WQ0016140_Application_19981117

State, of North Carolina
'Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
November 17, 1998
Mr. David Harris, Executive Director
Cameron Automotive/MOWASA
P. O. Box 1027
Carthage, NC 28327
NCDENR
NORTH AN
ENVIRONMENTNT AND L
P�OV 19 1998
FAYET TEVI LLE
REG. OFFICE
Subject: Application No. WQ0016140
Cameron Automotive
Sewer -Public
Moore County
Dear Mr. Harris:
The Division's Permits and Engineering Unit acknowledges receipt of your permit application and
supporting materials on November 16, 1998. This application has been assigned the number listed above.
Your project has been assigned to Mr. Ron Palumbo for a detailed engineering review. Should there be
any questions concerninCD
g your project, the reviewer will contact you with a request for additional information.
Be aware that the Division's Regional Office, copied below, must provide recommendations from the
Regional Supervisor or a Procedure Four Evaluation for this project, prior to final action by the division.
If you have any questions, please contact Mr. Ron Palumbo at 919/733-5083 ext. 533. If the engineer is
unavailable, you may leave a message on their voice mail and they will respond promptly.
PLEASE REFER TO THE ABOVE APPLICATION NUMBER WHEN MAKING INQUIRES ON
THIS PROJECT.
Sincerely,
"r. Kim H. Colson, P.E.
Supervisor, Non -Discharge Permitting Unit
cc: Fayetteville Regional Office, Water Quality
Nelson Consulting, Inc.
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

MEMO TO: State Review Group
Division of Water Quality
FROM:
Ricky Revels
Fayetteville Regional Office
SUBJECT: Procedure Four (4)
December 14, 1999
WQ0016140
Date
Cameron Automotive
Sewer Extension -Public
Town of Carthage
Moore County
State Review Group Review
Engineer Ron Palumbo
Regional Office
Contact Ric4 Revels
1)
Name of wastewater treatment plant
to receive the wastewater:
Moore Co. Regional WWTP
2)
WWTP design capacity
6.7000 MGD
3)
NPDES Permit No. NCO037508 Expiration Date: 11/30/1999
4)
Compliance Information:
Present treatement plant performance for previous _12_ months, beginning 97/01 &
97/11
(See attached self -monitoring data)
5) Quantity and type of wastewater from proposed sewers:
500 GPD
domestic X_ industrial other
6) Volume from previously approved projects not yet tributary to WWTP:
-52,000-GPD previously approved flows began with WQ0015947 dated 12/11/98
7) Regional
Recommendations: Approval X Denial
RR/rr
Enclosure

GKEX88/MP
12/03/98
COMPLIANCE EVALUATION ANALYSIS
REPORT
PAGE 1
4
PERMIT--NC0037508
PIPE--001
REPORT PERIOD:
9701-9712
LOC --- E
FACILITY--MOORE CO
WWTP
DESIGN FLOW--
6.7000
CLASS--4
LOCATION--CARTHAGE
REGION/COUNTY--06
MOORE
50050
00310
00530
00610
31616
50060
00300
TGP3B
MONTH
Q/MGD
BOD
RES/TSS
NH3+NH4-
FEC COLI
CHLORINE
DO
CERI7DPF
LIMIT F
6.7000 F
30.00
F 30.0
NOL
F 200.0
NOL
NOL
NOL
97/01
4.6645
4.21
3.5
.27
14.1
185.238
9.83
97/02
4.7321
3.93
4.3
.10
14.7
102.500
10.36
97/03
4.8741
3.27
5.0
.10
27.2
142.250
9.86
1
LIMIT F
6.7000 F
22.00
F 30.0
17.00
F 200.0
NOL
NOL
NOL
97/04
4.7633
3.60
6.1
.10
15.8
101.818
9.17
97/05
4.8483
2.59
4.6
.10
13.3
117.619
9.07
97/06
4.8233
2.26
2.7
.10
17.9
98.095
8.94
1
97/07
5.2935
2.51
4.9
.10
22.5
122.272
8.59
97/08
5.1387
2.50
4.2
.10
12.3
143.333
8.42
97/09
4.8533
2.60
6.4
.10
17.1
131.904
8.61
1
97/10
4.7741
3.03
4.0
.10
15.3
149.565
9.20
LIMIT F
6.7000 F
30.00
F 30.0
NOL
F 200.0
NOL
NOL
NOL
97/11
4.6333
3.62
7.3
.47
11.3
144.117
10.10
97/12
4.4548
3.11
5.3
.10
16.9
148.000
9.78
AVERAGE
4.8211
3.10
4.8
.14
16.5
132.225
9.32
1
MAXIMUM
8.4000
7.70
13.2
4.90
192.0
600.000
14.00
1
MINIMUM
2.3000
2.00
2.0
.10
1.0
30.000
5.70
1
UNIT
MGD
MG/L
MG/L
MG/L
#/100ML
UG/L
MG/L
PASS/FAI

