WQ0041631_Application (FTSE)_20200522

Permit Number WQ0041631
Program Category
Non -discharge
Permit Type
Gravity Sewer Extension, Pump Stations, & Pressure Sewer Extensions
Primary Reviewer
dean.hunkele
Coastal SWRule
Permitted Flow
Facility
Central Files: APS _ SWP _
4/21 /2020
Permit Tracking Slip
Status
Project Type
In review
New Project
Version
Permit Classification
A
Individual
Permit Contact Affiliation
Facility Name Major/Minor Region
Southwest Plaza Private Pump Station and Sewer Minor Wilmington
Location Address County
Onslow,
Owner
Owner Name
Fose Properties LLC
Dates/Events
Scheduled
Orig Issue App Received Draft Initiated Issuance
4/17/2020

R K E R & ASSOCIATES, INC
Dj;JAC
KS ONVILLE,, NORTH CAROLIN
VIA EMAIL AND MAIL
TO: Mr. Dean Hunkele
NCDENR-DWR
127 Cardinal Dr. Ext.
Wilmington, NC 28405-3845
WE ARE SENDING YOU:
LETTER OF TRANSMITTAL
DATE: April 15, 2020
REF: Southwest Plaza
Onslow County, NC
Sewer Improvements
Fast Track Sewer Application
One (1) original and One (1) copy of the Fast Track Application and the Flow Tracking/Acceptance Forms;
One (1) Check in the amount of $480.00 for the application fee; One (1) portion of the USGS map; and One (1)
copy of the Water & Sewer Plan, Sheet 8 of 11.
DELIVERY VIA:
O
Regular Mail
❑
Hand
❑
Federal Express
❑
UPS Overnight
❑
UPS Ground
❑
Other
THESE ARE TRANSMITTED AS CHECKED BELOW:
©
Far Approval
❑
As Requested ❑ For Review and Comment
❑
For Your Use
❑
For Bids Due
❑ Other
COMMENTS:
Dean, Fose Propertiees, LLC is proposing to build a commercial building on Hwy 258124. We have designed
the pump station and force main to tie to Blue Creek Utilities Sewer. Fose Properties will ow an
operate the Pump Station and Force Main. 1 I
Timothy 'M. jStc vart, P.
Copies To: 1
ec: Mr. Don Fose (LOT only)
Mr. Tommy Pollard (LOT only)
TMS/djh CF (P), LAM,
306 New ftfi $pbgutegP({RjlRlOWjftWj�l0)455-2414
C1.2020.TMS.LOT.Hunkele.StonesLanding3ParadF.".�jA&7,,W.NV430ber F-0108 I www.parkerjacksonville.com

State of North Carolina
DWR Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Dlvlslon of Witter Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: l 0 (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: FOSE PROPERTIES. LLC (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ❑ Municipal ® Other
3. Signature authority's name: Donald G. Fose. Jr. per 15A NCAC 02T .0106(b)
Title: Manager
4. Applicant's mailing address: P.O. Box 1394
City: Jacksonville State: NC Zip: 28541-_
5. Applicant's contact information:
Phone number: 910) 389-2030 Email Address: donfosena ec.rncom
II. PROJECT INFORMATION:
1. Project name: SOUTHWEST PLAZA
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ00 and issued date:
If new construction but part of a master plan, provide the existing permit number: W000_
3. County where project is located: Onslow
4. Approximate Coordinates (Decimal Degrees): Latitude: 34.76220 Longitude:-77.4869'
5. Parcel ID (if applicable): 021858
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Timothy M. Stewart License Number: 14575
Firm: Parker & Associates. Inc.
Mailing address: 306 New Bridge Street
City: Jacksonville State: NCa Zip: 28540-
Phone number: 9( 10) 455-2414 Email Address: office(a),Parkeriacksonville.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Blue Creek W WTP Permit Number: NCO056952
Owner Name: Blue Creek Utilities
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ_ Downstream (Receiving) Sewer Size: _ inch
System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s):
FORM: FTA 04-16 Page I of 5

