T .030� and the applicable mininwm desigm criteria. These
documents shall be available upon request by the Dk ision. 9
FeF
Projects that are deemed permitted (do not require a permit from the Division) are explained in 15-A NCAC 0=T.030,;. 4FPb
Projects not eligible for review via the fast track process must he submitted for lull technical res iew c
I Projects that require an environmental assessment in accordance with 15A NCAC IC .0100:
Projects that do not meet any part of the mininuim design criteria fN1DC) dOCtnnenC h
Projects that involve a variance from the requirements of 15A NCAC 2T:
Pressure sewer systems utilizing septic tank -effluent pumps (STEPS) or sintpleX grinder pumps:
STEP or sintpleX grinder pumps connecting to pressurized systems Ic.�1. Force mains):
A'aentllrt sewer systents.
General — When submitting an application, please use the tollowing 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 scraed, Flow allocation required. etc.
If necessary for clarity-, include attachments to the application form.
C. Application Fee (All New and Major Modification Application Packages):
® Submit a check or money order in the amount of $d80.00 dated within 90 days of application suhninaal.
Payable [o 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 he made.
❑ II' the Applicant Type in Item 1.2 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 1.2 is a partnership or d/h/a, enclose a copy of the certificate filed with the Register of
Deeds in the county of buSInCSS. `
® The Project Name in Item IL 1 shall be consistent with the project name on the Ilovv acceptance letters, agreements, etc.
® The Professional Engineer's Certification on Page 5 of the application shall he signed, sealed and dated by a North
Carolina licensed Professional Fminccr.
® The Applicant's Certification on Page 5 of the application shall be signed in accordance with 15A NCAC 02T .n 106(h).
Per 15A NCAC 02T .0106(c), an alternate person may he designated as the signing official if a delegation letter is
provided from a person who meets the criteria in 15A NCAC 02T .0106(h).
INSTRUCTIONS FOR FORM: FTA 01-16 & SUPPOR"LING DOCUMENTATION Pal-e I of I

E. Flow Tracking/Acceptance Form (Form: FTSE 04-I6) (If Applicable):
® Submit the completed and executed FTSE form from the owners of the downstream sewers and treatment facility.
I 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 he 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. 141-
1_ 15.67(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 I I -inch color copy of a USGS Topoeraphic Map of sufficient scale to identity the entire project
area and closest surface waters.
Location of the project (gravity sewer, pump stations & force main )
Downstream connection points and permit number (it known) for the recek in,, sewer
® Include a street level map (aerial) showing=eneral project area so that Div ision start 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 0105(h)( I ), submit documentation of power reliability for pumping stations.
This alternative is only available for average daily (lows less than 15,000 gallons per day
It shall he 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 sip*ned by the applicant (see 15A NCAC 02T .0106(h)) or
proposed contractor. stating that "the portable power generation unit or portahle, 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)
Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per 15A NCAC 02T .0115(a ( I ) provide the Certificate or 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 Commi,sion's y%atcramd_ Sewer Division Publie Starr statim, an
application for a franchise has been received and that the scrcice area is contiguous to an existing franchised area or
that I ranchise approcalis expected.
Operational Agreements (Applications from I(OA/POA and Developers for lots to be sold):
❑ Home/Property Owners' Associations
❑ Per 15A NCAC 02T 0115ic), submit the properly executed Operational A��rcemcnt (FORM IIOA).
❑ Per 15A NCAC 02T .01 15(c), submit a copy or the Articles of Incorporation. Declarations and By-laws.
❑ Developers of lots to he sold
❑ Per 15A NCAC 02T .01 15(b), submit the properly executed O perationul Aaroement (FORM: DF,V ).
/ gin' more infortttation, visit the Diri.rion's collection systems o ehsite
INSTRUCTIONS FOR FORM: FTA 04-I6 & SUPPORTING DOCUMFNTATION Pagc 2 of 3

THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORNIATION 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, Ponder
[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 FORA: FI-A 04-I6 & SUPPORTING DOCUhIGN"CATION PaLe 3 o(3

