WQ0028906_Application_20050531

USE THE TAB KEY TO MOVE FROM FIELD TO FIELD# Application Humber. ///���
(to be complet
ed by 0010) Le�O&90
1. Owner1.... — -
1a. Moe Q% nn%;n1-4
Full legal Name (company. nw,nicipality. HOA, utility, etc.)
0 lb. ►�1; R;,o EleS, PL-6Ilc.. L,srzks
Signing Official Name and Title (Please review 1 SA NCAC 2H .0206(b) for authorized signing offidalst)
'a
1c
The legal entity wto own this system is:
to l ual 0 Federal ❑ Municipality LJA State/County Q Private Partnership Q Corporation ❑ Other (specify):
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j 227 US HtCi�w.far_ ��sGl
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Address
Mailing Adds
city
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Z�5327
OState
zip Code
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(-Iiip) 6?4-1-5 1i. Qeic) G'4-7-t `f4L
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p &01e-59 ;V cy.YL.4 ne . g
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Telephone Facsimile
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2.
Proied (Faaldy) fn//tfrrrlatron:
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LlJI.�d � s -
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/ T ace 9
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Brief Project Name (permit will rsdar to this name)
County Where Project is Located
a
3.
Contact Pbrson:
a
3a.
Jose h M. l ,,),J i?E,
Name AlSiation of Someone Who Can Answer Questions
About
this Application
3b.
<<'t D) ( qi 2- - 1 to ,�9
3c.
----
Phone Number
S-maii
1. Project is ff New ❑ Mod*cabon (of an aidsting permit) if Modification. Per -it No.: y--
For modNlczdons, attach a separate sheet cfeerty explaining the mason for the modlficadon Me. addbm another
ClubCorp Service Center
3030 LBJ Frwy Suite 500
Dallas, Texas 75234
PAY Four Hundred and 00/100 Dollars
TO NC Dept of Environ & Natural Resources
THE Land Quality Section
ORDER 225 Green St Ste 714
OF Fayetteville, NC 28301-5043
Wells Fargo Bank, N.A.
115 Hospital Drive
Van Wert, OH 45891.

56-382
412
Check Date I Check Number
2.5-MAY-2005 1 1998524
$***************400.00
a",, T oolial iAI. vocume►ri teas A RtFLEc' IVE WAT9R14AR Oft Tli s/tcte < i+o l `AT srN A lr e,ro vteuli wili:lu% ctteci trtt; sNt�oRslea+ t+T
8. If the permitted flow is zero, indreale why:
❑ interce"or Line - Flow will be permitted in subsmtwd permits that connect to this tine
❑ Flow has steady been allocated In PenTA No.
i ❑ Rehabililadon or reptaoement of existing Sewer with no new now expected
F`CA 02/03 - Rev. 3 04/05

^ �F NA' 9 RECE I ED State of North Carolina
tUENR
MAY 3 1 Department of Environmentand ;Natural Resources
2005 Division of Water Quality
o - E'AYETTEI)1LLE REG NA
FAST -TRACK APPLICATION
TY SEWERS, PIJi4iP S'TATiONS, AI'YD FORCE M.ANM
Tm mm ccwm syntnts ale not to be inebdcd as part of qus 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 wig lead to your application
being returned as incomplete. This form may be photocopied for use as an original.
I( 1. 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 ®f 12).
1911. Application Fee - Submit a check in the amount of $400 made payable to: North Carolina Department of
Environment and Natural Resources (NCDENR). Checks shall be dated within 90 days of application submittal.
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 property executed operational agreement 'If
the sewer extension is permitted by a private applicant and will 5e serving residential or commercial lots (e.g.,
houses, cctidominiums, 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.
❑ V. 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 sewerA WTF. 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-specft flow acceptance
letter.
Vl. 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 10 is self chosen and used to cross reference the
location in Section C of the permit application.
7-1 Vil. Stream Claselficatk ns - 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)(3xD)).
• Use the guidance document entitled, "Determining Watershed Classifications for Form FTA 02/03 (Fast -Track
Sewer Systems)" available from hM://h2o.enr state nc us/peres or by contacting the appropriate regional
office.
FTA 02/03 - Rev. 3 04M

