WQ0034121_Application_20090604

(;F W A TAR State of North Carolina
Department of Environment and Natural Resources
cry r Division of Water Quality
n FAST —TRACK APPLICATION
aw
(FTA 12/07 very)
for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
(Pressure & Vacuum sewer systems are not to be included as part of this application package)
INSTRUCTIONS: Indicate that you have included/addressed the following list of required application package items by
checking the space provided next to each applicable item. Failure to submit all required items will lead to your application
being returned as incomplete. Forms are available from the web site or by calling the Regional Office serving your county.
http://h2o. enr. state.nc. us/peres/Collection % 20SystemsICollectionSystemApplications. html
® A. Application Form - Submit one original and one copy of the completed and appropriately executed application
form. The application should include a project narrative describing the final build -out design (i.e. system and/or
pump station to ultimately serve 500 homes, but flow for only 100 homes being requested now). For modifications,
clearly explain the reason for the modification (i.e. adding another phase, changing line size/length, etc.). Only
include the modified information in this permit application - do not duplicate project information that has already
been included in the original permit.
Any changes to this form will result in the application being returned. The Division of Water Quality (Division) will
only accept application packages that have been fully completed with all applicable items addressed. You do not
need to submit detailed plans and specifications unless you respond NO to Item 13(13).
Separate applications should be made for non-contiguous sewer systems.
® B. Application Fee - Submit a check in the amount of $480 made payable to: North Carolina Department of
Environment and Natural Resources (NCDENR). Checks shall be dated within 90 days of application submittal.
❑ C. Certificates of Public Convenience and Necessity — If the application is being submitted in the name of a
privately -owned public utility, submit two copies of the Certificate of Public Convenience and Necessity (CPCN)
which demonstrates that the public utility is authorized to hold the utility franchise for the area to be served by the
sewer extension. If a CPCN has not been issued, provide two copies of a letter from the North Carolina Utilities
Commission's Public Staff that states that an application for a franchise has been received, that the service area
is contiguous to an existing franchised area, and/or that franchise approval is expected. The project name in the
CPCN or letter must match that provided in Item A(2)a of this application.
❑ D. Operational Agreements — Submit one original and two copies of a properly executed operational agreement, as
per 15A NCAC 02T .0115, if the application is submitted by a private applicant and will be serving residential or
commercial lots (e.g., houses, condominiums, townhomes, outparcels, etc.) that will be sold to another entity. If
the applicant is a home or property owner's association, use Form HOA 02/03. If the applicant is a developer,
use Form DEV 02/03. EVEN IF THE PROJECT MAY BE TURNED OVER TO A MUNICIPALITY UPON
COMPLETION, FORM DEV 02/03 IS REQUIRED.
® E. Downstream Sewer, WWTF Capacity and Flow Tracking/Acceptance — FORM FTSE 10/07 (Flow
Tracking/Acceptance for Sewer Extension Permit Applications) is required with every application. The applicant
(and owners of downstream sewers, pump stations and/or treatment facilities submitting FORM FTSE-10/07)
certifies that the addition of the volume of wastewater to be permitted in this project has been evaluated along the
route to the receiving treatment plant, and that the flow from this project will not cause capacity related sanitary
sewer overflows or overburden any downstream pump station en route to the receiving wastewater treatment
plant. Where the applicant is not the owner of the downstream sewer, submit two copies of FORM FTSE 10/07
from the owner of the downstream sewer and owner of the WWTF, if different. The flow acceptance indicated in
FORM FTSE-10/07 must not expire prior to permit issuance and must be dated less than one year prior to the
application date. Submittal of this application and FORM FTSE-10/07 indicates that owner has adequate
capacity and will not violate G.S. 143-215.67(a). Intergovernmental agreements or other contracts will not be
accepted in lieu of project -specific FTSE 10/07.
® F Map — Submit an 8.5-inch by 11-inch COLOR copy of a USGS Topographic Map of sufficient scale to identify the
entire project area and the closest surface waters. Each map or maps must show the location of the sewer line
and pump stations and be of reproducible quality. Include a street level map showing the downstream connection
point, and the permit number for the downstream sewer, if known.
FTA 12/07

