WQ0037079_Application_20140404

DENR-FRCS
• State of North Carolina
AL v
DVVQ
Department of Environment and Natural Resources
Division of Water Resources
FAST- TRACK APPLICATION (FTA 08 13)
Division of Water Resources
for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
General — When submitting this 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.
For more information, visit the Surface Water Section's Collection Systems website or;
contact the Regional Office serving your county
Unless otherwise noted the Applicant shall submit one original and one copy of the application and supporting
documentation to the appropriate Regional Office (see page 3).
A. Cover Letter:
® Include a brief project narrative describing the final 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).
B. Application Form (FTA 08-13):
® Submit the completed and appropriately executed Fast -Track (FTA 08-13) Application. Any
unauthorized content changes to this form shall result in the application being returned. If necessary
for clarity or due to space restrictions, attachment to the application may be made, as long as the
attachments are numbered to correspond to the section and item to which they refer. You do not need
to submit detailed plans and specifications unless you respond NO to item B0 3).
® The Professional Engineer's Certification of the application shall be signed, sealed and dated by a
North Carolina licensed Professional Engineer.
❑ The Applicant's Certification 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).
C. Application Fee:
® Submit a check in the amount of $480 to: North Carolina Department of Environment and Natural
Resources (NCDENR).
➢ Checks shall be dated within 90 days of application submittal.
D. Certificate of Public Convenience and Necessity (For Privately -Owned Public Utilities Only):
❑ Per 15A NCAC 02T .0115(a)(1), provide two copies of 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 two copies of 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.
❑ The project name in the CPCN or letter must match that provided in Item A(2)a of this application.
E. Operational Agreements (For Home/Property Owners' Associations and Developers of lots to be sold):
Home/Property Owners' Associations
❑ Per 15A NCAC 02T .0115(c), submit the properly executed Operational Agreement (HOA 08-13).
❑ Per 15A NCAC 02T .0115(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
➢ Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(b), submit the properly executed Operational Agreement (DEV 08-13).
Even if the project may be turned over to a municipality upon completion, Form DEV 08-13 is required.
INSTRUCTIONS FOR APPLICATION FTA 08-13 & SUPPORTING DOCUMENTATION Page 1 of 6

F. Downstream Sewer, WWTF Capacity and Flow Tracking/Acceptance Form (FTSE 08-13)
® Submit the completed and appropriately executed Flow Tracking/Acceptance for Sewer Extension
Permit (FTSE 08-13) Form for all applications.
i% The applicant (and owners of downstream sewers, pump stations and/or treatment facilities submitting
form FTSE 08-13 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 08-13
from the owner of the downstream sewer and owner of the WWTF, if different.
Y The flow acceptance indicated in form FTSE 08-13 must not expire prior to permit issuance and must
be dated less than one year prior to the application date.
)i- Submittal of this application and form FTSE 08-13 indicates that owner has adequate capacity
and will not violate G.S. 143-215.67(a).
➢ Intergovernmental agreements or other contracts will not be accepted in lieu of a project -
specific FTSE 08-13.
G. Site Map (All Application Packages):
® Submit an 8.5-inch x 11-inch color copy of a USGS Topographic Map of sufficient scale to identify the
entire project area and closest surface waters. Each map must include at a minimum:
➢ The location of the sewer line and pump stations and be of reproducible quality.
➢ Downstream connection points and the permit number for the receiving sewer (if known)
➢ Pump Station Locations and the longitude and latitude for each pump station (if applicable)
® Include a street level map showing all relevant project areas.
H. Stream Classification (WSCAS 08-13)
❑ Submit the completed and appropriately executed Watershed Classification Attachment form
(WSCAS 08-13) if any portion of the sewer system project is within 100 feet of any surface water or
wetlands.
➢ A variance must be requested for encroachment within required setbacks or buffers pursuant to 15A
NCAC 02T .0305(f)
Environmental Assessments (Projects subject to an Environmental Assessment (EA)):
➢ Projects involving an Environmental Assessment per 15A NCAC 01 C .0408, must be submitted for a
full technical review and must be submitted to the PERCS Unit on application forms provided by the
Division.
Alternative Sewer Systems
➢ Projects involving low pressure sewer systems, vacuum sewer systems and other alternative sewer
systems must be submitted for a full technical review and must be submitted to the PERCS Unit on
application forms provided by the Division.
K. 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 the project, please indicate in B(12)
and give the permit number of the second facility.
L. 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(1b). 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 Permitting of Pump Stations and Force Mains (most recent version), as applicable to the project.
INSTRUCTIONS FOR APPLICATION FTA 08-13 & SUPPORTING DOCUMENTATION Page 2 of 6

