WQ0029746_Application_20060125

=TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
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USE THE TAB KEY TO MOVE FROM FIELD TO FIELD!
Application Number:
(to be completed by DWQ)WQ0029
`1.
Owner: ---
1 a.
Town of Southern Pines
Full Legal Name (company, municipality, FICA, utility, etc.)
Z
'1 b.
David R. White, Assistant Town Manager
O
Signing Official Name and Title (Please review 15A NCAC 2H .0206(b) for authorized signing officials!)
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1c.
The legal entity who will own this system is:
❑ Individual ❑ Federal ® Municipality ❑ State/County ❑ Private Partnership ❑ Corporation El, Other (speci
�
1d.
140 Memorial Park Court
1 e. Southern Pines
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Street Address
city
LL
_
Z
1f.
North Carolina
1g. 28387
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::
State
- -
Zip Code -- _
0
1 h.
910/692-1983 -1 i. 910/692-1085
1 j. [e-mail] _
Telephone Facsimile
E-mail
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2.
Project (Facility) Information:
J
2a.
Swim & Tennis Center at Mid South Club
2b. Moore County
[L
Project is Located
CL
Brief Project Name (permit will refer to this name)
County Where
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3.
Contact Person:
Q
3a.
Charles D. (Chuck) Heiser PE - with ESP Associates PA
-
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b.
919/858-9200
3c. [e-mail]
Phone Number
E-mail
1. Project is ® 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 ® 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.) or
Z ❑ Leasing units (lots, townhomes, etc. - skip to Item B(3))
0 ❑ Selling units (lots, townhomes, etc. - go to Item B(2b))
ESP ASSOCIATES P A
RALEIGH ACCOUNT
PO BOX 7030
CHARLOTTE, NC 28241
❑ Public Utility (Instruction III)
❑ Homeowner Assoc./Developer (instruction IV)
1427
W21/530
BRANCH 30199
DATE I
PAY
t�
O DER OF -�
WAICHOVIA
Wachovia Bank, N.A.
vachovia.00m
FOR TI' U' .1�J11�� F�f.� �L1 + _ -"''

LJ 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

AAST"-TP.ACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 1
�0F W ATFRQ `; State of North Carolina
�O G Department of Environment and Natural Resources
co 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.
® 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 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).
❑ I11. 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.
® 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 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.
® 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.
® VI1. 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.
® 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
Moor No
Alexander, Cabarrus, Catawba,
663le,
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,
[phone]
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
Wilmington, North Carolina 28405
Brunswick, Carteret, Columbus,
[phone]
Duplin, New Hanover, Onslow,
[phone] Fax
Pender
Winston-Salem Regional Office
585 Waughtown Street
Alamance, Alleghany, Ashe, Caswell,
Winston-Salem, North Carolina 27107
Davidson, Davie, Forsyth, Guilford,
[phone]
Rockingham, Randolph, Stokes,
[phone] 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
I ICC TLIC TAM 1rCV TA ■Xe%1JC Crl^R& CICI r% TA CICI MI ' Application Number:
vv� ...� If1Y .\L I . V 1►IV YL I f�Vl►1 1-1VLV 1 �./ TILL✓:- (to be completed by DWQ) w4a0029746
11.
Owner.
1 a.
Town of Southern Pines
Full Legal Name (company, municipality, HOA, utility, etc.)
Z
Ab.
David R. White, Assistant Town Manager
Q
Signing Official Name and Title (Please review 15A NCAC 2H .0206(b) for authorized signing officials!)
Q11
c.
The legal entity who will own this system Is
❑ Individual ❑ Federal M Municipality ❑ State/County ❑ Private Partnership ❑ Corporation ❑ Other (specify):
O
1 d.
140 Memorial Park Court 1 e. Southern Pines
LL----._...--
Street Address City
---- ---- -- - _ ---- --- - -- - --—_..---- - --- -_... --- - - -i
1f.
North Carolina 1g. 28387 j
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State Zip Code j
H
1h.
910/692-1983 1i. 910/692-1085 .1'. white southernpines.net
Telephone Facsimile E-mail
V
2.
Project (Facility) Information:
J
a.
Swim & Tennis Center at Mid South Club 2b. Moore County
_Brief
Project Name (permit will refer to this name) County Where Project is Located
------ --- __-----._-.. _—...—
Q
3.
...._ -- _; ----- --- - .--------- _..... -- -- - -- ----i
Contact Person: i
Q`
a.
Charles D. (Chuck) Heiser, PE - with ESP Associates, PA
Name and Affiliation of Someone Who Can Answer Questions About this Application {
b.
919/858-9200 3c. [e-mail]
Phone Number E-mail
1.
Project is M 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 j
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.
.
Owner is M Public (skip to Item B(3)) ❑ Private (go to Item 2(a))
a.
If private, applicant will be: 2b. If sold, facilities owned by a (must choose one)
❑ Retaining Ownership (i.e. store, church, single office, etc.) or, ❑ Public Utility (Instruction III)
Z
❑ Leasing units (lots, townhomes, etc. - skip to Item B(3)) El Homeowner Assoc./Developer (Instruction IV)
❑ Selling units (lots, townhomes, etc. - go to Item B(2b))
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Moore County
.
Owner of wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
a.
Moore County Water Pollution Control Plant 4b. NC 0037508
Name of WWTF WWTF Permit No. j
Z
5a.
Town of Southern Pines
b. 8-inch 5c. j
Owner of Downstream Sewer
Receiving Sewer Size Permit Number of Downstream Sewer (if known) j
The nrinin of thic wactawntar is (rhark all that annlvl
Zi- - - - -. _..._ __----••---.._
W j
,W � ®Residential Subdivision
0. I ❑ Apartments/Condominiums
i ❑ Mobile Home Park
❑ School
❑ Restaurant
i ❑ Office
❑ Car Wash
❑ Institution
❑ Hospital
❑ Church
❑ Nursing Home
M Other (specify): Swimming Pool
7. Volume of wastewater to be permitted in this project: 500 gallons per day
100 % Domestic/Commercial
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
% Industrial
% Other (specify):
FTA 02/03 - Rev. 1 06/03

