WQ0031498_Sewer Extension_20070320 (2)

•,cACK 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)
1 1. Owner.
la. Town of Aberdeen
Full Legal Name (company, municipality, HOA, utility, etc.)
1 b. Bill Zell, Town Manager
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:
❑ id
� Indivual ❑ Federal ® Municipality ❑ State/County ❑Private Partnership ❑Corporation ❑Other (specify):
0 Id. PO Box 785 - 115 N. Poplar Street Ile. Aberdeen
Z Mailing Address City
If. NC
Z State 1 g 28315
--- ---.. - -- - Zip Code
----- _
4-1115 1 i. 910-944-7459 _ _._..--
� 1j. ze111115Qalltel.net
Q Telephone Facsimile E-mail
(� 2. Project (Facility) Information: -- -- — ---
- ---- _ — --- -- - - -----
a. oodGreen Subdivision Phase 5A - - - - - 1
a � 2b. Moore
Brief Project Name (permit will refer to this name
) County Where Project is Located
Qj3. Contact Person: -
Q 3a. David T. Upchurch, P.E. Hobbs, Upchurch & Associates
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. 910-692-5616
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 8(3)) ❑ Private (go to Item 2(a))
2a. If private, applicant will be: 2b. If sold, facilities owned by a (must choose one)
❑ RetainingOwnership '
p (i.e. store, church, single office, etc.) or ! ❑Public Utility (Instruction 111)
Z ❑ Leasing units (lots, townhomes, etc. - skip to Item B(3)) ❑ Homeowner Assoc./Developer (Instruction IV)
Q ❑ Selling units (lots, townhomes, etc. - go to Item B(2b))
Q3. Moore County Public Utilities -- ` - ------
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
�
4a. Moore County Wastewater Treatment Plant � 4b. NPDES NC 0037508
nm
NJHOBBS, UPCHU CH & ASSOCIA?£,S, P.A. B�T � �� 71
CONSULTING ENGINEERS
P.O. BOX 1737, 300 S.W. BROAD STREET Branch Banking and Trust Company
SOUTHERN PINES. NC 28388 66-112/531
[phone]
Lctly Four hundred and no / 100 Dollars
DATE AMOUNT
3/13/2007 $400.00
C
0
HE
ER N . C . DENR .per.
V ID AFTER 90 DAYS I �J
NC
AUTHORIZED SIGNATURE
..■

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE 1
.and WATF9
pp1 State of North Carolina
bwa
�G ��ti Department of Environment and Natural Resources
co v
3 �Pyl OQ Division of Water Quality
° ` L 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/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 will lead to your application
being l.
ng returned as incomplete. This form may be photocopied for use as an origina
E inI. Application Form - Submit one original and one copy of the completed and appropriately ppropriately 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 andspecifications unless you respond NO to Item 1302).
0' II. 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 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.
dV. 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.
E? 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.
evil. 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
a 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/percs or by contacting the appropriate regional
office.
T�^r n AI /Al n___ 1

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], this application can not be used. Send the project application on Form PSFMGSA 10/99 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.
Rr 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.
❑ X. Downstream Sewer & 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 route 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 FTA02/03 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
2090 US Highway 70
Swannanoa, North Carolina 28778
Avery, Buncombe, Burke, Caldwell,
Cherokee, Clay, Graham, Haywood,
[phone]
[phone] Fax
Henderson, Jackson, Macon, Madison,
McDowell, Mitchell, Polk, Rutherford,
Fayetteville Regional OfficeSwain,
g
Street Suite 714
Trans Ivania, Yance
Anson, Bladen, Cumberland, Hamett,ville,
Z225en
North Carolina 28301
Hoke, Montgomery, Moore, Robeson,6-1541
6-0707 Fax
Richmond, Sampson, Scotland
Mooresville Regional Office
.Center Avenue, Suite 301
Mooresville, North Carolina 28115
Alexander, Cabarrus, Catawba,
Cleveland, Gaston, Iredell, Lincoln,
[phone]
[phone] Fax
Mecklenburg, Rowan, Stanly, Union
Raleigh Regional Office
1628 Mail Service Center
Raleigh, North Carolina 27699-1628
Chatham, Durham, Edgecombe, Franklin,
[phone]
Granville, Halifax, Johnston, Lee, Nash,
Northampton, Orange, Person, Vance,
Washington Regional Office
919 571-4718 Fax
943 Washington Square Mall
Wake, Warren, Wilson
Washington, North Carolina 27889
Beaufort, Bertie, Camden, Chowan,
Craven, Currituck, Dare, Gates, Greene,
[phone]
[phone] Fax
Hertford, Hyde, Jones, Lenoir, Martin,
Pamlico, Pasquotank, Perquimans, Pitt,
Wilmington Regional Office
9 9
127 Cardinal Drive Extension
Tyrrell, Washington, Wayne
Wilmington, North Carolina 28405
[phone]
Brunswick, Carteret, Columbus, Duplin,
New Hanover, Onslow, Pender
[phone] Fax
Winston-Salem Regional Office
585 Waughtown Street
Winston-Salem, North Carolina 27107
ny, Ashe, Caswell,
A=Randolph,
[phone]
Dorsyth, Guilford,
Rolph, Stokes, Surry,
[phone] Fax
WYadkin
For more information, visit our web site at http.//h2o. enr state. nc. us/peres/
PTA niim De I nA/nC