WQ0036954_Sewer Extension_20140131

DWR DENR-FRO
JAN 31 2014
Division of Water Resources I WO
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
FAST -TRACK APPLICATION (FTA 08-13)
for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
General — When submitting this application, please use the following instructions as a checklist in order to
ensure all required items are submitted. Adherence to these instructions and checking the provided boxes will
help produce a quicker review time and reduce the amount of requested additional information.
For more information, visit the Surface Water Section's Collection Systems website or;
contact the Regional Office serving your county
Unless otherwise noted the Applicant shall submit one original and one copy of the application and supporting
documentation to the appropriate Regional Office (see page 6).
A. Cover Letter:
® Include a brief project narrative describing the final 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).
B. Application Form (FTA 08-13):
® Submit the completed and appropriately executed Fast -Track (FTA 08-13) Application. Any
unauthorized content changes to this form shall result in the application being returned. If necessary
for clarity or due to space restrictions, attachment to the application may be made, as long as the
attachments are numbered to correspond to the section and item to which they refer. You do not need
to submit detailed plans and specifications unless you respond NO to item B(13).
® The Professional Engineer's Certification of the application shall be signed, sealed and dated by a
North Carolina licensed Professional Engineer.
® The Applicant's Certification of the application shall be signed in accordance with 15A NCAC 02T
.0106(b). Per 15A NCAC 02T .0106(c), an alternate person may be designated as the signing official if
a delegation letter is provided from a person who meets the criteria in 15A NCAC 02T .0106(b).
C. Application Fee:
® Submit a check in the amount of $480 to: North Carolina Department of Environment and Natural
Resources (NCDENR).
➢ Checks shall be dated within 90 days of application submittal.
D. Certificate of Public Convenience and Necessity (For Privately -Owned Public Utilities Only):
❑ Per 15A NCAC 02T .0115(a)(1), provide two copies of the Certificate of Public Convenience and
Necessity from the North Carolina Utilities Commission demonstrating the Applicant is authorized to
hold the utility franchise for the area to be served by the sewer extension, or
❑ Provide two copies of a letter from the North Carolina Utilities Commission's Water and Sewer Division
Public Staff stating an application for a franchise has been received and that the service area is
contiguous to an existing franchised area 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.
E. Operational Agreements (For Home/Property Owners' Associations and Developers of lots to be sold):
➢ Home/Property Owners' Associations
❑ Per 15A NCAC 02T .0115(c), submit the properly executed Operational Agreement (HOA 08-13).
❑ Per 15A NCAC 02T .0115(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
➢ Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(b), submit the properly executed Operational Agreement (DEV 08-13).
Even if the project may be turned over to a municipality upon completion, Form DEV 01-12 is required.
INSTRUCTIONS FOR APPLICATION FTA 08-13 & SUPPORTING DOCUMENTATION Page 1 of 6

F. Downstream Sewer, WWTF Capacity and Flow Tracking/Acceptance Form (FTSE 08-13)
® Submit the completed and appropriately executed Flow Tracking/Acceptance for Sewer Extension
Permit (FTSE 08-13) Form for all applications.
➢ The applicant (and owners of downstream sewers, pump stations and/or treatment facilities submitting
form FTSE 08-13 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 08-13
from the owner of the downstream sewer and owner of the WWTF, if different.
➢ The flow acceptance indicated in form FTSE 08-13 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 08-13 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 a project -
specific FTSE 08-13.
G. Site Map (All Application Packages):
® Submit an 8.5-inch x 11-inch color copy of a USGS Topographic Map of sufficient scale to identify the
entire project area and closest surface waters. Each map must include at a minimum:
➢ The location of the sewer line and pump stations and be of reproducible quality.
➢ Downstream connection points and the permit number for the receiving sewer (if known)
➢ Pump Station Locations and the longitude and latitude for each pump station (if applicable)
® Include a street level map showing all relevant project areas.
H. Stream Classification (WSCAS 08-13)
® Submit the completed and appropriately executed Watershed Classification Attachment form
(WSCAS 08-13) if any portion of the sewer system project is within 100 feet of any surface water or
wetlands.
➢ A variance must be requested for encroachment within required setbacks or buffers pursuant to 15A
NCAC 02T .0305(f)
Environmental Assessments (Projects subject to an Environmental Assessment (EA)):
➢ Projects involving an Environmental Assessment per 15A NCAC 01 C .0408, must be submitted for a
full technical review and must be submitted to the PERCS Unit on application forms provided by the
Division.
J. Alternative Sewer Systems
➢ Projects involving low pressure sewer systems, vacuum sewer systems and other alternative sewer
systems must be submitted for a full technical review and must be submitted to the PERCS Unit on
application forms provided by the Division.
K. 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 the project, please indicate in B(12)
and give the permit number of the second facility.
L. 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 Permitting of Pump Stations and Force Mains (most recent version), as applicable to the project.
INSTRUCTIONS FOR APPLICATION FTA 08-13 & SUPPORTING DOCUMENTATION Page 2 of 6

THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional Office
Water Quality Section
2090 US Highway 70
Swannanoa, North Carolina 28778
Avery, Buncombe, Burke, Caldwell, Cherokee,
Clay, Graham, Haywood, Henderson, Jackson,
[phone]
Macon, Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Fayetteville Regional Office
Water Quality Section
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
Water Quality Section
610 E. Center Avenue
Mooresville, North Carolina 28115
Alexander, Cabarrus, Catawba, Cleveland,
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
Raleigh Regional Office
Water Quality Section
1628 Mail Service Center
Raleigh, North Carolina 27699-1628
Chatham, Durham, Edgecombe, Franklin,
Granville, Halifax, Johnston, Lee, Nash,
[phone]
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
Warren, Wilson
Washington Regional Office
Water Quality Section
943 Washington Square Mall
Washington, North Carolina 27889
Beaufort, Bertie, Camden, Chowan, Craven,
Currituck, Dare, Gates, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
Wilmington Regional Office
Water Quality Section
127 Cardinal Drive Extension
Wilmington,
Brunswick, Carteret, Columbus, Duplin, New
North Carolina 28405
Hanover, Onslow, Pender
[phone]
[phone] Fax
Winston-Salem Regional Office
Water Quality Section
585 Waughtown Street
Winston-Salem, North Carolina 27107
Alamance, Alleghany, Ashe, Caswell, Davidson,
Davie, Forsyth, Guilford, Rockingham, Randolph,
[phone]
Stokes, Surry, Watauga, Wilkes, Yadkin
[phone] Fax
INSTRUCTIONS FOR APPLICATION FTA 08-13 & SUPPORTING DOCUMENTATION Page 3 of 6

USE THE TAB KEY TO MOVE FROM FIELD TO FIELD Application Number:
(to be completed by DWR)
1.
Owner/Permittee:
la.
Town of Aberdeen -
Full Legal Name (company, municipality, HOA, utility, etc.)
0
1 b.
William R. Monroe, Public Works Director
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
1 d.
121 Pumell Circle le. Aberdeen
LL
Z
Mailing Address City
1 f.
NC 1 g. 28315
Z
0
State Zip Code
1 h.
910-944-4525 1 i. 910-944-0540 1 j. rmonroe townofaberdeen.net
QTelephone
Facsimile E-mail
V
2.
Project (Facility) Information:
a.
SW Interceptor Phase 1-13 2b. Moore —
CLBrief
Project Name (permit will refer to this name) County Where Project is Located
Q
3.
Contact Person - -
Q
3a.
Bill Lester, Jr., P.E LKC Engineering, PLLC
Name and Affiliation of Someone Who Can Answer Questions About this Application
b.
910-420-1437 3c. [e-mail]
Phone Number E-mail
11.
Project is ❑ New ® Modification (of an existing permit) If Modification, Permit No.:
Owner is ® Public (skip to Item B(3)) ❑ Private (go to Item 2(a))
a.
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 El Public Utility (Instruction D)
❑ Leasing units (lots, townhomes, etc. - skip to Item B(3)) ❑ Homeowner Assoc./Developer (Instruction E)
❑ Selling units (lots, townhomes, etc. - go to Item B(2b))
Z
3.
Moore County
0
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
Qa.
Moore County Water Pollution Control Facility 4b. NC 0037508
Name of WWTF WWTF Permit No.
0
a.
Moore County 5b. 24" �® Gravity c. WQ 0036801
Owner of Downstream Sewer Receiving Sewer Size ❑ Force Main
Permit # of Downstream Sewer (Instruction F)
LL
Z
The origin of this wastewater is (check all that apply):
Residential Subdivision ❑ Retail (Stores, shopping centers) 100% Domestic/Commercial
❑ Apartments/Condominiums ❑ Institution o
/o Industrial
❑ Mobile Home Park [I Hospital
LG
❑ School ❑ Church (Attach Description)
IL
❑ Restaurant ❑ Nursing Home /o o Other
❑Office ElOther (specify): (p ty):
(Attach Description)
17.
Volume of wastewater to be allocated or permitted for this particular project: 6,480 gallons per day
*Do not include future flows or previously permitted allocations
.
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)
FTA 08-13 APPLICATION Page 4 of 6

