WQ0023150_Application_20031007

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,RACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 3
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD! Application Number: ,
(to be completed by DWQ)
9. Owner:
1a. The Town of Southern Pines
Full Legal Name (company, municipality, HOA, utility, etc.)
1b. Bobby B. Teague, P.E. Public works Director
Signing Official Name and Title (Please review 15A NCAC 2H .0206(b) for authorized signing officials!)
1 c. The legal entity who will own this system is:
❑ Individual ❑ Federal X Municipality ❑ State/County ❑ Private Partnership ❑ Corporation ❑ Other (specify):
1d. 140 Memorial Park Court le. Southern Pines
Street Address City
1f. North Carolina
State
1 g. 28387
Zip Code
1 h. [phone] 1 i. [phone] 1 j.
Telephone Facsimile
2. Project (Facility) Information:
E-mail
2a. Highland Road Sewer Extension 2b. Moore
Brief Project Name (permit will refer to this name) County Where Project is Located
3. Contact Person:
3a. Neal Smith, Professional Engineer
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. [phone] 3c. [e-mail]
Phone Number E-mail
1. Project is X New ❑ Modification (of an existing permit) If Modification, Permit No.:
.For_._..
modifications, attach a separate sheet clearly explaining 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 in B(7) and B(10-11) that has already been included in the original permit.
2. Owner is X Public (skip to Item B(3)) ❑ Private (.qo to Item 2(a))
HIGHLAND MANAGEMENT LIMITED CORP.
P.O. BOX 385
SOUTHERN PINES, NC 28388
WACHOVIA
WACHOVIA BANK, NJ1.
ACH R/T 053110400
66-1040/531
3859
9/29/2003
PAY TO THE NCDNR Division of Water Quality $ * *400.00
ORDER OF
Four Hundred and 00/100************************************************************** ooUAM
NCDNR Division of Water Quality
MEMO �.
,atED SI�.

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 - Rev. 1 06/03

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE I
OF W A TF,4 State of North Carolina
O� QG Department of Environment and Natural Resources
Division of Water Quality
o 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.
X 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).
X II. Application Fee - Submit a check in the amount of $400 made payable to: North Carolina Department of
Environment and Natural Resources (NCDENR).
❑ Ill. 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 is permitted 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
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.
X V. Flow Acceptance Letters — It 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.
X VI. Map — Submit an 8.5-inch by 11-inch COLOR 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 of the sewer line and pump stations, 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 shown for each different waterbody (where the sewer line is within
100 feet of such waterbody - see Instruction VII). This location ID is self chosen and used to cross reference the
location in Section C of the permit application.
❑ Vii. Stream 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.
FTA 02/03 - Rev_ 1 06/03

FAST -TRACK APPLICATION for GRAVITY, SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 2
❑ Vill. 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(1b). 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
Avery, Buncombe, Burke, Caldwell,
59 Woodfin Place
Cherokee, Clay, Graham, Haywood,
Asheville, North Carolina 28801
Henderson, Jackson, Macon,
[phone]
Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania,
Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Fayetteville, North Carolina 28301
Anson, Bladen, Cumberland, Harnett,
[phone]
Hoke, Montgomery, Moore, Robeson,
[phone] Fax
Richmond, Sampson, Scotland
Mooresville Regional Office
919 N Main Street
Mooresville, North Carolina 28115
Alexander, Cabarrus, Catawba,
[phone]
Cleveland, Gaston, Iredell, Lincoln,
[phone] Fax
Mecklenburg, Rowan, Stanly, Union
Raleigh Regional Office
1628 Mail Service Center
Chatham, Durham, Edgecombe,
Raleigh, North Carolina 27699-1628
Franklin, Granville, Halifax, Johnston,
(919) 571-47
Lee, Nash, Northampton, Orange,
[phone] Fax
Person, Vance, Wake, Warren,
Wilson
Washington Regional Office
Beaufort, Bertie, Camden, Chowan,
943 Washington Square Mall
Craven, Currituck, Dare, Gates,
Washington, North Carolina 27889
Greene, Hertford, Hyde, Jones,
[phone]
Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington,
Wayne
Wilmington Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus,
Wilmington, North Carolina 28405
Duplin, New Hanover, Onslow,
[phone]
Pender
[phone] Fax
Winston-Salem Regional Office
585 Waughtown Street
Alamance, Alleghany, Ashe, Caswell,
Winston-Salem, North Carolina 27107
Davidson, Davie, Forsyth, Guilford,
[phone]
Rockingham, Randolph, Stokes,
(336) 7714631 Fax
Surry, Watauga, Wilkes, Yadkin
For more information, visit our web site at: http://h2o.enr.state.nc.us/ndpu/
FTA 02/03 - Rev_ 1 06/03

