WQ0041517_Application_20200303

DWR
Division of Water Resources
KtUtivr-u
DEQIDVVR
State of North Carolina
Department of Environmental Quality
Al U 0 i 2020 Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number:
(to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Bladen Community Services, LLC (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: Gardner Altman. Jr. per 15A NCAC 02T .0106(b)
Title: Secretary of Bladen Community Services, LLC
4. Applicant's mailing address: 601 W. Rosemary Street, Unit 1001,
City: Chapel Hill State: NC Zip: 27516-.
5. Applicant's contact information:
Phone number: [phone] Email Address: ghair n chair-pa.com
IL PROJECT INFORMATION:
1. Project name: Emereau Charter School Sanitary Sewer and Lift Station
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ0040765 and issued date: 4/4/2019
If new construction but part of a master plan, provide the existing permit number: W000_
3. County where project is located: Bladen
4. Approximate Coordinates (Decimal Degrees): Latitude: 34.599677' Longitude:-78.5727330
5. Parcel ID (if applicable): 41069
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Larry F. Graham License Number: NC 11602
Firm: Environmental En ingt eerinQ Services
Mailing address: PO Box 426
City: Aberdeen State: NC Zip: 28315-
Phone number: 910 944-1648 Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Town of Elizabethtown W WTP
Owner Name: Town of Elizabethtown
Permit Number: NCO026671
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than W WTF):
1. Permit Number(s): WQCS00154 Downstream (Receiving) Sewer Size: 8 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS00154
Owner Name(s): Town of Elizabethtown
FORM: FTA 04-16 Pagel 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: DE V) 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) ❑ 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: 100 % 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 .0114(f) ❑ Yes ® No
➢ If yes, provide a cony of flow reduction aooroval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(fl)
Daily Design Flow',b
No. of Units
Flow
Charter School, Eventually Grades 1-12
10 gal/student/day
875
8750 GPD
gall
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
8710 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 ofthe 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.01141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 8750 GPD (per 15A NCAC 02T .0114)
➢ 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
❑ Other (Explain):
FORM: FTA 04-16 Page 2 of 5

VH. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 1325 PVC
➢ Section II & III 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)
➢ Oversizing lines to meet minimum slope requirement is not allowed and a violation of the WC
VIH. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: PS # 1
2. Approximate Coordinates (Decimal Degrees): Latitude: 34.600368' Longitude:-78.573862'
3. Design flow of the pump station: 0.00875 millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): 85 gallons per minute at 49 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
3
1490
PVC
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)(I)(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.
➢ 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(fl & (g)
➢ 15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below vertical
24 inches
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 water lines(horizontal - reclaimed over sewer
2 feet
**Any private or public water supply source, including any wells, WS-I waters of Class I or
Class II impounded reservoirs used 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 DI.2
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches
10 feet
Any 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 grade 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 webpage
➢ If noncompliance with 02T.0305( or (). see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ®Yes []No [—]N/A
➢ See the Division's draft separation requirements for situations where separation cannot be meet
➢ No variance is required if the alternative design criteria specified is utilized in design and construction
➢ As built documents should reference the location of areas effected
3. Does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ® Yes ❑ No ❑ N/A
➢ This would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Does the project require coverage/authorization under a 404 Nationwide or [—]Yes ® No
individual permits or 401 Water Quality Certifications?
➢ 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.0 I 05(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 15A 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 ❑ N/A
➢ 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(a)(5) or the permitee's individual System -Wide Collection permit.
FORM: FTA 04-16 Page 4 of 5