GKEX88/MP
12/03/98
COMPLIANCE EVALUATION ANALYSIS REPORT
PAGE 2
PERMIT--NC0037508
PIPE--001
REPORT PERIOD: 9701-9712
LOC ---
E
FACILITY--MOORE CO WWTP
DESIGN FLOW-- 6.7000
CLASS--4
LOCATION--CARTHAGE
REGION/COUNTY--06 MOORE
00010 00400
00600
00665 00720 01042
01077
01092
MONTH TEMP PH
TOTAL N
PHOS-TOT CYANIDE COPPER
SILVER
ZINC
LIMIT NOL 9.0 6.0
NOL
NOL NOL NOL
NOL
NOL
97/01 15.23 8.1-7.0
18.500
1.5500 .0000 7.5000
.0000
26.5000
97/02
97/03
LIMIT
97/04
97/05
97/06
97/07
97/08
97/09
97/10
LIMIT
97/11
97/12
AVERAGE
MAXIMUM
MINIMUM
UNIT
15.00
7.8-7.4
16.650
1.3800
17.15
7.8-7.0
17.200
1.2800
NOL
9.0 6.0
NOL
NOL
18.45
7.9-7.3
16.900
1.4000
.0000 8.5000
.0000 8.5000
NOL NOL
.0000 7.5000
.0000 27.5000
.0000 28.0000
NOL NOL
.0000 26.5000
20.47
7.8-7.2
14.900
2.0500
.0000
8.5000
.0000
21.5000
22.71
7.7-7.3
11.100
2.7000
.0000
10.0000
.0000
16.5000
25.22
7.8-7.5
16.500
1.8200
.0000
8.5000
.0000
17.0000
25.38
7.8-7.4
20.400
2.5900
.0000
11.0000
.0000
15.0000
24.52
7.6-7.2
15.800
2.2600
.0000
9.5000
.0000
31.0000
22.34
7.6-7.2
12.200
1.7500
.0000
7.0000
.0000
35.5000
NOL
9.0 6.0
NOL
NOL
NOL
NOL
NOL
NOL
19.00
7.6-6.9
15.080
2.1000
.0000
10.0000
.0000
27.5000
16.45
7.4-7.0
17.800
1.8700
.0000
10.5000
.0000
23.5000
20.16
16.085
1.8958
.0000
8.9166
.0000
24.6666
27.00
8.100
20.400
2.7000
12.0000
40.0000
14..00
6.900
11.100
1.2800
6.0000
12.0000
DEG.0
SU
MG/L
MG/L
UG L
UG/L
UG L
UG/L