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 4
Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2H
.0219(l) for Item B(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(l)(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(l)(3).
10 gal/member X 50 members = 500 gpd average
(max.: 1000 gpd)
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
415
Gravity
ENTER TOTAL LINE LENGTH IN MILES! 0.0786
l. Summary of Pump Stations to be Permitted (attach additional sheets as necessary) N/A
Location ID
Power Reliability Option
(self chosen - as shown on Design Flow Operational Point (I - dual line feed; 2- permanent generator MATS; 3-
pportable generator w/telemetrv; 4
lans for cross-reference) (MGD) GPM @ TDH -wet well storage)
12. Does the sewer system comply with the Minimum Design Criteria for the Fast rack Permitting of Pump Stations an - - Force
Mains (latest version), the Gravity Sewer Minimum Design Criteria (latest version) and 15A NCAC 2H .0200 as applicable?
pp licabl e.
Z Yes El No If no, please reference the pertinent minimum design criteria or regulation and indicate why a
variance is requested:
ISUBMIT TWO COPIES OF PLANS, SPECIFICATIONS OR CALCULATIONS PERTINENT TO THE VARIANCE WITH YOUR APPLICATION
3. Have the following permits/certifications been submitted for approval?
I Wetland/Stream Crossings - General Permit or 401 Certification? El Yes []No Z N/A
i
I
i Sedimentation and Erosion Control Plan? Yes []No ❑ N/A
Stormwater?
El Yes El No 0 N/A
FTA 02/03 - Rev. 106/03

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!
1 necessary). This document is available from our web site or by contacting the appropriate Division of Water Quality
Z
regional office (see instructions for addresses) OR indicate the following
® A Stream Classification is not needed because all parts of the project are at least 100 feet away from any down slope
waterbody, AND
(,)'
® 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.
yLocation
ID on Map
(self chosen - as shown on Name of Waterbody Stream Waterbody
map for cross-reference) Waterbody County River Basin Index Classification
V'
._.......
Unnamed Tributary
Site Moore Lumber 14-2-11-2-2-(1) C
w
Submit the 8.5" x 11" COLOR topographic map as required in Instruction VI
regardless of whether a classification is provided!
11. Applicant's Certification:
1, David R. White, attest that this application for Swim & Tennis Center at Mid South Club
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, 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 civ' ena/ties u 00 per violation.
Signing CWcial Signature Date i
Professional Engineer's Certification: I
1
Q
/ attest that this application for Swim & Tennis Center at Mid South Club has been
reviewed by me and is accurate, complete and consistent with the information in the engineering plans, calculations, and
Q
all other supporting documentation 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, Gravity Sewer Minimum Design Criteria
V
for Gravity Sewers adopted February 12, 1996, and the Minimum Design Criteria for the Fast -Track Permitting of Pump
LL,.
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
U1 ,
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 Class 2 j
•
misdemeanor which may include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
2a. Charles D. (Chuck) Heiser, PE
Professional Engineer Name
L
A.
2b. ESP Associates, PA � �
I
Engineering Firm - e,
12c.
961 Trinity Road ' r
°
Address 10614 °
81
2d. Raleigh 2e. NC 2f. 27607 IL
City State Zip +,►ysv�®���i ;' i
2g. 919/858-9200 2h. 919/858-9300 2i [e-mail]�t�pq IFS `>'V7/Q
�#8121 al-51 °" r
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Telephone Facsimile E-mail Seal, Si nature &Date i
. _ _ . -- -- _......._._ 9
FTA 02/03 - Rev. 1 06/03

County of Moore
Pu.6Cic -Works Department
T. O. Box 1927
Carthage, North CaroCirta 28327
`oJNjV OF Aron
Utifities Solid ^Waste
910-947-6315 (7eCephone) 11B4 on 910-947-3637 (7ehephone)
910-947-1992 (facsimile) a9 ... !1 ?` glo ,947 Igg2 (facsimiCe)
December 27, 2005
Mr. Charles D. Heiser, P.E.
ESP Associates, P.A.
961 Trinity Road
Raleigh, NC 27607
Dear Mr. Heiser:
RE: Flow Acceptance letter for Mid South Swim & Tennis Center, Southern Pines,
NC.,jX"" No. TH2O.400
1�5p
The Moore County Water Pollution Control Facility, NPDES # NC 0037508, presently
has sufficient capacity available to conditionally accept up to 500 gallons per day from
the above referenced project.
This project will be required to comply with all specifications and requirements of the
Town of Southern Pines, NC.. In addition all required fees must be paid to the Town of
Southern Pines.
The Moore County Sewer Use Ordinance prohibits Swimming Pool drainage systems to
discharge to a sanitary sewer system.
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 to include details of the pool drainage
system showing separation from the sanitary sewer system.
If you have any questions or comments please call me at [phone].

Mid South, Swim & Tennis Center, Flow Acceptance
December 27, 2005
Page 2
Sincerely,
OORE COUNTY PUBLIC WORKS
me Black
Engineering Project Manger
Cc: Mr. Marcus Jones, Director
Mr. Delmo Frye, WWTP Superintendent
Mrs. Pat Willett, Engineering Project Technician
Mr. Ben Vaughn, Operations Manager
Mr. Jim Hill, Public Works Director, Town of Southern Pines