WQ0038963_Application_20161221

RECEIVED
DECK/DWR State of North Carolina
Department of Environmental Quality
-DW,R Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
*"DlvisloVAR a( @r Resources INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION
FAYETTEVILLE REGIONAL OFFICE
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 1C .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 supporting documentation.
A. One Original and 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 and 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):
® 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 I.2 is a corporation or company, provide documentation it is registered for business with
the North Carolina Secretary 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.
N The Project Name in Item II.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 I SA NCAC 02T .0106(b).
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 1 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 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.).
3
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 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)(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 Alzreement (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

a
0
j
2
0
j
H
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 Regional 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 Regional 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, Pender
[phone]
[phone] Fax
Winston-Salem Regional Office
450 W. Hanes Mill Road
Alamance, Alleghany, 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 & SUPPORTING DOCUMENTATION
Page 3 of 3

State of North Carolina
U
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
"DivWon of Water Resources
FTA 04-16 &SUPPORTING DOCUMENTATION
Application Number: 0,1003 (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Hoke 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: Letitia Edens per 15A NCAC 02T .0106(b)
Title: County Manager
4. Applicant's mailing address: P.O. Box 240
City: Raeford State: NC Zip: 28376-
5. Applicant's contact information:
Phone number: [phone] Email Address: hvillinesp_hokecounty.org
II. PROJECT INFORMATION:
1. Project name: The Midlands at Bedford - Phase 2
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ00 and issued date:
If new construction but part of a master plan, provide the existing permit number: WQ00
3. County where project is located: Hoke
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.032770' Longitude:-79.1266840
5. Parcel ID (if applicable): 494660101005
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: James M. Kizer Jr. License Number: 20680
Firm: Moorman, Kizer, Reitzel, Inc.
Mailing address: 115 Broadf000t Ave.
City: Fayetteville State: NC Zip: 28305-
Phone number: [phone] Email Address: jkizer)rp_mkrinc.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Hoke County WWTF Permit Number: NCO089176
Owner Name: Hoke Countv
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ0037074
System Wide Collection System Permit Number(s) (if applicable): WQCS00352
Owner Name(s): Hoke County
FORM: FTA 04-16 Page 1 of 5

0
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/Propegy
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))
4 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 copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow','
No. of Units
Flow
The Midlands at Bedford - Phase 2
(Three Bedroom Residential Units
240 gat/unit
47
11,280 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
11,280 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.01141 shall
be determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 11,280 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. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 1,343 PVC, DIP
➢ 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 MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Puma Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station 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.
➢ 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

U
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(fl contains minimum separations that shall be Drovided for sewer systems:
® Yes ❑ No
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 11 impounded reservoirs used as a source of drinking water
100 feet
**Waters classified WS (except WS-I 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(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 webnaee
➢ If noncompliance with 02T.0305(fl or 1 see Section X of this application
Does the project comply with separation requirements for wetlands? (50 feet of separation) ® Yes ❑ No
➢ 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 all setbacks found in the river basin rules per 15A NCAC 02B .0200? ® Yes ❑ No
➢ This would include Trout Buffered Streams per 15A NCAC 2B.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
➢ 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 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
➢ 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.
t
FORM: FTA 04-16 Page 4 of 5

LA
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?
® Yes ❑ No
If No, complete and submit the Variance/Alternative Design Request application (VADC 10-14) and supporting documents
for review. Aauroval of the request is required prior to submittal of the Fast Track Application and supporting
documents.
2. Professional Engineer's Certification:
0
I,
/< Zap - —,1R.
(Professional Engineer's name from Application Item III.1.)
attest 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 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.
I,
North Carolina Professional Engineer's seal, signature, and date:
15A NCAC 02T .0106(b):
name & titld from Appliq*on Item I.3.)
attest that this application for
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. 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 143-215.6B, 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 exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: Date:
FORM: FTA 04-16
Page 5 of 5