GKEX88/MP
12/03/98
COMPLIANCE EVALUATION ANALYSIS
REPORT
PAGE 1
PERMIT--NC0037508
PIPE--001
REPORT PERIOD:
9711-9810
LOC --- E
FACILITY--MOORE CO
WWTP
DESIGN FLOW--
6.7000
CLASS--4
LOCATION--CARTHAGE
REGION/COUNTY--06
MOORE
50050
00310
00530
00610
31616
50060
00300
TGP3B
MONTH
Q/MGD
BOD
RES/TSS
NH3+NH4-
FEC COLI
CHLORINE
DO
CERI7DPF
LIMIT F
6.7000 F
30.00
F 30.0
NOL
F 200.0
NOL
NOL
97/11
4.6333
3.62
7.3
.47
11.3
144.117
10.10
LIMIT F
6.7000 F
30.00
F 30.0
NOL
F 200.0
NOL
NOL
NOL
97/12
4.4548
3.11
5.3
.10
16.9
148.000
9.78
98/01
5.2806
3.53
6.1
.10
18.2
165.789
9.96
1
98/02
6.1892
2.98
5.8
.10
7.9
203.000
10.14
98/03
6.3870
3.29
5.1
.10
15.3
167.272
10.37
1
LIMIT F
6.7000 F
22.00
F 30.0
17.00
F 200.0
NOL
NOL
NOL
98/04
6.3666
3.54
4.4
.10
10.2
160.000
9.23
98/05
6.0000
3.93
4.7
.10
26.1
173.000
8.39
98/06
5.4466
4.03
4.1
.10
23.3
95.909
8.06
1
98/07
5.1741
4.22
5.0
.10
21.1
150.434
7.82
98/08
5.0935
4.08
4.7
.10
28.1
114.285
7.96
98/09
4.8233
6.19
10.0
.10
54.6
156.666
8.16
1
98/10
4.8838
6.51
7.2
.10
33.1
284.318
8.25
AVERAGE
5.3944
4.08
5.8
.13
22.1
163.565
9.01
1
MAXIMUM
9.8000
11.70
26.0
4.90
4400.0
1145.000
14.00
1
MINIMUM
3.8000
2.00
2.0
.10
1.0
30.000
5.60
1
UNIT
MGD
MG/L
MG/L
MG/L
#/100ML
UG/L
MG/L
PASS/FAI

GKEX88/MP
12/03/98
COMPLIANCE EVALUATION
ANALYSIS REPORT
PAGE 2
PERMIT--NC0037508
PIPE--001
REPORT
PERIOD:
9711-9810
LOC ---
E
FACILITY--MOORE
CO
WWTP
DESIGN FLOW--
6.7000
CLASS--4
LOCATION--CARTHAGE
REGION/COUNTY--06 MOORE
00010
00400
00600
00665
00720
01042
01077
01092
MONTH
TEMP
PH
TOTAL N
PHOS-TOT
CYANIDE
COPPER
SILVER
ZINC
LIMIT
NOL
9.0 6.0
NOL
NOL
NOL
NOL
NOL
NOL
97/11
19.00
7.6-6.9
15.080
2.1000
.0000
10.0000
.0000
27.5000
LIMIT
NOL
9.0 6.0
NOL
NOL
NOL
NOL
NOL
NOL
97/12
16.45
7.4-7.0
17.800
1.8700
.0000
10.5000
.0000
23.5000
98/01
15.55
7.7-6.8
13.500
1.4000
.0000
8.0000
.0000
21.0000
98/02
14.60
7.8-7.3
11.000
1.6500
.0000
9.0000
.0000
21.5000
98/03
15.77
7.9-7.1
15.250
1.3700
.0000
8.0000
.0000
19.0000
LIMIT
NOL
9.0 6.0
NOL
NOL
NOL
NOL
NOL
NOL
98/04
18.47
7.9-7.4
8.130
2.4000
.0000
7.5000
.0000
19.5000
98/05
20.95
7.9-7.4
14.250
2.0500
.0000
11.0000
.0000
26.0000
98/06
23.90
7.9-7.3
12.760
2.2600
.0000
8.5000
.0000
20.0000
98/07
25.87
7.8-7.1
21.140
2.7000
.0000
10.0000
.0000
21.5000
98/08
26.09
7.8-7.4
15.170
1.9500
.0000
6.5000
.0000
21.0000
98/09
25.63
7.9-7.4
17.310
2.0200
.0000
10.0000
3.0000
25.0000
98/10
22.96
7.9-7.1
14.630
1.5900
.0000
7.5000
.0000
19.0000
AVERAGE
20.43
14.668
1.9466
.0000
8.8750
.2500
22.0416
MAXIMUM
27.00
7.900
21.140
2.7000
14.0000
6.0000
33.0000
MINIMUM
14.00
6.800
8.130
1.3700
6.0000
17.0000
UNIT
DEG.0
SU
MG/L
MG/L
UG L
UG/L
UG L
UG/L

