WQ0033513_Application_20081013

M ' OF \N A TFRp �F'vR— State of North Carolina
O G�Iv Department of Environment and Natural Resources
1, 7 OCT 1 3 200E Division of NVater Quality
o wQ COPY FAST -TRACK APPLICATION
D' " (FTA 12/07 )
for GRAVITY SE«'ERS, PUMP STATIONS, AND FORCE MAINS
(Pressure b; Vacuum seN%er systems are not to be included as part of this application package)
INSTRUCTIONS: Indicate that you have included/addressed the following list of required application package items by
checking the space provided next to each applicable item. Failure to submit all required items will lead to your application
being returned as incomplete. Forms are available from the web site or by calling the Regional Office serving your county:
http://h2o. enr, state. nc. us/peres/Collection % 20Systems/CollectionSystemApplications. html
X A. Application Form - Submit one original and one copy of the completed and appropriately executed application
form. The application should include a project narrative describing the final build -out design (i.e. system and/or
pump station to ultimately serve 500 homes, but flow for only 100 homes being requested now). For modifications,
clearly explain the reason for the modification (i.e. adding another phase, changing line size/length, etc.). Only
include the modified information in this permit application - do not duplicate project information that has already
been included in the original permit.
Any changes to this form will result in the application being returned. The Division of Water Quality (Division) will
only accept application packages that have been fully completed with all applicable items addressed. You do not
need to submit detailed plans and specifications unless you respond NO to Item 1303).
Separate applications should be made for non-contiguous sewer systems
X B. Application Fee - Submit a check in the amount of $480 made payable to: North Carolina Department of
Environment and Natural Resources (NCDENR). Checks ;hall be dated within 90 days of application submittal.
❑ C. Certificates of Public Convenience and Necessity — If the application is being submitted in the name of a
privately -owned public utility, submit two copies of the Certificate of Public Convenience and Necessity (CPCN)
which demonstrates that the public utility is authorized to hold the utility franchise for the area to be served by the
sewer extension. If a CPCN has not been issued, provide two copies of a letter from the North Carolina Utilities
Commission's Public Staff that states that an application for a franchise has been received, that the service area
is contiguous to an existing franchised area, and/or that franchise approval is expected. The project name in the
CPCN or letter must match that provided in Item A(2)a of this application.
❑ D. Operational Agreements — Submit one original and two copies of a properly executed operational agreement, as
per 15A NCAC 02T .0115, if the application is submitted by a private applicant and will be serving residential or
commercial lots (e.g., houses, condominiums, townhomes, outparcels, etc.) that will be sold to another entity. If
the applicant is a home or property owner's association, use Form HOA 02/03. If the applicant is a developer,
use Form DEV 02/03. EVEN IF THE PROJECT MAY BE TURNED OVER TO A MUNICIPALITY UPON
COMPLETION, FORM DEV 02/03 IS REQUIRED.
X E. Downstream Sewer, WWTF Capacity and Flow Tracking/Acceptance — FORM FTSE 10/07 (Flow
Tracking/Acceptance for Sewer Extension Permit Applications) is required with every application. The applicant
(and owners of downstream sewers, pump stations and/or treatment facilities submitting FORM FTSE-10/07)
certifies that the addition of the volume of wastewater to be permitted in this project has been evaluated along the
route to the receiving treatment plant, and that the flow from this project will not cause capacity related sanitary
sewer overflows or overburden any downstream pump station en route to the receiving wastewater treatment
plant. Where the applicant is not the owner of the downstream sewer, submit two copies of FORM FTSE 10/07
from the owner of the downstream sewer and owner of the WWTF, if different. The flow acceptance indicated in
FORM FTSE-10/07 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-10/07 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 project -specific FTSE 10/07.
X F Map — Submit an 8.5-inch by 11-inch COLOR copy of a USGS Topographic Map of sufficient scale to identify the
entire project area and the closest surface waters. Each map or maps must show the location of the sewer line
and pump stations and be of reproducible quality. Include a street level map showing the downstream connection
point, and the permit number for the downstream sewer, if known.
FTA 12/07