M
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Diviston of Water Resources
Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: Hoke County
Project Name for which flow is being requested: The Midlands at Bedford - Phase 2
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: Hoke County Wastewater Treatment Facility
b. WWTP Facility Permit #: NCO089176
All flows are in MGD
c. WWTP facility's permitted flow 1.500
d. Estimated obligated flow not yet tributary to the WWTP 0.402
e. WWTP facility's actual avg. flow 0.295
f. Total flow for this specific request 0.01128
g. Total actual and obligated flows to the facility 0.709
h. Percent of permitted flow used 47.2%
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 Approx. Not Yet Total Current
Station Firm Flow** Current Avg. Tributary Flow Plus
(Name or Capacity, * (Firm / p fl, Daily Flow, Daily Flow, Obligated Available
Number) MGD MGD MGD MGD Flow Capacity***
Bedford 0.576 0.230 0.014 0.011 0.024 0.205
Hwy 401 1.037 0.415 0.095 0.157 0.252 0.162
Regional 3.750 1.500 0.285 0.395 0.680 0.820
* 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): Hoke County
Downstream Permit Number: WQCS00352
Page 1 of 6
FTSE 04-16

3
III: Certification Statement:
I Letitia Edens, County Manager 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.
Official
Date
Page 2 of 6
FTSE 04-16

PLANNING ASSESSMENT ADDENDUM (PAA)
Submit a planning assessment addendum for each pump station listed in Section II where Available
Capacity is < 0.
Pump Station (Name or Number):
Given that:
a. The proportion and amount of Obligated, Not Yet Tributary Daily Flow (C) accounts for
% and MGD of the Available Capacity (E) in Pump Station
; and that
b. The rate of activation of this obligated, not yet tributary capacity is currently approximately
MGD per year; and that
c. A funded Capital Project that will provide the required planned capacity, namely
is in design or under construction with
planned completion in ; and/or
d. The following applies:
Therefore:
Given reasonably expected conditions and planning information, there is sufficient justification to
allow this flow to be permitted, without a significant likelihood of over -allocating capacity in the
system infrastructure.
I understand that this does not relieve the collection system owner from complying with G.S. 143-
215.67(a) which prohibits the introduction of any waste in excess of the capacity of the waste
disposal system.
Zoli
1
Page 3 of 6
FTSE 04-16

Instructions for Flow Tracking/Acceptance form (FTSE) and Planning Assessment Addendum (PAA)
Section I
a. WWTP Facility Name: Enter the name of the WWTP that will receive the wastewater flow.
b. WWTP Facility Permit #: Enter the NPDES or Non -Discharge number for the WWTP receiving the
wastewater flow.
c. WWTP facility's permitted flow, MGD: From WWTP owner's NPDES or Non -Discharge permit.
d. Estimated obligated flow not yet tributary to the WWTP, MGD: This includes flows allocated to other
construction projects not yet contributing flow to the collection system. Flows allocated through
interlocal agreements or other contracts not yet contributing flow to the collection system are also
included. For POTWs that implement a pretreatment program, include flows allocated to industrial
users who may not be using all of their flow allocation. Please contact your Pretreatment Coordinator
for information on industrial flow tributary to your WWTP.
As of January 15, 2008 the POTW should have reviewed flow allocations made over the last two years
and reconciled their flow records, to the best of their ability, so it is known how much flow has been
obligated and is not yet been made tributary to the WWTP, in accordance with local policies and
procedures employed by the reporting entity.
e. WWTP facility's actual avg. flow, MGD: Previous 12 month average.
f. Total flow for this specific request, MGD: Enter the requested flow volume.
g. Total actual and obligated flows to the facility, MGD Equals [d + e + f]
h. Percent of permitted flow used: Equals [(g / c)* 100]
For example:
On January 15 a POTW with a permitted flow of 6.0 MGD, reported to the Regional Office that there
is 0.5 MGD of flow that is obligated but not yet tributary. The annual average flow for 2007 is 2.7
MGD. There is a proposed flow expansion of 0.015 MGD.
The first Form FTSE submitted after January 15, 2008 may have numbers like this:
c. = 6.0 MGD
d. = 0.5 MGD
e. = 2.7 MGD
f.=0.015MGD
g. = 3.215 MGD
h. = 53.6 %
The next Form FTSE may be updated like this with a proposed flow expansion of 0.102 MGD:
c.
= 6.0
MGD
d.
= 0.515
MGD
e.
= 2.73
MGD
f.
= 0.102
MGD
g.
= 3.349
MGD
h.
= 55.8 %
Each subsequent FTSE form will be updated in the same manner.
Page 4 of 6
FTSE 04-16