--A�oczF (Watzz cSEUTEz c ut�Zozit , .-:�
Water Pollution Control System
R O. Box 813
Pinebluff, North Carolina 28373
0.0 WASA
OFFICE OF SYSTEM SUPERINTENDENT a
041
October 19, 1998
Mr. Ferrell Keough
State Engineering Review Group
N.C. Dept. of Environmental Health & Natural Resources
Division of Environmental
P.O. Box 27687
Raleigh, N.C. 27611
Dear Mr. Keough:
Re: 2" Force Main Sewer to serve
Cameron Automotive - Moore County
TELEPHONE, 910-281-3146
FAX: [phone]
E-mail: mowaaa2Qncpines.net
The Moore County Regional WWTP hereby agrees to conditionally accept up to 500 gallons
per day of wastewater from the above referenced project in accordance with the request of letter
of October 6, 1998 from Nelson Consulting, Inc. Civil Engineers - Pinehurst, N.C. 28374.
Upon completion of the referenced project, the applicant's engineer is to provide this office with
the following items:
1. Infiltration in gallons per day
2. Certification of completion as defined by N.C. Statutory Requirements #143-215.1;
Section 2-H.0200.
After Moore County has received a copy of the certification of completion, our office will provide
a final acceptance statement.
If you have any questions or comments concerning the reference, please do not hesitate to call
me at 910-281-3146.
Sincerely,
MOORE WATER AND SEWER AUTHORITY
�-
I
Gary Frick
System Superintendent
PC: Mr. Jim Tarnow, P.E., Moore Water and Sewer Authority
Mr. David Harris, Executive Director, MOWASA
Mr. W. David McNeill, Jr., Moore County Manager
Mr. Paul Rawls, Regional Supervisor, DEM, Fayetteville, N.C.
Mr. Eric B. Nelson, Jr., P.E. Nelson Consulting, Inc. Pinehurst, N.C.

Nelson Consulting, Inc.
Civil Engineers
300 Ampersand Road - PO Box 5889 - Pinehurst, NC 2837
910-295-1703
October 6, 1998
Mr. Gary Frick, System Superintendent `+
Moore Water and Sewer Authority /
P.O. Box 318
Pinebluff, NC 28373
RE: 2" Force Main Sewer to serve
Cameron Automotive
Moore County
Dear Mr. Frick:
r�4�e
Enclosed you will find a copy of the non -discharge application and a set of plans for the referenced project.
This project will produce 500 GPD of wastewater flow to the Moore Water Pollution Control Facility in
Addor. Please forward a copy of the acceptance letter, addressed to the NCDENR as indicated below, to
our office upon your accepting this flow at the treatment facility in Addor:
State Engineering Review Group
N.C. Dept. of Environment and Natural Resources
Division of Environmental Management
P.O. Box 27687
Raleigh, NC 27611
Should you have any questions or co ents with regard to this project, do not hesitate to contact our
office.
CC, Sincerely,
�Cov� Eric B. Nelson Jr., P.E.
Nelson Consulting, Inc

State of North Carolina -`'-
Department of Environment, Health and Natural ResouFees .,
Division of Environmental Management
Non -Discharge Permit Application
(THIS FORM MAY BE PHOTOCOPIED FOR USE AS AN ORIGINAL)��
GRAVITY SEWER EXTENSION,
PUMP STATIONS, AND PRESSURE SEWERS
I. GENERAL INFORMATION: SOC Project: Yes, No.
1. Applicant's name (please specify 'the name of the municipality, corporation; individual, etc.):
CAM 6 2 o.J %J -V-0 0T %mil 5--
2. Print Owners or Signing Official's name and title (the person who is legally responsible -for the facility and its compliance):
M o •.�l1as A
3. Mailing address: t 0 Z'1
City: State: V_A C_ Zip: Zt33z'1
Telephone Number: ( t o ) 't A--7 - (.,,315
4. Project Name (please specify the name of the subdivision, facility, or establishment - should be consistent with project
name on plans, specifications, letters of flow acceptance, Operational Agreements, etc.):
G gyp„ M EQ� 1►1 Q v TO tA 0 T- W
5. Application Date: 1 z - 016 6. Fee Submitted: S
6. County where project is located: tit O o C2E
II. PERMIT INFORMATION:
1. Application No. (will be completed by DEW �,� 1. ` IN �0 ` Q -
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:
existing permit number and the issue date
4. Specify whether the applicant is X public or private.
III. INFORMATION ON WASTEWATER:
1. Nature of Wastewater. I o o % Domestic/Commercial ; % Industrial;
% Other waste (specify):
2. Please provide a one or two word description specifying the origin of the wastewater, such as school, subdivision, hospital,
commercial, industrial, apartments, etc.:
3. Indicate any parameter(s) (and their concentration) that will be greater than normal domestic levels: gyp`
4. If wastewater is not domestic in nature, what level of pretreatment has been provided to ensure protection of the receiving
wastewater treatment facility? tJ /A
5: If a pretreatment permit is required, has one been issued?
pretreatment permit. If No, when will one be issued: /A
FORM: GSPSA 02/95 Page 1 of 8
Yes No. If yes, please attach a copy of the

