WQ0041610_Application_20200402 (2)

State of North Carolina
FM
Department of Environmental Quality
s Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division 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: City of Lumberton (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: T. Wayne Horne per 15A NCAC 02T .0106(b)
Title: City Manager �&
4. Applicant's mailing address: 500 N. Cedar Street APR 2 2020
City: Lumberton State: NC Zip: 28358-
5. Applicant's contact information:
DEO-FAYETTEVILLE REGIONAL OFPr
Phone number: [phone] Email Address: [e-mail]
II. PROJECT INFORMATION:
1. Project name: FY2017 Wastewater System Improvements - Rosewood MHP
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 aster lan, p vide the existing permit number: WQ00
3. County where project is locat : Robeson
CITY OF LUMBERTON
OPERATING ACCOUNT
P. O. BOX 1388
LUMBERTON, NC 28359
PAY FOUR HUNDRED EIGHTY AND XX / 100
TO THE NCDEQ
ORDER LAND QUALITY SECTION
OF 225 GREEN ST SUITE 714
FAYETTEVILLE, NC 28301
BB&T
BRANCH BANKING AND TRUST COMPANY
1-800-BANK BBT BBT.Com
66-112/531
DATE CONTROL NO.
03/24/2020
45326
45326
AMOUNT
m
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N
m
*********480.00 t
a
FID
FORM: FTA 04-16 Page 1 of 5