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, Pender
[phone]
[phone] Fax
Winston-Salem Regional Office
585 Waughtown Street
Alamance, Alieghany, Ashe, Caswell, Davidson,
Water Quality Section
Winston-Salem, North Carolina 27107
Davie, Forsyth, Guilford, Rockingham, Randolph,
[phone]
Stokes, Surry, Watauga, Wilkes, Yadkin
[phone] Fax
INSTRUCTIONS FOR APPLICATION FTA 08-13 & SUPPORTING DOCUMENTATION Page 3 of 6

USE THE TAB KEY TO MOVE FROM FIELD TO FIELD Application Number.
(to be completed by OWR � W2?0oX7079
1, 0WORLIErrmittm
la, 'Pi of Cho"
FuIl Legal Name (company. municipality, HOA. utility, etc,)
lb. Jeff Vreogdenhil, Director -
Signing Official Name and Title (Please review I 5A NCAC, 2 T for authorized signing officials)
1c The legal entity who will own this system is:
0 individual 71 Federal 0 Municipality F7 SlatetCounty [3 Private Partnership 0 Corporation77 Other (specify).
199
Mailing Address
le. Clinton
City
lf North Carolina I g 28329
- - — - -------- --
State Zip Code
Ih- 910-29"905
Telephone Facsimile
2 ProJect tF&ciidvl Information:
2a Yftit on Sunset Subdivision 2b
Brief Project Name (permit will refer to this name)
3. Contact Pemon:
yTyqclerihilglcityotc►n us._._
E-mail
meson
County Where Project is Located
3a, Gone B. Cobb, P, E
Name and Affiliation of Someone Who Can Answer Cluestions About this Application
3b, 919-2W9M . ........ . 3c, pne [e-mail]
Phone Number E-mail
1 Project is 0 New Modification (of an existing perrnit) If Modification, Permit No,-
2. Owner is El Public (sko to kwn 8(3)) Private (go to Item 2(a))
2a, If private, applicant will be. 2b. It sold, facilities owned by a (must choose gng)
El Retaining Ownership (ie, store. church, single office, etc.) or E,] Public Utility (instruction D)
Leasing units (lots, townhomes, etc, - skip to Item, 8(3)) F1 Homeowner Assoc,]Developer (Instruiatim E)
Selling units (lots, townhorries, etc - go to Itom 8(26))
3, Owner
of Clinton
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
4a. Norman H. Larkins WPCF 4b, NC 0020117
Name of VVVV7F WWTF Permit No,
Sa, Pity of Clinton_ ITm 8 Inch Gravity 5c.
Owner of Downstream Sewer H$cefvtng Sewer Size LJ Force Main Permit # of Downstream Sewer (instruction F)
6 The origin of this wastewater is (check all that apply),
Residential Subdivision
APartments'Condominrums
Mobile Home Park
School
Restaurant
El Office
Retail (Stores, shopping centers)
Institution
rl Hospital
r_1 Church
Nursing Home
Other (specify)
.% Other
(Attach Description)
(Attach Description)
7, Volume of wastewater W_0#At2otqd 11
gL9grmiA-. J.AW 0, llgaons per dayM, for this particular project
*Do not include future fie" or previously permitted allocation*
8,. If the permitted flow is zero, indicate why
i I Pump Station, Outfall or Interceptor Line where flow will be permitted in subsequent permits that connect to this fine
Flow has already been allocated in Permit No
Rehabilitation or replacement of existing sewer with no new flow expected
(see NCA C 02 T rU11K3 to dieter me 4 a permit is required)
FTA 08- 13 APPLICATION Pap ,r 4 ot'6

