WQ0031747_Sewer Extension_20070516

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J , rAs'T-TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 1
0, ;WA rFR State of North Carolina
of Q Ay DepArtmeot of Environment and Natural Resources
v� i 7 G� Division of Water Quality
FAST -TRACK APPLICATION
- - for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
-- (Ressure sewers systems are riot to be included as pan of this npplicahon packw)
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 returned as incomplete. This form may be photocopied for use as an onginat
® 1. Application Form - Submit one original and one copy of the completed and appropriately executed application
form Any changes to this form wig 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 1302).
It. 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.
❑ 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 REOUIRED.
❑ 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 sewersNWVTF. The flow acceptance must not
expire prior to permit issuance and must be dated less than a year prior to the application date.
Intergovemmental 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 dearly 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 O'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. Strewn Classifications — Section C
• If any portion of the project is wlthin 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 1SA NCAC 2H .0218(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/peres or by contacting the appropriate regional
office.
FTA n,)/nA nemt
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Jll�`J99-r4'7 I UUNV OF H=KLCCIV r r 1 Moe lint 1 1-4 - W f V10. V-4
FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 2
❑ VIII. Environmental Assessments -- N 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 10199 to the PERCS
Unit, 1617 Mail Service Center, Raleigh, NC 27699`1817. 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. CertHkatfons — 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 ow* the
application if he/she is untamFw 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.
Q X. Downstream Sewer a 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 Wong the route b the receiving treatment plant. The
Pow from this project will not cause capacity related sanitary sewer overf ows or overburden any downstream
pump station an route to the receiving wastewater treatment plant. If the applicant is not the owner of the
downstream sewer or receiving treatment plant, submittal of now ptan a letter(s) indicates that owner has
adequate capacity and will not violate G.S. 143-215.67(a).
THE COMPLETED F A 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 J Avery, Buncombe. Burke, Caldwell,
Swannenos, North Carolina 28778 Cherokee, Clay, Graham, Heywood,
(SM 295 45M Henderson, Jeckson. Macon, Madison.
(aU) 299-7043 Fax McDowell, Mitchell, Polk, Rutherford.
Swain, Traneyovenia, Yancey
Fayetteville Regional Office 225 Green Street Suite 714 Anson, Blsden. Cumberland. Harnett,
t
ayetteville, North Carolina 28301 Hoke, Mahtgomey, Moore, Robeson,
-- -910) 488-1541 R`chimm . Sampson, Soodend
910) 4862-0707 Fax
Mooresville Regional Office
Raleigh Regional 0mee
Washington Regional Olflee
Wilmington Regional Office
Winston-Salem Regional Office
610 E. Cerhter Avenue. Suite 301
Mooresville, North Caroline 28116
[phone]
[phone] Fax
IWO Mail Service Center
Raleigh. North Carolina 27699-IWS
(919) 5714700
943 Washington Square Mall
Washington. North Carolina 27889
[phone]
[phone] Fax
127 Cardinal Drive Extension
Wikningtai, North Carolina 28405
(010) 306-39M
[phone] Fax
585 WaughtoMnh Street
Winston-Salem. North Carolina 27107
[phone]
[phone] Fax
Alexander. Commis, Catawba.
Cleveland, Geston, kadell, Lincoln.
Mecklenburg, Rowan, Manly, Union
Chatham, Durham. Edgecombe, FraanNin,
Grenville, HeMax, Johnston, Lee, Nash,
Northampton, omng% Person, Vance,
BesuforL Bartle, Camden, Cfrorver,
Craven, Caurtkrek, Dare, Gates, Greene,
HO Ord. Hyde. Jules. Lenoir. Moth,
Pamlico, Pa Wotank, PaWmans. Pitt,
Brunswick. Carteret, Columbus, Duplin,
New Hanover, Onslaw. Pander
Alemance, Allegheny, Ashe, Caswell.
Davidson, Davie, Forsyth, Gul"brd,
Rockingham, Randolph, Stokes, Surry,
Watauga, Wilkes, Yedldn
For mac Jrftimehon. visit ourwrl0 site at. h phh2o.wwsra/e.nc. usipa W
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71kT-44 f4'7 1 LAMV LR- HOMM -MN r r 1 r17J rn i I" u r Lxo - W-J
FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP SfA 1'lt)NS. AND }'URGE IMAINS
wA(:F
„pplk~ Number. - WQ003.1747
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD) py pWQ) ..
1. Owner. —
1 a. Town of Aberdeen municipality. HOA. ub*, eta)
Full Legal Name (company.