® G. Stream Classifications — Watershed Classification Attachment (Form WSCAS-12/07) If any portion of the
• sewersystem project is within 100 feet of any surface water or wetlands, the Watershed Classification Attachment
may need to be completed. A variance must be requested for encroachment within required setbacks or buffers
pursuant to 2T .0305 (f) and be indicated in Item B-13 with supporting documentation/justification provided.
❑ H Environmental Assessments — If this project is subject to an Environmental Assessment (EA) [15A NCAC
01C], this application cannot be used. Send the project application on the most current version of Form
PSFMGSA to the Design Management Unit, 1633 Mail Service Center, Raleigh, NC 27699-1633. Applications
cannot be accepted until a Finding of No Significant Impact (FONSI) or Environmental Impact Statement (EIS)
has been issued. A copy is to be submitted with that permit application.
❑ I. Flow Direction — Many wastewater treatment systems are entering into agreements for regionalization efforts
and emergency treatment capacity. Parts of the system are installed so that the wastewater flow can be directed
to more than one treatment facility. If this is the case with this project, please indicate in B(12) and give the permit
number of the second treatment facility.
® J. Certifications — Section C
The application must be certified by both the applicant and the design engineer who is a North Carolina
Registered Professional Engineer (PE). The applicant signature must match the signing official listed in Item
A(1 b). The PE should NOT certify the application if he/she is unfamiliar with 15A NCAC Chapter 2T, the Gravity
Sewer Minimum Design Criteria (most recent version) and the Minimum Design Criteria for the Fast -Track
Permitting of Pump Stations and Force Mains (most recent version), as applicable to the project.
THE COMPLETED FTA 12107 APPLICATION PACKAGE, INCLUDING ALL SUPPORTING
DOCUMENTS AND $480 FEE, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional Office
2090 US Highway 70
Avery, Buncombe, Burke, Caldwell, Cherokee,
Swannanoa, North Carolina 28778
Clay, Graham, Haywood, Henderson, Jackson,
[phone]
Macon, Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Harnett, Hoke,
Fayetteville, North Carolina 28301-5094
Montgomery, Moore, Robeson, Richmond,
[phone]
Sampson, Scotland
[phone] Fax
Mooresville Regional Office
610 E. Center Avenue
Alexander, Cabarrus, Catawba, Cleveland,
Mooresville, North Carolina 28115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
Raleigh Regional Office
1628 Mail Service Center
Chatham, Durham, Edgecombe, Franklin,
Raleigh, North Carolina 27699-1628
Granville, Halifax, Johnston, Lee, Nash,
[phone]
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
Warren, Wilson
Washington Regional Office
943 Washington Square Mall
Beaufort, Bertie, Camden, Chowan, Craven,
Washington, North Carolina 27889
Currituck, Dare, Gates, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
Wilmington Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
Wilmington, North Carolina 28405
Hanover, Onslow, Pender
[phone]
[phone] Fax
Winston-Salem Regional Office
585 Waughtown Street
Alamance, Alleghany, Ashe, Caswell, Davidson,
Winston-Salem, North Carolina 27107
Davie, Forsyth, Guilford, Rockingham, Randolph,
[phone]
Stokes, Surry, Watauga, Wilkes, Yadkin
[phone] Fax
For more information, please visit our web site at:
http://h2o. enr.state.nc. us/peres/Collection%20Systems/CollectionSystemsHome.html
or contact the Regional Office serving your county.
FTA 12/07