EA
CERTIFICATIONS:
A. Does the submitted system comply with ISA DiCiIC 0sT, the t9ininuur Desiu Criteria for ite. 'yrmiaiu_o ur�;t>;;_aiion
gnri F;Forcivi ups triGes_'&rsion�, and the Gatiits. > l-c, 6_:nire�un pesi.r�i C- It:a ilat�st �I �t�n.i, as applicable?
0 Yes ❑ No
If No, complete and submit the Variance/AlWmative Design Request application (VADC 10.14) and supporting documents for
review. Anoroval of the request is required prior to submittal of the Fast Track Application and supporting documents.
2. Profssional Engineer's Certification:
�.rah_am,.__PE—._,_— ___-_---..-- --- —attest that this application for
(Professional Engineer's name from Application Item Ill. I.)
Emereau Charter School Sanitary Sewer & Lift Station
^,as been reviewed by the 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 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 ofthis
submittal package, inclusion of these materials under my signature and seal signifies that I have reviewed this material and
havejudged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.613, any person who knowingly makes any faise
statement, representation, or certification in any application package shall be guilty of a Cl misde ea 'h' r may
include a line not to exceed $10,000, as well as civil penalties up to $25,000 per v'
... 0111
North Carolina Professional Engineer's seal, signature, and date: ,�00.� .-....:_ lei.
SEAL
11602
3. Applicant's Certification per 15A NCAC 02T .0106(b):
1, _ Gardner Altman,__._Jr.—Secretary _ attest that this application for
nature Authorit 's name & title fro t A pjication Item 13.)
Emereau (SiNarter Sebool Lift Spta�ion
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. 1 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. I will 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 1 ± 115.6A and 143-2i j;t13; any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor. which ntay
include a fine not to exceed $10.000 as well as civil penalties up to $25,000 per violation.
Signature:. / r4_�- Date:. /.'N�rldn.,�.,i�27...Li.7.d
FORM: FTA 04-16 Page 5 of 5

EQ/DWR
ENVIRONMENTAL ENGINEERING SER
P.O. Box 426, Aberdeen, N.C. 28315 Phone: [phone] Fax: [phone] Email`U., FOO
r, u lim P,or l(' -
February 28, 2020
Mr. Trent Allen, Environmental Regional Supervisor
c/o NCDENR-DEQ
225 Green Street, Suite 714
Fayetteville, N.C. 28301-5094
Re: Sanitary Sewer Lift Station Permit Modification Request for the Emereau Charter School at 995
Airport Road in Elizabethtown, NC. Bladen County. Existing Permit Number WQ0040765 (issued
4/4/2019).
Dear Mr. Allen,
As you may recall, the Emereau Charter School (ECS) in Elizabethtown is permitted to install a new
sewage lift station for 1,200 students with a cafeteria and gymnasium. The contractor to do the work
has been selected and we are working toward breaking ground soon. The school management and
their General Contractor (GC) have been talking with me about the new lift station size and their
anticipated growth. As with any school that is growing, there will be a growth curve, which means it
will be several years before the final 1,200 enrollment number is achieved and it may be over 5 years
before a cafeteria and gym are built. Emereau currently has 475 students enrolled. There will be
several other phases of classroom construction that must take before any cafeteria or gymnasium are
built. It is not known exactly when or if the 1,200-student enrollment will be achieved. According to
estimated projections, the school plans not to exceed 875 students for another 3 to 5 years. The
permit we have from your office includes the design for the 1,200 students plus a cafeteria and a
gymnasium. To better match the infrastructure growth plans, we would like to modify the existing
permit to reflect an enrollment of 875 students and NO cafeteria and NO gymnasium.
Per our phone conversations, I am sending you this letter to summarize the changes we would like to
make based on the new enrollment values mentioned above. I feel like this letter is needed to outline
our thinking and to specify why the modifications are being requested. Please keep in mind that the
basic intent of the lift station at ECS has not changed, but some of the needed hardware has changed. I
will outline those major changes below. New drawings and specifications have been developed by
EES and these will be furnished to the contractor as soon as we receive your OK. My correspondence
to you includes:
• The revised executed permit application form FTA 04-16, titled "FAST TRACK SEWER
SYSTEM EXTENSION APPLICATION". I am sending you the revised original and a copy of
the permit application.
• One $480 check from Bladen Community Services, LLC who is the owner of the property. The
check is made out to NCDEQ. I have attached a copy of the check to the permit application
copy.
Of course, an original and one copy of this letter.