Section II
List the pump station name or number and approximate pump station firm capacity, approximate design
average daily flow (A) approximate current average daily flow (B), and the obligated, not yet tributary flow
through the pump station (C) for each pump station that will be impacted by the proposed sewer extension
project. Calculate the total current flow plus obligated flow (D=B+C) and the available capacity (E=A-D).
Include the proposed flow for this project with other obligated flows that have been approved for the pump
station but are not yet tributary (C).
Firm capacity is the maximum pumped flow that can be achieved with the largest pump out of service as
per the Minimum Design Criteria.
Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor (pf) of not
less than 2.5.
If the available capacity (E) for any pump station is < 0, then prepare a planning assessment for that pump
station if the system has future specific plans related to capacity that should be considered in the permitting
process.
(A)
(B)
(C)
(D)=(B+C)
(E)=(A-D)
Obligated,
Design
Approx.
Not Yet
Total Current
Firm
Average
Current Avg.
Tributary
Flow Plus
Pump Station
Capacity
Daily Flow
Daily Flow,
Daily Flow,
Obligated
Available
(Name or Number)
MGD
(Firm / pf)
MGD
MGD
Flow
Capacity*
Kaw Creek PS
0.800
0.320
0.252
0.080
0.332
-0.012
Valley Road PS
1.895
0.758
0.472
0.135
0.607
0.151
Page 5 of 6
FTSE 04-16

Plannine Assessment Addendum Instructions
Submit a planning assessment addendum for each pump station listed in Section II where available capacity
s is<0.
0
A planning assessment for Kaw Creek PS (see example data above) may be performed to evaluate whether
there is significant likelihood that needed improvements or reductions in obligated flows will be in place
prior to activating the flows from the proposed sewer extension project.
If the system decides to accept the flow based on a planning assessment addendum, it is responsible to
manage the flow without capacity related sanitary overflows and must take all steps necessary to complete
the project or control the rate of flow to prevent sanitary sewer overflows.
The planning assessment may identify a funded project currently in design or construction, or a planned
project in the future not yet funded but in a formal plan adopted by the system. The system should carefully
weigh the certainty of successful timely project completion for any expansion, flow management diversion
or infiltration and inflow elimination projects that are the foundation of a planned solution to capacity
tracking and acceptance compliance.
For example:
Given that:
a. The proportion and amount of obligated, not yet tributary flow accounts for 24 % and 0.080
MGD of the committed flow in Pump Station Kaw Creek; and that
b. The rate of activation of this obligated, not yet tributary capacity is currently approximately 0.01
MGD per year; and that
c. A funded capital project that will provide the required planned capacity, namely
is in design or under construction with
planned completion in ; and/or
d. The following applies:
The master plan and ten year capital plan contain recommended scone and fundins for a capital proiect
entitled Kaw Creek Pump Station upgrade with funding_ planned in July 2014. This project is planned to
add 0.100 MGD to the firm capacity of the pump station by October 2015. Inclusion of this proposed
capital project as a condition of this Flow Tracking/Acceptance for Sewer Extension Permit Application
elevates this project's priority for funding and construction to be implemented ahead of the activation of
obligated, not vet tributary flows in amounts that exceed the firm pump station capacities identified in
Section H above.
Therefore:
Given reasonably expected conditions and planning information, there is sufficient justification to allow
this flow to be permitted, without a significant likelihood of over -allocating capacity in the system
infrastructure.
Page 6 of 6
FTSE 04-16

