WQ0023532_Application (FTSE)_20040123

iiT-TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 1
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD! (toApplication
be c Number:
(to be completed by DWQW4 QO43 53 .�
1. Owner
la. Town of Spring Lake
Full Legal Name (company, municipality, HOA, utility, etc.)
z 1 b. Ethel T. Clark. - Mayor
Signing Official Name and Title (Please review 15A NCAC 2H .0206(b) for authorized signing officials!)
Q 1 c. The legal entity who will own this system is:
0 Individual ❑ Federal ® Municipality 0 State/County 0 Private Partnership ❑ Corporation 0 Other (specify):
1 d. P.O. Box 617 le. Spring Lake
Street Address
U.
Z 1f. North Carolina
State
0 lh. [phone] li. [phone]
Telephone Facsimile
0 2. Project (Facility) Information:
2a. McCauley Retail Center - NC 87
a Brief Project Name (permit will refer to this name)
< 3. Contact Person:
3a. P. Scott Beasley, P.E. - Crawford Design Company
PAY
TO THE
ORDER
OF:
McCAULEY & McDONALD INVESTMENTS, INC.
P.O. BOX 361
FAYETTEVILLE, NC 28302-0361
PH. [phone]
NCDENR
Sewer Permit
City
1 g. 28390
1 j.
Zip Code
E-mail
2b. Cumberland
County Where Project is Located
sear
BRANCH BANKING 8 TRUST COMPANY
FAYETTEVILLE, NC
l 80646 l4 .ru ' L"J"
001,
i.ng_ Lake ,_11C w.=. ,—�
LLJ
0
m
❑ Mobile Home Park
❑ School
❑ Restaurant
❑ Office
66-112/531 13488
DATE
AMOUNT
$ 400 .00*****************
❑ Hospital
❑ Church
❑ Nursing Home
®Other (specify): retail center
7. Volume of wastewater to be permitted in this project: 915 gallons per day
8. If the permitted flow is zero, indicate why:
❑ Interceptor Line - Flow will be permitted is subsequent permits that connect to this line
❑ Flow has already been allocated in Permit No.
0 Rehabilitation or replacement of existing sewer with no new flow expected
% Industrial
Other (specify):

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
FAST -TRACK APPLICATION
for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
(Pressure sewers systems are not to be included as part or this application package)
INSTRUCTIONS: Indicate that you have included the following list of required application package items by checking the
space provided next to each item. Failure to submit all required items will Lead to your application being returned as
incomplete or additional processing and review time. This form may be photocopied for use as an original.
Z I.
Application Form - Submit one original and one copy of the completed and appropriately executed application
form. Any changes to this form will result in the application being returned. The Division of Water Quality
(Division) will only accept application packages that have been fully completed with all applicable items
addressed. You do not need to submit detailed plans and specifications unless you respond NO to Item B(12).
❑ 11. Application Fee - Submit a check in the amount of $400 made payable to: North Carolina Department of
Environment and Natural Resources (NCDENR).
❑ III. Certificates of Public Convenience and Necessity — If the application is being submitted in the name of a
privately -owned public utility, submit two copies of the Certificate of Public Convenience and Necessity (CPCN)
which demonstrates that the public utility is authorized to hold the utility franchise for the area to be served by the
sewer extension. If a CPCN has not been issued, provide two copies of a letter from the North Carolina Utilities
Commission's Public Staff that states that an application for a franchise has been received, that the service area
is contiguous to an existing franchised area, and/or that franchise approval is expected. The project name in the
CPCN or letter must match that provided in Item A(2a) of this application.
❑ IV. Operational Agreements — Submit one original and two copies of a properly executed operational agreement if
the sewer extension will be serving residential or commercial Tots (e.g., houses, condominiums, townhomes,
outparcels, etc.) that will be owned by a homeowners' association or developer (Item B(2b)). If the applicant is a
homeowners' association, use Form HOA 02/03. If the applicant is a developer, use Form DEV 02/03. EVEN IF
THE PROJECT WILL BE TURNED OVER TO A MUNICIPALITY, FORM DEV 02/03 IS REQUIRED.
❑ V. Flow Acceptance Letters — If the owner of the downstream sewers and/or WWTF is different from the applicant,
submit two copies of a flow acceptance letter from the owner of the downstream sewers and WWTF, if different.
Flow acceptance letters must contain the following minimum information: applicant and project name, amount of
flow accepted, and name and permit number of the receiving sewers/WWTF. The flow acceptance must not
expire prior to permit issuance and must be dated less than a year prior to the application date.
Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific flow acceptance
letter.
® VI. Map — Submit an 8.5-inch by 11-inch copy of the portion of a 7.5-minute USGS Topographic Map along with this
form. The map should identify the entire project area location as well 'as the closest downslope surface waters as
clearly as possible. Each map portion must be labeled with the map name and number, the identified location,
and be of clear and reproducible quality. For instance, if the project involves 4 miles of interceptor sewer that
traverses over or near several different waterbodies (or counties, basins, etc.), the map should have location ID's
for each different waterbody (where the sewer line is within 100 feet of such waterbody - see Instruction VII).
❑ VII. Watershed Classifications — Section C
• If any portion of the project is within 100 feet of any down slope surface water, Section C must be completed
for the pertinent sections.
• If the entire project area is a minimum of 100 feet away from any down slope surface waters BUT there is a
pump station involved where a history of power outage is to be used to provide adequate design storage
instead of dual feed or permanent or portable generator, Section C must be completed to demonstrate that
the closest down slope surface water is Class C (see 15A NCAC 2H .0219(h)(3)(D)).
• Use the guidance document entitled, "Determining Watershed Classifications for Form FTA 02/03 (Fast -Track
Sewer Systems)" available from http://h2o.enr.state.nc.us/ndpu or by contacting the appropriate regional
office.
INSTRUCTIONS FOR FORM FTA 02/03

