WQ0035867_Sewer Extension_20120404

State of North Carolina
DENR-FRVepartment of Environment and Natural Resources
Division of Water Quality
.APR 0 4 7012 FAST -TRACK APPLICATION
��11����1/��(FTA 12/07 very)
for 6�CA QY SEWERS, PUMP STATIONS, AND FORCE MAINS
(Pressure & Vacuum sewer 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 returned as incomplete. Forms are available from the web site or by calling the Regional Office serving your county:
http://h2o.enr. state.nc. us/peres/Collection%20SystemsICollectionSystemApplications. html
® A. Application Form - Submit one original and one copy of the completed and appropriately executed application
form. The application should include a project narrative describing the final build -out design (i.e. system and/or
pump station to ultimately serve 500 homes, but flow for only 100 homes being requested now). For modifications,
clearly explain 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 that has already
been included in the original permit.
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(131
Separate applications should be made for non-contiguous sewer systems
® B. Application Fee - Submit a check in the amount of $480 made payable to: North Carolina Department of
Environment and Natural Resources (NCDENR). Checks shall be dated within 90 days of application submittal.
❑ C. 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(2)a of this application.
❑ D. Operational Agreements — Submit one original and two copies of a properly executed operational agreement, as
per 15A NCAC 02T .0115, if the application is submitted 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 home or property owner's association, use Form HOA 02/03. If the applicant is a developer,
use Form DEV 02/03. EVEN IF THE PROJECT MAY BE TURNED OVER TO A MUNICIPALITY UPON
COMPLETION, FORM DEV 02/03 IS REQUIRED.
® E. Downstream Sewer, WWTF Capacity and Flow Tracking/Acceptance — FORM FTSE 10/07 (Flow
Tracking/Acceptance for Sewer Extension Permit Applications) is required with every application. The applicant
(and owners of downstream sewers, pump stations and/or treatment facilities submitting FORM FTSE-10/07)
certifies that the addition of the volume of wastewater to be permitted in this project has been evaluated along the
route to the receiving treatment plant, and that 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. Where the applicant is not the owner of the downstream sewer, submit two copies of FORM FTSE 10/07
from the owner of the downstream sewer and owner of the WWTF, if different. The flow acceptance indicated in
FORM FTSE-10/07 must not expire prior to permit issuance and must be dated less than one year prior to the
application date. Submittal of this application and FORM FTSE-10/07 indicates that owner has adequate
capacity and will not violate G.S. 143-215.67(a). Intergovernmental agreements or other contracts will not be
accepted in lieu of project -specific FTSE 10/07.
® F Map — Submit an 8.5-inch by 11-inch COLOR copy of a USGS Topographic Map of sufficient scale to identify the
entire project area and the closest surface waters. Each map or maps must show the location of the sewer line
and pump stations and be of reproducible quality. Include a street level map showing the downstream connection
point, and the permit number for the downstream sewer, if known.
FTA12/07

❑ G. Stream Classifications —Watershed Classification Attachment (Form WSCAS-12/07) If any portion of the
'sewer system project is within 100 feet of any surface water or wetlands, the Watershed Classification Attachment
may need to be completed. A variance must be requested for encroachment within required setbacks or buffers
pursuant to 2T .0305 (f) and be indicated in Item B-13 with supporting documentation/justification provided.
❑ H Environmental Assessments — If this project is subject to an Environmental Assessment (EA) [15A NCAC
01C], this application cannot be used. Send the project application on the most current version of Form
PSFMGSA to the Design Management Unit, 1633 Mail Service Center, Raleigh, NC 27699-1633. Applications
cannot 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.
❑ I. Flow Direction — Many wastewater treatment systems are entering into agreements for regionalization efforts
and emergency treatment capacity. Parts of the system are installed so that the wastewater flow can be directed
to more than one treatment facility. If this is the case with this project, please indicate in 13(12) and give the permit
number of the second treatment facility.
® J. Certifications — Section C
The application must be certified by both the applicant and the design engineer who is 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 Chapter 2T, 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.
THE COMPLETED FTA 12/07 APPLICATION PACKAGE, INCLUDING ALL SUPPORTING
DOCUMENTS AND $480 FEE, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional Office
2090 US Highway 70
Avery, Buncombe, Burke, Caldwell, Cherokee,
Swannanoa, North Carolina 28778
Clay, Graham, Haywood, Henderson, Jackson,
[phone]
Macon, Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Harnett, Hoke,
Fayetteville, North Carolina 28301-5094
Montgomery, Moore, Robeson, Richmond,
[phone]
Sampson, Scotland
[phone] Fax
Mooresville Regional Office
610 E. Center Avenue
Alexander, Cabarrus, Catawba, Cleveland,
Mooresville, North Carolina 28115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
Raleigh Regional Office
1628 Mail Service Center
Chatham, Durham, Edgecombe, Franklin,
Raleigh, North Carolina 27699-1628
Granville, Halifax, Johnston, Lee, Nash,
[phone]
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
Warren, Wilson
Washington Regional Office
943 Washington Square Mall
Beaufort, Bertie, Camden, Chowan, Craven,
Washington, North Carolina 27889
Currituck, Dare, Gates, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
Wilmington Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
Wilmington, North Carolina 28405
Hanover, Onslow, Pender
[phone]
[phone] Fax
Winston-Salem Regional Office
585 Waughtown Street
Alamance, Alleghany, Ashe, Caswell, Davidson,
Winston-Salem, North Carolina 27107
Davie, Forsyth, Guilford, Rockingham, Randolph,
[phone]
Stokes, Surry, Watauga, Wilkes, Yadkin
[phone] Fax
For more information, please visit our web site at.,
http.Ilh2o.enr.state.nc.us/peres/Collection%20Systems/CollectionSystemsHome.html
or contact the Regional Office serving your county.
FTA 12/07

