WQ0041409_Application_20200114

State of North Carolina
JAN 14 2029 Department of Environmental Quality
®r�9ihe Division of Water Resources
D � Division of ll� C ,+ (tyV AC 02T 0300—FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Water u a((
r , r_l! $�T".rTI,?NS 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.
Projects that are, deemed permitted (do not require permit from the Division) are explained in 15A NCAC 02T.0303.
Projects not eligible for review via the fast track process (must be submitted for full technical review):
Projects that require an environmental assessment in accordance with 15A NCAC I C .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;
➢ Pressure sewer systems utilizing septic tank -effluent pumps (STEPS) or simplex grinder pumps;
➢ STEP or simplex grinder pumps connecting to pressurized systems (e.g. force mains);
➢ 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 supportingdocumentation.
A. One Original and One Copy of Application and Supporting Documents
® Required unless otherwise noted
R. 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 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):
I@ 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):
® 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 Secretes of State.
❑ If 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.
® The Project Name in Item 11.1 shall be consistent with the project name on the flow acceptance letters, agreements, etc.
® The Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a North
Carolina licensed Professional Engineer.
® 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 Pagel of 3

E. Flow Tracking/Acceptance Form (Form: FTSE 04-16) (If Applicable):
® 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-
215.67(a).
➢ Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific FTSE.
F. Site Maps (All Application Packages):
M Submit an 9.5-inch x I1-inch color copy of a USGS Topographic Map of sufficient scale to identify the entire project
area and closest surface waters.
➢ Location of the project (gravity sewer, pump stations & force main)
➢ Downstream connection points and permit number (if known) for the receiving sewer
❑ Include a street level map showing general project area.
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'.0I06(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 .0115(a)(I)'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):
❑ HomelProoerty Owners' Associations
❑ Per 15A NCAC '02T .0115(c), submit the properly executed Operational Agreement (FORM: HOA).
❑ 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 (FORM: DEV).
For more information, visit the Division's collection systems website
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,
(828) 29BA500
Macon, Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Anson, Sladen,: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
Raleiah 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 Mail
Beaufort, --.Berta, .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
Stakes, Burry, Watauga, Wilkes, Yadkin
[phone]
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 3 of 3

State of North Carolina
Department of Environmental Quality
DO'_ R Division of Water Resources
15A NCAC 02T.0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: Ut[�j i4I 401
(tobecompleedbyDWR)
All items must be completed or aoglication will be returned
1. APPLICANT INFORMATION:
1. Applicant's name: Town of Southern Pines (company, municipality, HOA, utility, etc.)
2, .Applicant type: ❑ Individual
❑ Corporation ❑ General Partnership
❑ Federal
❑ State/County ® Municipal
3. Signatures authority's name: Brent
Lockamy, P.E. per 15A NCAC 02T .0106(b)
Title: Town Engineer
4. Applicant's mailing address: 140 Memorial Park Court
City: Southern Pines
State: NC Zip: 28387-_
5. Applicant's contact information:
Phone number: (M) 692-1983
Email Address: lockamv(alsouthemoines.net
11. PROJECT INFORMATION:
❑ Privately -Owned Public Utility
❑ Other
1.. Project name: Midland Cottages (Residential Subdivision)
2. Application/Project status: . ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: W000_ and issued date:
If newconstruction but part of a master plan, provide the existing permit number: W000_
3. County whereproject is located:. Moore
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.198314° Longitude:-79.409440
5. Parcel ID (if applicable): 000330889
(or Parcel ID to closest downstream sewer)
111. CONSULTANT INFORMATION:
1. Professional Engineer: Bill Lester Jr., P.E. License Number: 17651
Firm: LKC Engineering. PLLC
Mailing address: 140 Aqua Shed Court
City: Aberdeen State: NC Zip: 28315-_
Phone'number: [phone] Email Address: bill(a).lkcengineering corn
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
Facility Name: Moore County Water Pollution Control Facility Permit Number: NC 0037508
Owner Name: Moore County
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. PermitNumber(s): WQR237073
System Wide Collection System Permit Number(s) (if applicable): WQCS_
Owner Name(s): Town of Southern Pines
FORM: FTA 04-16 Page 1 of 5