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes [:]No ®N/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached?
❑ Yes ❑No ®N/A
3. If the Applicant is a Home/Pro eeM Owners' Association, has an Operational Agreement (FORM: HQA) been attached?
❑ Yes ❑No ®N/A
4. Origin of wastewater: (check all that apply):
❑ Residential Owned ® Retail (stores, centers, malls) ❑ Car Wash
❑ Residential Leased ❑ Retail with food preparation/service ❑ Hotel and/or Motels
❑ School / preschool / day care ❑ Medical / dental / veterinary facilities ❑ Swimming Pool /Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater : % Domestic/Commercial % Commercial
_ % Industrial (See 15A NCAC 02T .0103(20))
"Is there a Pretreatment Program in effect? [-]Yes ® No
6. Hasa flow reduction been approved under 15A NCAC 02'1' .0l 14(fl? ❑ Yes ®No
➢ If yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 021.01140
Daily Design Flow'" b
No. of Units
Flow
Retail
130 gal/1000 SF
12,000 SF
1,560 GPD
gal/
GPD
gall
GPD
gal/
GPD
gal/
GPD
gal/
GPD
TO
1,560 GPD
a See 15A NCAC 02T .0114(b). (d)(e)(1) and (a)(2) for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use
areas; and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals
as defined in G.S. 42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T,01141 shall
be determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 1 560 GPD (per 15A NCAC 02T 0114)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
❑ Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit Number:
❑ Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain):
FORM: FTA 04-16 Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 281 PVC
➢ Section II & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section III contains information related to minimum slopes for gravity sewer(s)
➢ Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
VIIL PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: Southwest Plaza Pump Station
2. Approximate Coordinates (Decimal Degrees): Latitude: 34.76140 Longitude:-77.4872°
3. Design flow of the pump station: 0.00156 millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): 25 gallons per minute at 24 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
2
290
SDR 21 PVC
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(1):
❑ Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(h)(1)(B):
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
➢ Must be permanent to facility
Or if the pump station has an average daily flow less than 15,000 gallons per day:
® Portable power source with manual activation, quick -connection receptacle and telemetry - 15A NCAC 02T
.0305(h)(1)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry - 15A NCAC 02T .0305(h)(1)(C):
➢ It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant (draft agreement)
and is compatible with the station.
➢ If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations'
storage capacities and the rotation schedule of the portable power source or pump, including travel timeframes, shall be
provided in the case of a multiple station power outage.
FORM: FTA 04-16 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T.0305(f)):
1. Does the project comply with all separations found in 15A NCAC 02T.0305(f) & (g)
➢ 15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
® Yes ❑ No
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
24 inches
Water mains vertical -water over sewer including in benched trenches
18 inches
Water mains (horizontal)
10 feet
Reclaimed water lines vertical - reclaimed over sewer
18 inches
Reclaimed water lines horizontal - reclaimed over sewer
2 feet
**Any private or public water supply source, including any wells, WS-I waters of Class I or
Class II impounded reservoirs used as a source of drinking water
100 feet
**Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal
high water (or tide elevation) and wetlands (see item IX.2)
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches
10 feet
Any building foundation
5 feet
Any basement
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainages stems and interceptor drains
5 feet
Any swimming ools
10 feet
Final earth grade (vertical)
36 inches
➢ 15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
➢ If noncompliance with 02T.0305(f) or (M. see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ® Yes [-]No ❑ N/A
➢ See the Division's draft separation requirements for situations where separation cannot be meet
➢ No variance is required if the alternative design criteria specified is utilized in design and construction
➢ As built documents should reference the location of areas effected
3. Does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ®Yes ❑ No ❑ N/A
➢ This would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Does the project require coverage/authorization under a 404 Nationwide or ❑ Yes ® No
individual permits or 401 Water Quality Certifications?
➢ Information can be obtained from the 401 & Buffer Permitting Branch
5. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T.0105(c)(6), directly related environmental permits or certification applications are being prepared, have
been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion and
sedimentation control plans, stormwater management plans, etc.).
6. Does this project include any sewer collection lines that are deemed "high -priority?"
Per 15A NCAC 02T.0402, "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes ® No ❑ N/A
➢ If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at least once every six -months and
inspections documented per 15A NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit.
FORM: FTA 04-16 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Pump Stations
and Force Mains (latest version) and the Gravity Sewer Minimum Design Criteria (latest version) as applicable?
® Yes ❑ No
If No, complete and submit the Variance/Alternative Design Request application (VADC 10-14) and supporting documents
for review. Approval of the reauest is reaulred prior to submittal of the Fast Track Application and supporting
documents.
2. Professional Engineer's Certification:
Timothy M. Stewart, P.E. _ attest that this application for
(Professional Engineer's name from Application Item 1II.1.)
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans, specifications,
engineering calculations, and 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 for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track
Permitting of Pump Stations and Force Mains (latest version). Although other professionals may have developed certain
portions of this submittal package, 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.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.613, any person who knowingly makes any false
statement, representation, or certification in any application package 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 $25,000 per violation. m t I
North Carolina Professional Engineer's seal, signature, and date:
145?
3. Applicant's Certification per 15A NCAC 02T .0106(b):
�unu
1,. Donald G._Fose, Jr., Manager
(Signature Authority's name & title from Application Item I.3.)
I
+1512°
attest that this application for
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. I understand that any discharge of wastewater from this non -
discharge system to surface waters or the land will result in an immediate enforcement action that may include civil penalties,
injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water Resources should a
condition of this permit be violated. I also understand that if all required parts of this application package are not completed
and that if all required supporting information and attachments are not included, this application package will be returned to
me as incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215 6B any person who knowingly makes any false
statement, representation, or certification in any application package 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 $25,000 per violation.
Signature: j _ _ Date:_!S
FORM: FTA 04-16 Page 5 of 5