A Volume of wastewater generated by this project:
5'00
gallons per day
7. Explanation of how wastewater volume was determined:
6 0 C C-.-.) d r 7—s/ 0 A-.Z, K Z ema. L- /0�..� ) F wAtirLy�cA.rEcL
Eratg�NE��l�1L'1 Gat LGc�T�o.+ p►�.an PJwi(�1r—�� P%I��LAL� C.IJOEofl%V
IV. DESIGN INFORMATION:
1. Brief project description: Seve-1
ssoC-15J OF�<<- r� SQP-DES OLSo
Tw.o /�.00.r,oNA.L. Orrr,cr� t-FdasE SPA�.E.4.
2. Name of wastewater treatment facility receiving wastewater: M
o.t..lASl�- A-OAosz-
a. Facility Permit Number:
b. Engineer should provide statement of his evaluation of downstream sewers ability to accept the wastewater:
c. Permit Number for sewers immediately downstream:
r
d. - Pipe diameter of sewers immediately downstream:
3. Summary of GRAVfTY SEWER to be permitted, by diameter, length and pipe material:
Diameter
(in)
Length
(linear feet)
Pipe
Material
Circle C or
N Factor &
Specify
Value
Minimum
Slope (%)
Maximum
Slope (%)
Minimum
Velocity
(fps)
Maximum
Velocity
(fps)
Minimum
Cover (in)
NOTE: The
minimum velocity
must not
be less than 2 fps.
For
public sewers the
minimum
diameter is 8 inches.
For
private sewers the
minimum
diameter is 6 inches.
4. Anchors shall be provided for sewers with slopes greater than 20 %. The anchor spacing shall be a maximum of: 36 foo
separation for slopes of 21% to 35%; 24 foot separation for slopes of 36% to 50%; 16 foot separation for slopes grease:
than. 50%.
For velocities greater than 15 fps, it is strongly recommended that measures be considered which will protect the sewers an(
manholes from erosion. For velocities greater than 20 fps, erosion control treasures must be specified.
For any excessive slopes or velocities that will occur in any sewer line segment, what measures have been taken to protec
the sewer pipe and manholes?
5. Maximum length of sewer between manholes:
6. This sewer line segment occurs between manhole no.
linear feet.
and manhole no.
FORM: GSPSA 02/95 Page 2 of 8