X❑ Vill.-Environmental Assessments — If this project is subject to an Environmental Assessment (EA) 115A NCAC
%GiC1, this application can not be used. Send the project application on Form PSFMGSA 10199 to the PERCS
` Unit, 1617 Mail Service Center, Raleigh, NC 27699-1617. Applications can not 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.
❑ 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(lb). 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.
❑ X. Downstream Sever 6 Wastewater Treatment Plant Capacity
The applicant has assured downstream pipe, pump station and treatment plant capacity. The addition of new
sources of wastewater from this project has been evaluated along the route to the receiving treatment plant. The
flow from this project will not cause capacity related sanitary sewer overflows or overburden any downstream
pump station en mute to the receiving wastewater treatment plant. If the applicant is not the owner of the
downstream sewer or receiving treatment plant. submittal of flow acceptance letters) indicates that owner has
adequate capacity and will not violate G.S. 143-215.67(a).
THE COMPLETED FTA 02103 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
2090 US Highway 70
Avery, Buncombe, Burke, Caldwell,
Swomanoa, NonCarolina 28778
Cherokee, Clay Graham, Haywood.
(828) 296-4.5W
Henderson. Jackson. Macon. Madison.
[phone] Fax
McDowell, Mitchell, Pok Rutherford,
Swain, Transylvania. Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Hamett,
Fayetteville, North Carolina 28301
Hoke. Montgomery, Moore, Robeson,
(910) 4WIS41
Richmond, Sampson. Scotland
[phone] Fax
Mooresville Regional Office
610 E. Center Avenue, Suite 301
Alexander, Cabarrus, Catawba,
Mooresville, North Carolina 28115
Cleveland, Gaston, Iredell, Lincoln.
(7D4) W&Ies9
Mecklenburg. Rowan, Stanly, Union
(704) 66380 0 Fax
Raleigh Regional Office
1928 Mail Service Center
Chatham, Durham. Edgecombe, Franklin,
Raleigh, Noll Carolina 27699.1828
Granville. Haldax. Johnston, Lee, Nash,
[phone]
Northampton, Orange, Person. Vance.
19 571-4718 Fax
Wake, Warren, Wilson
Washington Regional Office
943 Washington Square Mall
Beaufort i
� .Camden. C
North Carolina 27889
Currifuck, Dare. Gateses,. Greene,
46 4B1
Hertford, Hyde. Jones, Lenoir, Martin,
(252) 9Fax
Pamlico. Pacquotank' Pemuimarts, Pitt.
Tyrrell, Washington. Wayne
Wilmington Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Dupiin,
Wilmington. North Carolina 28405
New Hanover. Onslow, Pender
(910) 3963900
(910) 350-20134 Fax
Winston. -Salem Regional Office
WS Waughtown Sew
Alariance. Alleghany, Ashe. Caswell,
WinstorrSalem. North Carolina 27107
Davidson, Davie. Forsyth, Guilford,
(336) 771 A600
Rockingham. Randolph. Stakes. Sur y,
[phone] Fax
Watauga, Wilkes, Yadkin
For more information. YW our web site at h*.I, ft enr srafe.nc. uxlwrd
FTA 02/03 Rev. 3 04/05