[]iG,. Stream Classifications — Watershed Classification Attachment (Form WSCAS-12/07) If any portion of the
• sewer system project is within 100 feet of any surface water or wetlands, the Watershed Classification Attachment
may need to be completed. A variance must be requested for encroachment within required setbacks or buffers
pursuant to 2T .0305 (f) and be indicated in Item B-13 with supporting documentation/justification provided.
❑ H Environmental Assessments — If this project is subject to an Environmental Assessment (EA) [15A NCAC
01C], this application cannot be used. Send the project application on the most current version of Form
PSFMGSA to the Design Management Unit, 1633 Mail Service Center, Raleigh, NC 27699-1633. Applications
cannot be accepted until a Finding of No Significant Impact (FONSI) or Environmental Impact Statement (EIS)
has been issued. A copy is to be submitted with that permit application.
❑ I. Flow Direction — Many wastewater treatment systems are entering into agreements for regionalization efforts
and emergency treatment capacity. Parts of the system are installed so that the wastewater flow can be directed
to more than one treatment facility. If this is the case with this project, please indicate in 13(12) and give the permit
number of the second treatment facility.
X J. Certifications — Section C
The application must be certified by both the applicant and the design engineer who is a North Carolina
Registered Professional Engineer (PE). The applicant signature must match the signing official listed in Item
A(lb). The PE should NOT certify the application if he/she is unfamiliar with 15A NCAC Chapter 2T, the Gravity
Sewer Minimum Design Criteria (most recent version) and the Minimum Design Criteria for the Fast -Track
Permitting of Pump Stations and Force Mains (most recent version), as applicable to the project.
THE COMPLETED FTA 12/07 APPLICATION PACKAGE, INCLUDING ALL SUPPORTING
DOCUMENTS AND $480 FEE, 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,
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,
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,
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,
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,
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
Wilmington, North Carolina 28405
Hanover, Onslow, Pender
[phone]
[phone] Fax
i
Winston-Salem Regional Office
585 Waughtown Street
Alamance, Alleghany, Ashe, Caswell, Davidson,
Winston-Salem, North Carolina 27107
Davie, Forsyth, Guilford, Rockingham, Randolph,
[phone]
Stokes, Surry, Watauga, Wilkes, Yadkin
[phone] Fax
For more information, please visit our web site at.* http://www.ncc-gLnet/EngineeringlSewerlo20Permits.htmi
or contact the Regional Office serving your county.
FTA 12/07

USE THE TAB KEY TO MOVE FROM FIELD TO FIELD! Application to Number:
b Number:
be completed ) W00033 513
1.
Owner/Permittee:
la.
Town of Biscoe
Full Legal Name (company, municipality, HOA, utility, etc.)
Z
1b.
James E. Blake Mayor
Signing Official Name and Title (Please review 15A NCAC 2T .0106 (b) for authorized signing officials!)
H
Q
1c.
The legal entity who will own this system is:
❑ Individual ❑ Federal X Municipality ❑ State/County ❑ Private Partnership ❑ Corporation ❑ Other (specify):
O
1 d.
P.O. Box 1228 1 e. Biscoe
LL
Mailing Address City
Z
1 f.
North Carolina 1 g. 27209
Z
State Zip Code
0
1 h.
910-428-2158 1 i. 910-428-3975
QTelephone
Facsimile E-mail
V
2.
Proiect (Facility) Information:
J
2a.
Biscoe Industrial Park 2b. Montgomery
IL
Brief Project Name (permit will refer to this name) County Where Project is Located
a
Q
3.
Contact Person:
3a.
Thomas K. Goodwin P.E., Hobbs, Upchurch and Associates, P.A. cF« y/o - So 5 2`1 89
Q
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b.
910-692-5616 3c. [e-mail]
Phone Number E-mail
1.
Project is X New ❑ Modification (of an existing permit) If Modification, Permit No.:
2.
Owner is X 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))
3.
Town of Biscoe
Z
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
0
4a.
Town of Biscoe Wastewater Treatment Facility 4b. NPDES NCO021504
QName
of WWTF WWTF Permit No.
5a.
Town of Biscoe 5b. 12 INCHES X Gravity 5c.
Owner of Downstream Sewer Receiving Sewer Size ❑ Force Main Permit # of Downstream Sewer (Instruction E)
0
LL
6.
The origin of this wastewater is (check all that apply):
?
�
% Domestic/Commercial
❑Residential Subdivision El Retail (Stores, shopping centers)
❑ Apartments/Condominiums ❑ Institution % Industrial (attach
❑ Mobile Home Park ❑ Hospital description.)
LJ.I
❑ School ❑ Church (RO: contact your Regional Office
X Restaurant ❑ Nursing Home
a
Pretreatment staff)
❑ Office ❑ Other (specify):
% Other (specify):
7.
Volume of wastewater to be allocated or permitted for this particular project: t4 0 6AP O 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)
FTA 12/07