USE THE TAB KEY TO MOVE FROM FIELD TO FIELDI j Application Number:
(to be completed by DWQ) W00034121
J.
Owner/Permittee:
11 a.
Town of Wadesboro
I
Full Legal Name (company, municipality, HOA, utility, etc.)
11 b.
John Witherspoon, Town Manager
0
'
Signing Official Name and Title (Please review 15A NCAC 2T .0106 (b) for authorized signing officials!)
Q
11c.
The legal entity who will own this system is:
El Individual ❑ Federal ® Municipality ❑ State/County ❑ Private Partnership ❑ Corporation ❑ Other (specify):
0
i1 d.
PO Box 697 1 e. Wadesboro
LL
I
Mailing Address City
Z
E1f.
NC 1g. 28170
Z
i
State Zip Code
0
11 h.
704-694-5171 11 i. 704-694-1331 1 j. [e-mail]
1
Telephone Facsimile E-mail
!2.
Project (Facility) Information:
J
Via.
------------------------------
Lennox Drive Sewer Extension
2b. Anson
d
Brief Project Name (permit will refer to this name)
County Where Project is Located
0.
Q
----
3.
------------------------------------------------------------------ -------------------------------------------------------------------------------
Contact Person:
Q;3a.
Wes Carter
Name and Affiliation of Someone Who Can Answer Questions About this Application
� 3b.
704-342-3000
c. [e-mail]
IPhone
Number
E-mail
11.
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))
�a.
If private, applicant will be:
2b. If sold, facilities owned by a (must choose one
❑ Retaining Ownership (i.e. store, church, single office, etc.) or
❑ Public Utility (Instruction C)
❑ Leasing units (lots, townhomes, etc. - skip to Item B(3))
❑ Homeowner Assoc./Developer (Instruction D)
!
❑ Selling units (lots, townhomes, etc. - go to Item B(2b))
�3.
Anson County
ZZ
;
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
�a.
Anson County WWTP 4b. 0041408
Name of WWTF WWTF Permit No.
Pa.
Town of Wadesboro 5b. 10" ® Gravity c. WQCSD 0051
Owner of Downstream Sewer Receiving Sewer Size ❑ Force Main Permit # of Downstream Sewer (Instruction E)
The origin of this wastewater isScheck all that a�ly�
— —
Z
100 % Domestic/Commercial
® Residential Subdivision ❑ Retail (Stores, shopping centers)
j
❑ Apartments/Condominiums ❑ Institution % Industrial (attach
❑ Mobile Home Park ❑ Hospital description.)
❑ School ❑ Church
=L
❑ Restaurant El Nursing Home (RO: contact your Regional Office
a
ElOffice ElOther (specify): Pretreatment staff)
% Other (specify):
7.
Volume of wastewater to be allocated or aermitted for this particular project: 6,840 gallons per day
i
*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
j
permit is required)
FTA 12/07

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).
19 residences x 360 gallons per day = 6,840 gpd
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches)
Length (feet) New Gravity or Additional
_..
Force Main
8
_
3,812 gravity
G
111. Summary of Pump Stations w/ associated
Force Mains to be Permitted (attach additional sheets as necessary)
W
Pump Station Location ID
N/A
(self chosen - as shown on plans/map for reference)
Z
Design Flow
Operational Point
Power Reliability Option
Z
(MGD)
GPM @TDH
1 - permanent generator w/ATS; Force Main Size Force Main Length
O
j
2 - portable generator w/MTS
Z!
Q(Pump
Station Location ID
N/A
(self chosen - as shown on plans/map for reference)
Design Flow
Operational Point
Power Reliability Option
(MGD)
GPM @TDH
1 -permanent generator w/ATS; Force Main Size Force Main Length
Q
2 - portable generator w/MTS
H
I
W
IL
m 1
2. Will the wastewater flow in the proposed sewer lines or pump stations be able to be directed to another treatment facility?
] Yes ® No If Yes, permit number of 2nd treatment facility
RO — if "yes" to 6,12 please contact the Central Office PERCS Unit)
3. Does the sewer system comply with the Minimum Design Criteria for the Fast Track Permitting of Pump Stations and Force
Mains (latest version), the Gravity Sewer Minimum Design Criteria (latest version) and 15A NCAC Chapter 2T as
applicable?
® 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 12/07

