WQ0031514_Variance Request_20210527

DU�R
Division of Water Resources
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
15A NCAC 02T .0105 — VARIANCE/ALTERNATIVE DESIGN REQUEST
VADC 10-14 & SUPPORTING DOCUMENTATION
Application Number: _ (if applicable, to be completed by DWR) 1 '
I. APPLICANT INFORMATION:
1. Applicant's name: Cape Fear Public Utility Authority
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State ❑ Municipal ❑ County
3. Signature authority's name: Jeff Theberge per 15A NCAC 02T .0106(b) Title: Engineering Manager
4. Applicant's mailing address: 235 Government Center Drive
City: Wilmington State: NC Zip: 28403-
5. Applicant's contact information:
Phone number: [phone] Email Address: [e-mail]
II. PROJECT INFORMATION:
1. Project name: Parson Mill Subdivision
2. Project status: ❑ Proposed ® Existing (if existing, Permit Number: W00031514 )
III. CONSULTANT INFORMATION:
1. Professional Engineer: J. Phillip Norris. P.E.
Firm: Norris & Tunstall Consulting Engineers. P.C.
Mailing address: 1429 Ash -Little River Raod
City: Ash State: NC Zip: 28420-_
Phone number: [phone] Email Address: pnorris(a.ntengineers.com
IV. VARIANCE REQUEST:
License Number: 1196
1. Provide a detailed list of specific criteria that a variance request is submitted for:
(e.g., NCAC 02T.0305(f) - Separation, MDC for Pump Stations / Force Mains 3.04(A)(1)(b) — Discharge Piping Velocity, etc)
1. Separation: Interference Manhole#4 STA 32+46 (Parson's Mill Drive) due to conflict with 24" stormdrain. Sheet PR5.
2. Separation: Interference Manhole#5 STA 37 + 05 (Parson's Mill Drivel due to conflict with 24" stormdrain. Sheet PRS.
3. Separation: Interference Manhole#8 STA -0 + 17 (Daffodil Drive) due to conflict with 24" stormdrain. Sheet PRE.
FORM: VADC 10-14 Page 1 of 2

Applicant's Certification per 15A NCAC OLT .01004
117,.9M.(pe 1 1.1f: .1Z11JIa ANA6F FZ
(Signature Authority's name & title from Request Item 1.3.)
AP,SoN ,%11�L SuISOlv151o0
(Project name from Request Item 11.1.)
attest that this request for
has been reviewed by me and is accurate and complete to the best of my knowledge. I also understand that if all required parts of
this request package are not completed and that if all required supporting information and attachments are not included, this request
package will be returned to me as incomplete. I understand that by certifying this variance request, I shall adhere to the
requirements of the variance approval should it be approved and all permit conditions should the permit be approved.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.60, any person who knowingly makes any false statement,
representation, or certification in any request 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:
Date: 5'2 512-1
Professional Engineer's Certification:
I, 0 4.4 i l ! drel d5
y� (Professional Engineer's name from Request Item 111.1.)
1 63/4r- tCv1 J ml II St1 dfW1 St P✓!
(Project name from Request Item 11.1.)
attest that this request for
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, in accordance with 1SA NCAC 02T.01051n] will provide; equal or better treatment of the waste;
equal or better protection of the waters of the state; and no increased potential for nuisance conditions from noise, odor, or vermin.
I further attest as been prepared in accordance with this request. package and its instructions, as well as all applicable regulations and
statutes. 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 request 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:
FORM: VADC 10-14 Page 2 of