IT, BRAG NOTES:
RESERVATION 1.) PROPERTY IS ZONED R-8.
�e 2.) THE MIDLANDS AT BEDFORD PHASE 2CONTAINS ID.59 ACRES, BY COORDINATES.
SITE 3.) TOTAL OF AS LOTS IN 'HE MIDLANDS AT BEDFORD PHASE 2.
A'P US 401 41 SMALLEST LOT CONTAINS 7,5935F(LOT 249): LARGEST LOT CONTAINS 8,874 S.F.
CLIMB,(LOTS 270277L
OD.
5I TOTAL OF I.S. LV OF STREM
at� SEWER BY PUBLIC SEWER MOPE CO.).WRTER BY HOPE COUNTY.
r' 7.)Sf1BACl(SSHOWNAREASFOLLOWS: FRONT: 30'; REAR: 2S' MIN.; SIDE:lVmIN.
N SI' 8.) ALL DISTANCES SHOWN ARE HORQONTAL GROUND. GRID FACTOR IS 0.SSI-lS.
ry4 7F P 9.) IRON PINS TO BE SET AT ALL GOPHERS UNLESS OTHERWISE NOTED.
10.) SIIF IS NOT LOGTFO WITHIN A FLOOD HAZARD AREA.
US �j4y"vP55 c 11.)FAMRTYREFERENCE:D.B.731,PG.173 HC0TCO,N.GREGISTRY.
' POCNFISH 123101)0'N.C.D.01 NGHT TRIANGLES AT ALL INTERSECTIONS.
-FORD SR. 14M 13.) AN EASEMENT IS HEREBY ESTABLISHED OVER THE COMMON AREA AND EMERY LOT WITHIN
THE PROPERTIES FOR THE BENEFIT OF APPLICABLE GOVERNMENTAL AGENCIES FOR INSTALLNG,
REMOVING, AND READING WATER METERS, MAINTAINING AND REPLACING WATER AND SEWER
FACILITIES, TRANSPORTING CH I LOREN TO AND FROM SCHOOL AND ACTING FOR OTHER PURPOSES
CONSISTENT WITH PUBLIC SAFETY AND WELFARE, INCLUDING, WITHOUT LIMITATION, LAW
ENFORCEMENT, FIRE PROTECTION, GARBAGE COLLECTION AND THE DELIVERY OF MAIL
SR, Tppy
PELICAN PROPERTY /
HOLDINGS, LLC %
AND
1 GREAT OAKS %
PROPERTY HOLDINGS,
R LLC /
ROBf50N O.B. M. PG. 498
2.
VICINITY MAP % �
LEGEND
8
PROPERTY BOLWDARY LANE %
223
stow ar Norm craMo
camtr or Har.
R.- W. s of Hoka Ceunty, ulr[ily
that tn• map r peat to .nlr:i NIA carlillPRI - I.
am..a m«1a dl
Mtutary r•aak•m h far rwvdinq.
R-- ONkr
Oat.
s � rwNAaOIAq
LOT LINES B.bDD c
,yt' ,g° 9 261
8,7601,
L,NE5 HOT SLAVEYED % BREEZEWOOD OF
LLC
'P�
- - - - - - - - - B..SEACK u SETBACK % FAYETTEVILLE, 222
(FUTURE DEVELOPMENT) e,aoD:.r
sf
- -- - 5' PERM. UTIL ESY'T. ALQ2G RV
221 yy
239 Q�C
8.400 s.f27
.,y�c
8,400 sf dt
.
e)IDs.r.
CIL USING IRON STAKE /' N y F�
ECM. EwsTa2c DalO. MERRIMENT e4o o.r J a\
4g
240 91
/. �M1
258
219 r pP . 8.40p e1.
^h "� R tr 27Z
8
874 11.257
( 8514s.1
218
8400sf.
a2743 r. CA
�
e,aoo ���
ffi 32
33
s.r.(� g 254
275
SAM 1.1.
% Q '4 r�O 245 N e.aoo, r.
O� 34
`.. '-
e,2Bie6 �r.
Q JS
246 nE)z53
/ (�P' ..LI
214 `_ I, ADD sf. N81'd5'36'W
a¢ \
s.t.
Bl ( 82 � 8 Q 252
277 A�
THE HIGHLAND $ AT 213 J �` B24 s.l. - THE L:pLANDS AT "M1
BEDFORD PH 1 s>• BEDFONB, PHASE
6.a00 s f. ?�, GAB. MAP D00 `-
CAB. Y P DE.4-77. �gOq2R.
$
\
- 278 \ ,, 20
M1 d
d sss,FFF xY 248251
-\ 37 \
\
47 't $
\ \
1Y 'P
ME TI
ME
279
\7�/
\\ 7
RDL•LAI„c BEDFORD PHASETHE