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
Stormwater?
❑ Yes ❑ No ® N/A
15. Does this project include any high priority lines, [see 15A NCAC 02T .0402 (2)] involve aerial lines, siphons, or interference
manholes)? These lines will be considered high priority and must be checked once every six months
Check if Yes: ® and provide details Approximate 25' aerial crossing in order to tie to existing line.
1. Owner/Permittee's Certification: (Signature of Signing Official and Project Name)
1, John Wiitherspoon, attest that this application for Lennox Drive Sewer Extension has been reviewed by me and is
accurate and complete to the best of my knowledge. I understand that if all required pants of this application an: not
completed and that if all requited supporting documentation and attachments are not included, this application package
is subject to being returned as incomplete. Note: In accordance with North Carolina General Statutes 143-215.6A and
143-215.6B, any person who knowingly makes any false statement, representation, or certification in any application
shall be guilty of a ass 2 misdemeanor, which may include a fine not to exceed $10,000 as well as civil penalties up to
$25, 000 per vjgQg6n. % % /i
la. {
Signing 0 A Signature Date
71i
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
Q2. Professional Engineer's Certification: (Signature of Design Engineer and Project Name)
V 1, Blake W. Carterr, attest that this application for Lennox Drive Sewer Extension has been reviewed by me and is accurate,
LL complete and consistent with the information in the engineering plans, calculations, and all other supporting documentation
to the best of my knowledge. I further attest that to the best of my knowledge the proposed design has been prepared in
accordance with the applicable regulations, Gravity Sewer Minimum Design Criteria for Gravity Sewers adopted February
W 12, 1996, and the Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains adopted June
(� 1, 2000 and the watershed classification in accordance with Division guidance. Although other professionals may have
developed certain portions of this submittal package, inclusion of these materials under my signature and seal signifies that
I have reviewed this material and have judged it to be consistent with the proposed design. Note: In accordance with NC
General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement, representation, or
certification in any application shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed $10, 000 as
well as civil penalties up to $25,000 per violation.
2a. Blake W. Carter
Professional Engineer Name
2b. Hobbs, Upchurch & Associates
Engineering Firm
2c. 9140 Arrowpoint Blvd, Suite 120
Mailing Address
2d. Charlotte
City
2g. 704-342-3000
Telephone
2h. 704-342-3077
Facsimile
2e. NC 2f. 28273
State Zip
2i. [e-mail]
E-mail
A R p��
a SEA6� �
%��•' . HG I N�.�'Q���•
�A�
NC PE Seal, Signature & Date
FTA 12/07

�F WATFR State of North Carolina
Department of Environment and Natural Resources
r Division of Water Quality
>
Flow Tracking/Acceptance for Sewer Extension Permit Applications
(FTSE—10/07)
Project Applicant Name: Town of Wadesboro
Project Name for which flow is being requested: Lennox Drive Sewer Extension
More than one MF-10107 maybe require! for a single project if the owner of the WWTP is not responsible for all
pump stations along the route of the proposed wastewaterJlow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Anson County WWTP
b. WWTP Facility Permit #: 0041408
All flows are in MGD
c. WWTP facility's permitted flow 3.5
d. Estimated obligated flow not yet tributary to the WWTP 0.0009
e. WWTP facility's actual avg. flow 1.28
f. Total flow for this specific request 0.0068
g. Total actual and obligated flows to the facility 1.288
h. Percent of permitted flow used 36.8
II. Complete this section for each pump station you are responsible for along the route of this
proposed wastewater flow.
List pump stations located between the project connection point and the WWTP
Pump Station Name Approx. Capacity, MGD Approx. Current Avg.
(Finn/Design) Daily Flow, MGD
Gould's Fork PS 1.300 0.758
Hwy 52 PS 1.500 0.875
III. Certification Statement:
I, Vance Gulledge , certify that, to the best of my knowledge, the addition of the
volume of wastewater to be permitted in this project has been evaluated along the route to the receiving
wastewater treatment facility and that the flow from this project is not anticipated to cause any capacity
related sanitary sewer overflows or overburden any downstream pump station en route to the receiving
treatment plant under normal circumstances. This analysis has been performed in accordance with local
established policies and procedures using the best available data. This certification applies to those items
listed above
'boovv/e°in Sections I and II for which I responsible party. Signature of this form indicates
f tew eflo}�+,/ May 28, 2009 ../
Signing Official Signature— Vance Gul ge — Anson County
Anson County Wastewater Treatment Plant Facility
ME County Manager

