WQ0040988_Application (FTSE)_20190712

DEODAIR State of North Carolina
Department of Environmental Quality
1 0 3 2019 Division of Water Resources
�.. 15A NCAC 02T .0300 —FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
` Divislon of Water Resources 1 r ) ` STRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION
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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 a 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 IC .0100;
➢ Projects that do not meet any part of the minimum design criteria (MDC) document;
➢ Projects that involve a variance front 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.
Genet -at 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 supporting documentation.
A. One Original anti One Copy of Application and Supporting Documents
® Required unless otherwise noted
B. 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 anti Major Modification Application Packages):
❑ 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):
R 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 5ecretaiy 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 III 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 Page I 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):
® Submit an 8.5-inch x 11-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 (aerial) showing general project area so that Division staff can easily locate it in the field.
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 .0106(b)) or
proposed contractor, stating that "the portable power generation unit or portable; independently -powered pumping
units, associated appurtenances and persommel 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)
Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per 15A NCAC 02T .0115(a)(1) 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):
❑ Home/Property 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 nrore 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,
[phone]
Macon, Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Fayetteville Realonat Office
225 Green Street Suite 714
Anson, Bladen, 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
Raleigh 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 Reaional Office
943 Washington Square Mall
Beaufort, Bertie, 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, Fender
[phone]
[phone] Fax
Winston-Salem Reaional Office
450 W. Hanes Mill Road
Alamance, Allegheny, Ashe, Caswell, Davidson,
Water Quality Section
Suite 300
Davie, Forsyth, Guilford, Rockingham, Randolph,
Winston-Salem, North Carolina 27105
Stokes, Surry, Watauga, Wilkes, Yadkin
[phone]
INSTRUCTIONS FOR FORM: FTA 04-16 R SUPPORTING DOCUMENTATION Page 3 of 3

State of North Carolina
Department of Environmental Quality
Division of Water Resources
�' a•� 15A NCAC 02T .0300 —FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources p FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: 1AQDa kO l %� (to be completed by DWR)
All items must be completed or the application will be returned
1. APPLICANT INFORMATION:
1. Applicant's name: Moore County (company, municipality, HOA, utility, etc,)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ® State/County ❑ Municipal
3. Signature authority's name: Randy Gould. P.E. per 15A NCAC 02T .0106(b)
Title: Public Works Director
4. Applicant's mailing address: PO Box 1927
City: Carthaee State: NC Zip: 28327
5. Applicant's contact information:
Phone number: (910 947-6315 Email Address: reould2moorecountync:eov
II. PROJECT INFORMATION:
❑ Privately -Owned Public Utility
❑ Other
1. Project name: Pinehurst #7 Interceptor Replacement
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: W000_ and issued date: _
If new construction but part of a master plan, provide the existing permit number: W000_
3. County where project is located: Moore
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.1874410 Longitude:-79.443755'
5. Parcel ID (if applicable): 00024957
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Adam P. Kiker, P.E. License Number: 35038
Firm: LKC Engineerine
Mailing address: 140 Aqua Shed Court
City: Aberdeen State: NC Zip: 28315
Phone number: [phone] Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (W WTF) INFORMATION:
1. 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):
Permit Number(s): WQ_ Downstream (Receiving) Sewer Size: 24 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS00034
Owner Name(s): Moore CoumN
FORM: FTA 04-16 Page l of 5

VI. GENERAL REQUIREMENTS
I. 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 ®NIA
3. If the Applicant is a Home/Prol2= 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 ® Switmning 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(P)? ❑ Yes M No
➢ If yes, provide a copy of flow redaction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 021.01140
Daily Design Flow "b
No. of Units
Flow
N/A
gal/
GPD
gal/
GPD
gal/
GPD
gall
GPD
gal/
GPD
gall
GPD
Total
0 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.0114) shall
be determined using available flow data, water rising fixtures, occupancy or operation patterns, and other measured data.
S. Wastewater generated by project: 0 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

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Sunmunize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
24
1,790
PVC
12
550
PVC
8
300
PVC
➢ Section II & RI 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 MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
L Pump station number or name: N/A
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 puunp(s): _ gallons per minute at feet total dynamic head (TDH)
5. Summarize the force train 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(lu)(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.
➢ 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 tinuefranies, shall be
provided in the case of a multiple station power outage.
FORM: FTA 04-16 Page 3 of 5

°IX. SETBACKS At SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(0):
1. Does the project comply with all separations found in 15A NCAC 02T .0305(f) & (e)
W
➢ 15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewers stems:
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-1 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 IX.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(e) contains alternatives where separations in 02T.0305 cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webnaee
➢ 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 ❑ 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 hr design and constriction
➢ 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 & BufferPermitting 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 15A NCAC 02T.0402. "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or server
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes M 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