low,
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B. Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC,2T,,C 114 for
the value in Item 8(7) ANDIO the design flow for line or pump station sizing if a reduced or zero 46Wis- W­-n"g'requW—ed in
Item B(7), Values other than ftl in I SA NCAC 2T 0114 (b) and (c) must be suppodW with actual water or wastewater use
data in accordance with I SA NCAC 2T 0114 (f)
U6 sit *0
29 lots x.40frapd/residence ='!.jXMf gpd
10 Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches) Length (feet) Now Gravity or Additional
Force Main
8 fftch 1130 Now gravity
11 Summary of Pump Stations wl associated Force Main$ to be Permitted (attach additional sheets as necessary)
Pump Station Location 10: (self chosen - as shown on plan reap for reference)
Longitude: Latitude-,
Design Flow Power Reliability Option
(MGD) Operational Point GPM @TDH I - Permanent generator w1ATS; Force Main Size Force Main Length
2 - portable generator w/MTS
Pump Station Location 10- (soft chosen - as shown on plans/map for reference)
Longitude:
Latitude:
Design Flow Otional Power Reliability Option
pera
(MGD) Point I - permanent generator w1ATS; Force Main Size Force Main Length
GPM @TDH 2 - portable generator w/MTS
12. Will the wastewater flow in the proposed sewer tines or pump stations be able to be directed to another treatment facififty?
[I Yes E No If Yes, permit number of 2' treatment facility �
(RO - if -yes` to B. 12 please contact the Central Office PERCS Unit)
13. Does the sewer system Compty with the aft% D'
ff-peril erla tr the Permltt,�r -, �Ypu�m St
(latest version), the Grav Sewer Mmmual Desqr, -r4eri
-MA LAgp-te—r2 T as applicable?
(latest version) and !,,5A N_C
23 Yes 0 No If No, please reference the pertinent minimum design criteria or regulation and indicate why a
variance is requested. SUBWT MO COPIES OF PLANS, SPECIFICATIONS OR CALCULATtM
PERTINENT TO THE VARIANCE VATH YOUR APPLICATION
H A 08- 1 8 A ITI AC A T 10'%.' Page 5 of 6

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
® N/A
Sedimentation and Erosion Control Plan?
® Yes
❑ No
❑ N/A
Trout Buffer Waiver?
❑ Yes
❑ No
® N/A
Stormwater?
❑ Yes
❑ No
® N/A
15. Does this project include any high priority lines (15A NCAC.U2T_ 0402s•2J) involve aerial lines, siphons, or interference
manholes)? Thm sins will be considenKf high priority and must be checked once ewry six months
Check if Yes: ❑ and provide details:
T 1. Owner/Permittee's Certification: (Signature of Signing Official and Project Name)
i, Jeff Vreuodenhil attest that this application forVillaae on Sunset Subdivision
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 143-215.68 any person who knowingly makes any false statement, representation, or certification
in any application shall be guilty of a Clameanor, which may include a fine not to exceed $10,000 as well as civil
penalties up to;; 000,WviolatioW ss 2
ignature Date
ENGINEERING DESIGN DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL OF THIS
APPLICATION. THESE DOCUMENTS MUST INCLUDE PLAN AND PROFILE OF SEWERS, THEIR PROXIMITY
TO OTHER UTILITIES, DESIGN CALCULATIONS, ETC. REFER TO 15A NCAC 02T .0305
Z
O
2. Professional Engineer's Certification: (Signature of Design Engineer and Project Name)
V I, Gene B. Cobb attest that this application for Village on Sunset Subdivision
L _ 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
W Design Critede for Gravity Sewers adopted February 12, 1996, and the Minimum Design Criteria for the Fast -Track
V Pe►mitting of Pump Stations and Force Mains adopted June 1, 2000 and the watershed classification in accordance with
C.i 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._68, 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. Gene B. Cobb
Professional Engineer Name
2b. Triangle Civilworks, P.A.
Engineering Firm
2c, 211 Tyler Drive 5j
Mailing Address V/ 3rl
2e. NC 2f. 27577 sjl'=`
2d. Smithfield
City State Zip �'�iE 1, Cr�L����s
2g. 919-209-9955 2h. 919-209-1045 2i. gene.cobbOtricivil.com
Telephone Facsimile E-mail NC PE Seal, Sionature & Data
FTA 08-13 APPLICATION Page 6 of 6