VI. GENERAL REQUIREMENTS
1:. 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: HOA) been attached?
Yes []No ®N/A
4. Origin of wastewater: (check all that apply):
® Residential Owned
❑ Retail (stores, centers, malls) El 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: 1Q0%Domestic/Commercial %Commercial
_ % Industrial (See 15A NCAC 02T .0103(20))
"is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .01 14(t)?. []Yes ®No
D If yes. orovide a cony of flow reduction approval letter
7. Summarize wastewater generatedby project:
Establishment Type (see 02T.01140
Daily Design Flow"gib
No. of Units
Flow
Residential Lots (36)
120 gaVbedroom
36
12,960 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
12,960 GPD
a See 15A NCAC 02T .0114(b). (d). (e)(1). and (e)(2) 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.0114j shall
be determined using available flow data, water using fixtures; occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 12960 GPD (per 15A NCAC 02T..0114)
D 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 has already been allocated in Permit Number: _
❑ Rehabilitation or replacement of existing sewer with no new flow expected
El Other (Explain): _
FORM: FTA 04-16 Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers)f
1. Summarize gravitysewer to be permitted:
Size (inches)
Length (feet)
Material
B
560
DIP
8
892
PVC
Section li &Ill 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)
D Oversizing lines to meet minimum slope requirement is not allowed anda. violation of the MDC.
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) '--02T .0305 & MDC'(Pum) Stations/Force Mains):
COMPLETE FOR EACH PUMP. STATION INCLUDED IN THIS PROJECT
L Pumpstation. 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):_ gallons 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 15A NCAC 02T.0305(h)(1):
❑ 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
➢ 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.
D 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 .0305(f) & (g) ® Yes ❑ No
D 15A NCAC 02T.0305(f) contains minimum senaratinns that chall he nrnv(dnd fhr ca..,ar aucta,,,c-
SetbackParameter*
Separation Reuired
.Storm sewers and other utilities not listed below ( vertical
24inches
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 waterlines horizontal - reclaimed over sewer
2feet
**Any. private or public water supply source, including any wells, WS-1 waters of Class I or
Class 11 impounded reservoirsused as a source of drinking water
100 feet
**Waters classified WS (except WS-1 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 ground water lowering and surface drainage
ditches
10 feet
Anv building foundation
5 feet
Any basement
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
- Drainage systems and interceptor drains
5'feet
Any swimming pools
10 feet
Final earth ggrade vertical
36 inches
15A NCAC 02T.0305(g)'contains alternatives where separations in 02T.0305(fl cannot be achieved.
**Stream classifications can be. identified using the Division's NC Surface Water Classifications weboage
➢ 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
Seethe Division's draft separation requirements for situations where separation cannot be meet
D No variance is required if the alternative design criteria specified is utilized in design and construction
D As built documents should reference the location of areas effected
3. Does the project comply with all setbacks found in the river basin rules per 15A NCAC 02B .0200? ® Yes ❑ No
➢ This would include Trout Buffered Streams per 15A NCAC 26.0202
4. Does the project comply with an individual 404 Permit or any 401 Certifications? ® Yes ❑ No
Wetland -related permits shall be requested, obtained, and adhered to for projects that impact wetlands or surface waters
D 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 I5A NCAC 02T.0402, "high -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
➢ 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(2)(5) or the permitee's individual System -Wide Collection permit.
FORM: FTA 04-16 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted. system comply with 15A NCAC 02T the Minimum Design Criteria for the Per]
and Force Mains (latest version). and the Gravity Sewer Minimum Design Criteria (latest version) as
®Yes [I No
If No, complete and submit the Variance/Altemative.Design Request application (VADC I0-14) and supporting documents
for review. Approval of'the request is reauired prior to submittal of the Fast Track Application and supportiriff
documents:
2. Professional Engineer's Certification:
1, I:Dt l( 1-�4&z- �i'. � _ attest that this application for
(P�rofe�ssioonyal Engineer's name from Application Item 111.1.)
has beeen reviewed by nte, a 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. 1 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 shallbe 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.
' .a..:e.
North Carolina Professional Engineer's seal, signature, and date:
0
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I Brent Lockamy attest that this application for
(SignatureAuthority's- name & title from Application Item 1.3.)
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. Iwill 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 143-215.66, 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:_ Date: 3-23-18
FORM: FTA 04-16 Page 5 of 5

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: Black Point Development, LLC
Project Name for which flow is being requested: Midland Cottages Sewer Ext.
More than one FTSE maybe required for a 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 are the owner of the wastewater treatment plant
a. WWTP Facility Name: _
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
All flows are in MGD
0.01296
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) (E)=(A-D)
Design
Obligated,
Average
Approx.
Not Yet
Total Current
Pump Station Firm Daily Flow**
Current
Tributary
Flow Plus
(Name or Capacity, * (Firm / pt),
Avg. Daily
Daily Flow,
Obligated Available
Number) MGD MOD
Flow, MGD
MGD
Flow Capacity***
WarriorWoods 1.33 0.53 0.144 0.299 0.443 0.09
* 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.
Downstream Facility Name (Sewer): Town of Southern Pines -
Downstream Permit Number:
Page 1 of 6
FTSE 04-16

III. Certification Statement:
I Brent Lockamy, P.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 indicates acceptance of this wastewater flow.
3-23-18
Signing Official Signature Date
Page 2 of 6
FTSE 04-16