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T the Minimum Design Criteria for the Permitting of Pump Stations
and Force Mains (latest version), and the Gravity Sewer Minimum Design Criteria (latest version) as applicable?
1Z1Moogmw
If No, complete and submit the Variance/Alternative Design Request application (VADC 10-14) and supporting documents
for review. Approval of the request is required prior to submittal of the Fast Track Application and supporting
documents.
2. Professional Engineer's Certification:
name
that this application 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 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 143-215.613, any person who knowingly makes any false
statement, representation, or certification hi 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.
North Carolina Professional Engineer's seal, signature, and date: �AitCe
3. Applicant's Certification per 15A NCAC 02T .0106(b):
�, L , attest that this application for
name &s 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
application 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 143-215.6A and 143215.6B, 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 exC = 00 as well as cjyiI penalties up to $25,000 per violation.
Date: I/z�/9
FORM: FTA 04-16 Page 5 of 5

June 27, 2019
Mr. Trent Allen, DWR Regional Supervisor
NCDEQ Fayetteville Regional Office
225 Green Street, Suite 714
Fayetteville, NC 28301-5094
Re: Moore County
Pinehurst #7 — Interceptor Replacement
Fast -Track Sewer Application
Dear Mr. Allen,
1 JJ
DEOIDW
JUL 01 2019
WQR03
!=%�,YE:7TlVIl.i.F�rz�=r��nniat r,%�[r;r_
Regarding the above referenced project, please find the following items:
1. One original & one copy of the Fast Track application and supporting documents
2. One check for the $480.00 application fee
The project features the replacement and relocation of a section of Moore County's gravity
sewer interceptor located within the Pinehurst Resort No. 7 golf community near the
intersection of Inverrary Rd and US 15-501. The scope includes the installation of
approximately 1,790 feet of 24" gravity sewer, 550 feet of 12" gravity sewer, and 300 feet of 8"
gravity sewer, all associated manholes and other appurtenances. The proposed project will
replace a section of existing 24" gravity sewer interceptor by installing new 24" gravity sewer
within the golf course open areas which will allow for easier maintenance and future repairs.
Once the new sewer line is tested and placed into service, the existing sewer line will be
abandoned. No new or additional flow is associated with this project.
As indicated on the Fast Track Application, the project meets setback and separation
requirements of Rule 15A NCAC 02T .0305(f) except for the 50 feet of separation to wetlands.
As stated under Item IX.2 on the application, no variance is required if the alternate design
criteria are used in design and construction. There are two sections of the project, including
four manholes that are closer than 50 feet to wetlands; therefore, those areas will be
constructed to meet the alternate design criteria covered in the Division's draft version of
alternate Rule 02T.0305(f).
LKC Engineering, PLLC, 140 Aqua Shed Court, Aberdeen, North Carolina 28315
PH: 910/420-1437 * FAX: [phone] * License No. P-1095

Moore County is currently in the process of studying future wastewater flow projections
upstream of the subject project area and sewer interceptor. Preliminary results indicate that
upsizing to a 30" gravity sewer main may be beneficial, therefore the County wishes to seek
alternate bids to install 30" pipe instead of 24" pipe associated with this proposed project. If
the bids come in favorable for the project budget, the County may elect to proceed with the
upsized pipe. If so, at that time we will revise and submit the necessary items for a permit
revision prior to construction.
If you have any questions, please do not hesitate to contact me at [phone] or by email at
[e-mail].
Sincerely,
LKC Engineering, PLLC
1-'V '�� Acx'e
Logan J. Parsons, E.I.

D11 R
Dlvlslon of Water Resources
,[ate or norin varouna
Department of Environmental Quality
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: Moore County (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: Randy Gould. P.E. per 15A NCAC 02T .0106(b)
Title: Public Works Director t'(r_ier_i V LU
4. Applicant's mailing address: PO Box 1927 DEUm119i R
City: Carthage State: NC Zip: 28327 JUL 6 3 2019
5. Applicant's contact information: g ! 66A.
Phone number: (9IOJ 247-6315 Email Address: [e-mail] moorecountync.gov �9�1" S
AYr:.T'rtllp
If. PROJECT INFORMATION:
Owner Name: Moore County
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ_ Downstream (Receiving) Sewer Size: 24 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS00034
Owner Name(s): Moore County
FORM: FTA 04-16
Page I of 5

DEGIDWR
JUL 0 3 2019
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FAYETTEVILI_c_ RFGIONIALGI=RCF

Permit Number W00040988
Program Category
Non -discharge
Permit Type
Gravity Sewer Extension, Pump Stations, & Pressure Sewer Extensions
Primary Reviewer
trent.allen
Coastal SWRule
Permitted Flow
0
Facility
Central Files: APS _ SWP -
7/12/2019
Permit Tracking Slip
Status
Project Type
Active
New Project
Version
Permit Classification
1.00
Individual
Permit Contact Affiliation
Facility Name Major/Minor Region
Plnehurst #7 Interceptor Replacement Minor Fayetteville
Location Address County
Moore
Facility Contact Affiliation
Owner
Owner Name
Owner Type
Moore County
Non -Government
Owner Affiliation
Randy G. Gould
Director Public Works
PO Box 1927
Dates/Events
Carthage NC 28327192
Scheduled
Ong Issue App Received Draft Initiated Issuance
7/12/2019 7/3/2019
Regulated Activities
Wastewater collection
Outfall
Public Notice Issue Effective Expiration
7/12/2019 7/12/2019
Requested /Received Events
Additional information requested
Additional information received
Waterbody Name Streamindex Number Current Class Subbasin