Revised Sewage Flow Estimates.
As you know, the construction of a sewage lift station based on a student population that is 4 to 6 years
away can be costly and underutilized for years. The Emereau Directors have reconsidered their
projections and wish to size the tank more in line with enrollment projections for the next few years. A
student population of 875 is now being considered a target value from a design standpoint. Therefore,
I have redesigned the lift station for the 875 students using sewage flow data outlined in "WASTE
NOT DISCHARGED TO SURFACE WATERS" Subchapter 15A NCAC 02T, Section .0300 "Sewer
Extensions", by the N.C. Department of Environmental Quality (DEQ), Division of Water Resources
(DWR) Section .0114 (c). Seethe revised projected flows in Table 1.
TABLE 1
Summa of Future Sew a a Flow Volumes at ECS
Item
Flow Per
Number of
Daily Flows Using a Future
Student
Students for the
Enrollment of 875 Students
Modified Design
School Days Only)
Unadjusted sewage flows 15A
10 gpd /
875 students
8,750 gals. per day
NCAC 02T - Section .0114 c .
student
Sewage Flow Estimates with a Peaking Factor Added.
According to the document titled "Minimum Design Criteria for the Permitting of Pump Stations and
Force Mains", a peaking factor for populations served by pump stations is shown in Equation 1, but in
no case shall the peaking factor for hourly flows be less than 2.5.
PF = (18+ �P)/(4+4P) (Equation 1)
Where: PF = Peaking Factor
P = service population in thousands
PF = (18+�0.875)/(4+q0.875) = (18+0.9354)/(4+0.9354) = 3.84
Schools produce most of their wastewater during regular school hours. Flows usually begin around 7
AM and diminish significantly after about 3 PM. Typically by 5 PM sewage flows stop. There will be
some evening and weekend use of water from athletic events, school productions, and community
meetings, but typically these sewage additions do not exceed school day peaks. Table 2 looks at
calculating a peak one -hour flow based on typical school day flows.
TABLE 2
Summary of Peak Flow Rates at ECS Assuming 875 Students
Item
Flow Per Student
Unadjusted sewage flows 15A NCAC 02T - Section .0114 c .
8,750 gallons per day
Average hourly flow assuming the typical hours of school operation is
from 7 AM to 5 PM or 9 hours
972 gallons per hour
16.2 gallons per minute
Calculated Peaking Factor for maximum hourly water production
3.84
Calculated Maximum estimated sewage production per hour
3,732 gallons per hour
62.2 gallons per minute
Chosen pump -out capacity for the Lift Station
85 gallons per minute