p.2
USE THE TAB KEY TO MOVE FROM FIELD TO MELD! aPPlicztion Number- - —" -
- ---1-- Owner _ _ - _. _ (tobe c�� by �Q� Lv� 9�_6. .
rr
Z Full Legal Name (company. mums ipality FIOA uti(dy, etc.)
}- Signing 015cial Name and Title (Please review IbA NCAC 2H 02
Q 1c The I )Tor aulhoriaed signing ofSaalsl)
�• entity who wdl awn this systern is:
0 IndMduel ❑ Federal ❑ Municipality State/County D Private Partn
e
Q 2 7 U 5 H 1 g w rsn�p D carpo.ation ❑Other (speafy): i
Z Mailing Address
if. _A) C c+ty --
Z stage 19• Z b 3 2 7
1h. Cr 4-7_ (l j l S ZIP'�Code
aTelephone f i. Fatsrrni(e��7-
C� 2. Pmjed (Facility) Information:
a Bnef Project Name (permit win refer to thrs name) 2b.
Q I Contact Person: County where Project is Located
38.
Name and Afiliefion of Someone Who Can 3b. q�y„� 17uestions About this q
��f'►O /e Q.Z. - ((o `i✓''+�j PPlieafian
Phone Number — 3c
1- Project is ErNew Email
_ _ D ModiFtation (of an eidsting Permit) If Modificallo.--
phase,'---- --
For mod _ tion. Perth
Kicatiar�, attach a separies sheet clse -.--.
changirmg tome size/ferrgth, gee.)_ Only inc � m g the reason for the rnod(fkmd t.e. ad dupli"te Projrft i od�ed infoneation in lhls Pemttt ( �$ another
i nfoneation in 8(7) and t3(10-11) that has aiready b� i uded in the aWica� - do not
2. Cwner is 2 Public (slop jo Item ep)) -- -n —_ oeipinel permit
11- 2a. ff D Pn�e (W to Item 2(a))
Pate, applicant will be: -- - --
2b. ff sold. ladl'fies owned
❑ Retainhg Ownerch;a (must choose i
Z ❑ Leasing units P (.e_°• Church. sine office. etc) or
O ❑ Sel>�ng units (lots, es. etc. - sMp to Item sp) Public Utility (fetstrUetion Ilq
' _ r, etm - go to hern 6(2b)) Homeowner er
(Instruction !1)
- Owner of Wa1AIRIrilw Treatment FadlitY MVVM T `
4a- a Q u , a E Qo II u r>oatRg Wastewater From This Project
O t6." f FvCt �! _ Name of wwTF 4b. nl LL eo 37 S o 8 _ ....
L. Permit
5a. rl�ac- t t,- � i �hlrL uL ' :may' r No. Z rSb.... - -•
Owner of_Downttre2m Sewer ReceivIrmg Sewer Size Gmvdy Sc. �^JRC OQo 3 �4-
F 6_ The a ' rn of this D Force Main Permit Number of Downsln�m
n9 wastewater is (ehedc ali t>SaIt eDPh!): - - Sewer (if lvtoWn) '
f2fResidentw Subdivision ---- -....
D Aparbnener/Condominiums Q l� Wash
IL ❑ School Home Paris
a sfm,s°^
D Hospital LQ_ 56 17omesfidcon mercol
m 0 Ofce � nt Chwch
N ding Home % lndusftj
7. vohWW of ( �' (specify):
Other (spfy):
wastewater to be be alkxgted for this
*Oo net +ndude previously PaftUar per+++itmal alloeae Project: O gallons per day
8. if the Permitted R ° flow is z —
❑ Into �' indicate why.-
Intercepter Ling -Flow will be Permitted in atr perMits that con
❑ Flow has atrrady been agocated In pal., N �� nett to this line
2'Rehabditatlon or repphcemerd of existing
sewer with no new flow exDeCted
PTA 02/03 _ rr...

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 4
9. Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2H
.0219(I) for Item 8(7) or the design Row for line or pump station sizing if zero flow in the space below. Values other than
that in 15A NCAC 2H .0219(1)(1-2) must be supported with actual water or wastewater use data in accordance with 15A
NCAC 21-1.0219(l)(3).
vldr/ �.�{i3t�ny t�n1- /►lv Jdd�flte7��
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (Inches) Length () Gravity or Force Main
(use the pull down menu)
W
Z
Z ENTER TOTAL LINE LENGTH IN MILES
V 11. Summary of Pump Stations to be Permitted (attach additional sheets as necessary)
Z Location ID Power Reliability Option
O (self chosen - as shown on Design Flow Operational Point (1- dust lime feed; 2- pornlanent generator w1ATS; 3-
Qplans for cross-reference) (MGD) GPM @ TDH portable generator w/telemetry; 4-wet well storage)
0
N..
Z
12. Does a sewer system comply with the Minimum Design Criteria for the Fast Trade Permitting of Pump Stations and Force;
M ' s (latest version), the Gravity Sewer Minimum Design Criteria (latest version) and 15A NCAC 2H .0200 as applicable?'
W Yes ❑ No if no, please reference the pertinent minimum design criteria or regulation and indicate why a
f - variance is requested. SUBMIT TWO COPIES OF PLAN$, SPECIFICATIONS OR CALCULATIONS
PERTINENT TO THE VARIANCE WITH YOUR APPLICATION
� m
13. Have the following permits/certifications been submitted for approval?
I
Wellend/Stream Crossings - General Permit or 401 CertSficah'on? ❑ Yes ❑ No [5 N/A
I
Sedimentation and Erosion Control Plan? ❑ Yes ❑ No Q NIA
Stormwater? ❑ Yes ❑ No 0"N/A
14. Does this project involve aerial lines or siphons? Check if yes: ❑
These Ones will be considered hleh ottor8v and must be dteeAed amm even !ox morRhe
15. Does this project have gravity sewer lines designed at minimum slopes? ❑
Se aware thal the Glvieron wW not accept installed fines more then 10% belt r then the mhdenlrtt slope. Linea in&hKW ouaide tMs loterenae *Wo Ad be
rx—C ed prW to 7ubmlMnq ftw nnal o"wM om no aertw4adon..
FTA 02/03 - Rev. 3 04/05