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Lennox Drive Sewer
Culpepper Creek Town of WadeSbor4
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LEGEND
1- "gym* �.�,� t ';-eew. s-p-+-, . y q� �� �''�e�'s,+� �' °�q k � :,per .»., ` � .«—.. _: t• F e �� �e!`�. +� }y1 �. h',Tu'pk+.
/;/V Existing GM
Lennox GM
"� �,��"�- ap � �d �� Vk '3,txt � w,..,r..i E � � s 1 • p+ 's t �i:�.aT --^i.....-`- �µ+F,�,,�
Exist Manholes
_„r ,...��� - 'i��1 r® '-w'= Lennox Manholes
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• � `�� k`4 Fes. .,� --,yip � _"' _a°°('a� "�t - 1�� wMe }� 1
�t�wx � "'`�-s; �" ' - q � €d " ! """' �' � � ,� �� �,x.•+. •��,.'' 250 125 0 250 500 750
Feet
s.. _`...r re4 , 'ss.,�s.d f r �, *.t.�?T +mod. • fT s,-• CIF ��
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N:\PROPOSALS\CLIENTS\Wadesboro\Lennox Drive Sewer

FORM WSCAS-12/07
WATERSHED CLASSIFICATION ATTACHMENT
FOR SEWER SYSTEMS
\o��F W ATF9OG
r
Applicant Name
Project Name
Town of Wadesboro
Lennox Drive Sewer Extension
Professional Engineer Name
Engineering Firm Name
Blake W. Carter
Hobbs, Upchurch & Associates, P.A.
Location
ID
Name of Waterbody'
County
River
Basin
Waterbody Stream
Index No.
Waterbody
Classification
1
Culpepper Creek
Anson
Yadkin
13-20-15-2
C
' If unnamed, indicate "unnamed tributary to X", where X is the named waterbody to which the unnamed tributary joins.
I certify that as a Registered Professional Engineer in the State of
North Carolina that I have diligently followed the Division's instructions
for classifying waterbodies and that the above classifications are
inclusive of the stated project, complete and correct to the best of my
knowledge and belief.
PE Seal, Signature and Date
*** END OF FORM WSCAS-12/07 ***
FORM: WSCAS-12/07 Page 1 of I