7. Does the owner/operator have the ability to clean this length? Yes No. For sewer reach lengths greater
than 425 feet, please provide a letter from the owner/operator, stating the ability to clean the specified reach and include the
equipment specifications.
8. Sewers subject to existing or planned traffic bearing loads? y— Yes No. If yes, what measures are being taken
to(enable the sewers to withstand the loads?
VJc-'C-% k¢or.► v�J�`.`. PjE �T�L�%Eo J��E� �vtit�C�E�Z
LA
9. Outside drop manholes are provided where invert separations exceed: feet (provide for separations > or = 25)
10. Identify (by manhole number) those manholes that have drop connections:
11. Maximum allowable infiltration/exfiltration test rate:
NOTE: Must not exceed 100 GPD/pipe diameter inch/mile of pipe.
GPD/pipe diameter inch/mile of pipe.
12. Minimum separation distances as shown on the plans and addressed in the specifications. If a, b, or c below is no, explain
in an attachment (This section must be completed for all collection systems including force mains and pressures sewers):
a) 100 ft. horizontal separation from wells or other water supplies? _2L Yes ' No
b) 12 in. vertical separation from storm sewer or ferrous pipe sanitary sewer specified? X Yes No
c) 10 ft horiz. sep. from water mains or 18 in vertical sep. (water over sewer) or ferrous pipe specified? X Yes No
13. Are manholes subject to flooding? Yes X No. If Yes, are manhole rim elevations 1 foot above 100-year flood
level, (100 year flood elevation should be indicated on plans)? Yes No; Or, are the manholes watertight, venter
1 foot above the 100-year flood elevation and vented every 1,000 feet (should be shown on plans)? Yes No.
14. Identify (by manhole number) those manholes that are vented:
15. Does this project involve any stream crossings? X Yes - No. If yes, what precautions or special features have beer
utilized to ensure protection of the sewer line and not restrict stream flow? Identify the sheet of the plans and station
number where stream crossings are located: k ► ;E a1-7)
3 s . V ►-i O E z 5 c^� EO.M C- o S S r ► L� �`� �' E P` tsr.1 / �%►O �� �.E
SN'Pc E_T SZ-p, . ; \ %-_J J. %—
Please note: The Division recommends all stream crossings be located three (3) feet below the stream bed or ferrou:
material pipe be specified. In addition, all aerial stream crossings must be located above the 25-year flood elevation. Bod
the 25-year flood elevation and the 100-year flood elevation should be indicated on the plans.
16. Sewers may not be installed in WS-I watersheds. Are any of the subject wastewater collection systems located in a WS-
watershed? Yes _ <' No.
FORM: GSPSA 02/95 Page 3 of 8

V . PUMP STATION INFORMATION
Pump Station No. or Name: k
(A separate page 4 of 8 should be submitted for each pump station)
2. Name of closest downslope surface waters: ►-4 i c—V— S C--e-i=_EK
3.. Classification of closest downslope surface waters: W s ^� (as established by the Environmental Management
Commission & specified on sheet 5 of 8 of this application).
4. In accordance with 15A NCAC 2H .0219 (h)(3), describe the measures that are being implemented to prevent impacts on
downslope surface waters, should a power failure occur at this pump station. NOTE: Alternative power MUST be
addressed for every pump station in accordance with the above regulation.
5. What size pumps are provided: C Z ti� e � Z.m GPM; and how many?
Z
6. What is the design total dynamic head? a 5 feet
7 How many pumping cycles will occur at average daily flow? Z cycles per hour.
NOTE: 15A NCAC 211.0219 (h)(2) requires 2 to 8 pumping cycles per hour be achieved at average daily flow.
8. The following items are typically required in the design for pump stations. Check the appropriate blank to signify that
these items hayr, lx&n provided in the design plans and specifications: -
Alternate Power Source
Wet Well Vented with Screen
Fillets in Wet Well
Check Valves and Gate Valves
Security Fencing
Lockable Wet Well Cover
Area Light
110V Electrical Convenience Outlet
Flood/Buoyancy Protection
High Water Alarm (one choice may be specified) Audible and Visual Auto Dialer
9. Summary of FORCE MAIN or PRESSURE SEWER to be permitted, by diameter, length and pipe material:
Diameter
(in)
Length
(linear feet)
Pipe
Material
. High
Elevation
(ft)
Low
Elevation
{ft)
Minimum
Velocity
.( )
Maximum
Velocity
(fps)
Minimum
Cover (in)
Z
3z3 ►
F.eC
142.co
10. Are air release valves provided at all high points along the force main (must be provided where the elevation difference
exceeds 10 feet)? x Yes —No
11. Is the pump station subject to flooding? _ Yes K No. If Yes, what measures are being taken to protect against flooding
12. If subject to flooding, specify the 100-year flood elevation: r-tlP- Feet MSL
13. Are there existing or planned pump stations downstream of this station? Yes X No. If Yes, the enginee
shall evaluate the ability of those pump stations to adequately handle the subject flows and shall include that evaluation a
an attachment to this application.
FORM: GSPSA 02/95 Page 4 of 8