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
ISA NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
ETA 04-16 R SUPPORTING DOCUMENTATION
Application Number:
no he completed be 1AR i
All items must be completed or the application will be returned
I. APPLICANT INFORMATION
I. Applicant's name: Town of Avdcn (company, mmnicipalily. HOA. utili(y. etc.)
3. Applicant type: ❑Individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State/Count. ® Municipal
3. Signature authority's name: Ste%cat L.Harrell peel>:A C-ACU?"f.01n6ih,
Tide: Town %lanascr
4. Applicant's mailing address: -H4d N West A.c
City: A den State: NC Zip: 28513-
5. Applicant's contact inRxmanon:
Phone number. [phone] Email Address: sharrell(layden.cont
II. PROJECT INFORMATION
❑ Priv:
❑ Othe
I. Project name: Montevallo. Section I, Phase I
�. Application/Project status: ® Proposed (New Permit) ❑ Existing Pennit/Project
If a modification, pro% ide the existing permit number "'QUO and issued date:
If new construction but purl of a master plan. provide the existing pennit mmnher: "'QUO
3. County where project is located: Pitt
d. Approximate Coordinates (Decimal Degrees): Latitude: 35.464394 Longitude:-77.389853
5. Parcel ID (if applicable): 0.4933
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
I. Professional Engineer: Igor PHINwda License Numher: 043249
Firm: Baldwin Design Consultants PA
Mailing address: 1700-D East Arlin=ton Boule.ard
City- Greenville Statc: NC Zip: '_7858-
Phone numher: [phone] Email Address: ipalc. oduC 6aldwindesignconsulrtnts om
IN'. WASTEWATER TREATMENT FACILITY (IN NN I'F) INF ORNI.ATION:
1. Facility- Name: Contentnea Metropolitan Scwer District Permit Number: NC0031077
Owner Name: Contentnea Metropolitan Sewcr District
Y. RECE►YING DO�%NSTREA-NI SEWER INFORNIA'I'ION (if different than �%R"CF):
I. Permit Number(s): WQ Do..nstrc:un (Rcceicing) Sc..erSiic: 10 inch
Svstent Wide Collection SvStCm P rmit Num[ICNI) (ifaphlicable): WQCS00=69
Owner Name(s): Town of Avdcn
FORM: FIA 04-16 Pagc I of 5

vI. GENERAL REQUIREMENTS
I. 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 DcNeloper'S Operational Aareenrent (FORM: DEV) been attached'?
❑ Yes ❑No ®N/A
3. It the Applicant is a Home/Propetiv Owners' rAsociwion. has an Unerationul Aerecment FORA: HOA) been attached?
❑ Yes ❑No ®N/A
4. Orrin of wastewater: (check all that apply):
® Residential Owned ❑ Retail (stores, centers, malls) ❑ Cur Wash
❑ Residential Leased ❑ Retail with food preparation/service ❑ Hotel and/or Motels
❑ School / preschool / day care ❑ Medical / dental / seterinan facilities ❑ Swimming Pool /Clubhouse
❑ Food and drink facilities El Church ElSwiinnune Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nuaing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater : 100 % Domestic/Commercial r% Commercial
rG Industrial (See IiANGVC_0_-1 0103t10o
is there a Pretrcaunent Progrum in effect' ❑ Yes ❑ No
0. Has a flow reduction been approved under I5A SC -AC 0_'1 01 144), ❑ Yes ® No
If yes, provide a copv of flow reduction approval letter
7. Summarize wastewater venerated by project:
Establishment Type (see 02T.0I la(f))
Daily Design Flow "'''
No. of Units
Flow
Residential
360 val/-t-bedroom house
18
6,480 GPD
gal/
GPD
val/
GPD
dal/
GPD
cal/
GPD
Kcal/
GPD
Total
6.480 GPD
Sec ISA NCAC 021- .01 la(ht. o-h lea I i and tcnL 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 cast of the Atlantic Intracoastal )A'atcmav to be used as vacation rentals
as defined in G.S. 42A-4).
Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table I5A NCAC 021.01 1 1] shall
he determined usins available flow data. water using fixtures. nccupanC or operation patterns. and other measured data.
8. Wastewater generated by project: 0.480 GPD (per 15ANCAC 021 .01 14)
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 subscyuent permits that connect to this line
❑ Flow has already been allocated in Permit Number:
❑ Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain):
FORM: PTA 04-16 Pavc 2 of 5