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TRIANGLE CIVILWORKS, P.A.
211 TYLER DRIVE
SMITHFIELD, N.C. 27577
,< [phone]
March 31, 2014
Water Quality Section
North Carolina Department of Environmental and Natural Resources
225 Green Street, Suite 714
Fayetteville, NC 27699-1634
Re: Application for Approval of Fast Track Application
Sanitary Sewer System Extensions for Village On Sunset Subdivision
Clinton, North Carolina
Dear sir/madam:
Please find enclosed "Fast Track Application" form for the referenced project.
Also please find a check in amount of $480.00 for the review fee.
The proposed new sanitary sewer extensions will serve a new 29-lot residential
subdivision in Clinton, N.C., and will consist of approximately 1,830 linear feet
of conventional 8-inch gravity sewer lines. These lines will discharge to the
City of Clinton sewer system on Forest Drive (near intersection with NC 24),
and upon satisfactory completion, will be dedicated to the City of Clinton.
Thank you in advance for your review of this submittal and approval, if in
order. If further information or documentation is needed in any way, please do
not hesitate to call on me.
Respectfully yours,
Gene B. Cobb, P.E., P.L.S.
Triangle Civilworks, P.A.
Encls (as noted)
cc: Jeff Vreugdenhil, Director, Dept of Public Works, City of Clinton
George Wilson, Wilson Family Properties
Mary Rose, Clinton -Sampson County Planning Dept

USE THE TAB KEY TO MOVE FROM FIELD TO FIELD (to be Application Number: q
(to be completed by DWR) W (�at�3 �%0
1. Owner/Permittee:
1a. City of Clinton --
Full Legal Name (company, municipality, HOA, utility, etc.)
Z 1 b. Jeff Vreugdenhil Director - Department of Public Works
0 Signing Official Name and Title (Please review 15A NCAC 2T .0106 (b) for authorized signing officials)
H
lc.
The legal entity who will own this system is:
❑ Corporation ❑ Other
❑ Individual ❑ Federal ® Municipality ❑ State/County ❑ Private Partnership (specify):
0
1d.
P. O. Box 199
le. Clinton
LL
Mailing Address
City
Z
1f.
North Carolina
1g. 28329
Z
State
Zip Code
0
1 h.
910-299-4905 1 i. 910-592-3625
1 j. vreugdenhil cityofciinton.us
QTelephone
Facsimile
E-mail
V
2.
Protect (Facility) Information:
J
2a.
Village on Sunset Subdivision
2b. Sampson
aBrief
Project Name (permit will refer to this name)
County Where Project is Located
Q
3.
Contact Person:
3a.
Gene B. Cobb P.E.
Q
About this Application
Name and Affiliation of Someone Who Can Answer Questions
3b.
919-209-9955
3c. [e-mail]
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:
2b. If sold, facilities owned by a (must choose one
❑ Retaining Ownership (i.e. store, church, single office, etc.) or
❑ Public Utility (Instruction D)
❑ Leasing units (lots, townhomes, etc. - skip to Item B(3))
❑ Homeowner Assoc./Developer (Instruction E)
Z
O
F-
O
N.
Z
a
J
❑ Selling units (lots, townhomes, etc. - go to Item B(2b))
3. City of Clinton
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
4a. Norman H. Larkins WPCF 4b. NC 0020117
Name of WWTF WWTF Permit No.
5a. City of Clinton 5b. 8 Inch ®Gravity 5c.
Owner of Downstream Sewer Receiving Sewer Size ❑ Force Main Permit # of Downstream Sewer (instruction F)
6. The origin of this wastewater is (check all that apply):
® Residential Subdivision ❑ Retail (Stores, shopping centers) QO % Domestic/Commercial
❑ Apartments/Condominiums ❑ Institution % Industrial
❑ Mobile Home Park ❑ Hospital (Attach Description)
❑ School ❑ Church
❑ Restaurant ❑ Nursing Home % Other
❑ Office ❑ Other (specify): (Attach Description)
7. Volume of wastewater to be allocated or permitted for this particular project: 11,600 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)
FTA 08-13 APPLICATION Page 4 of 6

