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HomeMy WebLinkAboutWQ0022935_Application_20030804E State of North Carolina Department of Environment and Natural Resources j Division of Water Quality FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS (Pressure sewers systems are not to be included as part of this application package) INSTRUCTIONS: Indicate that you have included the following list of required application package items by checking the space provided next to each item. Failure to submit all required items will lead to your application being returned as incomplete or additional processing and review time. This form may be photocopied for use as an original. I. Application Form - Submit one original and one copy of the completed and appropriately executed application form. 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 B(12). II. Application Fee - Submit a check in the amount of $400 made payable to: North Carolina Department of Environment and Natural Resources (NCDENR). ❑ III. 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(2a) of this application. ❑ IV. Operational Agreements — Submit one original and two copies of a properly executed operational agreement if the sewer extension will be serving residential or commercial lots (e.g., houses, condominiums, townhomes, outparcels, etc.) that will be owned by a homeowners' association or developer (Item B(2b)). If the applicant is a homeowners' association, use Form HOA 02/03. If the applicant is a developer, use Form DEV 02/03. EVEN IF THE PROJECT WILL BE TURNED OVER TO A MUNICIPALITY, FORM DEV 02/03 IS REQUIRED. XV. Flow Acceptance Letters — If the owner of the downstream sewers and/or WWTF is different from the applicant, submit two copies of a flow acceptance letter from the owner of the downstream sewers and WWTF, if different. Flow acceptance letters must contain the following minimum information: applicant and project name, amount of flow accepted, and name and permit number of the receiving sewers/WWTF. The flow acceptance must not expire prior to permit issuance and must be dated less than a year prior to the application date. Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific flow acceptance letter. XV1. Map — Submit an 8.5-inch by 11-inch copy of the portion of a 7.5-minute USGS Topographic Map along with this form. The map should identify the entire project area location as well as the closest downslope surface waters as clearly as possible. Each map portion must be labeled with the map name and number, the identified location, and be of clear and reproducible quality. For instance, if the project involves 4 miles of interceptor sewer that traverses over or near several different waterbodies (or counties, basins, etc.), the map should have location ID's for each different waterbody (where the sewer line is within 100 feet of such waterbody - see Instruction VII). X 11. Watershed Classifications — Section C • If any portion of the project is within 100 feet of any down slope surface water, Section C must be completed for the pertinent sections. • If the entire project area is a minimum of 100 feet away from any down slope surface waters BUT there is a pump station involved where a history of power outage is to be used to provide adequate design storage instead of dual feed or permanent or portable generator, Section C must be completed to demonstrate that the closest down slope surface water is Class C (see 15A NCAC 2H .0219(h)(3)(D)). • Use the guidance document entitled, "Determining Watershed Classifications for Form FTA 02/03 (Fast -Track Sewer Systems)" available from http://h2o.enr.state.nc.us/ndpu or by contacting the appropriate regional office. INSTRUCTIONS FOR FORM FTA 02/03 =TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 1 ----- _ _._ .......... ------ . _ _ _ ._._.. ......... ._ USE THE TAB KEY TO MOVE FROM FIELD TO FIELD! Application Number (to be completed by DWQ) 1. Owner. _ __. 