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 3
......... ..... _... ........... ......... ............ .... .........
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD! Application Number: ,
(to be completed by DWQ) ( 0p9
1. Owner:
la. The Town of Southern Pines
Full Legal Name (company, municipality, HOA, utility, etc.)
Z 1b. Bobby B. Teague, P.E. Public works Director
0 Signing Official Name and Title (Please review 15A NCAC 2H .0206(b) for authorized signing officials!)
1c. The legal entity who will own this system is:
❑ Individual ❑ Federal X Municipality ❑ State/County ❑ Private Partnership ❑ Corporation ❑ Other (specify):
1d. 140 Memorial Park Court le. Southern Pines
Street Address City
Z 1f. North Carolina 1g. 28387
Z State Zip Code
1 h. [phone] 1 i. [phone] 1 j.
~ Telephone Facsimile E-mail
C.) 2. Project (Facility) Information:
J 2a. Highland Road Sewer Extension 2b. Moore
a
a Brief Project Name (permit will refer to this name) County Where Project is Located
Q 3. Contact Person:
Q 3a. Neal Smith, Professional Engineer
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. [phone] 3c. [e-mail]
Phone Number E-mail
_. _ .........
1. Project is X New ❑ Modification (of an existing permit) If Modification, Permit No.:
For modifications, attach a separate sheet clearly explaining 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 in B(7) and B(10-11) that has already been included in the original permit.
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)
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3.
❑ Retaining Ownership (i.e. store, church, single office, etc.) or ❑ 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))
Moore County Public Utilities
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
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4a.
Moore County Water Pollution Control Facility 4b. NC 0037508
LL
Name of WWTF WWTF Permit No.
5a.
The Town of Southern Pines 5b. 8" 5c.
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Owner of Downstream Sewer Receiving Sewer Size Permit Number of Downstream Sewer (if known)
6.
The origin of this wastewater is (check all that apply):
X Residential Subdivision ❑ Car Wash
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❑ Apartments/Condominiums ❑ Institution 100 %Domestic/Commercial
❑ Mobile Home Park ❑ Hospital
❑ School ❑ Church % Industrial
❑ Restaurant ❑ Nursing Home % Other s eci
(p)'
El Office El Other (specify):
7.
Volume of wastewater to be permitted in this project: 1,440 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
V'rA M/A2 D- i nc/Al

FAST -TRACK APPLICATION for GRAVITY SEWT;RS, PUMP STATIONS, AND FORCE MAINS PAGE 4
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9. Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2H
.0219(I) 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 2H .0219(I)(3).
3 three/four bedroom houses at 480 gallons per day = 1,440 gallons per day
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches) Length (feet) Gravity or Force Main
(use the pull down menu)
8" 144' Gravity
ENTER TOTAL LINE LENGTH IN MILES 0.027 miles
11. Summary of Pump Stations to be Permitted (attach additional sheets as necessary)
Location ID Power Reliability Option
(self chosen - as shown on Design Flow Operational Point (1- dual line feed; 2- permanent generator w/ATS; 3-
plans for cross-reference) (MGD) GPM @ TDH portable generator w/telemetry; 4-wet well storage)
12. 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 2H .0200 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
13. Have the following permits/certifications been submitted for approval?
Wetland/Stream Crossings - General Permit or 401 Certification? ❑ Yes ❑ No X N/A
Sedimentation and Erosion Control Plan? X Yes ❑ No ❑ N/A
Stormwater?
❑ Yes ❑ No X N/A
FTA 02/03 - Rev. 1 06/03