❑ VIII. Environmental Assessments — If this project is subject to an Environmental Assessment (EA) ]15A NCAC
01C .0500], this application can not be used. Send the project application on Form PSFMGSA 10/99 to the
Non -Discharge Permitting Unit, 1617 Mail Service Center, Raleigh, NC 27699-1617. Applications can not be
processed until a Finding of No Significant Impact (FONSI) or Environmental Impact Statement (EIS) has been
issued. A copy is to be submitted with that permit application.
1X. Certifications — Section D
The application must be certified by both the applicant and a North Carolina Registered Professional Engineer
(PE). The applicant signature must match the signing official listed in Item A(1b). The PE should NOT certify the
application if he/she is unfamiliar with 15A NCAC 2H .0200, the Gravity Sewer Minimum Design Criteria (most
recent version) and the Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains
(most recent version), as applicable to the project. Certification by a PE who is unfamiliar with these documents
is subject to NC Board referral.
THE COMPLETED FTA 02103 APPLICATION PACKAGE, INCLUDING ALL SUPPORTING DOCUMENTS AND $400
FEE. SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional Office
59 Woodfin Place
Asheville, North Carolina 28801 A
Ashe 251-6208
(828) [phone] Fax
Avery, Buncombe, Burke, Caldwell,
Cherokee, Clay, Graham, Haywood,
Henderson, Jackson, Macon, Madison,
McDowell, Mitchell, Polk, Rutherford, Swain,
Transylvania, Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Fayetteville, North Carolina 28301
[phone]
[phone] Fax
Anson, Bladen, Cumberland, Harnett, Hoke,
Montgomery, Moore, Robeson, Richmond,
Sampson, Scotland
Mooresville Regional Office
919 N Main Street
Mooresville, North Carolina 28115
[phone]
[phone] Fax
Alexander, Cabarrus, Catawba, Cleveland,
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
Stanly, Union
Raleigh Regional Office
1628 Mail Service Center
Raleigh, North Carolina 27699-1628
g
[phone]
[phone] Fax
Chatham, Durham, Edgecombe, Franklin,
Granville, Halifax, Johnston, Lee, Nash,
Northampton, Orange, Person, Vance, Wake,
Warren, Wilson
Washington Regional Office
943 Washington Square Mall
Washington, North Carolina 27889
[phone]
[phone] Fax
Beaufort, Bertie, Camden, Chowan, Craven,
Currituck, Dare, Gates, Greene, Hertford,
Hyde, Jones, Lenoir, Martin, Pamlico,
Pasquotank, Perquimans, Pitt, Tyrrell,
Washington, Wayne
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, North Carolina 28405
[phone]
[phone] Fax
Brunswick, Carteret, Columbus, Duplin, New
Hanover, Onslow, Pender
Winston-Salem Regional
Office
585 Waughtown Street
Winston-Salem, North Carolina
27107
[phone]
[phone] Fax
Alamance, Alleghany, Ashe, Caswell,
Davidson, David, Forsyth, Guilford,
Rockingham, Randolph, Stokes, Surry,
Watauga, Wilkes, Yadkin
For more information, visit our web site at: http://h2o. enr. state. nc. us/ndpu/
INSTRUCTIONS FOR FORM FTA 02/03