W
M
Z
Z
0
V
Z
0
H
Q
0
U.
Z
H
W
a
71
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 13(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).
Waffle House @ 34 seats/day @ 40 gallons/day =1=W gpd
1360
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches)
1Y
Length (feet) New Gravity or Additional
Force Main
249.16 LF Gravity
11. Summary of Pump Stations w/ associated Force Mains to be Permitted (attach additional sheets as necessary)
Pump Station Location ID
Design Flow
(MGD)
(self chosen - as shown on plans/map for reference)
Operational Point Power Reliability Option
GPM @TDH I - Permanent generator w/ATS; 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 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 X No If Yes, permit number of 2rd 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?
X 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
FTA 12/07

14 Have the following permits/certifications been submitted for approval for the system or project to be served?
Wetland/Stream Crossings - General Permit or 401 Certification? ❑ Yes [:]No X N/A
Sedimentation and Erosion Control Plan? ❑ Yes ❑ No X N/A
Stormwater? ❑ Yes ❑ No X N/A
15. Does this project include any high priority lines, [see 15A NCAC 02T .0402 (2)) involve aerial lines, siphons, or interference
manholes)? These lines will be considered high priority and must be checked once every six months
Check if Yes: ❑ and provide details
1. Owner/Permittee's Certification: (Signature of Signing Official and Project Name)
1, _James E. Blake, Mayor , attest that this application for The Waffle House 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. Note: In accordance with North Carolina General
Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement, representation, or
certification in any application shall be guilty of a Class 2 misdemeanor, which may include a fine not to exceed $10,000
as well as civ' enalties up to $25,000 p iol io
1 a.
gning Official Signature /Dade
ENGINEERING DESIGN DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL OF THIS
APPLICATION. THESE DOCUMENTS MUST INCLUDE PLAN AND PROFILE OF SEWERS, THEIR PROXIMITY
TO OTHER UTILITIES, DESIGN CALCULATIONS. ETC. REFER TO 15A NCAC 02T .0305
Z
O
Q2. Professional Engineer's Certification: (Signature of Design Engineer and Project Name)
_V 1, _Thomas K. Goodwin attest that this application for The Waffle House has been
tL reviewed by me and is accurate, complete and consistent with the information in the engineering plans, 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
uJ for Gravity Sewers adopted February 12, 1996, and the Minimum Design Criteria for the Fast -Track Permitting of Pump
(,) Stations and Force Mains adopted June 1, 2000 and the watershed classification in accordance with Division guidance.
Although other professionals may have developed certain portions of this submittal package, inclusion of these materials
V 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 NC General Statutes 143-215.6A and 143-215.6B, any person who knowingly
makes any false statement, representation, or certification in any application 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.
2a. Thomas K. Goodwin
Professional Engineer Name
2b. Hobbs, Upchurch and Associates, P.A.
Engineering Firm
2c. P.O. Box 17737
Mailing Address
2d. Southern Pines
City
2g. 910-692-5616
Telephone
2h. 910-692-7342
Facsimile
2e. NC 2f. 28387
State Zip
2i. [e-mail]
E-mail
. I,-
NC PE Seal, Signature & Date
FTA 12/07

Project Narrative:
Waffle House — Biscoe, North Carolina
HUA MC0809
This project consists of the installation of new 8" sanitary sewer to serve the Waffle
House as part of a larger tract `Biscoe Industrial Park" located in Biscoe, North Carolina.
Final build -out design for the project consists of 20 business lots, but flow for 1 lot
(Waffle House) is being requested now.