♦. w"' 7.5939s./. a 230 •,THE MHILANDS AT.FO� b
CORNER CAB. 4, SLIDE 4-78, 4g * y �. PHASE/9 \ •,
MAP W7 MAP 16
THE HIGHLANDS AT 17E) .---. CN�4:-SUDkt76.
-�\_ O
PHASE i S33'03'35'W O
- Q07
BEDF
CAB. �41DE h77, a N7e+4P 94.54'
45 I SSp'29'34^N 41
`
MAP D02 �7' PS
39
\
49 NB9'33'OD'W H fi0'.50' 43 42
48 e 8:� 68.12' I THE MIDLANDpS AT BEDYIORD I
w 17 Y
\ \ /
S'`' NInF X,7 PHASE 1 1
` Y / i CM. 4. SUDE 4-76. MAP oo7
@
® 16 \\
2 (D CEHF E.T. 14os1 HSa-Fn9k1'
L\ 15'\
\
14
2�PRIVA 6 I 7 j 6 j 9 'I to 1z
j 13
1 \
BE7 I I
" THE: MIDLANIPH
CAB.I4. SLIDE -76. MAP
I
L 1
o
`
C/L STREET CURVE DATA CURVE TABLE (LOT 212) SLIDE
® R.675.00' D=26°10'OD' T=156.87' (CHD.N63-05-DO-E 305,60) C45 L-M 80 R=325W D=06'0B'W CH>. L=34.79
CHD. DIR.=SD2.3T'GA"E
m (Z R=275.00' D=49`33.00° T=12697 (CHD.N25'13'30°E 230.48')
MAP
m R=230.DU D-40'2T00' T-04.7W (CHD.N79°46'30-W 15903')
Ha`fP
Q) III D=16°49'O6' T=44.35' (CHD. N07°5T33'W 87.74')
u"m
Ryq mr � � W +swo = Is«r ...row as vcl'u•
4
'
'M rMr M m r+MHa w« s Dvow a Iva.
`_ _ s sterq Nl PrFAaasie a"'�1=
KINLAW DEVELOPMENT /
`^\ D.B. 359. PG. 740
159
COLONIAL CHARTERS
BREEZEWOOD OF 2, CAB. SLIDE 2-43. Mo01
FAYETTEVILLE, LLC--AP --
(FUTURE DEVELOPMENT)
ISO
rE \
29
\ CERTIFICATE OF OWNERSHIP i DEDICATION
\ hereby crtlly Nat Ne ore Ne oNnr. of lna
26 ` pprroprty anoNn ma a.sarroad nrm. Rn�<n Is
Ix tad in the slbdlW.lon Jurladiclim o1 Hoke
-\ CaunlY and toot "s hrMY odopl thh plan of eub-
AT BE -'\ % OlMabn •Htl, our Nee cmeent and eatablM
ASE 1 25 \/ alrleets and ea".anenita to Public use. edkate dl
E 1-76 .007 l ;
\
2/ / Date
-
\ % 0-(.)
\ / 23 BREZEWDOD OF FAY., LLC
`\/
I hereby < tify Nat dl et..tB. utilti.. d
oNr re9uied 4npovemmta MW, been N-R.d
-\_ % a m approYea by the Pproprlate state or
t2 local authmityt and c dlnq to ty pacif-
y -time d andardA . Na SEDFORD bdir,sion
Nal -IIINe f the inalallatm of me
% re9wred �'„"woYemenis In n m t md�m r
BREEZEWOOD OF liefactmy to Hoke CounT�have been eiwa and
\/ That o fllinq f« In the a nl of has
J FAYETTEVILLE. LLC. bean paid ma Hal Ih pot naa Been approves by
(FUTURE DEVELOPMENT) the Hoke Cmnly Boore of commlesi r fm
/ in H.
office of Ina Regieler of Dseds o/ Noka"County
Dote SubdiWeion Admmat,ot.,
'PRELIMINARY PLAT' - NOT FOR RECORDATION, CONVEYANCES OR SALES
PRELIMINARY PLAT
THE MIDLANDS
AT BEDFORD
PHASE 2
PROPERTY OF
BREEZEWOOD OF FAYETTEVILLE, LLC,
MCLAUCHLIN TWP. HOKE COUNTY
SCALE: 1 "= 100' FEBRUARY 2016
GRAPHIC SCALE
IN FM)
I IDph - 100 /L
MOORMAN, KIZER & REITZEL, INC. 115 BROADFOOT AVE. FAYETTEVILLE, N.C. 29305
PHONE[phone] FAX[phone] LICENSEBF-0306

