WQ0036608_Return Application_20130719

■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
GEOSCIENCE GROUP
500 - K CI:ANTON ROAD
CHARI OITF, NC 28217
A.
X ❑ Agent
❑ Addressee
B., Received bX ( C. D to of D ivery
D. Is delivery address diffgfent from item 17 ❑ Yes
If YES, enter delivery address below: ❑ No
3. Service Type
Certified Mail ❑ Express Mail
❑ Registered Return Receipt for Merchandise
❑ Insured Mail ❑ C.O.D. I
4. Restricted Delivery? (Extra Fee) E] Yes
2. Article Number 7009 3410 0001 6831 1622
(transfer from service label)
IPS Form 3811, February 2004 Domestic Return Receipt 102595-02-M-1540

UNITED STATES POSTAL SERVICE
First -Class Mail
Postage & Fees Paid
USPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4 in this box •
NC DEPT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
ATTN: 'I'RENT ALLEN 225 GREEN STREET, SUITE 714 DENR-FRO-lcQ
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FAYETTEVILLE NC 28301-5043
JUL 19 2013
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North Carolina Department of Environment and Natural Resources
Division of Water Quality
Pat McCrory Thomas A. Reeder
Governor Acting Director
July 15, 2013
CERTIFIED MAIL: 7009 3410 0001 6831 1622
RETURN RECEIPT REQUESTED
Kevin S. Caldwell, PE
Geoscience Group
500 — K Clanton Road
Charlotte, NC 28217
Subject: Incomplete Fast- Track Application
Health Pavilion Hoke
Wastewater Collection System Extension
Hoke County
Dear Mr. Caldwell:
John E. Skvarla, 111
Secretary
This letter is in reference to your permit application received on June 24, 2013 for the construction and
operation of the subject wastewater collection system extension.
Question #8 in the Permit Information should be completed. This is required due to question #7 showing
a zero (0) flow.
We are returning your application as incomplete in accordance with North Carolina General Statute § 143-215.1.
Please be advised that construction and/or operation of wastewater collection system without a valid
permit is a violation of North Carolina General Statute §143-215.1 and may subject the owner/operator
to appropriate enforcement actions in accordance with North Carolina General Statute § 143-215.6A-6C.
Civil penalties of up to $25,000 per day per violation may be assessed for failure to secure a permit
required by North Carolina General Statute §143-215.1.
o e
NhCarolina
Naturally
North Carolina Division of Water Quality 225 Green Street — Suite 714 Fayetteville, NC 28301-5043 Phone [phone] Customer Service
Internet: h2o.enr.state.nc.us FAX [phone]
An Equal Opportunity/Affirmative Action Employer — 50% Recycled/10% Post Consumer Paper

When you have obtained the requested information that is needed to make your application package complete,
return it for review. If you have any questions or comments concerning this matter, please contact Trent Allen at
[phone], or via E-mail at [e-mail].
Sincerely,
e-'IZQ44y�
Trent Allen
Surface Water Protection
Enclosures
cc: FRO Files