1a. Town of Carthage Full Legal Name (company, municipality, HOA, utility, etc.) Z 1 b. Q AUG !.4 2D O Signing Official me and Title (Please review 154 NCAC 2H .0206(b) for authorized sigi ling Icials!) Q1c. The legal entity who will owo this system is: ❑ Individual ❑ Federal FerMunicipality ❑ State/County ❑ Private Partnership ❑ Corporation Uther (specify): 1d. O1 Ia. LL Street Address City Z State Zip Code 1h( ll0 331 Q1b�Q��� 1j.eC.4 e.e+w ood Cd nc. rr. ors Qel hone `'Facsimile E-mail V 2. Project (Facility) Information: J 2a. Little River Golf - Clubhouse and Lodges 2b. Moore a p_ Brief Project Name (permit will refer to this name) County Where Project Is Located 3. Contact Person: PAY TO THE 2. Owner is E] Public (skip to Item B(3)) ❑ Private (go to Item 2(a)) 2a. If private, applicant will be: ❑ Retaining Ownership (i.e. store, church, single office, etc.) ❑ Leasing units (lots, townhomes, etc. - skip to Item B(3)) ❑ Selling units (lots, townhomes, etc. - go to Item B(2b)) LAND DESIGN, INC. OPERATING ACCOUNT P.O. BOX 36959 CHARLOTTE; NC 28236 2b. If sold, facilities owned by a (must choose one) ❑ Public Utility (Instruction III) ❑ Homeowner Assoc./Developer (Instruction IV) 14-'406 aay358236 /y 66-85/531 DATE. d $ /fva _ DOLLARS u .- RBC Centura RBC Centura Bank Charlotte, NC 2,207 IYP v. n ;u NGr1rROV IIVW ID tei V, IIiVIVQIp Wily. ❑ Intuerceptor Line - Flow will be permitted is 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 FTA 02/03 ❑ VIII. Environmental Assessments — If this project is subject to an Environmental Assessment (EA) ]15A NCAC 01C .0500], this application can not be used. Send the project application on Form PSFMGSA 10/99 to the Non -Discharge Permitting Unit, 1617 Mail Service Center, Raleigh, NC 27699-1617. Applications can not be processed 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. X IX. Certifications — Section D The application must be certified by both the applicant and a North Carolina Registered Professional Engineer (PE). The applicant signature must match the signing official listed in Item A(1 b). The PE should NOT certify the application if he/she is unfamiliar with 15A NCAC 2H .0200, 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. Certification by a PE who is unfamiliar with these documents is subject to NC Board referral. THE COMPLETED FTA 02/03 APPLICATION PACKAGE, INCLUDING ALL SUPPORTING DOCUMENTS AND $400 FEE, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE REGIONAL OFFICE ADDRESS COUNTIES SERVED Asheville Regional Office 59 Woodfin Place Avery, Buncombe, Burke, Caldwell, Asheville, North Carolina 28801 Cherokee, Clay, Graham, Haywood, (828) 251-6208 Henderson, Jackson, Macon, Madison, (828) 251-6152 Fax McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania, Yancey Fayetteville Regional Office Anson, Blade Berland, Harnett, Hoke, 225 Green Street Suite 714 Montgomert, MoorejZobeson, Richmond, Fayetteville, North Carolina 28301 Sampson, (910) 486-1541 (910) 486-0707 Fax Mooresville Regional Office 919 N Main Street Alexander, Cabarrus, Catawba, Cleveland, Mooresville, North Carolina 28115 Gaston, Iredell, Lincoln, Mecklenburg, Rowan, (704) 663-1699 Stanly, Union (704) 663-6040 Fax Raleigh Regional Office Chatham, Durham, Edgecombe, Franklin, 1628 Mail Service Center Granville, Halifax, Johnston, Lee, Nash, Raleigh, North Carolina 27699-1628 Northampton, Orange, Person, Vance, Wake, (919) 571-4700 Warren, Wilson (919) 571-4718 Fax Washington Regional Office Beaufort, Bertie, Camden, Chowan, Craven, 943 Washington Square Mall Currituck, Dare, Gates, Greene, Hertford, Washington, North Carolina 27889 Hyde, Jones, Lenoir, Martin, Pamlico, (252) 946-6481 Pasquotank, Perquimans, Pitt, Tyrrell, (252) 975-3716 Fax Washington, Wayne Wilmington Regional Office Brunswick, Carteret, Columbus, Duplin, New 127 Cardinal Drive Extension Hanover, Onslow, Pender Wilmington, North Carolina 28405 (910) 395-3900 (901) 350-2004 Fax Winston-Salem Regional 585 Waughtown Street Alamance, Alleghany, Ashe, Caswell, Office Winston-Salem, North Carolina Davidson, David, Forsyth, Guilford, 27107 Rockingham, Randolph, Stokes, Surry, (336) 771-4600 Watauga, Wilkes, Yadkin (336) 771-4631 Fax For more information, visit our web site at http://h2o.enr.state.nc.uslndpul INSTRUCTIONS FOR FORM FTA 02/03 FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 1 USE THE TAB KEY TO MOVE FROM FIELD TO FIELD! Application Number: (to be completed by DWO) 1. Owner: la. Town of Carthage _ - Full Legal Name (company, municipality, HOA, utility, etc.) _ _ _ Aug --A Z 1 b. Q 0 Signing Official me and Title (Please review 159 NCAC 2H .0206(b) for authorized sig ing icials!) _ . . ... Q 1c. The legal entity who will qW9 this system is: ❑ Individual ❑ Federal WrMunicipality ❑ State/County ❑ Private Partnership ❑ Corp8ration EJ Uther sped : O 1d. 1e. �'f.39�i �SlS OI S;�QARc�+ L t ........... Street Address City ..........._ ................ ... ...... ...... .............................. ........ __ _._.._.. . Z if. -ric,- 11 g. .Z $ 3.1-7 Z State Zip Code 1h�l� %-J331 1i*csimile b,4�'7_ 3D7 9 1j C'� e.e.'hW DOd CGl 11C. f`. 0l` Qel hone E-mail V 2. Project (Facility) Information: J 2a. Little River Golf - Clubhouse and Lodges 2b. Moore IL 0. Brief Project Name (permit will refer to this name) County Where Project is Located 3. Contact Person: .......-... �,........_- .. .._._.... ........... /...... Q 3a. f� 91&) W • VO bEL , P. t Name and Affiliation of Someone Who Can Answer Questions About this Application ......... .._ _..__ .. 3b. (104ialb--7l-7-1 3c. 640ErmL@ C.dM Phone Number E-mail 1. Project is El New ❑ Modification (of an existing permit) If Modification, Permit No.: 2. Owner is El 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.) ❑ Public Utility (Instruction III) ❑ Leasing units (lots, townhomes, etc. - skip to Item B(3)) ❑ Homeowner Assoc./Developer (Instruction IV) ❑ Selling units (lots, townhomes, etc. - go to Item B(2b)) Z 3. MDORE %o V lJT't WLYCEIL 4 rjC Wc3z i%"T2 VT`( ----- ... -- -- ----- - Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project 404Oo{Zfc UAT62 P6Uw`no^1 CnNT2CL GC1L1T`( 4Aff31SD8 3 7 Name of WWTF WWTF Permit No. - --- -._._.---_.__.T..._-...-..__- ...___._...._...._......_.---_-..._........_.............._.._....-_-...._-..._...._-..._....-...-----......--.--...........__........_.-..._........._...._.._-.........___.............................. 0 5aTy_+l cp 0.PX-rAA&nE. b• 8 Vic• l�QDOl3l53 Z Owner of Downstream Sewer I Sewer Size Permit Number of Downstream Sewer —Receiving --- 8 The origin of this wastewater is (check all that apply): ❑ Residential Subdivision ❑ Car Wash W❑ Apartments/Condominiums El Institution L % Domestic/Commercial ILElMobile Home Park El Hospital ❑ School ❑ Church % Industrial m ❑ Restaurant ❑ Nursing Home o ❑ Office r- /o Other (specify): ❑ Other (specify): Golf Clubhouse,.. 7. Volume of wastewater to be permitted in this project:1�1A& gallons per day 8. If the permitted flow is zero, indicate why: ❑ Interceptor Line - Flow will be permitted is 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 FTA 02/03 FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 2 9. Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2H .0219(1) for Item 13(7) or the design flow for line or pump station sizing if zero flow in the space below. Values other than that in 15A NCAC 2H .0219(I)(1-2) must be approved prior to submittal of this application. Submit a separate request to the Division of Water Quality, Non -Discharge Permitting Unit, 1617 Mail Service Center, Raleigh, NC 27699-1617 in accordance with 15A NCAC 21-1.0219(1)(3). sf ....... ......... ........ _... ......................................... / __ .. ....... ......... .._...... .... .............. L1oI.F CL epNW.�'e-, Qoo EA;: ra IZo GPt> _ Z,bZb U1'a �.00�C-DES 3Z �N�TS CQ ZZO UPp �UtvlT = ES�(o�O (aPt7 (-rnTQL ikt Lilo 10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary) Size (inches) Length (feet) Gravity or Force Main 8 inches 1,018 feet Gravity G W D Z U .... ......... .... ... . Z ENTER TOTAL LINE LENGTH IN MILES' 0.1928 ........ ..._ Q 11. Summary of Pump Stations to be Permitted (attach additional sheets as necessary) N/A ._...... ............................... ........ ......... ............................... ........ .......... .......... Power Reliability Option Location ID Design Flow Operational Point (dual line feed, permanent generator w/ATS, 0 (as shown on plans) (MGD) GPM @ TDH portable generator w/autodialer, wet well storage) U. H W LL...... ........ .._.... 12. Does the sewer system comply with the Minimum Design Criteria for the Fast Track Permitting of Pump Stations and Force m, Mains (latest version), the Gravity Sewer Minimum Design Criteria (latest version) and 15A NCAC 2H .0200 as applicable? El 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 3. Have the following permits/certifications been submitted for approval? Wetland/Stream Crossings - General Permit or 401 Certification? ❑ Yes ❑ No [D N/A Sedimentation and Erosion Control Plan? El Yes ❑ No ❑ N/A Stormwater? 