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE 1
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD! Application numoer:
(to be completed by DWQ4.4) p 04 3 5 3Q
1. Owner.
1 a. Town of Spring Lake
Full Legal Name (company, municipality, HOA, utility, etc.)
lb. Ethel T. Clark. — Mayor
z
0 Signing
H lc*The
■
te 1 d. P.O.
Official Name and
legal entity who will
Individual ■ Federal
Box 617
own
►.i
Title (Please review
this system
Municipality
is:
■
15A NCAC
State/County
2H
■
.0206(b) for authorized
Private Partnership
le. Spring Lake
signing officials!)
■ Corporation
■
Other (specify):
0 Street
Z 1 f. North
Address City
Carolina 1 g. 28390
Z State
0 lh. (910)
Zip Code
436-0241 1 i. [phone] 1 j.
1— Telephone
0 2. Project
2a. McCauley
Facsimile E-mail
(Facility) Information:
Retail Center — NC 87 2b. Cumberland
a.
0. Brief
< 3. Contact
Q 3a. P.
Project Name (permit will refer to this name) County Where Project is Located
Person:
Scott Beasley, P.E. — Crawford Design Company
Name
3b. (910)
and Affiliation of Someone Who Can Answer Questions About this Application
221-0033 3c. [e-mail]
Phone
Number E-mail
1. Project
is I4 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.)
Leasing units (lots, townhomes, etc. - skip to Item B(3))
Selling units (lots, townhomes, etc. - go to Item B(2b))
■
■
Public Utility (Instruction 111)
Homeowner Assoc./Developer (Instruction IV)
Z 3. Town
of Spring Lake
Owner
of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
Q 4a. Town
of Spring Lake Sewage Treatment Plant 4b. NC0030970
a Name
of VVWTF WWTF Permit No.
Ce
0 5a. Town
of Spring Lake
5b. 8"
pc. WQ oCi
0I 4
LL
Il Number Downstream Sewer
Z Owner
of Downstream Sewer I Receiving Sewer Size
Permit of
6. The
origin of this wastewater is (check all that apply):
2
WII
a
•
■
Residential Subdivision
Apartments/Condominiums
Mobile Home Park
School
•
•
■
II
Car Wash
Institution 100 % Domestic/Commercial
Hospital % Industrial
Church
m
II
•
Restaurant
■
Nursing Home %Other (specify):
•
Office
0
Other (specify): retail center
7. Volume of wastewater to be permitted in this project: 915 gallons per day
8.
If the
■
■
permitted flow is zero, indicate why:
Interceptor Line - Flow will be permitted is subsequent permits that connect to this line
Flow has already been allocated in Permit No.
• Rehabilitation or replacement of existing sewer with no new flow expected