USE THE TAB KEY TO MOVE FROM FIELD TO FIELDI Application Number: ©i�3 tp- �1
(to be completed by DWQ) Gad e J O
1.
-------..— ---------- ---------_-_-_—____ —----------_____
Owner/Permittee:
1 a.
..
Town of Southern Pines
Full Legal Name (company, municipality, HOA, utility, etc.)
Z...
Z
1b.
_ _ ..
Brent Lockam , P.E. Town Engineer
Signing Official Name and Title (Please review 15A NCAC 2T .0106 (b) for authorized signing officials!)
_ .. _ ......... ..........
1c.
The legal entity who will own this system is:
❑ Individual ❑ Federal ® Municipality ❑ State/County ❑ Private Partnership ❑ Corporation ❑ Other (specify):
0,,
'ld.
140 Memorial Park Court 1e. Southern Pines
U.
Mailing Address City
1f.
North Carolina 1g. 28387
Z
State Zip Code
1 h
.. ......... .... .......... ........... , ....... ........ ......... .........
910-692-1986 1 i. 910-692-1085 1'. Lockam southern ines.net
QTelephone
Facsimile E-mail
2
Project (Facility) Information:
-- . _ _ _
j
;2a.
Utility Improvements to Serve Edgemoore Heights Subdivision 2b. Moore
a
Brief Project Name (permit will refer to this name) County Where Project is Located
G.
Q
3
... ...
Contact Person:
a.3a.
Lee Humphrey, Project Manager
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.) or : ❑ Public Utility (Instruction C)
❑ Leasing units (lots, townhomes, etc. -skip to Item B(3)) ❑ Homeowner Assoc./Developer (Instruction D)
❑ Selling units (lots, townhomes, etc. - go to Item B(2b))
I3.
---------------------- ----------- -- -- --
Moore County Public Utilities
Z
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
Q
............................................................
4a.
...................................................... ..... ...... .... ........ ... ................................................................................................................................................ .... ..... .... ......... ........................................................... Q..................................................................................................................................................................
Moore County Wastewater Treatment Plant 4b. NCO03758
QName
of WWTF WWTF Permit No.
5a.
Town of Southern Pines 5b. 8" ® Gravity 5c. unknown
O
Owner of Downstream Sewer Receiving Sewer Size ❑Force Main Permit # of Downstream Sewer (Instruction E)
6.
..---- ..._ _ ..
The origin of this wastewater is (check all that apply):
Z
® Residential Subdivision ® Retail (Stores, shopping centers) 100 %Domestic/Commercial
-
❑ Apartments/Condominiums ❑ Institution % Industrial (attach
❑ Mobile Home Park ❑ Hospital description.)
LU
❑ School El Church
❑ Restaurant ❑ Nursing Home (RO: contact your Regional Office
G.
El Office El Other (specify): Pretreatment staff)
% Other (specify):
.....
7.
..... _ Z5 ....
Volume of wastewater to be allocated or permitted for this particular project: - gallons per day
*Do not include future flows or previously permitted allocations
8.
If the permitted flow is zero, indicate why:
❑ Pump Station, Outfall or Interceptor Line where flow will be permitted in 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 (see 15A NCAC 02T .0303 to determine if a
permit is required)
FTA12/07

9. Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2T .0114 for
FTA12/07

14. Have the following pdrmits/certifications been submitted for approval for the system or project to be served?
Wetland/Stream Crossings - General Permit or 401 Certification? [:]Yes ❑ No ® N/A
U)
0
H
Q
L)
LL
H
W
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A
u
Sedimentation and Erosion Control Plan? ❑Yes ❑ No ®N/A
Stormwater? ❑ Yes ❑ No ® N/A
__..
15. Does this project include any high priority lines, [see 15A NCAC 02T .0402 (2)] involve aerial lines, siphons, or interference
manholes)? These lines will be considered high priority and must be checked once every six months
heck if Yes: ❑ and provide details
1. Owner/Permittee's Certification: (Signature of Signing Official and Project Name)
1 a.
1, _Brent Lockamy_, attest that this application for Utility Improvements to Serve Edgemoore Heights Subdivision has
been reviewed by me and is accurate and complete to the best of my knowledge. 1 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 $25,000 per violation.
Signing Official SignaTure
-19 - �Z'
Date
ENGINEERING DESIGN DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL OF THIS
APPLICATION. THESE DOCUMENTS MUST INCLUDE PLAN AND PROFILE OF SEWERS, THEIR PROXIMITY
TO OTHER UTILITIES, DESIGN CALCULATIONS. ETC. REFER TO 15A NCAC 02T .0305
2. Professional Engineer's Certification: (Signature of Design Engineer and Project Name)
1, David T. Uphcurch , attest that this application for Utility Improvements to Serve Edgemoore Heights Subdivision
has been reviewed by me and is accurate, complete and consistent with the information in the engineering plans,
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 adopted February 12, 1996, and the Minimum Design Criteria for the Fast -Track
Permitting of Pump Stations and Force Mains adopted June 1, 2000 and the watershed classification in accordance with
Division guidance. Although other professionals may have developed certain portions of this submittal package, inclusion c
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 NC 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 $25,000 per violation.
2a. David T. Upchurch
Professional Engineer Name
2b. Hobbs Upchurch and Assoiciates P.A.
Engineering Firm
2c. 300 S.W. Broad Street
Mailing Address
Southern Pines 2e. NC 2f. 28387
City State Zip
[phone] 2h. [phone] 2i. [e-mail]
Telephone Facsimile E-mail
.3_Z.6-12
NC PE Seal, Signature & Date
FTA 12/07

Hobbs Upchurch Associates
FJ4
DENR-FRO
TRANSMITTAL
TO: Division of Water Quality
Fayetteville Regional Office
225 Green Street, Suite 714
Fayetteville, NC 28301
FROM: Lee Humphrey
Hobbs, Upchurch Est Associates, P.A.
DATE: April 3, 2012
RE: Edgemoore Heights Subdivision
Fast Track Sewer Application
Enclosed please find:
APR 0 4 2012
Dwo
HUA PROJECT # SP1204
(1) Original and (1) copy of the Fast Track Application
(1) Copy of the Flow Tracking/Acceptance for Sewer Extension Permit Applications
(2) USGS color map of the project area
(1) Check for $480.00
Please call this office if you have any questions.
T: 910-692-5616 • F: 910-692-7342 • 300 SW BROAD STREET • SOUTHERN PINES, NC 28374 • WWW.HOBBSUPCHURCH.COM
SUPERIOR PERFORMANCE THROUGH INNOVATIVE DESIGN