O1b W, a /a.. 1, (i)CNRaF,� ,
0 Signing Official Name and Title (Please review 15A NCAC 2H .0208(b) for authorized d9ning o(icxsls.)
le. The legal entity who will own this system iS: at+on Other (specify):
❑ individual 0 Federal ® Municipality ❑ Stnte/CourtN Q Private Partnership D CorPOr
IX _1e. Aberdeen
IX id coy
Z miuinp Address
1f. NOrth Carolina — Zip Code
Z State i
_QSf - p5 O ti
APMMrar-
0 IN go y V -�J-1 i Facsimile E-mail
QTelephone
2. Project (Facility) Information: 2b. Moore
J 2a.
will refer to this name) County Where Project is LOtamoed — ^�-
_ _
L Brief Project Name (permit
Q 3. CL
Contact Person
About this Application
Q Name and Affiliation Of omeone Who Can Answer Qwstions y� fiot ILrC1 -eep. 1
Phone Number
1 Project is New ❑ Modi%c8ti0n (0f an existing permd) If Modifx anon: Permit No.:
For mpditicatlorrs. atprch a separate Sheet dearly expleining the reason for the modification (i e. adding arroRher
phase. changing line sbn.%ngth, etc.). Only include the rnodcfIed ibeen abi0tt in in perndt application - do not
duplicate project infortnat3on In OV) and Sl10-11) not 1s a�+dy �n ineNrded M ttfs original pernrit. -
2. Owner is ® Public (drip to Item 8(3)) ❑Private (go to Item t IR _
2a. If private, epplicantwill be:
2b. If Id, fadMies owned by a (must choose QWJ
Retaining Owns (1.e. store, dwrch, single ofics, etc•) or ❑ Public Utility (Instruction 111)
townhomes, etc. - skip to Item 9(3)) D Homeowner Assoc-iDevelOPe► (Irl:lr MV" M
Leasing units (lots. to Mem DOW _ _ -
❑ Selling units pots, townhormeS. �O -
3. Moore Court — T(eeiiing Wastewater From This Proold -- -•
Owner of Wastewater Treatment Fadity NWVTFl.. 4b. NC t>037508 —
4a. Moore County Water Pohution Control FaciKy — WWTF Permit No.
Name of WWTF
5a. Town of Aberdeen ' Force Main Permit Number of Downstrwm Sewer (If known)
h. Receiving Sewer site ❑
Owner d Downstream Sewer _. . _ ..
B. The origin of this wastEw der is (Cht#, all Uwt _ - - _ -
Residential Subdivision Q Car Wash wfitution% Domesdc/CWM*rcial
Aparlm0rd /COndOminiums I ospkW1
Mobile Home Park Hspdsl %Industrial
School Cl Church % Other (specify).
Restaurant ❑ using Home
office
7. Volume of wastewater 1, be albc�ed for this perocular pfOjea. 7 �1O^s Per day - -
•Do not irrc'.Iude peviouelll Ps^^itEed allocations
8. If the penritted flow Is zero. Indicale mltled in wbsequh+t PAS that conned to thus line
Interceptor Line " Flow will be per
Flow has aheedY beets alioaeted in Permit No- with no new flow expected Rehabil'itstion or ntplacemeM -
_ - FTA 02/03 - Arw. 3 04105
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• FASt-TRACK APPLICATION for GRAVITY SEWERS, PUMP STA'r10N5. AND t'ORCh fdAINS
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9. Provide the wastewater wow caMutations used in dete(MMning the pew flow M accondence v Mf 15A NCAC 211
0219p) for item 8(7) or the design wow for Moe Or Pump station siz►rq if zero flow in the sbelow. Values other than
P�
use data in accordance;
SA
that in 1 SA NCAC 2H .0219(1)(1-2) must be supported with adusl water or waaccordance; ` 1
NCAC 2H .02190)(3)-
2 water closets �250 9atid��
10. Summary of Sewer Lines to be PermHted (~ additional sheets it neceSsary)
Size (inches) LMVM (feet)
3- schedule 40 PVC pipe 13M
ENTER TOTAL LINE LENGTH IN MILES •263
Gravity or Force Main
(use the pull down menu)
force
11. Summary of Pump Stations to be Permitted (attach additional sheets as necessary)
Location ID po"r ReNability Option
(self chosen - ass#roww+ on Design Flow Operstlonal Point (1-dual linefeed. 2- pennanent generator WATS; 3-
plans for crvees-reteronce) (MM) GPM @ TDH po•v� 9 wtlslearetrlt: 4- vtreM ata►rage)
#A -750-964day
pump Stab" and Force
12. Does the sewer system compy► with the 1lwrilrnt=rt Design Criteria palest version) and 1 Srileria for the Fast Track A Perm" of
2H .0200 as aPPl' '
Mains (latest version). the Gravity Sewer Minimturr+ Desgn edtaerta of nMuiation and indcate whir a