VIL GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & NIDC (Gravity Sewers):
I. Summarize vanity sewer to be permitted:
Size (inches)
Length (feet)
Material
10
1,I04
PVC
8
194
PVC
i Section II & III of the MDC for Permitting of Grtrvity Sewers contains information related to desisn criteria
Section III contains information related to minimum slopes for grmity sewenv
Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
VIll. PUMP STATION DESIGN CRITERIA (If Applicable) — 02"F.0305 & MDC (Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROTECT
I . Pump station number or name:
2. Appio.eimate Coordinates (Decimal Degrees): Latitude: Longitude: - -
3. Design Ilow of the pump station: millions gallons per dae (firm capacm )
4. Operational point(S) of the punlp(S): gallons per minute at feet total dynamic head (TDH)
5. Summarize the force main to he permitted (for this Pump Station):
Size (inches) T Length (feet) Material
6. Power reliahility in accordance with I5A NCAC 021 .0305 h�i 1 c
❑ Standby power source or pump with ❑utontatic actuation and lelemcn'y - 15A NCAC 02T .0305(h)(1)(B):
Required for all pump stations with an average daily Ilow greater than or equal to 15.000 gallons per day
Must he permanent to facility
Or if the pump station has an avcralge daily Ilow less than 15.000 callous per cla :
❑ Portable power Source with manual activation. quick -connection receptacle and telemetry - I5A NCAC 02T
.0305(h)( I )(C)
or
❑ POftahle pumping unit e011 plugged emergency pump connection and tclemetrc - I SA NCAC 02T .0305(h)( I )(C):
I It shall he demonstrated to the Division that the portable Source is awned of contracted by the applicant (draft agreement)
and is compatible with the station.
11' the portable power source or pump is Cledicated to multiple pump stations. an evaluation of all the pump Stations'
storage capacities and the rotation Schedule of the portable power source or pump. includine travel timefrunes. shall be
provided in the case of a multiple station power outage.
FORM: FTA 04-16 Pa_,e 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
I. Does the project comply with all separations found in I5A NCAC 02-T_0',05ff) &. (L) ® Yes ❑ No
i 15A NCAC O2T.0305(t) contains minimum sconnnions that sh;dl he ,o,o d,,l ri, 11,,,1,,..
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 am wells. WS-1 waters of Class I or
Class It impounded reservoirs used as a source of drinking water
100 feet
'I 'Waters classified WS (except WS-I or WS-V), B. SA. OWA. HQW, ur SB front normal
high water (or tide elevation) and wetlands (see item IX?)
50 feet
""Any other stream, lake, impoundment, or around water lowering and Surface drainage
ditches
10 feet
Any building foundation
5 feet
Anv basement
10 feet
Top slope of embankment or cuts of 2 feet ur more scrtical hewf t
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
I ISA NCAC 02T 0305(g) contains alternatives where separations in 02T,0305( f) cannot be achieved.
":"Stream classifications (:all be identified using the Division's NC Surl'ace._NV'atcr Clasil'ications wcbnagc
I If noncompliance with 02T.0305(f 1 or) go, see Section X of this application
'_. Dues the project comply with separation requirements for wetlands'? (50 feel of separation) El Yes ❑ No ®N/A
I See the Division's draft separation requirements fur 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 15.N NCAC 0213 .0?0O ) ❑ Yes ❑ No ® N/A
I This would include Trout Buffered Streams per 1=A NCAC _113.0_02
T. Does the project require coverage/authorization under a 404 Nationwide or ❑ Yes ® No
individual permits or-401 Water Quality Certifications"
i Information can be obtained from the 401 & Buffer Permitting Branch
5. Dues project comply with ISA NCAC 02T.01.05(c)(6) (additional permits/certificutionsf? ®Yes ❑ No
Per 15A NCAC 021 0105(c )6 ), directly related emironmental permits or certification applications are being prepared, have
been applied for. or have been obtained. Issuance of this permit is contingent un issuance of dependent permits (erosion and
sedimentation control plans. stormwater numagement plans, etc.).
6. Dues this project include any sewer collection lines that are deemed "high -priority?"
Per I5A NCAC 02T (402. "high -priority sewer' means "am aerial sewn. sewer contacting surface waters, siphon, ur sewer
positioned parallel to sucambanks 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.O403(ah-;) or the permitee's individual System -Wide Collection permit.
FORNI: FTA 04-16 Page 4 of 5