@H%F—G .lviziJ
Qr uV
FEES 2 6 20 J State of North Carolina
( t�ll4 y Department of Environmental Quality
r� Division of Water Resources
it
Misiou of Water Resources ECi-ifi'APce for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: Town of Southern Pines
Project Name for which flow is being requested: Midland Cottages
More than one FTSE may be required for a 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 are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Moore County Water Pollution Control Facility
b. WWTP Facility Permit #: NC 0037508
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
All flows are in MGD
10.000
.66314
4.366
0.01296
5.04
50.4
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) (E)=(A-D)
Design
Obligated,
Pump
Average Daily
----,V-pprox:
Not Yet-
Total Current
Station
Firm Flow"*
Crurent Avg.
Tributary
Flow Plus
(Name or
Capacity, * (Firm / pt),
Daily Flow,
Daily Flow,
Obligated Available
Number)
MGD MGD
MGD
MGD
Flow Capacity***
SP #4 5 2 1.048 .027 1.075 .925
* 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.
Downstream Facility Name (Sewer): Moore County Water Pollution Control
Downstream Permit Number: WQCS00034
Page 1 of 6

January 8, 2020
Ms. Trent Allen, PE
NCDENR Fayetteville Regional Office
225 Green Street, Suite 714
Fayetteville, NC 28301
Re: Town of Southern Pines
Cottages at Midland
Fast Track Sewer Extension Application
LKC Project No.: Rok-15.01
Ms. Henson,
JAN 14 2020
7AYCT, C-tgJWQR0S
In regards to the above referenced project, please find the following items:
1. One original & one copy of the Fast Track Application Package (Including all applicable
USE forms & site maps)
2. One application fee check for $480.00
The project includes the installation of approximately 1,452 feet of 8-inch PVC and DIP gravity
sewer to serve the residents of Midland Cottages as a part of the residential development
located off Talamore Drive. The new gravity sewer will connect to existing gravity sewer serving
the Subdivision, permitted and certified under Permit No. WQ0037073.
If you have any questions, please do not hesitate to contact me at [phone] or by email at
[e-mail].
Sincerely,
LKC Engineering, PLLC
Jackson Maples, E.I.
LKC Engineering, PLLC, 140 Aqua Shed Court, Aberdeen, North Carolina 28315
PH: 910/420-1437 * FAX: [phone] * License No. P-1095

F
LEGEND
1 4 Q Midland Cottages Construction Area
MIDLAND COTTAGES N
LKC MOORE COUNTY, NC WE
LKC ENGINEERING, PLLC USGS TOPOGRAPHIC MAP 3

State of North Carolina
Department of Environmental Quality
QWR Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APgIACATION
Division of Water Resources FTA 04-16 & SUPPORTING DOCUMj*AJJ0rit 9Y
e
Application Number:
(to be completed by DWR)
All items must be completed or the application will be returned JAN 14 2020
I. APPLICANT INFORMATION:
I. Applicant's name: Town of Southern Pines (company, municipality, HOA, utility, etc.)���`=+
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ® Municipal ❑ Other
3. Signature authority's name: Brent Lockamy. P.E. per 15A NCAC 02T .0106(b)
Title: Town En tg'nceer
4. Applicant's mailing address: 140 Memorial Park Court
City: Southern Pines State: NC Zip: 28367-_
5. Applicant's contact information:
Phone number: 910) 692-1_9833 Email Address: lockamy(la,southernpines.net
IL PROJECT INFORMATION:
I. Project name: Midland Cottages (Residential Subdivision)
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: W000_ and issued date:
If newconstruction but part of a master plan, provide the existingpermit number: WQ00_
3. County where project is located: Moore
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.198314° Longitude:-79.402440
5. Parcel ID (if applicable): 000330889
(or Parcel ID to closest downstream sewer)
Ill. CONSULTANT INFORMATION:
I. Professional Engineer: Bill Lester Jr.. P.E. License Number: 17651
Firm:. LKC. Engineering PLLC.
LKC ENGINEERING, PLLC .
PO Box 888
Aberdeen, NC 28315
[phone]
PAY TO THE
ORDER OF L11i.
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FOR
7852
DATE— I' C) 6q-358/531
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DOLLARS

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JAN 14 2020
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Permit Number W00041409
Central Files: APS _ SWP _
2/26/2020
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
12,960
Facility
Facility Name
Major/Minor
Region
Midland Cottages (Residential Subdivision)
Minor
Fayetteville
Location Address
County
Moore
Facility Contact Affiliation
Owner
Owner Name
Owner Type
Town of Southern Pines
Government - Municipal
Owner Affiliation
James Michel
PE
140 Memorial Park Ct
Dates/Events
Southern Pnes
NC 28387
Scheduled
Ong Issue App Received Draft Initiated
Issuance Public Notice Issue Effective Expiration
2/26/2020 1/14/2020
2/26/2020 2/26/2020
Regulated Activities
Requested /Received Events
Wastewater collection
Additional information requested
214120
Additional information received
2/26120
Curtail
Waterbody Name
Streamindex Number Current Class
Subbasin