This form must be completed by the appropriate DEM regional office and included as a part of the project
submittal information.
INSTRUCTIONS TO NC PROFESSIONAL ENGINEER:
The classification of the downslope surface waters (the surface waters that any overflow from the facility would flow toward)
in which these sewers will be constructed must be determined by the appropriate DEM regional office. Therefore, you are
required, prior to submittal of the application package, to submit this form, with items 1 through 7 completed, to
the appropriate Division of Environmental Management Regional Water Quality Supervisor (see page 8 of 8). At a
minimum, you must include an 8.5" by 11" copy of the portion of a 7.5 minute USGS Topographic Map which shows the
location of these sewers and the downslope surface waters in which they will be located. Identify the closest downslope
surface waters on the attached map copy. Once the regional office has completed the classification,
reincorporate this completed page and the topographic map into the complete application form and
submit the application package.
1. Applicant (specify name of the municipality, corporation, individual, etc.):
2. Name & complete address of engineering firm:
P-A 0,t4 ,4,, S A
Ql.-S �..�?Er-►TEJ�L.S � NEL-So tJ
Telephone number. ( I I I ) Z 9
aV- o
J. Project name: G r�-t-�1 r-► L`.� ro vt o-r t.sE
4. Name of closest downslope surface waters:
t-1 %ems ' s L¢-E v-- t
5. County(ies) where sewers and surface waters are located:
6. Map name and date:
7. NC Professional Engineer's Seal, Signature, and Date:
TO: REGIONAL WATER QUALITY SUPERVISOR
Please provide me with the classification of the watershed where these sewers will be constructed, as identified on the attachec
map segment:
Name of surface waters:
Classification (as established by the Environmental Management Commission):
Proposed classification, if applicable: _
Signature of regional office personnel:
Date:
FORM: GSPSA 02/95 Page 5 of 8

THIS APPLICATION PACKAGE WILL NOT BE ACCEPTED BY THE DIVISION OF ENVIRONMENTAL
MANAGEMENT UNLESS ALL OF THE APPLICABLE ITEMS ARE
INCLUDED WITH THE SUB1xITTAL
Required Items
a. One original and one copy of the completed and appropriately executed application form. If modifications to the form are
required as a result of additional information requests by the Division, the additional information must be transmitted under
the signature of the applicant and the actual modification must be initialed by the NC Professional Engineer.
b. Two (2) sets of detailed plans and specifications signed and sealed by a North Carolina Professional Engineer. The plans must
include a general location map, a plan view of the sewer extension, a profile of the sewer extension, and must show the
proximity of the sewer extension to other utilities and natural features. Specifications may be omitted for delegated
authorities. Each sheet of the plans and the First page of the specifications must be signed and sealed. Two (2) copies of the
existing permit if a- modification. The plans and specifications must not contain phrases (such as: FOR REVIEW ONLY,
NOT FOR CONSTRUCTION, etc.) that indicate that they are anything other than final plans and specifications. However,
the plans and specifications may contain: FINAL DESIGN - NOT RELEASED FOR CONSTRUCTION.
C. Two copies of all calculations, including pump selection, friction calculations, cycle time, pump curves (including system
curves applicable with one pump running, two pumps running, three pumps running, etc.), and evaluation of downstream
pump stations. These items must be submitted under the signature and seal of the NC Professional Engineer.
A The appropriate permit processing fee, in accordance with 15A NCAC 2H .0205(c)(5). The fee for sewer extensions for
nondelegated municipalities is $400. The fee for sewer extensions for delegated municipalities (applies only to those
governmental jurisdictions that have specific delegation review authority, as granted by the Environmental Managemew
Commission) is $200. Name changes without other modifications are $100.
e. If the owner/authority of the wastewater treatment facility (W W IFS that will be accepting the wastewater flow from tliii
project is different from the applicant of the project, then a letter must be provided from the owner/authority of the WWTF
specifying the volume of flow that will be accepted. The letter should be a recent letter and should refer to the project by the
same name as that identified on the application and the plans/specifications.
f. If the application is being submitted in the name of a privately owned public utility, evidence must be submitted from tht
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, evidence must be provided from the Utilities Commission acknowledging these areas air
covered under an existing franchise.
g. A properly executed Operational Agreement (original and two copies - form provided by DEM) must be submitted if the sewe
extension will be serving single family residences, condominiums, mobile homes, or town houses and if the subject sewe
extension is owned by the individual residents, a homeowners association, or a developer.
h. The downslope surface waters classification must be determined by the appropriate DEM regional office, using page 5 of 8 c
this form, prior to the submittal of the application package to the Water Quality Permits an,
Engineering Unit. Once the regional office has completed the classification, page 5 of 8 should be reincorporated into th
application package and the entire application package may then be submitted to Water Quality Permits and Engineering Uni
i. A cover letter, which briefly describes the project, should be included with each application package. If necessary for clarit:
feel free to include attachments to the application form. Such attachments will be considered as part of the application an
should be numbered to correspond to the section to which they refer.
All materials and fees submitted in support of this request for a permit become the property of the Division of Environment:
Management; therefore, if the permit is not issued for any reason, the Division will return submitted materials only at i
option.
FORM: GSPSA 02/95 Page 6 of 8