r
m
A T
667 10
1
10000
Q�
a
ov
O oi, Q RFr',yFNRi
r°
y4)'W00p _--- -- - _ _
9
1
kryopo5erj
5e.weh
'14AWS 1%96e.
Ex �ewet
Johnsons
Mill
%__ 277
�r
'ONt,SON �ILV �` Cy rr
3°76
+ W
0
1 ? eao Z g
Ao V JPPY CREEK C/R
F
O
$ILLA MAE �l+ _ N751wmN
✓, _ 35*00'
669 -- i700' E 79°07'30"
ROAD CLASSIFICATION
t C ector
Expressway Loca W.
NORTH CAROLIN
•
Secondary Hwy — - Local Road
Ramp 4WD
of Interstate Route C3 US Route O State Route
QUADRANGLE LOCATION
1 Niagara
2 Lobelia
3 Overtlills
4 McCain
M3BPari(ton
5 Clifdale
6 Wagram
NICHOLSON CREEK, NC
7 Raeford
2016
ADJOINING QUADRANGLES
N
o N
�°r M
fir.. Y
N
�X
== 0
O
D
Z
LU
�Z 3

December 20, 2016
Mr. Trent Allen
NCDENR
225 Green Street
Suite 714 Systel Building
Fayetteville, NC 28301
Re: Fast -Track Application for Gravity Sewer Mains
The Midlands at Bedford Phase 2
Hoke County, NC
Dear Mr. Allen,
ENGINEERS
PLANNERS
SURVEYORS
MOORMAN, KIZER & REITZEL, INC.
115 Broadfoot Ave.
P.O. Box 53774
Fayetteville, NC 28305
[phone]
Fax: [phone]
www.mkrinc.com
RECEIVED
DEQ/DWR
DEC 21 2016
WQROS
FAYETTEVILLE REGIONAL OFFICE
Enclosed you will find one original and one copy of the Fast -Track Application, Flow
Tracking Application, Watershed Classification Attachment, check for $480.00 and all
necessary documents for permitting the gravity sewer mains for The Midlands at Bedford
Phase 2 in Hoke County. This project is located off of US 401 South — Fayetteville Road
in Hoke County and is an addition to the existing Bedford Phase I development.
The work associated with The Midlands at Bedford Phase 2 will include gravity sewer
infrastructure to serve a total of 47 residential lots at full "build out" of this particular
phase. Flows generated from these residential lots in the development will discharge to
the recently completed Hoke County WWTP.
I would appreciate you reviewing this information as soon as possible and letting me
know if you have any questions or need additional information in regards to the project.
Please feel free to give me a call or e-mail me at 910-484-5191 or ksmithkmkrinc.com.
Respectfully Submitted,
Ken Smith Jr., EI

State of North Carolina
11WR Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Dlvlslon of Water Resources 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: Hoke County (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ® State/County ❑ Municipal
3. Signature authority's name: Letitia Edens per 15A NCAC 02T .0106(b)
Title: County Manager
4. Applicant's mailing address: P.O. Box 240
City: Raeford State: NC Zip: 28376-
5. Applicant's contact information:
El Privately -Owned Public Utility
❑ Other t- E(;EIVEU
DEQ/DWR
DEC 21 2016
WQROS
FAYETTEVILLE REGIONAL OFFICE
Phone number. (910J j/5-0385 Email Address: hvillmesLWhokeco1M.org
II. PROJECT INFORMATION:
1. Project name: The Midlands at Bedford - Phase 2
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ00 and issued date:
If new construction but part of a master plan, provide the existing permit number: WQ00
3. County where project is located: Hoke
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.032770' Longitude:-79.126684'
RALPH HUFF HOLDINGS, LLC
2919 BREEZEWOOD AVE., STE 400
FAYETTEVILLE, NC 28303
Se" ATnist
nk
66-1233/531
12/9/2016
PAY TO THE NCDEQ
ORDER OF
Four Hundred Eighty and 00/100 $ 480.00
MEMO
0
NCDEQ
The Midlands at Bedford - Sanitary Sewer
FORM: FTA 04-16
2927
DOLLARS
rePt SEft T`
AU?RORIZED SIGNATURE
o rW
9
ODES
Page 1 of 5

1
Permit Number W00038963
Program Category
Non -discharge
Permit Type
Gravity Sewer Extension, Pump Stations, & Pressure Sewer Extensions
Primary Reviewer
trent.allen
Coastal SWRule
Permitted Flow
11,280
Facility
Central Files: APS _ SWP
1/11/2017
Permit Tracking Slip
Status
Project Type
Active
New Project
Version
Permit Classification
1.00
Individual
Permit Contact Affiliation
Facility Name Major/Minor Region
The Midlands at Bedford - Phase 2 Minor Fayetteville
Location Address County
Hoke
Owner
Owner Name
Hoke County
Facility Contact Affiliation
Owner Type
Non -Government
Owner Affiliation
Letitia Edens
227 N Main St
Dates/Events Raeford NC 28376
Scheduled
Orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
1 /11 /2017 12/21 /2016 1 /11 /2017 1 /11 /2017
Regulated Activities Requested /Received Events
Wastewater collection Additional information requested
Additional information received
Outfall
Waterbody Name Streamindex Number Current Class Subbasin