0 Yes ❑ No ❑ N/A FTA 02/03 FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 3 1. Use the Division's guidance document entitled, "DETERMINING STREAM CLASSIFICATIONS FOR FORM FTA 02103 Z (FAST -TRACK SEWER SYSTEMS)" to collect and record the stream classification data below (attach additional sheets as 0 necessary). This document is available from our web site or by contacting the appropriate Division of Water Quality H regional office (see instructions for addresses) OR indicate the following. Q ❑ A Watershed Classification is not needed because all parts of the project are at least 100 feet away from any down (� slope waterbody; AND, ❑ A Watershed Classification is not needed because the design does not depend on wet well storage as a power yreliability option for any pump station near a Class C down slope waterbody. Q Location ID Name of Waterbody Stream Waterbody V on Map Waterbody County River Basin Index Classification W W F— V Submit the 8.5" x 11" topographic map as required in Instruction VI regardless of whether a classification is provided! ----...---..- ...... _..... 1. Applicant's Certification: I attest that this application forE has been reviewed by me and is accurate and complete to the best of my knowledge. 1 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 civil penalties up to $25,000 per violation. la. 1� M&Aa CZA_ Signing Official S nature Date 2. Professional Engineer's Certification: Z I attest that this application for L1"t Cuf,?WeZ 60tF CLUb RoEehas been reviewed by me and is accurate, complete 0 and consistent with the information in the engineering plans, calculations, and all other supporting documentation to the H best of my knowledge. 1 further attest that to the best of my knowledge the proposed design has been prepared in Q accordance with the applicable regulations, Gravity Sewer Minimum Design Criteria for Gravity Sewers adopted February V 12, 1996, and the Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains adopted June LL 1, 2000 and the watershed classification in accordance with Division guidance. 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. Note: In W 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 $25,000 per violation. 2a. ���t l W • �l0 C-EL. P E • NX.0 111 q�q���i Professional Engineer Name y 2b. V4W I� b6cA C�tJ 1 ti1L s Engineering Firm 2c. 2116 Address 2d. CiaA(Lll�T� ty C 2f. '232.02 ,p City State Zips 2h. (304�31b-c3) 2i. Q �An►D17CS1GdJ•Cyth i�• �� 301�3 Telephone Facsimile E-mail Seal, Signature Date FTA 02/03 kx Uate/lime HUb-UI-ifUU3(tR1) 11:5e 91U9&(JU(9 001/01/20103 10:32 9109473079 TOWN OF CARTHAGE 08/01/2003 0 :59 910-947-1992 MOORE CO. PUB. UTIL Department of Pu buc t1tilhies P.O. Box 1927 ti• Carthap, NC 28327 Augu 1, 2003 Mr. y Taylor Dire r of Public Works T of Carthage 4396 wy 151501 Cart NC 28327 Dear Mr. Taylor, P.UU3 PAGE 03 PAGE 02/03 Dennis L. lsrobst, Director Telephone: (910) 947.63 L 5 Facsimile: 19101947.1992 &Tvail: dbrobatommoomnaus RE: IFlow Acceptance letter for 32 units and clubhouse, phase 1 Little River Golf Club, Carthage NC. The to County Water Pollution Control Facility, NPDBS # NC 00375011, p v=tly leas re cient capacity available to conditionally accept up to 11,268 gallons per day from the mferenced project. This iroject wil.) be required to comply with all speci$catim and requirements of fire Tovio of Carthage, NC.. In addition all requited fees must be paid to the Town of completion of the reftnnced project, the applicant's cngitmr is to provide our with the following items: 1, Certification of Completion. 2. Complete set of As -Built drawings. have any questions or comments please call me at (910) 947-6313. 