In the engineer's opinion, a Peaking Factor of 3.84 is high for a typical school, so the engineer used a
flow simulation program to help in sizing the new lift station. This program uses typical sewage
generation values throughout the school day, realizing that higher water use will take place around the
lunch hour. Since time -of -day use was taken into consideration, the engineer used a peaking factor of
2.5 during the highest water use hour. Based on that simulation, a pump capable of pumping 85
gallons per minute is more than sufficient to manage even peak flows at the school while leaving a
large emergency storage capacity in the tank. More will be said about emergency storage volumes
below.
Proposed Changes to the Lift Station Tank.
The lift station itself has been changed to a cylindrical configuration. We believe this configuration
will help with installation. In addition, it will afford us some extra emergency water storage volume.
The plan is to use a 10 ft. diameter cylindrical concrete precast tank with an internal height of 18 feet.
We plan to leave the 85 gpm duplex pumps in place. The full volume of this tank will be at least
10,575 gallons. Based on numerous simulations, the emergency storage in this tank with an 875-
student enrollment is almost a full day of predicted water use at the school. Until enrollment reaches
875 students, there will be more than a day's sewage generation available for emergency storage.
As I have mentioned to you before, my experience shows that seldom do sewage flows from schools
without cafeterias or gyms use 10 gpd/student. Hopefully after 4 or 5 years of operation we will have
more accurate flow data from the school and can re-evaluate the lift station details at that time.
Proposed Changes to the Emergency Power Equipment.
In our original pen -nit request, we estimated the sewage flows to exceed 15,000 gpd using 02T values
for schools. Now that we have reduced the student enrollment to 875 and removed the gymnasium and
cafeteria from the mix, the average daily flow will be 8,750 gallons. This means we no longer need a
permanent standby electrical generator. Since we will have a day or more of emergency storage in the
new tank, the threat of overflows is not of great concern. I have included a quick connection electrical
coupler for a portable generator should the need arise. I might also mention that I have added a quick
connection for a portable sewage pump if that would become necessary. All -in -all removing the
generator is prudent as long as the Emereau flows remain below 15,000 gpd.
Summary.
In summary, the revisions for the ECS sewage lift station are:
• Change the predicted enrollment to 875 students and to eliminate the addition of a gymnasium
and cafeteria. Projected average daily flows are now at 8,750 gallons.
• Flow simulations with peaking factors added demonstrate an emergency storage volume in the
new tank design to be at least one day at an average flow of 8,750 gallons.
• Change the configuration of the concrete tank to a cylindrical model with more emergency
storage volume. The new tank would have a 10 ft. internal diameter and have an internal
height of 18 feet and contain around 10,575 gallons.

• To eliminate the need for a permanent standby electrical generator at the lift station. A portable
generator connection will be added so the system can be operated via this power source.
• Most of the other basic infrastructure for the new lift station has remained the same as stated in
the original permit.
• This permit revision does not propose any changes to the upstream sanitary sewer components
as designed by Anderson Engineering & Associates.
• The installation contractor will be provided a complete copy of the new drawings and
specifications as mentioned above.
Once your office is OK with these revisions and gives us the green light to proceed, I will coordinate
with everyone to get revised plans out and hold pre -construction meetings. Duties, responsibilities,
questions, etc. will be handled at the pre -construction conference. When the system is finally installed,
I will send you and all concerned my certification of completeness.
In order to meet construction deadlines, we will need to begin construction ASAP, so please do not
hesitate to get back to me with any questions or needs. I will also be happy to furnish you with copies
of the revised plans upon your request. On behalf of Emereau Charter School, Bladen Community
Services, LLC, and Anderson Engineering & Associates, I want to thank you for your timely review of
this project. Please let me know if you have any questions.
Best
Enclosures
Cc: GardnerAlhnan
Larry Anderson
Trey Greer
Chad DeVane
F. GrW=, P.E.
mmental Engineering Services
4