. ___. ____ ....._.............. .
. Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2T .0114 foi
the value in Item 13(7) AND/OR the design flow for line or pump station sizing if a reduced or zero flow is being requested in
Item 13(7). Values other than that in 15A NCAC 2T .0114 (b) and (c) must be supported with actual water or wastewater use
data in accordance with 15A NCAC 2T .0114 (f).
18 existing/future residences @ 360 gpd each = 6,480 gpd
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary) —�
Size (inches) Length (feet) New Gravity or Additional
Force Main
8" PVC .. 1,580 New Gravity _
LIJ
(11. Summary of Pump Stations w/ associated Force Mains to be Permitted (attach additional sheets as necessary)
Z _ _
VPump Station Location ID: N/A (self chosen - as shown on plans/map for reference)
,Longitude: Latitude:
�... Design Flow Operational Power Reliability Option
(MGD) Point
GPM @TDH 1 - Permanent generator w/ATS; Force Main Size Force Main Length
2 - portable generator w/MTS
LL
Z Pump Station Location ID: N/A (self chosen - as shown on plans/map for reference)
Longitude: Latitude:
aDesign Flow Operational Point' Power Reliability Option
(MGD) GPM @TDH 1 -permanent generator w/ATS; Force Main Size Force Main Length
m 2 - portable generator w/MTS
12. Will the wastewater flow in the proposed sewer lines or pump stations be able to be directed to another treatment facility?
❑ Yes ® No If Yes, permit number of 2"d treatment facility
(RO — if "yes" to B,12 please contact the Central Office PERCS Unit)
13. Does the sewer system comply with the Minimum Design Criteria for the Permitting of Pump Stations and Forc1. e Mains
(latest version), the Gravity Sewer Minimum Design Criteria (latest version) and 15A NCAC Chapter 2T 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
FTA 08-13 APPLICATION Page 5 of 6

4. Have the following permits/certifications been submitted for approval for the system or project to be served?
Wetland/Stream Crossings - General Permit or 401 Certification?
Sedimentation and Erosion Control Plan?
Trout Buffer Waiver?
Stormwater?
❑ Yes
❑ No
® N/A
❑ Yes
® No
❑ N/A
❑ Yes
[:]No
® N/A
[:]Yes
[:]No
® N/A
5. Does this project include any high priority lines (15A NCAC 02T .0402 (2)) involve aerial lines, siphons, or interference
manholes)? These lines will be considered hi-gh priority and must be checked once every six months
if Yes: ❑ and provide details:
Owner/Permittee's Certification: (Signature of Signing Official and Project Name)
I, William R. Monroe, Public Works Director, attest that this application for SW Interceptor Phase 1-13 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 143-215.68. 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.
Ia. ,,e ///g —
Signing Official Signature Date
ENGINEERING DESIGN DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL OF THIS
APPLICATION. THESE DOCUMENTS MUST INCLUDE PLAN AND PROFILE OF SEWERS, THEIR PROXIMITY
Z i TO OTHER UTILITIES, DESIGN CALCULATIONS, ETC. REFER TO 15A NCAC 02T .0305
Q. Professional Engineer's Certification: (Signature of Design Engineer and Project Name)
ci
1, Bill Lester, Jr.. P.E. ,attest that this application for SW Interceptor Phase 1-13 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. 1 further attest that to the best of my knowledge the proposed design has
LJ.I been prepared in accordance with the applicable regulations, Gravity Sewer Minimum Design Criteria for Gravity Sewers
UJ 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
V 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 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.
a. Bill Lester, Jr., P.E. t • ��
Professional Engineer Name
b. LKC Engineering, PLLC _- `\,.�, . • AIQO�
Engineering Firm `�20• �FSSS16- 4-
: c%
� 9 c. 140 Aqua Shed Court _ SEAL r;_
Mailing Address = 17651
d. Aberdeen 2e NC '2f. 28315 cif �Q; •
City State Zip �i�Bj� •,GINS
g. 910-420-1437 22h. 910-420-1438 2i. [e-mail] j ESTER
Telephone Facsimile E-mail NC PE Seal Signature &Date
FTA 08-13 APPLICATION Page 6 of 6