O�O�WAT�RpG
cisDJJa
O �
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
Flow Tracking/Acceptance for Sewer Extension Permit Applications
(FTSE—10/07)
Project Applicant Name: _Waffle House
Project Name for which flow is being requested: Biscoe Industrial Park
More than one FTSE-10107 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:
b. WWTP Facility Permit #:
Town of Biscoe Wastewater Treatment Facility
NPDES NCO021504
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
All flows are in MGD
.500 MGD
NONE
.184 MGD
1500 GPD
APP. .184 MGD NONE OBLIGATED
APP. 40Z
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
Pump Station Name Approx. Capacity, MGD Approx. Current Avg.
(Firm/Design) Daily Flow, MGD
III. Certification Statement:
I, _James E. Blake, Mayor , certify that, to the best of my knowledge, 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. 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) Sections I and II for which I am the responsible party. Signature of this form indicates
accentance�df this wastewater flower /7 i
i�txg Official Signature

Instructions for: Flow Tracking/Acceptance for Sewer Extension Permit
Applications (FTSE—10/07)
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.
The obligated flow not yet tributary plus actual flow will be reconciled annually for systems at less
than 60% of permitted flow used. Annual updates shall be submitted to the appropriate Regional
Office by January 15 of each year and cover the previous calendar year.
Semi -Annual updates shall be required when the percent of permitted flow used reaches 60%. Semi-
annual time period are defined as January 1 through June 30 and July 1 through December 31. Semi-
annual updates shall be submitted to the appropriate Regional Office by July 15 and January 15 of
each year.
Quarterly updates shall be required when the percent of permitted flow used reaches 80%. Quarters
are defined as Qtrl (Jan -Feb -Mar); Qtr2 (Apr -May -Jun); Qtr3 (Jul -Aug -Sep); Qtr4 (Oct -Nov -Dec).
Quarterly updates shall be submitted to the appropriate Regional Office by April 15, July 15, October
15 and January 15 of each year.
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.
The first Form FTSE-10/07 submitted after January 15, 2008 may have numbers like this:
c. = 6.0 MGD
d. = 0.5 MGD
e. = 2.7 MGD
f. = 0.015 MGD
g. = 3.215 MGD
h. = 53.6 %
The next Form FTSE-10/07 may be updated like this:
c. = 6.0 MGD
d.=0.515MGD
e. = 2.73 MGD
f. = 0.102 MGD
g. = 3.349 MGD
h. = 55.8 %
Each subsequent Form FTSE-10/07 will be updated in the same manner.
Section II
List the name, approximate pump station firm (design) capacity and approximate current average flow
(previous 12 months) through the pump station for each pump station that will be impacted by the
proposed sewer extension project. Include the proposed flow for this project and other flows that have
been approved for the pump station but are not yet tributary.
Firm (design) capacity is the design average daily flow of the pump station as calculated by the design
engineer or the station capacity with the largest pump out of service as per the Minimum Design Criteria
if the design capacity is unknown.
Section III
Form FTSE-10/07 must be signed by the appropriate official as per 15A NCAC 02T .0106.

BISCOE QUADRANGLE
NORTH CAROUNA-MONTGOMERY CO,
7.5-MINUTE SERIES (TOPOGRAPHIC)
7` 30' 510 1611 1770000 FE T 613 79045'
35022' 30`
FaithfuF. � (5) 3915
591
r2"i i ia7�
590000
FEET
[e
r nt ,t i 3914
: N
s
t7u'�
fast Win
;� . _ -- « . ... •�} , � -,,—(�!r�;`'".�r�' � . Taps.
Btsc
r t • �it
,
a }food
� � � • r �rnf�el • Va
AQ
�--s�outl wo
C f `
• j5
���� •� `G '' (/ �� ti 3912
Ra
87
609
ss
1
,r.•t. �... fast .� t ,, X er j -r
t

Hobbs, Upchurch
& Associates, P.A.
Consulting Engineers
TRANSMITTAI P.O. Box 1737
300 S. W. Broad Street
Southern Pines, North Carolina 28388
[phone] FAX [phone]
TO: NCDENR — Division of Water Quality HUA PROJECT # MCO V EI V R —1 R "
Fayetteville Regional Office �J ' V
225 Green Street, Suite 714 OCT 13 2008
Fayetteville, NC 28301-5094 ry,R j
V:tl
FROM: Tom Wanko HUA FILE NO. # MC0809
Hobbs, Upchurch & Associates, P.A.
DATE: October 10, 2008
RE: Waffle House — Biscoe Industrial Park
MESSAGE: Please find the following Enclosed:
1-original Fast -Track Application (FTA 12/07)
1-copy Fast -Track Application (FTA 12/07)
1-copy Project Narrative
1- original Flow Tracking/Acceptance for Sewer Extension Permit App. (FTSE-10/07)
1-copy Color USGS Topographic Map
1- check for $480.00
Please contact our office for any questions or concerns.
Thank you
h: I mcOW 3W &ansmittal- ncdenr-water qualityfayetteville. doc