- -- � 1nr , r A 11UNS. AND FORCE, MAINS
PAGE
1. Use the Oivision's guidance document entitled. ^pRMINING STREAM C
(FAST -TRACK SEWER SYSTEMS)' to coded and record the s LASSIFICATIONS FOR FORM FTA 0-
necessary). This doctxnent is available from our web stream classification data below (attach additional sheets as regional office (see instructions for addresses) OR indicater a Ong the apprtipriats Division of Water Quality 2103
the following:
It Aw y; AND,
is not needed because all parts of the pit are at least 100 feet away from any down Wope
L''( A Stream Classification is not needed because the
option for any pump station near a Class C down slope water".design does not depend on wet well storage as a power reliability
Location ID on Map
(SW choson - as shown on Name of
map for cress-mfaence) Waierbody County River �1° Was oily Stream Waterbody
ex Classifleation
A
Submit the s.5" :11" COLOR tiopogrjoic map as nwWired in Instruction VI
-- - f4gardless of whether a classi6catbn
1- Applicant's Cettation: -- _ - --_'s Pr+oridedf
iftc
Z
a
d
F�
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U
r-01
I. SIGN/NG OFFICIAL
NAME, �n mat �s �a�n for
pmo JFCT NAw `
has been reviewed by me and is acwr� and
parts of tJtis ePOliplion are not►Plehe to
tl►t. bast of my !mo►vA�ryge. l understand that if all' included. Mis app . flonage Iee and Mat if al/ �Med U�hng documentation end mired
General is subject to being rehnned as i attachments are not Statutes 143-215 SA end 143.215. 6a any person who ^c�Pk'fe. Note: In t�fal MvrM Carina
eertifC"On in any aPP/l a on shall be gutty of a Crass 2 �rOW/ Vly makes any false statamen�
as weAf as awl penaig" u b $25, OOp +�derrreanpr which may include a finer not to lion, or
.'e % /9 /_ � � Per vnolaiYon. exceed SlO, 000
taw
jgning at" Signal
2. PrOlb"ipnal Engineer's Certification:
FA
I attest that ties app&_abiorr for
and CWW Ment with Hte iMbmeadon in the engrneenn9 Plans, che" 6ft47e/eu/agans, and ad
best ormy �r+ed by rrnE` and is aopiratie, �rnp/ete midge. I f abler attest Met to the best of oilier SuPPoK►ng docu nertta" to the
accordance wide Me appNcab/e regulet}oru Gratriljr Server A De fe Pied d"W has been prepared in
1 Z t00 a and Me 1 torchedMyn Deaden in /or Me Fact-Tiaryr Pbmti[tlrtq p 597 M" "' Sew �Ak■d Febma
t, 2000 and the watershed d ry
Package may have been developed by aCCOrdance "A �►s guidance. A SW �s �OP1ed June
-49ndies Mat 1 have mvie �° 101' tateon of Mesa me Brio t� portions of Mir she/
accordance wiM wed tlfis meleeia/ and haveju�7ed it to be Con WWV wIM � ^�1' Wafwt3 and seal
NC Genera/ Statutes t43-215.6A and 143-215.6a, any Ak*. In
&Ceed 310,000 as veal/ as chap � �C/ess nys� ymakes any 'n moment.!
2a. ✓aJ ' A m.
Professional Engineer Nance
!Lo �i�rJSan
rm
2b.
Engineering Firm C .
2c
Mailing Address
2d.
City 2e. 2t. Z 8 3 2
2g. 310.4 9 Z . l = Slat` 92hzip
. .Saw,,, ,
_ Telephone 2i a 6 rn 1 z a
F,d; ez 1
-- -- -- •— -- Facsimile - -- E-mail
+e��rNrurey,�,
.•� GARCC/N
_
Seal. Sicmwy t .5 rate
FTA mrm = os„

Joseph NL Robinson, JR P.E.
1�RdL
car0wge, NC 28=7
RECEIVED
MAY 31 2W5
May 27, 2005 OENR - fAYtirEtn(,LE REGIONAL OFFICE
NCDENR
Land Quality Section
225 Green St. Suite 714
Fayetteville, N.C. 28301
Dear Sir:
Enclosed for your consideration is a "fast track" application for the relocation of an 8" sewer fine located
in Moore County.
If you have any questions or if I can be of further help please let me know
ours T fy
M. Robinson, A