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 13(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).
29 lots x 400 gpd/residence = 11,600 gpd
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches)
8 inch
W
D
Z
Length (feet)
1,830
New Gravity or Additional
Force Main
New gravity
H 11. Summary of Pump Stations w/ associated Force Mains to be Permitted (attach additional sheets as necessary)
Z
Pump Station Location ID:
VLongitude:
Z
0
�:.
Design Flow
(MGD)
0
LL.
Z
Z
Pump Station Location ID:
1—
Longitude:
W Design Flow
a' (MGD)
m
(self chosen - as shown on plans/map for reference)
Latitude:
Operational Point Power Reliability Option
GPM @TDH 1 - permanent generator WATS; Force Main Size Force Main Length
2 - portable generator w/MTS
(self chosen - as shown on plans/map for reference)
Latitude:
Operational Point Power Reliability Option
GPM @TDH 1 - permanent generator w/ATS; Force Main Size Force Main Length
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 2"d treatment facility :
(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 Permitting of Pump Stations and Force Mains
(latest version), the Gravity Sewer Minimum Design Criteria (latest version) and 15A NCAC Chapter 2T as applicable?
® 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
FTA OR-13 APPLICATION Page 5 of 6

0VWYATc , State of North Carolina
Department of Environment and Natural Resources
r- Division of Water Quality
fl Flow Tracking/Acceptance for Sewer Extension Permit Applications
(FTSE 06-13)
Project Applicant Name: City of Clinton
Project Name for which flow is being requested: Village On Sunset Subdivision
More than one FTS'E may be required for a single project if the owner of the K'WTP is not responsible for all pump
stations along the route of the proposed wastewater flow.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Norman H. Larkins WPCF
b. WWTP Facility Permit #: NC 002011.7
All flows are in MGD
c. WWTP facility's permitted flow 5.0
d. Estimated obligated flow not yet tributary to the WWTP OS
e. WWTP facility's actual avg. flow 2.7
f. Total flow for this specific request 0.01044
g. Total actual and obligated flows to the facility 3.21
h. Percent of permitted flow used 64.2°l0
11, 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)
(E)=(A-D)
Design
Obligated,
Pump
Average Daily
Approx.
Not Yet
Total Current
Station
Firm
Flow**
Current Avg.
Tributary
Flow Plus
(Name or
Capacity,*
(Firm / pt),
Daily Flow,
Daily Flow,
Obligated
Available
Number)
MGD
MGD
MGD
MGD
Flow
Capacity***
Deer Run
1.09
0.436
0.357
0
0.357
67%
* The Firm Capacity 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.
*** 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.
Page 1 of 1
1=TSE 06-13