0F V`IATLc9 State of Nodlin carofina
`0� 4G Department of EnArommeni and Natural Resources
rn Division of Water Qualft
o Flow Trackha h-kcc.eptmAmee for Sewer Extetusion Permit Applaeations
(?=TSr —10/07
Project Applicapt biame: MWR alln 4H II I
Project biame for dvl;t� h flow is being r;q�iested:C'A�t�ore.. gs, o-A 5 t;oAem fl J
.More than one FTSE-10107 mqv he required for a single project if the owner of the WWTP is not respons.;b.<e for 211
pump stations along the route of the proposed wastewaier flow.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility blame: rA662E Couv►� (J�r RIIc�lav% At4nol ntI'Lnt
b. WWTP Facility Permit #: M C QO 3 75 8
All flows are in PV[GD
c. WWTP facility's permitted flow (p, 7
d. Estimated obligated flow not yet tributary to the WWTP 2. D 132
e. WWTP facility's actual avg. flow 4,01
f. Total flow for this specific request 6,0025
g. Total actual and obligated flows to the facility �, 62 57
h. Percent of permitted flow used Acj, cj
1I. 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
Pump Station Name Approx. Capacity, MGD Approx. Current Avg.
(Firm/Design) Daily Flow, MGD
III. Certification Rat ment:
1, QZhj� COUI , certify that, to the best of my knowledge. the addition of the
volume of iiastelNar< r to be permitted M, this project has been ;- akiatLd along the route :.-) the rviceivina
aste,wgter treatment I and that the n,, m this project is n.;. ',.iraLed to cause ,n pacity
r-.iat�d sanitary se' ter 0`,,:i Or overburden a[1 ;itTeam pump si i3 rJUii t0 the re— .
treatment plant under normal ti.-,,!Jmstances. This ana j is has been performed accordarce xith Iola'
established policies and ii;e, best a`,ailaJi% data. This ,:ef-LiFicaJon applies tD those it..-m_i
listed above in Sections I and 11 For,, hick I am thv responsible ;:a.-+-.,. Signature, ofthis Form indicaics
acceptance of this rite x ater flo",'.
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USE THE TAB KEY TO MOVE FROM FIELD TO FIELD!
Application Number:
----=---
- - - _
(to be completed by DWQ)
1.
- - — ------ -- --- --------
Owner/Permittee:
nCA'�_
1a.
Town of Southern Pines
Full Legal Name (company, municipality, HOA, utility, etc.)
,
.... ........... _............. ............-PR...._g... -1
z__
0
1b.
Brent Lockamy, P.E. Town Engineer
Signing Official Name and Title (Please review 15A NCAC 2T .0106 (b) for authorized signing officials!) ,,AA��
1c.
The legal entity who will own this system is:
❑ Individual ❑ Federal ® Municipality ❑ State/County ❑ Private Partnership ❑ Corporation ❑ Other (specify):
0
1d.
140 Memorial Park Court
1e. Southern Pines
LL
Mailing Address
City
Z
1f.
North Carolina
1g. 28387
Z
State
Zip Code
0
_
1 h.
910-692-1986 1 i. 910-692-1085
1 . Lockam
) [e-mail]
QTelephone
Facsimile
E-mail
V
2.
Project (Facility) Information:
J
2a.
Utility Improvements to Serve Edgemoore Heights Subdivision
2b. Moore
CL
Brief Project Name (permit will refer to this name)
County Where Project is Located
Q
3.
Contact Person:
Q3a.
Lee Humphrey, Project Manager
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..
0
f—
a
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 ❑ Public Utility (Instruction C)
❑ Leasing units (lots, townhomes, etc. - skip to Item B(3)) El Homeowner Assoc./Developer (Instruction D)
El Selling units (lots, townhomes, etc. - go to Item B(2b))
Moore County Public Utilities
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
4a. Moore County Wastewater Treatment Plant 4b. NCO03758
Name of WWTF WWTF Permit No.
Town of Southern Pines
8" 10 Gravity
unknown
HOBBS, 2/PCHuRcH & A.SSOCiATLS, P- . BW
CONSULTING ENGINEERS
P.O. BOX 1737, 300 S.W. BROAD STREET NOCAR FJ4 RTH OUT7
SOUTHERN PINES, NC 28388 66-112-531
[phone]
Exactly Four hundred eighty and no / 100 Dollars
PAY
TO THE
ORDER NC DENR - Division of Water Quality
OF:
NC
71417
71417
DATE AMOUNT
3/26/2012 $480.00 0
VOID AFTER 90 DAYS7A1,_ Z;�
8
fy ,
AUTHORIZE IGNATURE
1180007
07

HOBBS, upcH41RC9f & AssOCIA` T.5, P.A..
NC DENR - Division of Water Quality
Tran # Invoice Type Date Reference
51841 326012 Invoice 03/26/12
Date: 3/26/2012
Balance
$480.00
4�.
FJ4HOBBS, UPCHURCH & ASSOCMES. P..
CONSULTING ENGINEERS .
P.O. BOX 1737, 300 S.W. BROAD STREET NORTH CAROLINA
SOUTHERN PINES. NC 28388 66-112.531
[phone]
Check Number:
Check Amt:
Discount
$0.00
71417
71417
$480.00
Pay Amount
$480.00'
71417
71417
Exactly
Four hundred eighty
and no / 100 Dollars
DATE
AMOUNT
3/26/2012
$480.00
PAY
TO THE
ORDER
NC DENR - Division
of Water Quality
OF:
VOID AFTER 90 DAYS
NC
� f`
V404
04 AUTHORIZE IGNATURE