Name of Stream
Description
Curr. Class
Date
Basin
Stream Index #
Cabbage Branch
From source
to
Brown
C
09/01/74
Yadkin
13-20-14
Creek
Goulds Fork
From source
to
Brown
C
09/01/74
Yadkin
13-20-15
Creek
Rocky Ford Creek
From source
to
Goulds
C
09/01/74
Yadkin
13-20-15-1
Fork
Culpepper Creek
From source
to
Goulds
C
09/01/74
Yadkin
13-20-15-2
Fork
Grindstone Branch
From source
to
Goulds
C
09/01/74
Yadkin
13-20-15-3
Fork
Palmetto Branch
From source
to
Brown
C
09/01/74
Yadkin
13-20-16
Creek
Canal Branch
From source
to
C
09/01/74
Yadkin
13-20-16-1
Palmetto Branch
Ingold Pond
Entire pond
and
C
09/01/74
Yadkin
13-20-16-1-1
connecting stream to
Canal Branch
Gaddys Goose
Entire ponds and
C
09/01/74
Yadkin
13-20-16-1-2
Ponds
connecting stream to
Canal Branch
Hurricane Creek
From source
to
Brown
C
09/01/74
Yadkin
13-20-17
Creek
Flat Fork
From source
to
Brown
C
09/01/74
Yadkin
13-20-18
Creek
Rushing Branch
From source
to
Brown
C
07/01/73
Yadkin
13-20-2
Creek
Black Jack Branch
From source
to
Brown
C
07/01/73
Yadkin
13-20-3
Creek
Big Branch
From source
to
Brown
C
07/01/73
Yadkin
13-20-4
Creek
Key Branch
From source
to
Big
C
07/01/73
Yadkin
13-20-4-1
Branch
Kelly Branch
From source
to
Big
C
07/01/73
Yadkin
13-20-4-2
Branch
Lick Creek
From source
to
Brown
C
09/01/74
Yadkin
13-20-5
Creek
Swans Branch
From source
to
Brown
C
07/01/73
Yadkin
13-20-6
Creek
Ledbetter Branch
From source
to
Brown
C
07/01/73
Yadkin
13-20-7
Creek
Little Brown
From source
to
Brown
C
09/01/74
Yadkin
13-20-8
Creek
Creek
Leggett Branch
From source
to
Little
C
09/01/74
Yadkin
13-20-8-1
Brown Creek
Haileys Branch
From source
to
Brown
C
07/01/73
Yadkin
13-20-9
Creek
Cedar Creek
From source
to
Pee Dee
C
09/01/74
Yadkin
13-21
River
Turkey Top Creek
From source
to
Pee Dee
WS-IV
08/03/92
Yadkin
13-24
River
Page 3 of 6
2009-05-23 05:26:37

Hobbs, Upchurch & Associates, P.A.
Consulting Engineers
June 2, 2009
NC DENR
Division of Water Quality
Non -Discharge Permitting Unit
225 Green St, Suite 714
Fayetteville, NC 28301-5094
Re: Lennox Drive Sewer Extension
Town of Wadesboro
Anson County, NC
HUA Project ID: WB0901-315
To whom it may concern:
Please review this Fast Track application submittal for the above referenced project.
The project will include approximately 3,812 If of 8" gravity sewer line and
miscellaneous appurtenances to extend sewer service to the project area. The
project was designed to meet all requirements contained in the 15A NCAC Chapter 2T
Minimum design requirements for gravity sewer.
Attached to this letter are the following documents:
• Fast Track Application
o Form FTA 12/07 (1 original, 1 copy)
o Form FTSE 10/07 (1 original)
o Form WSCAS 12/07 (1 original)
• $ 480.00 check for Application Fee
• Project Map
If there are any questions about this application, please do not hesitate to call me in
our office at 704-342-3000.
Sincerely,
HOBBS, UPCHURCH & ASSOCIATES, P.A.
Blake "Wes" Carter III, P.E.
Project Manager
Charlotte, NC • Telephone [phone] • Fax [phone] • e-mail: [e-mail]
Southern Pines • Nags Head • Charlotte • Beaufort 9 Wilmington