Certification Statement:
I Jeff Vreugdenhil 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 11
plus all attached planning assessment addendurns for which I am the responsible party.
Signature of this form indicates accepprice ofAis wastewater flow.
Date
Page 2 of 2
FTSE 06- t 3

FTSE PLANNING ASSESSMENT ADDENDUM (PA A)
Submit a planning assessment addendum for each pump station listed in Section II when; Available
Capacity is < O.
Pump Station (Name or Number):
Given that:
a. The proportion and amount of Obligated, Not Yet Tributary Daily Flow (C) accounts for
% and MGD of the Available Capacity (E) in Pump Station
and that
b. The rate of activation of this obligated, not yet tributary capacity is currently approximately
MC:aD per year; and that
c. A funded CapitalProjectthat will provide the required planned capacity, namely
is in design or under construction with
planned completion in ; and/or
d. The following applies:
Therefore:
Given reasonably expected conditions and planning information, there is sufficient justification
to allow this flow to be permitted, without a significant likelihood of over -allocating capacity in
the system, infrastructure.
I understand that this does not relieve the collection system owner from complying; with G.S.
143-215.67(a) which prohibits the introduction of any waste in excess of the capacity of the
waste disposal system.
Sfgrring Qffacial Signature
Date
Page 3 of 3
FTSE 06-13

Instructions for: Flow Tracking/Acceptance for Sewer Extension Permit Applications (FTSE) and
Planning Assessment Addendum (PAA)
Section I
a. WWTP Facility Name:. Enter the name of the WWTP that will receive the wastewater flow.
b. wWTP Facility Permit #: Enter the NPDES or Non -Discharge number for the Vb'WrP receiving the
wastewater flow.
c. WWTP facility's permitted flow. MGD: From WWTP owner's NPDES or Non -Discharge permit.
d. Estimated obligated flow not yet tributary to the WWTP. MGD: This includes flows allocated to
other construction projects not yet contributing flow to the collection system. Flows allocated through
interlocal agreements or other contracts not yet contributing flow to the collection system are also
included. For POTWs that implement a pretreatment program, include Flows allocated to industrial
users who may not be using all of their flow allocation. Please contact your Pretreatment Coordinator
for inforination on industrial flow tributary to your WWTP.
As of January 15, 2008 the POTW should have reviewed flow allocations made over the last two
years and reconciled their flow records, to the best of their ability, so it is known how much flow has
been obligated and is not yet been. made tributary to the wwrp, in accordance with local policies and.
procedures employed by the reporting entity.
The obligated flow not yet tributary plus actual flow will be reconciled annually for systems at less
than 60% of permitted flow used. Annual updates shall be submitted to the appropriate Regional
Office by January 15 of each year and cover the previous calendar year.
Semi -Annual updates shall be required when the percent of permitted flow used reaches 60%. Serni-
annual time period are defined as January I through June 30 and July 1 through December 31. Semi-
annual updates shall be submitted to the appropriate Regional. Office by July 15 and January 15 of
each year.
Quarterly updates shall be required when the percent of permitted flow used reaches 80nro. Quarters
are defined as Qtrl (Jan -Feb -Mar), Qtr2 (Apr -May -Jun); Qtr3 (Jul -Aug -Sep); Qtr4 (Oct -Nov -Dec).
Quarterly updates shall be submitted to the appropriate Regional Office by April 15, July 15, October
15 and January 15 of each year.
e. WWTP facility's actual avg. flow. MGD: Previous 12 month average.
f. Total flow for this specific request, MGD: Enter the requested flow volume.
g. Total actual and obligated Flows to the facility, MGD Equals [d + e + f]
h. Percent of f)ermitted flow used: Equals [(g! c)*100]
Page 4 of 4
1~TSE 06-1