FORM WSCAS 08-13
WATERSHED CLASSIFICATION ATTACHMENT
FOR SEWER SYSTEMS
Applicant Name
Project Name
Town of Aberdeen
Southwest Interceptor Phase 1-B
Professional Engineer Name
Engineering Firm Name
Bill Lester Jr., P.E.
LKC Engineering, PLLC
Location
ID
Name of Waterbody'
County
River
Basin
Waterbody
Stream Index No.
Waterbody
Classification
S-1
UT to Aberdeen Creek
Moore
Cape Fear
14-2-11-(6)
C
S-2
LIT to Aberdeen Creek
Moore
Cape Fear
14-2-11-(6)
C
' If unnamed, indicate "unnamed tributary to X", where X is the named waterbody to which the unnamed tributary joins.
/ certify that as a Registered Professional Engineer in the State of
North Carolina that / have diligently followed the Division's
instructions for classifying waterbodies and that the above
classifications are inclusive of the stated project, complete and
correct to the best of my knowledge and belief.
PE Seal, Signature and Date
*** END OF FORM WSCAS 08-13 ***
�6� y\ CARO���i�
�oFESS1o9y9.,
0-SEAL
17651
�49.,-a4-4
FORM: WSCAS 08-13 Page 1 of 1

- `talioti II Watershed Classification Map
Town of Aberdeen
Southwest Interceptor Sewer Phase I
r !
Golsoji
Op T.6we
1 It
'� r _�,,-'-5..r . � • � ♦ �� -- _N __ Line S-1 . �, _ ;1•
r ` I .. u y _ Line S-2 •� > _ • '
�
� i 2Il
Unnamed Tributary � rY r Connect to Existing
a4s` to Aberdeen Creek (C) , 4 Sanitary Sewer
Index # 14-2-11-(6) /� •;•_
ol
• ,� ice LAadplatfa
Ito
Q
op
eet
• ! ' 1
0 — - - 1,000- 2,000 3,0}� I t `�� '_ - - • •
Document Path: L Aber--14.01 Aberdeen SW Interceptor Phase 1-BI300 - PermitslPhase 1B Watershed Classification Map.mxd

Document Path. L:V0e04.01 Aberdeen SW Interceptor Phase 1-B1300 - PermitslPhase 1B Street Level Map.mxd

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Flow Track ing/Acceptance for Sewer Extension Applications
(FTSE 08-13)
Project Applicant Name: Town of Aberdeen
Project Name for which flow is being requested: Southwest Interceptor Phase 1-13
More than one FT.SE ntay be required fora single project if the owner of the WtVTP is not responsible for all pump
stations along the route of the proposed wasteivater flow.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Moore County Water Pollution Control Facility
b. WWTP Facility Permit #: NC 0037508
All flows are in MGD
c. WWTP facility's permitted flow 10.000
d. Estimated obligated flow not yet tributary to the WWTP 2.194
e. WWTP facility's actual avg. flow 4.889
f. Total flow for this specific request 0.006
g. Total actual and obligated flows to the facility 7.089
h. Percent of permitted flow used 70.9
Il. 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 Average Daily Approx. Not Yet Total Current
Station Firm Flow** Current Avg. 'Tributary Flow Plus
(Name or Capacity,* (Firm / pf), Daily Flow, Daily Flow, Obligated Available
Number) MGD MGD MGD MGD Flow Capacity***
* The Firm Capacity 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.
*** 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.
Page l of 6
I�TS1; 08-13