1 E COUNTY PUBLIC UTILITIES Project Technician M,5"O�v Gr it 9 it 71 It ;So It it I it 43 If it IN 50, SCALE 1:24000 MILE State of North Carolina Department of Environment and Natural Resources Division of Water Quality WATERSHED CLASSIFICATION ATTACHMENT Any changes made to this form will result in the application being returned. (THIS FORM MAY BE PHOTOCOPIED FOR USE AS AN ORIGINAL) INSTRUCTIONS: To determine the classification of the watershed(s) in which the subject project will be located, you are required to submit this form, with Items 1 through 8 completed, to the appropriate Division of Water Quality Regional Office Water Quality Supervisor (see Page 2 of 2) prior to submittal of the application for review. At a minimum, you must include an 8.5" by 11" copy of the portion of a 7.5-minute USGS Topographic Map that shows the surface waters immediately downslope of the project. You must identify the location of the project and the closest downslope surface waters (waters for which you are requesting the classification) on the submitted map copy. If the facility is located in the Neuse River Basin, also include a copy of the soil survey map for the project location. The corresponding non -discharge application may not be submitted until this form is completed by the appropriate regional office and included with the submittal. 1. Applicant's name (name of the municipality, corporation, individual, etc.): Little River Golf, Inc. 2. Name and complete address of applicant: Little River Golf, Inc. 500 Little River Farm Blvd. City: Carthage State: NC Zip: 28327 Telephone number: ( _910_ ) 949-4609 Facsimile number: ( 3. Project name (name of the subdivision, facility or establishment, etc.): Little River Farm Golf Club — Clubhouse and Lodges 4. County where project is located: Moore 5. Name(s) of closest surface waters: Little River/S12ring Valley Lake 6. River basin(s) in which the project is located: Little River 7. Topographic map name and date: Carthage Quadrangle Rd. �♦ �i i 8. North Carolina Professional Engineer's seal, signature, and date: ` Uk 21 W4 = fit?'♦ hHlI1NtN 1 `✓ TO: REGIONAL OFFICE WATER QUALITY SUPERVISOR Please provide me with the classification(s) of the surface waters, watershed(s), and appropriate river basin(s) where these activities will occur, as identified on the attached map segment: Name(s) of surface waters and river basin(s): Classification(s) (as established by the EMC): Proposed classification(s), if applicable: River basin buffer rules, if applicable: Signature of regional office personnel: Date: FORM: WSCA 10/99 Page 1 of 2 .1 0 -1 r Transmittal 223 North Graham Street Charlotte, NC 2820.- Phone:7o¢.376-7777 Phone:7o4-333-o325 Faa:704.376-8235 F-: 7o¢-332-3246 Services: Landscape Architecture Land Planning Urban Design Civil Engineering Offices: Charlotte, NC Alexandria, VA Southern Pines, NC Franklin, TN Asheville, NC Tampa, FL ................................................................................................, TO: DATE 7/30/03 Non -Discharge Permit Review Engineer PROJECT NAME Little River Golf Club -Phase 1 PROJECT # 5002033 NCDENR # PAGES 1 225 Green Street, Suite 714 BUS. PHONE (910) 486-1541 BUS. FAX (910) 486-0707 Fayetteville NC 28301 BUS. MOBILE CARBON COPIES: WE ARE SENDING: VIA: PURPOSE: Bob Koontz, LandDesign Drawings Mail x Approval Jeff Neubauer Specifications Fax Your Use x Applications Courier Your Information x Fees FedEx Ground Review / Comment Redlines x FedEx Overnight Your Request Diskette/CD Hand Delivery Signature Other Pick Up Email QTY ITEM DESCRIPTION 1 Application Form - FTA 02/03 Original and Copy 1 Application Fee - $400.00 2 Flow Acceptance Letter 1 USGS Map 1 Watershed Classification Attachment AUI 4 L� f - NOTES Package is submitted to obtain permit to construct 8" gravity sewer extension to serve new clubhouse and lodges in the Little River Farms development in Carthage, NC. Please note that the OLD watershed classification form is provided as it was available. However, the proposed sewer improvements do not lie within 100 feet of classified waters. FROM: Kevin Vogel, P.E. If this document was delivered via FAX, the accompanying transmission contains confidential information intended only for the use of the individual of the entity named above. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution or the taking of any action in reliance on the contents of this facsitmle information is strictly prohibited. If you have received this FAX in error, Please immediately notify us by telephone to arrange for disposition or return of the documents to us.