For example:
On January 15 a POTW with a permitted flow of 6.0 MGD, reported to the Regional. Office that there
is 0.5 MGD of flow that is obligated but not yet tributary. The annual average flow for 2007 is 2.7
MGD. There is a proposed flow expansion of 0.015 MGD.
The first Form FTSE submitted after January 15, 2008 may have numbers like this:
c. = 6.0 MGD
d. = 0.5 MGD
e. = 2.7 MGD
f. = 0.015 MGD
g. = 3.215 MGD
h. = 53.6 %
The next Form FTSE may be updated like this with a proposed flow expansion of 0.102 MGD:
c. = 6.0 MGD
d. = 0.515 MGD
e. = 2.73 MGD
f. = 0.102 MGD
g. = 3.349 MGD
h. = 55.8 %
Each subsequent Form F':l`SE- will be updated in the same planner.
Section H
List the pump station name or number and approximate pump station firm capacity, approximate design
average daily flow (A) approximate current average daily flow (13), and the obligated:, not yet tributary
flow through the pump station (C) for each pump station that will be impacted by the proposed sewer
extension project. Calculate the total current flow plus obligated flow (D=B+C) and the available
capacity (E=A-D). Include the proposed flow for this project with other obligated flows that have been
approved for the pump station but are not yet tributary (C).
Firm capacity is the maximum pumped flow that can be achieved with the largest pump out of service as
per the Minimum Design Criteria.
Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor (pf) of
not less than 2.5.
If the available capacity (I) for any pump station is < 0, then prepare a planning assessment for that pump
station if the system has future specific plans related to capacity that should be considered in the
permitting process.
Pump Station
(Name or Number)
Kaw Creek. PS
Valley Road PS
(A)
Design
Firm Average
Capacity Daily Flow
MGD (Firm ? pf)
0.800 0.320
1.895 0.758
(B)
.Approx.
Current Avg.
Daily Flow,
MGD
0.252
0A72
Rage 5 of 5
(C)
(D)=(B+C)
(E)=(A-D)
Obligated,
Not Yet
Total Current
Tributary
Flow Plus
Daily Flow,
Obligated
Available
MGD
Flow
Capacity*
0.080
0.332
-0.012
0.135
0.607
0.151
FTSE 06-13

Planning Assessment Addendum Instructions
Submit a planning assessment addendum for each pump station listed in Section 11 where available
capacity is < O.
A planning assessment for Kaw Creek PS (see example data above) may be performed to evaluate
whether there is significant likelihood that needed improvements or reductions in obligated flows will be
in place prior to activating the flows from the proposed sewer extension project.
If the system decides to accept the flow based on a planning assessment addendum, it is responsible to
manage the flow without capacity related sanitary overflows and must take all steps necessary to
complete the project or control the rate of flow to prevent sanitary sewer overflows.
The planning assessment may identify, a funded project currently in design or construction, or a planned
project in the future not yet funded but in a formal plan adopted by the system. The system should
carefully weigh the certainty of successful timely project completion for any expansion, flow
management diversion or infiltration and inflow elimination projects that are the foundation of a planned
solution to capacity tracking and acceptance compliance.
For example:
Given that:
a. The proportion and amount of obligated, not yet tributary flow accounts for 24 % and 0.080
MGD of the committed flow in Pump Station law Creek; and that
b. The rate of activation of this obligated, not yet tributary capacity is currently approximately 0,01
MGD per year, and that
c. A funded capital project that will provide the required planned capacity, namely
is in design or under construction with
planned completion in ; and/or
d. The following applies:
The master ._plan and ten year capital plan contain recommended scope and funding for a capital project
entitled :Kaw C reek Pump Station upgrade with funding planned in July 2014. Thisprojectis planned to
add 0.100 MGD to the firm capacity of the pump station by October 2015 Inclusion of this ,proposed
capital project as a condition of this Flow 'Tracking/A.ccolAnce for Sewer Extension Permit Application
elevates this project's priority .for funding and construction to be implemented ahead of the activation of
obligated, not vet tributaraiiows in amounts that exceed the firm pump station capacities identified in
Section 11 above.
'Therefore:
Given reasonably expected conditions and planning information, there is sufficient justification to allow
this flow to be permitted, without a significant likelihood of over -allocating capacity in the system
infrastructure.
Page 6 of
FTSE 06-13

