WQ0030150_Application_20060418

_;,'k APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 1
X,
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD!
Application Number: 1. I
(to be completed by DWQ) V V Q1 OQ 30 1 50
1.
Owner.•
1 a.
Town of Southern Pines
Full Legal Name (company, municipality, HOA, utility, etc.)
Z
1 b.
David R. White Assistant Town Manager
0
Signing Official Name and Title (Please review 15A NCAC 2H .0206(b) for authorized signing officials!)
Q
1 c.
The legal entity who will own this system is:
❑ Individual ❑ Federal ® Municipality ❑ State/County ❑ Private Partnership Corporation ❑ Other specify -
_
0
1 d.
140 Memorial Park Court
1 e. Southern Pines
LL
Street Address
-North
City
Z
1f.
Carolina
1g. 28387
Z
State
ZipCode _..... .-- - - ... -_---- -- - -- - -
O
!1 h.
910-692-1983 1 i. 910-692-1085
1 j. white .southempines.net
QTelephone
Facsimile
E-mail
U
2.
Project (Facility) Information:
eL2a.
a
Forest Creek Golf Course Development Section 17
2b. Moore
a,
Brief Project Name (permit will refer to this name)
County Where Project is Located
3.
Contact Person:
........ ..__. ..... __._..... _ -- - - _ .......... _._._. ..... _-_...... .__._.. -.._.
Q
3a.
Lee Humphrey
Name and Affiliation of Someone Who Can Answer Questions
About this Application
3b.
[phone]
3c. [e-mail]
Phone Number
E-mail
1.
Project is ® New ❑ Modification (of an existing permit)
If Modification, Permit No.:
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.)
❑ Public Utility (Instruction III)
❑ Leasing units (lots, townhomes, etc. - skip to Item B(3))
❑Homeowner AssocJDeveloper (Instruction IV)
❑ Selling units (lots, townhomes, etc. - go to Item B(2b))
z 3. Moore County 1
---
r_ •. .......�_. _ — _ N.+
HOMS, Of &ASSOC7AgES, P-A.. BB
CONSULTING ENGINEER B.. h13MkmgnATevaCO-P-Y
P.O. BOX 1737, 300 S.W. BROAD STREET WIIZ1531
SOUTHERN PINES, NC 28388
[phone]
xactly Four hundred and no / 100 Dollars
AY
0 THE N , C . DENR
IRDER
IF:
NC
DATE
4/12/2006

5§M90
AMOUNT
$400.00 €
a
I AFTER 90 DAYS 8
AUTHORIZED SIGNATURE
FTA 02/03

�
p� �AtutivtuTEi4 APR 18 2006 State of North Carolina
O� QG 'Department Anvironment and Natural Resources
v� DENR-FAYETTEVILLEREGIONAL MIE 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).
❑ 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 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.
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 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).
❑ VII. 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

❑ Vill. Environmental Assessments — If this project is subject to an Environmental Assessment (EA) ]15A NCAC
.01C .0500], this application can not be used. Sand 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(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) 251-6
Henderson, Jackson, Macon, Madison,
[phone] 52 Fax
McDowell, Mitchell, Polk, Rutherford, Swain,
Transylvania, Yancey
Fayetteville Regional Office
Anson, Bladen, Cumberland, Harnett, Hoke,
225 Green Street Suite 714
Montgomery, Moore, Robeson, Richmond,
Fayetteville, North Carolina 28301
Sampson, Scotland
[phone]
[phone] Fax
Mooresville Regional Office
919 N Main Street
Alexander, Cabarrus, Catawba, Cleveland,
Mooresville, North Carolina 28115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] 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,
[phone]
Warren, Wilson
[phone] 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,
[phone]
Pasquotank, Perquimans, Pitt, Tyrrell,
[phone] Fax
Washington, Wayne
Wilmington Regional Office
Brunswick, Carteret, Columbus, Duplin, New
127 Cardinal Drive Extension
Hanover, Onslow, Pender
Wilmington, North Carolina 28405
[phone]
[phone] 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,
[phone]
Watauga, Wilkes, Yadkin
[phone] Fax
For more information, visit our web site at: http.-Ah2o.enr.state.nc.us/ndpu/
INSTRUCTIONS FOR FORM FTA 02/03

BAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 1
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD! Application Number: Q
(to be completed by DWQ)
J.
Owner:
1 a.
Town of Southern Pines -
Full Legal Name (company, municipality, HOA, utility, etc.)
Z
11 b.
David R. White, Assistant Town Manager
0
Signing Official Name and Title (Please review 15A NCAC 2H .0206(b) for authorized signing officials!)
Q'1
c.
The legal entity who will own this system is:
_❑ Individual El Federal ® Municipality_❑ State/County ❑ Private Partnership ❑Corporation ❑Other (speci L _
0
1 d.
140 Memorial Park Court 1 e. SouthernPines
LL
Street Address City
Z
1f.
North Carolina 1g. 28387
Z
State Zip Code
_..... _....... .... ..... - .....- ...._.............. _._.... .__. ._._...
~
1h.
910-692-1983 1i. 910-692-1085 1. white southern ines.net
1
Telephone Facsimile E-mail
V
2.
Project (Facility) Information:
EL
a '
2a.
Forest Creek Golf Course Development Section 17 2b. Moore
a
!
Brief Project Name (permit will refer to this name) County Where Project is Located
J.
_ _.... _.._.. ......... . ._......... . ... . -.. ...... ......... . .. _.... _......
Contact Person:
Q
3a.
.. .._.... .... .............. _ .. _
Lee Humphrey
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b.
[phone] 3c. [e-mail]
Phone Number E-mail
1.
Project is ® New ❑ Modification (of an existing permit) If Modification, Permit No.:
2.
Owner is ®Public (skip to Item 8(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.) El Public Utility (Instruction 111)
❑ Leasing units (lots, townhomes, etc. - skip to Item B(3)) El Homeowner AssocJDeveloper (Instruction IV)
❑ Selling units (lots, townhomes, etc. - go to Item B(2b))
Z
0
3.
Moore County
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
4a.
Moore County Water Pollution Control Plant
4b. NC 0037508
Name of WWTF
WWTF Permit No.
0
5a.
Town of SouthernPines
5b. 8"
5c.
Receiving Sewer Size
Permit Number of Downstream Sewer
Z
Owner of Downstream Sewer
F.
The origin of this wastewater is (check all that apply):
❑ Residential Subdivision ? ❑ Car Wash E
W®
Apartments/Condominiums ElInstitution 1 100% % Domestic/Commercial
d
❑ Mobile Home Park # ❑ Hospital
❑ School ❑ Church % Industrial
m
i
❑Restaurant ❑ Nursing Horne %Other (specify):
❑ Office ❑ Other (specify):
i
7.
Volume of wastewater to be permitted in this project: 8,640 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(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(1)(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).
18 apartment units @ 4 bedrooms each x 120 gallons per bedroom =8,640 gpd
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches)
Length (feet)
Gravity or Force Main
(pull down menu)
8"
2138
Gravity
a;
LU....._........
_............ ..._... _........... _.._... ........ _..... _..... __-........................... _........._.............. ......._......_._.._................
..... _............. _.... ................... __...._.__........ _..... ................ _..... .......__....._.............. .............
....... _....... _.................... _...... _.._...._..._.._.._..._.__...._..._..._... _._........_.......
Z
F-
............ __......__._._.......___.._............... _.._._...__.................._...__....._._......_..._................._......._.._._.._........-------
......_.._.._......_......_.......... ...... .._...._....._._.---------- _.._...._._..__...............
_......._............ _......_............. _........ _....... _._..___... ___...
Z
v
ENTER TOTAL LINE LENGTH IN MILES
0.405
a`.11.
Summary of Pump Stations to be Permitted (attach additional sheets as necessary)
Power Reliability Option
Location ID
Design Flow
Operational Point (dual line feed, permanent generator,
0
as shown on lens
MGD
GPM @ TDH _portable generator, wet well storage)
LL--
Z
W
a
'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?
® 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 ® N/A
Sedimentation and Erosion Control Plan? ® Yes ❑ No ❑ N/A
Stormwater? ® Yes ❑ No ❑ N/A
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(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).
18 apartment units @ 4 bedrooms each x 120 gallons per bedroom =8,640 gpd
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches)
Length (feet)
— Gravity or Force Main —
_
(pull down menu)
8"
..........................................................._ ......... .
2138
j._....... ... .. ..... .. ..............__ ..
Gravity
##,
........_ ......... ............_.. ......
_
...._.
Z.._
O
........ ... .._ . --. ......... __....
ENTER TOTAL LINE LENGTH IN MILES
_ .. .. _._._.
_ 2.76
....... _....... _ .. _ ..._.._ ...... ._....... ....._.__ ._..
0
Q11.
Summary of Pump Stations to be Permitted (attach additional sheets as necessary)
Power Reliability Option
Location ID
laps
Design Flow
Operational Point (dual line feed, permanent generator,
as shown on
___(Mgl] _
_ GPM @ TDH _ _portable generator, wet well storaLL �eL
Z
_...__ _, _....-_. _. ............. ............. ........ _........... ....... ..... .... ....... _ ..................... ............ -..
W
_._...... _____---..__.__--_-------
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?
® 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 ® N/A
Sedimentation and Erosion Control Plan? ® Yes ❑ No ❑ N/A
Stormwater? ® Yes ❑ No ❑ N/A
FTA 02/03