USE THE TAB KEY TO MOVE FROM FIELD TO FIELD!
Application Number:
(to be completed by DWQ) OZ33 (;iv
111.
Owner/Permittee:
la.
Hoke County, North Carolina
Full Legal Name (company, municipality, HOA, utility, etc.)
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11b.
Tim Johnson, Coun Manager
Signing Official Name and Title (Please review 15A NCAC 2T .0106 (b) for authorized signing officials!)
1c.
The legal entity who will own this system is:
❑ Individual El Federal ❑Municipality® State/County ❑ Private Partnership ❑ Coloration ❑ Otherspecify)_ _
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11d.
227 N. Main Street 1e. Raeford
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Mailing Address City
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-- --
North Carolina 11g. 28736
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State i_ Zip Code
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910.875.8751 1 i. 910.875.9222 --"-� -----
1 j. t'ohnson hokecoun .or
QTelephone
Facsimile E-mail
V
i2.
Project (Facility) Information:
J
i2a.
Health Pavilion Hoke 12b. Hoke
a
!
Brief Project Name (permit will refer to this name) County Where Project is Located
Q 13.
Contact Person:
Q
3a.
Kevin S. Caldwell -
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b.
704.941.2252 �3c.
[e-mail]
Phone Number
E-mail
�1.
Project is ® New ❑ Modification (of an existing permit) If Modification, Permit No.:
2.
Owner is ® Public (skip to Item B(3)) ❑ Private (go to Item 2(a))
�
2a.
If private, applicant will be: 2b. If sold, facilities owned by a (must choose one)
❑ Retaining Ownership (i.e. store, church, single office, etc.) or ❑ Public Utility (Instruction C)
❑ Leasing units (lots, townhomes, etc. - skip to Item B(3)) ❑ Homeowner Assoc./Developer (Instruction D)
❑ Selling units (lots, townhomes, etc. - go to Item B(2b))
13.
Public Works Commission (PWC) — Fayetteville, North Carolina
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Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
4a.
Rockfish i4b. NC 0050b5
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Name of WWTF WWTF Permit No.
5a.
PWC 5b. 8 inch Gravity 5c. WQ 0035727
Owner of Downstream Sewer Receiving Sewer SizefDForce Main Permit # of Downstream Sewer (Instruction E)
LL 6.
The origin of -this wastewater is (check all that apply):
Z
100 % Domestic/Commercial
❑Residential Subdivision El Retail (Stores, shopping centers)
❑ Apartments/Condominiums ❑ Institution o
/o Industrial (attach
❑ Mobile Home Park ® Hospital description.)
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❑ School ❑ Church
❑ Restaurant El Nursing Home (RO: contact your Regional Office
a'
El Office Pretreatment staff)
® Other (specify): Medical Office
m
% Other (specify):
7. Volume of wastewater to be allocated or permitted for this particular project: 0 gallons per day
"Do not include future flows or previously permitted allocations
8. If the permitted flow is zero, indicate why:
❑ Pump Station, Outfall or Interceptor Line where flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit No.
❑ Rehabilitation or replacement of existing sewer with no new flow expected (see 15A NCAC 02T .0303 to determine if a
permit is required)
FTA12/07

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9. Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2T .0114 for
the value in Item 13(7) AND/OR the design flow for line or pump station sizing if a reduced or zero flow is being requested in
Item B(7). Values other than that in 15A NCAC 2T .0114 (b) and (c) must be supported with actual water or wastewater use
data in accordance with 15A NCAC 2T .0114 (f).
0
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches) i Length (feet) I New Gravity or Additional
-- - --- ---- ---- — - — '--- Force Main
8 701.74 Gravity
11. Summary of Pump Stations w/ associated Force Mains to be Permitted (attach additional sheets as necessary)
'Pump Station Location ID — — (self chosen - as show_ n on plans/map for reference)
Design Flow Operational Point Power Reliability Option
(MGD) GPM @TDH 1 - permanent generator wIATS; Force Main Size Force Main Length
2 - portable generator w/MTS
Pump Station Location ID (self chosen - as shown on plans/map for reference)
Design Flow Operational Point; Power Reliability Option
(MGD) GPM @TDH 1 - permanent generator wIATS; Force Main Size Force Main Length
2 - portable generator w/MTS
_--------- ---- --- -------_----------- --- --------------------
.Pump Station Location ID _ _ (self chosen - as shown on plans/map for reference) —
Design Flow Power Reliability Option
Operational Point i
(MGD) i GPM @TDH 1 - permanent generator w/ATS; Force Main Size Force Main Length
2 - portable generator w/MTS
12. Will the wastewater flow in the proposed sewer lines or pump stations be able to be directed to another treatment facility?
❑ Yes ® No If Yes, permit number of 2"d treatment facility
(RO — if "yes" to B,12 please contact the Central Office PERCS Unit)
13. Does the sewer system comply with the Minimum Design Criteria for the Fast Track Permitting of Pump Stations and Force
Mains (latest version), the Gravity Sewer Minimum Design Criteria (latest version) and 15A NCAC Chapter 2T as
applicable?
® Yes ❑ No If No, please reference the pertinent minimum design criteria or regulation and indicate why a
variance is requested. SUBMIT TWO COPIES OF PLANS, SPECIFICATIONS OR CALCULATIONS
PERTINENT TO THE VARIANCE WITH YOUR APPLICATION
FTA12/07