DENR-FRC
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD
Application Number:
(to be completed by DWR)
1.
Owner/Permittee:
IWO
1a.
City of Clinton
Full Legal Name (company, municipality, HOA, utility, etc.)
Z
1 b.
Jeff Vreugdenhil Director - Department of Public Works
O
Signing Official Name and Title (Please review 16A NCAC 2T
,0106 1b) for authorized signing officials)
1 c.
The legal entity who will own this system is:
❑ Individual ❑ Federal ® Municipality ❑ State/County ❑
Private Partnership ❑ Corporation ❑ Other (specify):
0
1d.
P. O. Box 199
1e. Clinton
U.
Mailing Address
City
Z
1f.
North Carolina
1g. 28329
Z
State
Zip Code
0
1h.
910-299-4905 1i. 910-592-3625
1j. [e-mail]
QTelephone
Facsimile
E-mail
V
2.
Project (Facility) Information:
J
2a.
Village on Sunset Subdivision
2b. Sampson
CL
Brief Project Name (permit will refer to this name)
County Where Project is Located
CL Q
3.
Contact Person:
3a.
Gene B. Cobb, P.E.
Q
Name and Affiliation of Someone Who Can Answer Questions
About this Application
3b.
919-209-9955
3c. [e-mail]
Phone Number
E-mail
1.
Project is ® New ❑ Modification (of an existing permit)
If Modification, Permit No.:
2.
Owner is ® Public (skip to Item 8(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 D)
❑ Leasing units (lots, townhomes, etc. - skip to Item B(3))
❑ Homeowner Assoc./Developer (Instruction E)
❑ Selling units (lots, townhomes, etc. - go to Item B(2b))
3.
City of Clinton _... _ . -•--
1320
GEORGE E. WILSON FAMILY ENTERPRISES, LLC AT
P.O. BOX 28 as �„ BANKING R& Go pq„ DATE
CLINTON, NC 28329 NORTH CAROLINA
Check Number: 1320 66-112-531 Mar 31, 2014
AMOUNT
Memo: ,
Four Hundred Eighty and 00/100 Dollars $ 480.00
PAY
TO THE
ORDER
OF: NC DENR
GEORGE E. WILSON FAMILY ENTERPRISES, LLC
Az
AUTHORIZED SIGNATURE
_. ._�,............... .. v. vnrouna, JGWGI WILII IIV IICW IIvW CAPT;ULCU
(see 15A NCAC 02T .0303 to determine if a permit is required)
FTA 08-13 APPLICATION Page 4 of 6

Central Files: APS _ SWP
r.
4/17/2014
Permit Number WQ00370'� Permit Tracking Slip
Program Category
Status
Project Type
Non -discharge
Active
New Project
Permit Type
Version
Permit Classification
Gravity Sewer Extension, Pump Stations, & Pressure Sewer Extensions
1.00
Individual
Primary Reviewer
Permit Contact
Affiliation
trent.allen
Coastal SWRule
Permitted Flow
11,600
Facility
Facility Name
Major/Minor
Region
Village on Sunset Subdivision
Minor
Fayetteville
Location Address
County
Sampson
Facility Contact Affiliation
Owner
Owner Name
Owner Type
City of Clinton
Government - Municipal
Owner Affiliation
Jeff Vreugdenhil
Director Public Works
PO Box 199
Dates/Events
Clinton
NC 28328019
Scheduled
Orig Issue App Received Draft Initiated
Issuance Public Notice Issue Effective Expiration
4/17/2014 4/4/2014
.. 4/17/2014
Regulated Activities
Requested /Received Events
Wastewater collection
Additional information requested
4/7/14
Additional information received
4/15/14
Outfall
Waterbody Name
Streamindex Number Current Class
Subbasin