WQ0014084_Application_19970703

' State of North Carolina
Department of Environment, Health and Natural Resources
Division of Environmental Management
NON -DISCHARGE PERMIT APPLICATION
GRAVITY SEWER COLLECTION SYSTEMS
for use as an original. Pump Stations, force mains and low pressure sewers
be photocopied,
is form may P Th Y P
(including S.T.E.P. systems) are not to be included as part of this application package. to rn
Any changes made to the content of this form shall not be allowed and will result in the `©
application being returned.�'`� =+
This application will not be accepted by DEM unless all of the applicable items are include„ I'll q�
with the submittal. z„ -, r*t.<-
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I. REQUIRED ITEMS CHECKLIST: 0'6 ca
Please indicate that you have read the following list of application requirements by signing your initials in the space provid—
next to each item.
Annli mnt's lni i
executed application form. C M
l . One original and one copy of the completed and properly aPP
2. The appropriate permit processing fee, in accordance with 15A NCAC 2H .0205(cX5). The fee for
sewer extensions is S400. The fee for sewer extensions by partially delegated municipalities
(applies only to those governmental jurisdictions that have specific delegation review authority, CM
as granted by the Division of Environmental Management) is $200.
3. If the owner/authority of the wastewater treatment facility (WW rF) and/or collection system that will be
accepting the wastewater flow from this project is different from the applicant of the project, then a letter(s)
must be provided from the owner/authority of the WW'IF and/or collection system specifying the
flow that will be accepted. 'Ilse letter(s) should be recent (within one [1] year) and should
volume oCM
refer to the project by the same name as that identified on the application and the plans/specifications.
4. If the application is being submitted in the name of a privately owned public utility, written
documentation must be submitted from the Utilities Commission which demonstrates that the utility
is authorized to hold the franchise for the area to be served. In the case of contiguous service areas,
written documentation must be provided from the Utilities Commission acknowledging these areas C M
are covered under an existing franchise.
5. One original and two copies of a properly executed operational Agreement must be submitted if the
sewer extension will be serving single family residences, condominiums, or town houses AND if the CM
subject sewer extension is owned by the individual residents, a homeowners association, or a developer.
11. PERMIT INFORMATION: SOC Project: Yes % No.
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1. Application Number (will be completed by DENO: w M
::,=;L
2. Specify whether project is: % new modification.
3. If this application is being submitted as a result of a modification to an existing permit, please complete:
it number and permit issue date
existing perm
4. Specify whether the applicant is: % public private.
S. Application Date: MAY 26, 1997 6. Fee Submitted: $ --r
7. County(ies) where project is located:
HORE
8. Applicant's Name (Please specify the name of the municipality, corporation, individual, etc.):
CITY OF RAEFORD
FORM: GSPA 02/96
Page 1 of 4
1,400 copies of this document were printed at a cost of $117.32, or $0.084 per copy.

III. GENERAL INFORMATION:
I. Print Owners or Signing Official's name and title (the person who is legally responsible for the facility and its compliance): JAMES M. MCNEILL, CITY MANAGER P �)'
2. Mailing address: CITY OF RAEFORD, 315 N. MAIN STREET, P.O. BOX 606
City: RAEFORD State: NC
Zip: 28376
Telephone Number. ( 910 ) 875-8161
3• Project Name (Please specify the name of the subdivision, facility, or establishment The name should be consistent with
the project name on plans, specifications, letters of flow acre acceptance, , Operational Agreements, etc.):
MCMILLAN STREET SEWER EXTENSION
IV. INFORMATION ON WASTEWATER:
1. Nature of Wastewater. _ 100 % Domestic/Commercial
90 Industrial
% Other (specify)
2.' Volume of wastewater generated by this project: 2,880
gallons per day,
3. Explanation of how wastewater volume was determined: 15 NCAC 2H .0200, 8 APARTMENTS WITH
3 BEDROOMS EACH @ 120 GPD PER BEDROOM
4. Name of wastewater treatment facility receiving wastewater. CITY OF RAEFORD 1,1AST>:WATER TREATMENT PL
ANT
Owner of wastewater treatment facility: CITY OF RAEFORD
Facility Permit Number: NC00 26514
or WQ
5. Indicate any parameters (and their concentrations) which will be greater than normal domestic levels:
N/A
6. If wastewater is not domestic in nature, what level of pretreatment has been provided to ensure protection of the receiving wastewater treatment facility?
N/A
7. If a pretreatment permit is required, has one been issued?
Yes No. If Yes, please attach a copy of
the pretreatment permit. If No, when will one be issued? N/A
FORM: GSPA 02/96
Page 2 of 4

V . DESIGN INFORMATION:
1. Summary of GRAVITY SEWER to be permitted, by diameter and length
Diameter inches Len (linear feet)
8" SDR 35 PVC 864 LF
2. Are there any sections of the Gravity Sewer Minimum Design Criteria .or 15A NCAC 2H .0200 with which the subject
wastewater collection system will not be able to comply? Yes A No. If Yes, please identify and explain:
IMPORTANT:
If you responded Yes to question V.2 above, the completed application package,
including two (2) copies of pla�ns._snpcifications, supporting information and
any other materials, should be submitted for an individual permit.
FORA: GSPA 02/96 Page 3 of 4

VI. CERTIFICATIONS:
Name and Complete Address of Engineering Firm: HOBBS, UPCHURCH & ASSOCIATES, P.A.
290 S.W. BROAD STREET P.O. BOX 1737
City: SOUTHERN PINES
Telephone Number. (
910
Professional Engineer's Certification:
State: NC
692-5616
I, ERIC WEATHERLY , attest that this application for
Zip: 28388
MCMILLAN STREET SEWER EXTENSION
has been reviewed by me and is accurate and complete. I further attest the proposed design has been prepared in accordance with the
applicable regulations and the North Carolina Gravity Sewer Minimum Design Criteria adopted February 12, 1996Although certain
portions of this submittal package may have been developed by other professionals, inclusion of these materials under my signature
and seal signifies that I have reviewed this material and have judged it to be jffij�stent with the proposed design.
North Carolina Professional Engineees Seal, Signature, and Date. aoO�LlN CA.
tp1 2%
14996
Applicant's Certification:
s/zr. j9-7
I, JAMES M. MCNEILL , attest that this application for
MCNIILI.AN STREET SEWER EXTENSION
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 information and attachments are not included, this application package
will be returned to me as incomplete. Upon approval and completed construction, I will operate this system in accordance with the
North Carolinalkastewater collection permit requirements.
1)/l w A A . l
Signatures
THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DIVISION OF ENVIRONMENTAL MANAGEMENT
WATER QUALITY SECTION
PERMITS AND ENGINEERING UNIT
POST OFFICE BOX 29535
RALEIGH, NORTH CAROLINA 27626-0535
TELEPHONE NUMBER: [phone]
FOR1f: GSPA 02/96 Page 4 of 4