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 5
1. Use the Division's guidance document entitled, "DETERMINING STREAM CLASSIFICATIONS FOR FORM FTA 02/03
(FAST -TRACK SEWER SYSTEMS)" to collect and record the stream classification data below (attach additional sheets as
necessary). This document is available from our web site or by contacting the appropriate Division of Water Quality
Oregional office (see instructions for addresses) OR indicate the following:
X A Stream Classification is not needed because all parts of the project are at least 100 feet away from any down slope
Qwaterbody; AND,
0 X A Stream Classification is not needed because the design does not depend on wet well storage as a power reliability
option for any pump station near a Class C down slope waterbody.
Location ID on Map
U) (self chosen - as shown on Name of Waterbody Stream Waterbody
Jmap for cross-reference) Waterbody County River Basin Index Classification
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Submit the 8.5" x 11" COLOR topographic map as required in Instruction VI
regardless of whether a classification is provided!
1. Applicant's Certification:
1, Bobby Teague, Public Works Director, attest that this application for Highland Road Sewer Extension
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, o
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. � ��� ��'oZ—U-j
Signing Official Signature Date
2. Professional Engineer's Certification:
Z I, Neal Smith, PE attest that this application for Highland Road Sewer Extension has been
reviewed by me and is accurate, complete and consistent with the information in the engineering plans, calculations, and
H all other supporting documentation to the best of my knowledge. I further attest that to the best of my knowledge the
Q proposed design has been prepared in accordance with the applicable regulations, Gravity Sewer Minimum Design Criteriaz
V for Gravity Sewers adopted February 12, 1996, and the Minimum Design Criteria for the Fast -Track Permitting of Pump
1L Stations and Force Mains adopted June 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
LU the proposed design. Note: In accordance with NC General Statutes 143-215.6A and 143-215.6B, any person who
L) knowingly makes any false statement, representation, or certification in any application shall be guilty of a CI 2
misdemeanor which may include a fine not to exceed $10, 000 as well as civil penalties up to 25, 000 p r olati
2a. Neal Smith, PE os
Professional Engineer Name' �� •' �� ' y� '.,
2b. Neal Smith Engineering, Inc.
Engineering Firm
2c. 575 SE Broad Street, Suite 11
Address
2d. Southern Pines
City
2e. NC 2f. 28387
State Zip
2g. 910-695-8825 2h. 910-695-8835 2i. [e-mail]
Telephone Facsimile E-mail
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= 19311
2FN�IN1�
Seal, Signature & Date
FTA 02/03 - Rev. 1 06/03

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0 0.2 0.4 0.6 0.8 1 mi
Map center is UTM 17 646386E 3891025N (NAD27)
Southern Pines quadrangle
Projection is UTM Zone 17 NAD83 Datum MN=-g • 98
9/25/03

TRANSMITTAL
TO:
ALAN W KLIMEK, P.E.
DIRECTOR, DIVISION OF WATER QUALITY
FROM:
BOBBY TEAGUE, P.E.
TOWN OF SOUTHERN PINES
SUBJECT:
FAST TRACK APPLICATION
DATE:
10/3/2003
CC:
Dear Mr. Klimek:
Enclosed please find a "Fast -Track Application" for "Highland Road Sewer Extension" in
Southern Pines, North Carolina.
Tw f
0�#outhpern n
'.?l it11 F TM AW S.A Ai
� b. emk�
140 MEMORIAL PARK COURT — SOUTHERN PINES, NC — 28387

Department of Public Utilities
P.O. Box 1927
Carthage, NC 28327
upaunty a/ (P'Aaaxe
October 1, 2003
Mr. Tom Wanko
Neal Smith Engineering, Inc
575 SE Broad St. -Suite 11
Southern Pines, NC 28387
Dennis L. Brobst, Director
Telephone: [phone]
Facsimile: [phone]
E-mail: [e-mail]
1.1
Re: Flow Acceptance Letter for sanitary sewer improvements to serve the Highland Road
sewer extension project, NSE job # 0309342
Dear Tom:
The Moore County Water Pollution Control Facility, permit# NC 0037508, presently has
sufficient capacity available to conditionally accept up to 1,440 GPD from the above
referenced project.
The project will be required to comply with all specifications and requirements of the
Town of Southern Pines, NC and pay all required fees.
Upon completion of the referenced project, the applicant's engineer is to provide our
office with the following items:
1. Certification of completion.
2. Complete set of As -built drawings.
If you have any questions or comments please call me at [phone].
Sincerely,
MOORE COUNTY PUBLIC UTILITIES
vid C. Dave rt
Engineering oject Technician

y90 'Town of Southern Pines
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a
_ Public Works Department
140 MEMORIAL PARK CT. - SOUTHERN PINES, NORTH CAROLINA 28387
March 20, 2001
Ms. Kristin E. Miquez, Environmental Technician
DCNENR, Non -Discharge Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Dear Ms. Miquez:
Please accept this letter as documentation that Public Works Director, Bobby B. Teague
is a duly authorized employee delegated to sign non -discharge permit applications for the
Town of Southern Pines.
Respectfully
�g,wnKy So ner
PHONE:[phone] - FAX:[phone]