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USE THE TAB KEY TO MOVE FROM FIELD TO FIELD! Application Number:
(to be completed by DWQ)
:1.
Owner/Permittee:
11 a.
Town of Wadesboro
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Full Legal Name (company, municipality, HOA, utility, etc.)
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0
1 b.
John Witherspoon, Town Manager
Signing Official Name and Title (Please review 15A NCAC 2T .0106 (b) for authorized signing officials!)
1 c.
The legal entity who will own this system is:
❑ Individual ❑ Federal ® Municipality El.-State/County ❑ Private Partnership ❑ Corporation ❑ Other (specify):
O ''
jil d.
PO Box 697 1 e. Wadesboro
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Mailing Address City
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—
�1f.
-..__ — .__. - . __—
NC 1 28170
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State Zip Code
1 h.
704-694-5171 11 i. 704-694-1331 1 . wade-sboro-*[e-mail]
Telephone I Facsimile E-mail
V12.
Proiect (Facility) Information:
J
�2a.
Lennox Drive Sewer Extension �2b. Anson
a
Brief Project Name (permit will refer to this name) County Where Project is Located
- -------------------
13.
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Contact Person: — —
a13a.
Wes Carter
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Name and Affiliation of Someone Who Can Answer Questions About this Application
13b.
704-342-3000
3c. [e-mail]
Phone Number
I E-mail
i1.
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
I{
❑ Retaining Ownership (i.e. store, church, single office, etc.) or
❑ Public Utility (Instruction C)
❑ Leasing units (lots, townhomes, etc. - skip to Item B(3))
❑Homeowner Assoc./Developer (Instruction D)
❑ Selling units (lots, townhomes, etc. - go to Item B(2b))
3.
Anson Count
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Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
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Anson County WWTP 4b. 0041408
�4a.
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Name of WWTF iWWTF Permit No.
5a.
Town of Wadesboro 5b. 10" ® Gravity 5c. WQCSD 0051
Owner of Downstream Sewer Receiving Sewer Size ❑Force Main Permit # of Downstream Sewer (Instruction E)
LL
6.
The origin of this wastewater is check all that apply).
® Residential Subdivision
[:1 Retail (Stores, shopping centers)
100 % Domestic/Commercial
❑ Apartments/Condominiums
❑ Institution
% Industrial (attach
n hAnhilP Hnmp Park
n HoSDital
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HOBBS UPCHURCH & ASSOCIATES PA
CHARLOTTE ACCOUNT
PO BOX 1737
SOUTHERN PINES, NC 28388
PAY
TO THE (
ORDER
FOR
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DATE L-e _ ` ` C
BB&T
BRANCH BANKING AND TRUST COMPANY
SOUTHERN PINES, NORTH CAROLINA

1110
66-112/531
88507
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HOBBS UPCHURCH & ASSOCIATES PA
CHARLOTTE ACCOUNT
PO BOX 1737
SOUTHERN PINES, NC 28388
11 PAY
TO THE
ORDEJR OF t
L' ' i t
DATE b. I J
1110
66-112/531
88507
$ '-t i `1
=UIILLARS
BRANCH BANKING AND TRUST COMPANY
SOUTHERN PINES, NORTH CAROLINA
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® FOR

Central Files: APS SWP
06/16/09
Permit Number WQ0034121 '- Permit Tracking Slip
Program Category
Non -discharge
Permit Type Track
Gravity Sewer Extension, Pump Stations, & Pressure Sewer
Extensions
Primary Reviewer
trent.allen
Coastal SW Rule
Permitted Flow
6840
Facility Name
Lennox Drive Sewer Extension
Location Address
Owner
Status
Project Type
Active
New Project
Version
Permit Classification
1.00
Individual
Permit Contact Affiliation
Major/Minor Region
Major Fayetteville
County
Anson
Facility Contact Affiliation
Owner Name
Owner Type
Town of Wadesboro
Government - Municipal
Owner Affiliation
John Witherspoon
Manager Town
PO Box 697
Wadesboro NC 28170
Dates/Events
Scheduled
Orig Issue App Received Draft Initiated Issuance
Public Notice Issue Effective Expiration
06/16/09 06/04/09
06/16/09 06/16/09
Regulated Activities
Requested/Received Events
Wastewater collection
Additional information requested
Additional information received
Outfall NULL
Waterbody Name Stream Index Number Current Class Subbasin