X. CERTIFICATIONS:
I. Does the submitted system comply with 15A NCAC 02T. the Minimum Design Criteria Ibr the Permitting of Pump Stations
and Force plains (latest torsion) and the Gravity Sewer Minin Um Design Ciilcria (latest version) as applicable?
® Yes ❑ No
It' 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:
✓�
1. LAniC 1 0rIJ,j\/ 0j
that this application for
3(Proressional Engin'iIer's name from Application Item Ill. I.)
Mor �CVM ln, Sec-ko)o It PtiaSe 1
has been reviewed by me and is accurate complete and consistent wuh the information supplied in the plans, specifications.
engineering Calculations. and all other supporting documentation to the best or my knowied_e. I lurther attest that to the best
or 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 vorsion). Although other processionals ntay hate dovcloped certain
portions of this submittal package, inclusion orthese materials under my signature and sal signifies that I hove reviewed this
material and havejudged it to be consistent with the proposed design.
NOTE — In accordance with General Statutea 143-215.6A and 143-115.613. any person who knowingly makes any Hulse
statement, representation, or certification in any application package shall he guilty of a Class 2 misdemeanor, which may
include a tine nut to exceed S 10,000, as well as civil penalties up to "S25 000 per violation.
t 1,1
North Carolina Professional Engineer's seal, signature, and date:,,�"
...... :............
..
3. Applicant's Certification per 15A NCAC 02T .0106(b):
i, -�t ". I 1 n. Ie 11 if 0WA F FIWA __ attest that this application for
(Signature Aythority's name & title from Applicalic Item L3. t
Mf102.VQ.11b) S-eG-HOA 4, PA
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that Wall 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 incnmpletC. I understand that any discharge or wastewater float this non -
discharge system to surface waters or the land will result in an immediate enforcement action that ntay include civil penalties,
injunctive reliaf, and/or criminal prosecution. I will make no claim against the Division or Water Rewurces should a
condition or 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 attachmens are not included, this application package will be returned to
me as incomplete.
NOTE — In accordance with General Statutes I43-215.6..A and 141-21S.hB, am person who knowingly makes any false
statement, representation. or certification in any application packa�e shall be guilty of a Claus 2 misdentcanor, which may
include a nine not to exceed $10.000 as well as civil penalties up to 525.000 per violation.
t
Signature: '�bL� Date: Z 0ZU
FORM: FTA 04-16 Page 5 or5

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow "Tracking for Sewer Extension Applications
(FTSF. 10-18)
Entity Requesting Allocation: /CQW n 04 jg10 e n
Project Name for which flow is being requested: non 4cJo lloh Seri- 65e I.
More than one FTSC inay be required fora 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 arc the owner of the wastewater treatment plant.
a. WWTP Facility Name: _
b. WWTP Facility Permit #:
Al[ flows are in
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
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:
(A)
Design
pump
Pump
Average
Station
Station
Firm
Daily Flow**
(Name or
Permit
Capacity, *
(Firm / pf),
Number)
No.
MGD
MGD
l9
•Y�l
,iS�i
(B)
(C)
(D)=(B+C)
(E)=(A-D)
Obligated,
Approx.
Not Yet
Total Current
Cun'ent
Tributary
Flow Plus
Avg. Daily
Daily Flow,
Obligated
Available
Flow, MGD
MCID
Flow
Capacity***
. ors
667
081a
/Oz
* The Firm Capacity (design flow) of any pump station is defined as the maxhnum pumped flow
that can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor
(pf) not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): C /iS /50Ui- , e 4 r r' d , / -fit6 {4%-Oy)
Downstream Permit Number:
Page I of 6
FTSE 10-18