t6t1Vt3!
���,� State of North Carolina
Department of Environmental Quality
vl a-f 0 3 2020 Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources 1°ROS FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: (to be completed by DwR)
AR items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1.
Applicant's name: Bladen Community Services. LLC (company, municipality, HOA, utility, etc.)
2.
Applicant type: ❑ Individual ® Corporation ❑ General Partnership
❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ❑ Municipal
❑ Other ctL-fLA:: 'v(<® b
3.
Signature authority's name: Gardner Altman. Jr. per 15A NCAC 02T .0106(b)
ty' P
)
DEQiDVVR
Title: Secretary of Bladen Community Services, LLC
10 A it 0 3 V7P
4.
Applicant's mailing address: 601 W. Rosemary Street. Unit 1001,
City: Chapel Hill State: NC Zip: 27516-_
5.
Applicant's contact information:
Vhf 6�E.011-HC=
Phone number: [phone] Email Address: ghairaa ehaina.com
IL PROJECT INFORMATION:
1. Project name: Emereau Charter School Sanitary Sewer and Lift Station
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: W00040765 and issued date: 4/4/2019
If new construction but part of a master plan, provide the existing permit number: WQ00_
3. County where project is located: Bladen
4. Approximate Coordinates (Decimal Degrees): Latitude: 34.5996770 Longitude:-78.572733'
5. Parcel ID (if applicable): 41069
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
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M44V 41t1...; CIIIIGrC�/i�%
TO NCDEQ
THE C/O LARRY GRAHAM ENV ENGINEERING
ORDER PO BOX 426
OF ABERDEEN, NC 28315-0426 12837
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480.00
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Signafure Gan file
This check has been authorized ,
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DEQ
'� State of North Carolina
VVR Department of Environmental Quality
'ei Ax 0 3 2020 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: (to be completed by DWR)
All items must be comuleted or the anolication will be returned
I. APPLICANT INFORMATION:
1.
Applicant's name: Bladen Community Services. LLC (company, municipality, HOA, utility, etc.)
2.
Applicant type: ❑ Individual ® Corporation ❑ General Partnership
❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ❑ Municipal
❑ Other
V �arF
aN;T t c, �
it,J-
3.
Signature authority's name: Gardner Altman. Jr. per 15A NCAC 02T .0106fb)
-;)
/,h ��
OTEC
Title: Secretof Bladen Community Services, LLC
ary
4.
Applicant's mailing address: 601 W. Rosemary Street. Unit 1001,
4 .Zd o24
City: Chanel Hill State: NC Zip: 27516-_
5.
Applicant's contact information:�
rn i3
t" t � `
Phone number: 404 200-8343 Email Address: &[e-mail]
IL PROJECT INFORMATION:
1. Project name: Emereau Charter School Sanitary Sewer and Lift Station
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: W00040765 and issued date: 4/4/2019
If new construction but part of a master plan, provide the existing permit number: WQ00_
3. County where project is located: Bladen
4. Approximate Coordinates (Decimal Degrees): Latitude: 34.5996770 Longitude:-78.572733°
5. Parcel ID (if applicable): 41069
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
t;—.. Numherc NC 11602
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Permit Number WQ0041517
Central Files: APS _ SWP
3/4/2020
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
stephanie.zorio
Coastal SWRule
Permitted Flow
8,750
Facility
Facility Name
Major/Minor
Region
Emereau Charter School Sanitary Sewer and Lift Station
Minor
Fayetteville
Location Address
County
Bladen
Facility Contact Affiliation
Owner
Owner Name
Owner Type
Bladen Community Services LLC
Non -Government
Owner Affiliation
Gardner Altman Jr.
601 W Rosemary St
Dates/Events -
Chapel Hill
NC 27516
Scheduled
Orig Issue App Received Draft Initiated
Issuance Public Notice Issue Effective
Expiration
3/4/2020 3/3/2020
3/4/2020 3/4/2020
Regulated Activities
Requested /Received Events
Wastewater collection
Additional information requested
Additional information received
Quffall
Waterbody Name
Streamindex Number Current Class
Subbasin

Permit Number WQ0041517
Program Category
Non -discharge
Permit Type
Gravity Sewer Extension, Pump Stations, & Pressure Sewer Extensions
Primary Reviewer
stephanie.zorio
Coastal SWRUle
Permitted Flow
8,750
Facility
Facility Name
Emereau Charter School Sanitary Sewer and Lift Station
Location Address
Owner
Owner Name
Bladen Community Services LLC
Central Files: APS _ SWP
3/4/2020
Permit Tracking Slip
Status
Project Type
Active
New Project
Version
Permit Classification
1.00
Individual
Permit Contact Affiliation
Major/Minor Region
Minor Fayetteville
County
Bladen
Facility Contact Affiliation
Owner Type
Non -Government
Owner Affiliation
Gardner Altman Jr.
601 W Rosemary St
Dates/Events Chapel Hill NC 27516
Scheduled
Orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
3/4/2020 3/3/2020 3/4/2020 3/4/2020
Regulated Activities Requested /Received Events
Wastewater collection Additional information requested
Additional information received
Curtail
Waterbody Name Streamindex Number Current Class Subbasin