Name and Complete Address of Engineering Firm: ti-�E �-S�" C-o ►---x %►--LL-t , \'.
30o L�►MPE�SA,. �0 �-o�o - ��� Sox 5889 , mac- 2-8374;
City: L�.P�� Q.OeE�--► State: N C- Zip: Z-2> S
Telephone Number. ( cr\ \ c )
Z,:2tS - 1-103
Professional Engineer's Certification:
I, C r►c- (� )�G �SoV� Tv {, attest that this application for 6Zwte-~ Ay�f'"// 7ye-
has been reviewed by me and is accurate and complete 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. Although 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 consistent with the proposed design.
North Carolina Professional Engineer's Seal, Signature, and Date: C�AjR�0���`//
N o.. Fess�a •ti i
_ ; a SEAL r
20208
Applicant's Certification:
I,
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 information and attachments are not included, this application package
will be returned to me as incomplete.
Signature
Date
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]
FORM: GSPSA 02/95 Page 7 of 8

DIVISION OF ENVIRONMENTAL MANAGEMENT REGIONAL OFFICES (12194)
Asheville Regional WQ Supervisor
59 Woodfin Place
Asheville, NC 28801
[phone]
Fax [phone]
Avery
Macon
Buncombe
Madison
Burke
McDowell
Caldwell
Mitchell
Cherokee
Polk
Clay
Rutherford
Graham
Swain
Haywood
Transylvania
Henderson
Yancy
Jackson
Fayetteville Regional WQ Supervisor
Wachovia Building, Suite 714
Fayetteville, NC 28301
[phone]
Fax [phone]
Anson
Moore
Bladen
Robeson
Cumberland
Richmond
Harnett
Sampson
Hoke
Scotland
Montgomery
Washington Regional WQ Supervisor
Post Office Box 1507
Washington, NC 27889
[phone]
Fax [phone]
Winston-Salem Regional WQ Supervisor
585 Waughtown Street
Winston-Salem, NC 27107
(910) 77146W
Fax [phone]
Alamance Rockingham
Alleghany Randolph
Ashe
Stokes
Caswell
Surry
Davidson
Watauga
Davie
Wilkes
Forsyth
Yadkin
Guilford
Beaufort Jones
Bettie
Lenoir
Camden
Martin
Chowan
Pamlido
Craven
Pasquotank
Currituck
Perquimans
Dare
Pitt
Gates
Tyrell
Greene
Washington
Hertford
Wayne
Hyde
Mooresville Regional WQ Supervisor
919 Norff Main Street
Mooresville, NC 28115
[phone]
Fax [phone]
Alexander
Mecklenburg
Cabar us
Rowan
Catawba
S tanly
Gaston
Union
Iredell
Cleveland
Lincoln
Raleigh Regional WQ Supervisor
Post Office Box 27687
Raleigh, NC 27611
[phone]
Fax [phone]
Chatham
Nash
Durham
Northampton
Edgecombe
Orange
Franklin
Person
Granville
Vance
Halifax
Wake
Johnston
Warren
Lee
Wilson
Wilmington Region. WQ Supervisor
127 Cardinal Drive Extension
Wilmington, NC 28405-3845
[phone]
Fax [phone]
Brunswick New Hanover
Carteret Onslow
Columbus Pender
Duplin
FORM: GSPSA 02/95 Page 8 of 8