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 2
9. Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2H
.0219(1) for Item B(7) or the design flow for line or pump station sizing if zero flow in the space below. Values other than
that in 15A NCAC 2H .0219(I)(1-2) must be approved prior to submittal of this application. Submit a separate request to
the Division of Water Quality, Non -Discharge Permitting Unit, 1617 Mail Service Center, Raleigh, NC 27699-1617 in
accordance with 15A NCAC 2H .0219(I)(3).
7,625 s.f. x 120 gal/1000 s.f. = 915 gallons/day
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
or Force
Size (inches) Length (feet) Gra (pull down Main
(P menu)
8 320 Gravity
Gravity
0 Gravity
W
Gravity
Gravity
Z Gravity
0
Gravity
Z ENTER TOTAL UNE LENGTH IN MILES 0.061
0
Q11. Summary of Pump Stations to be Permitted (attach additional sheets as necessary)
2 Power Reliability Option
Location ID Design Flow Operational Point (dual line feed, permanent generator,
O (as shown on plans) (MGD) GPM @ TDH portable generator, wet well storage)
LL
Z
1-
2
W
a' 12. Does the sewer system comply with the Minimum Design Criteria for the Fast Track Permitting of Pump Stations and Force
Mains (latest version), the Gravity Sewer Minimum Design Criteria (latest version) and 15A NCAC 2H .0200 as applicable?
® Yes ❑ No If no, please reference the pertinent minimum design criteria or regulation and indicate why a
variance is requested:
SUBMIT TWO COPIES OF PLANS, SPECIFICATIONS OR CALCULATIONS PERTINENT TO THE VARIANCE WITH YOUR APPLICATION
13. Have the following permits/certifications been submitted for approval?
Wetland/Stream Crossings - General Permit or 401 Certification? ❑ Yes ❑ No ® N/A
Sedimentation and Erosion Control Plan? ® Yes ❑ No ❑ N/A
Stormwater? ❑ Yes ❑ No ® N/A

FAST -TRAC• K APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE 3
1. Use the Division's guidance document entitled, "DETERMINING STREAM CLASSIFICATIONS FOR FORM FTA 02J03
Z (FAST -TRACK SEWER SYSTEMS)" to collect and record the stream classification data below (attach additional sheets as
O necessary). This document is available from our web site or by contacting the appropriate Division of Water Quality
regional office (see instructions for addresses) OR indicate the following:
E—
�j ® A Watershed Classification is not needed because all parts of the project are at least 100 feet away from any down
C� slope waterbody; AND,
tL ® A Watershed Classification is not needed because the design does not depend on wet well storage as a power
reliability option for any pump station near a Class C down slope waterbody.
Cn
• Location ID Name of Waterbody Stream Waterbody
on Map Waterbody County River Basin Index Classification
CI
W
2
f�
W
Submit the 8.5" x 11" topographic map as required in Instruction VI regardless of whether a classification is provided!
1. Applicant's Certification:
1 a.
CO
O 1 attest that this application for McCauley Retail Center 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
E— 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 12, 1996,
and the Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains adopted June 1, 2000
LL. and the watershed class(cation in accordance with Division guidance. Although certain portions of this submittal package
▪ may have been developed by other professionals, inclusion of these materials under my signature and seal signifies that I
have reviewed this material and have judged it to be consistent with the proposed design. Note: In accordance with NC
L I 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
1 attest that this application for McCauley Retail Center 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 retumed as
incomplete. Note: In accordance with North Carolina General Statutes 143-215.6A and 143-215.6B, any person who
knowingly makes any false statement, representation, or certification in any application shall be guilty of a Class 2
misdemeanor which may include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
//.2o/anov
Date
Signing cial Signature
2. Professional Engineer's Certification:
Q well as civil penalties up to $25,000 per violation.
2a. P. Scott Beasley, PE
Professional Engineer Name
2b. Crawford Design Company
Engineering Firm
2c. 914 Hay Street
Address
2d. Fayetteville 2e. NC 2f. 28305 ', a
City State Zip '�'',o�C�j"r 8
°°°°i°nn;lo � /t9
2g. 910-221-0033 2h. 910-221-0035 2i. [e-mail] J
Telephone Facsimile E-mail Seal, Signature & Date
` 00
�'9���'�.

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Grawford dti Company
TO:
Mr. Grady Dobson
TRANSMITTAL
FROM:
P. Scott Beasley, PE
COMPANY:
NCDENR — Division of Water Quality
DATE:
1/21/04
ADDRESS:
225 Green Street, Suite 714
Fayetteville, NC 27301
PHONE NUMBER:
486-1541
PHONE NUMBER:
[phone]
RE:
Fast Track Sewer Application for the
McCauley Retail Center in Spring Lake, NC
FAX NUMBER:
[phone]
0 URGENT ® FOR REVIEW
0 PLEASE COMMENT 0 PLEASE REPLY
COMMENTS:
Mr. Dobson,
Enclosed are the following required items:
• One copy and one original of the Fast Track Application
• $400.00 Permit Application Fee
Please review the application for approval and contact us if you have any questions or require further
information.
Sincerely,
Crawford Design Company
Scott
914 HAY STREET • FAYETTEVILLE, NORTH CAROLINA 28305