III. Certification Statement:
I Randy Gould, P.E. 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
en 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 indicates acceptance of this wastewater flow.
r
enhw Obi cal Si nature
Page 2 of 6
FTSE 08-13

LKCno,eering,pUc
January 30, 2014
Ms. Belinda Henson, Regional Supervison DWQ
NCDENR Fayetteville Regional Office
225 Green Street, Suite 714
Fayetteville, NC 28301
Re: SW Interceptor Phase 1-13
Town of Aberdeen, NC
LKC No. Aber-14.01
Ms. Henson,
Please find enclosed one original and one copy of the Fast Track Application package and an application fee check
in the amount of $480.00 for the above referenced project.
Please do not hesitate to contact me with any questions or comments.
Sincerely,
LKC Engineering, PLLC
i�
6�
Bill Lester, .14,110E.
Enclosures
140 Aqua Shed Court, Aberdeen, North Carolina 28315 * PH: 910/420-1437 * FAX: [phone]
License No. P-1095

USE THE TAB KEY TO MOVE FROM FIELD TO FIELD
Application Number:MU
(to be completed by DWR)
1.
Owner/Permittee:
i----
1 a
-- -- - -- -- -- - ---
Town of Aberdeen
-. - -- -- ._ _. ---- --- - -- — ----
-- -
Full Legal Name (company, municipality, HOA, utility, etc.)
Z
0
{1 b.
William R. Monroe, Public Works Director
—
{
Signing Official Name and Title (Please review 15A NCAC 2T .0106 (b) for authorized signing officials)
11 c.
The legal entity who will own this system is:
F
El Individual ❑ Federal ® Municipality ❑ State/County ❑ Private Partnership ❑ C"oration ❑ Other
0
11d.
121 Purnell Circle
1e. Aberdeen
LL.
Zt
;
Mailing Address
-- ------ .___ --- ___..._.. _ . _
City
_ ._ _.._
_ _ _ -,---
1g. 28315
Z
--_State
_-
zip Code
E—
1 h.
910-944-4525 ;1 i. 910-944-0540
.1 j. rmonroe townofaberdeen.net
a
Telephone Facsimile
Email
V
,2.
-- _ -
Project (Facility) Information. _ _
J
2a.
_SW Interceptor Phase 1-13
2b. Moore -- v—
CL
Brief Project Name (permit will refer to this name)
Cou
Q
(3.
Contact Person: _ — --
- _ -_ _ _—.
a
3a.
—
Bill Lester, Jr., P.E., LKC Engineering, PLLC
— -----` --- ---
I
Name and Affiliation of Someone Who Can Answer Questions About this Application
-----_---------__
I3b:
910-420-1437
_-- 3c. [e-mail] —`_-----_
Phone Number
E-mail
1.
Project is ❑ New ® Modification (of an existing permit)
If Modification, Permit No.:
Owner is ® Public (skip to Item B(3)) ❑ Private (go to Item 2(a))
a.
If private, applicant will be:
2b. If sold, facilities owned by a (must choose one
200 B WESTGATE DR
L AIK ce-�-,-
eering, plIc WEST END, NC 27376
[phone]
fidefityBank
RMYO® JMEMWkffChKkFraW
RIGHT W YOU
66-358-531
01 /30/2014
PAY TO THE
ORDER OF NCDENR $'*480.00
Four hundred eighty and 00/100•.*.***»*....«****..*..**...*«..**...*....*...***..*�.***«**..*.«►,..**..*.**,,...,
NCDENR
5660
s
S
DOLLARS
❑ 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
I
(see 15A NCAC 02T .0303 to determine if a permit is required)
FTA 08-13 APPLICATION Page 4 of 6