III. Certification Statement:
I ���,'� pyt certify to the best of my knowledge that 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, given the implementation of the planned improvements
identified in the planning assessment where applicable. 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 plus all attached planning assessment addendums for which I
am the responsible party. Signature of this form certifies that the receiving collection system or treatment
works has adequate capacity to transport and treat the proposed new wastewater.
Official
Title of Signing Official
Page 2 of 6
FTSE 10-18

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow'I'racking for Sewer Extension Applications
(FTSE 10-18)
i
Entity Requesting Allocation: /p, yy 04 J%yej[n
Project Name for which flow is being requested: non}f J&Akol Sec�:unT a 5c
More than one FTSE may be required for a single project rf the owner of the WWTP is not responsible for• all pranp
stations along the route of the proposed wastewater flow.
Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name:
b. WWTP Facility Permit #:
All flows are in
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
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:
(A)
Design
Pump
Pump
Average
Station
Station
Firm
Daily Flow**
(Name or
permit
Capacity, *
(Firm / 1)
Number)
No.
MGD
MGD
19
w61
,Igq
(B)
(C)
(D)=(B+C)
(E)=(A-D)
Obligated,
Approx.
Not Yet
Total Current
Current
Tributary
Flow Plus
Avg. Daily
Daily Flow,
Obligated
Available
Flow, MGD
MGD
Flow
Capacity***
, o/S
.067
D8o
10,2
* The Firm Capacity (design flow) of any pump station is defined as the maximum pumped flow
that can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the point) station divided by a peaking factor
(pf) not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendmn shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is <0.
Downstream Facility Name (Sewer): C l'is 1) Asa- 4,Edp- LU. / -46 fq}ioyl
Downstream Permit Number:
Page I of (i
FTSE 10-18

III. Certification Statement:
I' Ddt,,'e o-4 e, certify to the best of my knowledge that 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, given the implementation of the planned improvements
identified in the planning assessment where applicable. 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 plus all attached planning assessment addendums for which I
am the responsible party. Signature of this form certifies that the receiving collection system or treatment
works has adequate capacity to transport and treat the proposed new wastewater.
Official
CO/�lc�on /Di:$f!
Title of Signing Official
Page 2 of 6
FTSE 10-18

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4343 Ayden Golf Club Rd - Google Maps
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Google Maps 4343 Ayden Golf Club Rd
Imagery 02020 Maxar Technologies, USDA Farm
4343 Ayden Golf Club Rc c(,Dcec4
Ayden, NC 28513 P r° N C 5
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4343 Ayden Golf Club Rd - Google Maps
https://www.google.com/maps/place/4343+Ayden+Golf+Club+Rd...
Got igle Maps 4343 Ayden Golf Club Rd
Imagery ©2020 Maxar Technologies, USDA Farm Service
4343 Ayden Golf Club Rc -� 0�5 Aadc�s5
Ayden, NC 28513 I _ �o, e 0- / 1„
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CMSD
POST OFFICE BOX 477
GRIFTON, NORTH CAROLINA 28530
CHARLES M. SMITHWICK, JR.
DISTRICT MANAGER
May 27, 2020
Mr. Igor Palyvoda, PE
Baldwin Design Consultants
1700-D East Arlington Blvd
Greenville, NC 27858
Re: Montevallo, Section 1, Phase 1
Dear Mr. Palyvoda:
I am in receipt of your request for the Contentnea Metropolitan Sewerage District (CMSD) to accept the
additional flow of 6, 480 gpd of wastewater that will be generated by this project.
By virtue of this letter, the CMSD will accept this additional flow. Please find the attached FTSE form
and supporting documentation.
Please advise if you have questions or comments.
Sincerely,
(/�44 0
Charles M. Smithwick Jr.
District Manager, CMSD