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: FOSE PROPERTIES, LLC
Project Name for which flow is being requested: SOUTHWEST PLAZA
More than one FTSE maybe required for a single project if the owner of the WWTP is not responsible for all pump
stations along the route of the proposer! wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: BLUE CREEK WWTP
b. WWTP Facility Permit #: NCO056952
All flows are in MGD
c. WWTP facility's permitted flow 0.100
d. Estimated obligated flow not yet tributary to the WWTP 0
e. WWTP facility's actual avg. flow 0.0465
f. Total flow for this specific request 0.00156
g. Total actual and obligated flows to the facility 0.04806
h. Percent of permitted flow used 48%
II. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
List pump stations located between the project connection point and the WWTP:
(A) (B) (C) (D)=(B+C)
(E)=(A-D)
Design Obligated,
Pump Pump Average Approx. Not Yet Total Current
Station Station Firm Daily Flow** Current Tributary Flow Plus
(Name or Permit Capacity, * (Firm / pf), Avg. Daily Daily Flow, Obligated
Available
Number) No. MGD MGD Flow, MGD MGD Flow
Capacity***
Blue Crk
DA 0.288 0.115 0.017 0 0.017
0.098
* The Firm Capacity (design flow) of any pump station is defined as the maximum pumped flow
that can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor
(pf) not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): Blue Creek Road SPS
Downstream Permit Number: 11332
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I B.T. POLLARD certify to the best of my knowledge that the addition of
the volume of wastewater to be permitted in this project has been evaluated along the route to the
receiving wastewater treatment facility and that the flow from this project is not anticipated to cause any
capacity related sanitary sewer overflows or overburden any downstream pump station on route to the
receiving treatment plant under normal circumstances, given the implementation of the planned
improvements identified in the planning assessment where applicable. This analysis has been performed
in accordance with local established policies and procedures using the best available data. This
certification applies to those items listed above in Sections I and II plus all attached planning assessment
addendums for which I am the responsible party. Signature of this form certifies that the receiving
collection system or treatment works has adequate capacity to transport and treat the proposed new
wastewater.
Si nineicialature B.T. POLLARD
S $Sn
President
Title of Signing Official
Date
Page 2 of 6
H'CSi Is

4/21/2020
North Carolina Secretary of State Search Results
• File an Annual Report/Amend an Annual Report • Upload a PDF Filing • Order a Document Online
Add Entity to My Email Notification List • View Filings • Print a Pre -Populated Annual Report form
Print an Amended a Annual Report form
Limited Liability Company
Legal Name
FOSE PROPERTIES, LLC
Information
Sosld: 0728577
Status: Current -Active
Date Formed: 6/3/2004
Citizenship: Domestic
Annual Report Due Date: April 15th
Currentgnnual Report Status:
Registered Agent: Fose, Donald G Jr
Addresses
Reg Office
3340 Richlands HWY Apt 1
Jacksonvile, NC 28540-3065
Reg Mailing
P.O. Box 1394
Jacksonville, NC 28541-1394
Company Officials
Principal Office
3340 Richlands Hwy
Jacksonville, NC 28540-2937
Mailing
p.o box1394
Jacksonville. NC 28541-1394
All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20.
Manager
Donald G Fose , Jr.
3340 Richlands Hwy Apt 1
Jacksonville NC 28540-2937
https://w .sasnc.gov/online_services/search/Business_Registration_Results 1/2

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