❑ Yes [j NO if no, please reference the pertltterri tairnirrlum daaiglt
variance is requested- SU Mil TWO COPIES OF MANS. SPECIFICATIONS Oil CALCO-An,
PERTINENT TO THE VARWiCE 1MTH YOUR APPLICATION
13. Have the following t�tn4 ices; been submitted for appraral?
Wetland/Stream Crossings - General Permit or 401 Certification? ❑ Yes ❑ NO is NSA
cementation and Erosion Control F%nT
❑ Yes ❑ NO El NIA
(] Yes [] No tA WA
Stormweten
14. Does this ProjW ittwvlve aerial Gnas or siphons? CtNdc it yea: ❑
T hW ho" win be ebnsftmd W, WWW aria must be cheesed onus a� sbPea9 ❑
15. Does this project have 9WIh sewer fines designed at MS%~ eudda tint: tits wm s WJW ba
Be aware loaf the DWlsfon wIM net seowOt trrstaltad tlnlla maw flan t 0% rhlta wun tna naninwe ddrae. t alas
conoctsd poor to sWr+rMinp M f4+ru.nOrre�M'D cerUhl:+rb^.. _... _.. _..
FTA 02/03 - Rev. 3 04/05
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71 U'J44 (4'7 I LAAJN l.J1- Ht3tKL -t=N
((1 rM MHT 14 Afff M;Ub
FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP S'I'AT1014s, ANO J;OK L MAINS CAC E 5
r.�
Use the oiwwn's guidance document entitled. -DETERNIINING
STREAM CLASSIFICATIONS FOR FORM FTA 0243
(FAST -TRACK SEWER SVSYEM r to oolbat end recmd the stream cial IN P' I I data 13 - A m l► (*"Bch sddibonsl shoals as
necessary) This doaunent is available ftm our web sm or by contaWn9 the apP1100nale Division of VYstar OUMMY
regional office (see instructions for addresses) 99 indicate the following
❑ A Stream Ctassifir aeon m not needed because all Pena of ttw project are at least I W feat away from any down slope
waterbody; AND,
❑ A Stream Classification is not needed bacause the design does not depend on wet wen storage as a power reliability
option for any pump station new a Class C down slope volerbodY
vocation ID on Map Walerbodw Stream Wataody
(Sall chosen - as shown an llar of County RiverBasin Inrbdex Clawsifieation
map for cross-rd+rencs) WoserbodY
Submit the >s_5" X 11" COLOR topographic map as required In Instruction VI
regardless of whether a classification is peovidadt
1. Applicant's Cefdflcstion:
1. SIGNING OFFIOAL NAW aftSt that Otis Wkaffan for pM/ECT NAME
has been reviewed by me and is sccwsf�e and complete 10 fie best d my bwm*dge. I wrderstand that hall roquined
Parts of this applcation amno► completed and that d all requnert wPp�>g docurneaftbOn and attachments are not
included. this
app page is sub)W to j)@*V returned as rnoonrpiata. Now in woo►derm with North Carotlna
General Statutes 143-215.6A and 143-215.8�aany Class 2person nwh mwho kwwwxjiy 3 any false
o exceed fs OOd
ceWjoatlon Rol any appfks rAOn spat► be 9�Y
as we/I ascivJil�pe►raMbs UP i25.� Per viohatioM. —
la. tV,
Signing Official Signature
2. Professional Engineer's Certificstion
has been reviewed by me and is accurate, complete
I attest that this WPAC06orl for plans,calculations, and all other MVPorting docarnenta6on to the
and consistent with the mfiorrnatW in the eto Me best ofM de has been prepared w
beat of my knowledge. I fu~ attest that b the best w r Ivl rum a the Ctftna '
re errs Gravity Sewer AtWtimu+n Design Criteria for Gravity Sewers adopted February
accordance with the epPkW& . '
12. 1996. and the NkiinXun Design CMleMa for the Fast -Track Penni�q d Pump Stallions and Force Mains adapted June
1. 2000 and the watershed classification in accordance with Division grddanee. A1dlaugh codukr portlons of this submittal
package Wray have been developed by other pralessiorlals inekrafon or these materials under my *MOOD and seal
d to be eo►rsi9ler with Me proposed desgn. Note: In
signifies that i have towewed tMs matenaf and helm judged ' melees �y false statement,
accondance With NC Gonen d Stabiles 143-215 6A and 143-21 .8 a peClass r r WhIlCh y ineny f a Ens not to
.epmsan fkwk or csltmeation in any application shell be gully
exceed S10.000 as well as crud penalties up to us;000 Per via &Wn.
2s. Joseph M ROOMBOrk, A.—
Protessional Engineer Name
2b. 42IMt M. Robinstor_+. ? P.E.
Engineering Firm
2C. 152 W�Rd.
Maifing Address
2d. CeRhaae 2e. N.C. �2f. 7
City
State Zip
���•�� CARO'�•,,,
4�p . *ESSII �!•'%
$ sn SEAL
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29. 1=99'10-692-1b'89 _2h 1_91a69z-1888 .^Zi. romiles� t — a Data _
Telephone Facsimile E-mail _ _ Seal.
FTA OZ03 - Rev. 3 014105
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