State of North Carolina
Division of Water Resonrces
Entity Requesting Allocation: Town of
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Project Name for which flow is being requested: Montevallo, Section 1, Phase 1
More than one FTSE nervy be required fora single project if the owner of the WWTP is nol responsible for all punep
stations along the route of the proposer/ wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Contentnea
b. WWTP Facility Permit
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
District
All flows are in MGD
3.5
.484
1.7
.00648
2.19
62.57%
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
Pump
Station
Station
(Name or
Permit
Number)
No.
(A)
Design
Average
Daily
Firm Flow**
Capacity, * (Firm / p fl,
MGD MGD
Hwy 11 WQCS00080 7.5
(B)
Approx.
CunTent
Avg. Daily
Flow,
MGD
1.195
(C)
(D)=(B+C) (F)=(A-D)
Obligated,
Total
Not Yet
Current Flow
Tributary
Plus
Daily Flow,
Obligated Available
MGD
Flow Capacity***
.484 1.679 1.321
S. Edge WQCS00080 2.4 .962 .402 .089 .491 .471
The Firm Capacity (design flow) of any pump station is defined as the maximum pumped flow
that can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor
(pf) not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): Contentnea Metropolitan Sewerage Distr.
Downstream Permit Number: NC0032077
Page 1 of 6
FTSE 10-18

III. Certification Statement;
I Charles A Smithwick , Jr certify to the best of my knowledge that 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, given the implementation of the planned improvements
identified in the planning assessment where applicable. 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 plus all attached planning assessment addendums for which I
am the responsible party. Signature of this form certifies that the receiving collection system or treatment
works has adequate capacity to transport and treat the proposed new wastewater.
Official Signature
W
Official
,5=a7-ao�a
Date
Page 2 of 6
FTSE 10-18

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aateiztCtea Glf%tw�aolitaia eS'eureurge Owtma
CMSD
POST OFFICE BOX 477
GRIFTON, NORTH CAROLINA 28530
CHARLES M. SMITHWICK, JR.
DISTRICT MANAGER
May 27, 2020
Mr. Igor Palyvoda, PE
Baldwin Design Consultants
1700-D East Arlington Blvd
Greenville, NC 27858
Re: Montevallo, Section 1, Phase 1
Dear Mr. Palyvoda:
I am in receipt of your request for the Contentnea Metropolitan Sewerage District (CMSD) to accept the
additional flow of 6, 480 gpd of wastewater that will be generated by this project.
By virtue of this letter, the CMSD will accept this additional flow. Please find the attached USE form
and supporting documentation.
Please advise if you have questions or comments.
Sincerely,
(/4 '�
Charles M. Smithwick Jr.
District Manager, CMSD

F ta
Dlulaion of Water Resources
Entity Requesting Allocation: Town of
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Project Name for which flow is being requested: Montevallo, Section 1, Phase 1
More than are FTSE niay be required fora stugle project if the owner of the WWTP is not responsible for all pnnrp
stations along the route of the proposed wastewaler flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Contentnea Metropolitan Sewerage District
b. WWTP Facility Permit #: NC0032077
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
AlI lows are in MGD
3.5
.484
1.7
00648
2.19
62.57%
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:
(A)
(B)
(C)
(D)=(B+C)
(B)=(A-D)
Design
Average
Approx.
Obligated,
Total
Pump Pump
Daily
Current
Not Yet
Current Flow
Station Station Firm
Flow**
Avg. Daily
Tributary
Plus
(Name or Permit Capacity, *
(Firm / pf),
Flow,
Daily Flow,
Obligated
Available
Number) No. MGD
MGD
MGD
MGD
Flow
Capacity***
Hwy 11 WQCS00080 7.5
3
1.195
.484
1.679
1.321
S. Edge WQCS00080 2.4
.962
.402
.089
.491
.471
* The Firm Capacity (design flow) of any pump station is defined as the maximum pumped now
that can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a pealing factor
(pf) not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): Contentnea Metropolitan Sewerage Distr.
Downstream Permit Number: NC0032077
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I Charles M. Smithwick , Jr certify to the best of my knowledge that 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, given the implementation of the planned improvements
identified in the planning assessment where applicable. 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 plus all attached planning assessment addendums for which I
am the responsible party. Signature of this form certifies that the receiving collection system or treatment
works has adequate capacity to transport and treat the proposed new wastewater.
Official Signature
qyer ezo u#aK C�
of Signing Official
S=a9-do�a
Date
Page 2 of 6
FTSE 10-18

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