F°'AST-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 02/03
Z (FAST -TRACK SEWER SYSTEMS)" to collect and record the stream classification data below (attach additional sheets a:
O necessary). This document is available from our web site or by contacting the appropriate Division of Water Quality
regional office (see instructions for addresses) OR indicate the following:
F- _ ........ .......- . _
® A Watershed Classification is not needed because all parts of the project are at least 100 feet away from any down
C) slope waterbody; AND,
® A Watershed Classification is not needed because the design does not depend on wet well storage as a power
ca
reliability option for any pump station near a Class C down slope waterbody.
U) _
JLocation ID Name of Waterbody Stream Waterbody
on Map Waterbody County River Basin Index Classification
.....
A Nicks Creek Moore Cape Fear WS III CA 18 23-3-(1 5)
0 - _ .... - - - -_ -
LU
V Submit the 8.5" x I " topographic map as required in Instruction VI regardless of whether a classification is provided
1. Applicant's Certification:
I attest that this application for Forest Creek Golf Course Development Section 17 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 civil penalties up to
$25,
Signh4j'Official Signature Date
C0 2. Professional Engineer's Certification:
Z I attest that this application for Forest Creek Golf Course Development Section 17 has been reviewed by me and is
accurate, complete and consistent with the information in the engineering plans, calculations, and all other supporting
1-- documentation to the best of my knowledge. I further attest that to the best of my knowledge the proposed design has
Q been prepared in accordance with the applicable regulations, Gravity Sewer Minimum Design Criteria for Gravity Sewers
V adopted February 12, 1996, and the Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force
LL 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 the proposed design.
LLJ Note: In accordance with NC General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
V statement, representation, or certification in any application shall be guilty of a Class 2 misdemeanor which may include a
Qfine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
_ ......... _... .
2a. Fred M. Hobbs, P.E.
Professional Engineer Name
........... .._.... ......._.
2b. Hobbs, Upchurch & Associates, P.A.
Engineering Firm
....
2c. 300 SW Broad Street
Address
2d. Southern Pines 2e. NC 2f. 28388
City State Zip
?g. [phone] 2h. [phone] 2i. [e-mail]
Telephone Facsimile E-mail
Seal, Signature & Date
FTA 02/03

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09/12/2005 16:22 910-947-1992 MOORE CO. PUB. UTIL PAGE 02/03
County of Moore
1-1-ub6c -Narks D,, art~m.ent
P. 0- l30x 1927
Carthage, :North Carolina 28327
`oJMTY OF Moo��
uticities i SoCicf "Waste
910-947-6315 irQCeyhone) r� vea ■■ 910-947-3637 (`re6epFi[>ne1
910-947-19.92 (facsimile.) .91a 947 29g2 (Fat=sim(le)
�FkON1N �pP
September 12, 2005
Mr. David T. Upchurch, P.E.
Hobbs, Upchurch & Associates, P.A.
P O Box 1737
Southern Pines, NC 28388
Dear Mr. Upchurch:
RE: Flow Acceptance letter for Forest Creek Subdivision, Section 17, Southern Pines.
NC.
The Moore County Water Pollution Control Facility, NPDES # NC 0037509, presently
has sufficient capacity available to conditionally accept up to 8,640 gallons per day fxom.
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 mpjired fees must be paid to the Town of
Southern Pines.
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].

-OW12/2005 16: 22
910-947-1992
MOORE CO. PUB. UTIL
PAGE 0 3/03
Sincerely,
MO;17
TY PUBLIC WORKS
M
xv-A'd-
Ernie Black
Engineering Project Manger
Cc: Mr. Marcus Jones, Director
Mr. Delmo Frye, WWIP Superintendent
Mrs. Pat Willett, Engineering Project Technici.an.
Mr. Ben Vaughn, Operations Manager
Mr. Jim Hill, Public Works Director, Town of Southern Pines