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WQ0037461_Sewer Extension_20141112
9PC is W Z State of North Carolina nWR NOV 12 2014 Department of Environment and Natural Resources Division of Water Resources FAST -TRACK APPLICATION (FTA 10-14) Division of Water ResourO&TTEVILLE REGIONAL. OFFIG' 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 3). 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 10-14): ❑ Submit the completed and appropriately executed Fast -Track (FTA 10-14) 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. r 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 08-13 is required. INSTRUCTIONS FOR APPLICATION FTA 10-14 & SUPPORTING DOCUMENTATION Pace 1 of 6 F. Downstream Sewer, WWTF Capacity and Flow Track!ng/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) I. 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. Alternative Sewer Systems ➢ Projects involving low pressure sewer systems systems must be submitted for a full technical application forms provided by the Division. K. Flow Direction , vacuum sewer systems and other alternative sewer review and must be submitted to the PERCS Unit on ➢ 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 10-14 & 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 2090 US Highway 70 Avery, Buncombe, Burke, Caldwell, Cherokee, Water Quality Section Swannanoa, North Carolina 28778 Clay, Graham, Haywood, Henderson, Jackson, (828) 296-4500 Macon, Madison, McDowell, Mitchell, Polk, (828) 299-7043 Fax Rutherford, Swain, Transylvania, Yancey Fayetteville Regional Office 225 Green Street Suite 714 Anson, Bladen, Cumberland, Harnett, Hoke, Water Quality Section Fayetteville, North Carolina 28301-5094 Montgomery, Moore, Robeson, Richmond, (910) 433-3300 Sampson, Scotland (910) 486-0707 Fax Mooresville Regional Office 610 E. Center Avenue Alexander, Cabarrus, Catawba, Cleveland, Water Quality Section Mooresville, North Carolina 28115 Gaston, Iredell, Lincoln, Mecklenburg, Rowan, (704) 663-1699 Stanly, Union (704) 663-6040 Fax Raleigh Regional Office 1628 Mail Service Center Chatham, Durham, Edgecombe, Franklin, Water Quality Section Raleigh, North Carolina 27699-1628 Granville, Halifax, Johnston, Lee, Nash, (919) 791-4200 Northampton, Orange, Person, Vance, Wake, (919) 788-7159 Fax Warren, Wilson Washington Regional Office 943 Washington Square Mall Beaufort, Bertie, Camden, Chowan, Craven, Water Quality Section Washington, North Carolina 27889 Currituck, Dare, Gates, Greene, Hertford, Hyde, (252) 946-6481 Jones, Lenoir, Martin, Pamlico, Pasquotank, (252) 975-3716 Fax Perquimans, Pitt, Tyrrell, Washington, Wayne Wilmington Regional Office 127 Cardinal Drive Extension Brunswick, Carteret, Columbus, Duplin, New Water Quality Section Wilmington, North Carolina 28405 Hanover, Onslow, Pender (910) 796-7215 (910) 350-2004 Fax Winston-Salem Regional Office 585 Waughtown Street Alamance, Alleghany, Ashe, Caswell, Davidson, Water Quality Section Winston-Salem, North Carolina 27107 Davie, Forsyth, Guilford, Rockingham, Randolph, (336) 771-5000 Stokes, Surry, Watauga, Wilkes, Yadkin (336) 771-4630 Fax INSTRUCTIONS FOR APPLICATION FTA 10-14 & SUPPORTING DOCUMENTATION Page 3 of 6 Z _O F Q 0 LL Z O H Q ci J IL Q a O IH a O LL _Z H LU a Im USE THE TAB KEY TO MOVE FROM FIELD TO FIELD Application Number: (to be completed by DWR) ©Qqq 1. Owner/Permittee: 1 a. Town of Aberdeen Full Legal Name (company, municipality, HOA, utility, etc.) 1b. William R. Monroe, Public Works Director Signing Official Name and Title (Please review 15A NCAC 2T .0106 (b) for authorized signing officials) 1 c. The legal entity who will own this system is: ❑ Individual ❑ Federal ® Municipality ❑ State/County ❑ Private Partnership ❑ Corporation ❑ Other (specify): 1 d. 115 N. Poplar Street le. Aberdeen Mailing Address City 1 f. North Carolina 1 g. 28315 State Zip Code 1h. 910-944-7012 1i. 910-944-0540 1j. rmonroe@townofaberdeen.net Telephone Facsimile E-mail 2. Project (Facility) Information: 2a. Sanitary Sewer Improvements - Berkley Phase III 2b. Moore County Brief Project Name (permit will refer to this name) County Where Project is Located 3. Contact Person: 3a. Bill Lester, Jr., P.E. Name and Affiliation of Someone Who Can Answer Questions About this Application 3b. 910-420-1437 3c. Bill@ LKCengineering.com 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 j i ❑ Retaining Ownership (i.e. store, church, single office, etc.) or ❑ 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)) 3. Morre County Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project 4a. Moore County Water Pollution Control Facility 4b. NCO037508 Name of WWTF WWTF Permit No. 5a. Town of Aberdeen i5b. 8-Inch I® Gravity 115c. NA Owner of Downstream Sewer �Receiving Sewer Size ❑ Force Main Permit # of Downstream Sewer (Instruction F) 6. The origin of this wastewater is (check all that apply): ® Residential Subdivision ❑ Apartments/Condominiums ❑ Mobile Home Park ❑ School ❑ Restaurant ❑ Office ❑ Retail (Stores, shopping centers) ❑ Institution ❑ Hospital ❑ Church ❑ Nursing Home ❑ Other (specify): 100% Domestic/Commercial % Industrial (Attach Description) • Other (Attach Description) 7. Volume of wastewater to be allocated or permitted for this particular project: 14,400 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) FTA 10-14 APPLICATION Page 4 of 6 0 W D Z_ H Z O ci Z O a O LL Z W a ie 9 Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2T .0114 ford the value in Item B(7) AND/OR the design flow for line or pump station sizing if a reduced or zero flow is being requested in Item B(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). 40 Residences @ 360 gpd / each = 14,400 gpd Total 10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary) Size (inches) 8 Length (feet) 7,250 New Gravity or Additional Force Main New Gravity 11. Summary of Pump Stations w/ associated Force Mains to be Permitted (attach additional sheets as necessary) Pump Station Location ID: NA (self chosen - as shown on plans/map for reference) Longitude: Latitude: Design Flow Operational Point Power Reliability Option (MGD) GPM @TDH 1 - permanent generator w/ATS; Force Main Size Force Main Length 2 - portable generator w/MTS Pump Station Location ID: NA (self chosen - as shown on plans/map for reference) Longitude: Latitude: Design Flow Operational Point Power Reliability Option (MGD) GPM @TDH 1 - permanent generator w/ATS; Force Main Size Force Main Length 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 2nd 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 Force Mains (latest version), the Gravity Sewer Minimum Design Criteria (latest version) and 15A NCAC Chapter 2T as applicable? ® Yes ❑ No If No, complete and submit the Variance/Alternative Design Request (VADC 10-14) application and supporting documents for review. Approval of the request is required prior to submittal of the Fast Track Application and supporting documents. FTA 10-14 APPLICATION Page 5 of 6 14. Have the following permits/certifications been submitted for approval for the system or project to be served? Z O H Q U LL H W 0 u Wetland/Stream Crossings - General Permit or 401 Certification? ❑ Yes ❑ No ® N/A Sedimentation and Erosion Control Plan? ❑ Yes ® No ❑ N/A Trout Buffer Waiver? [:]Yes ❑ No ® N/A Stormwater? ❑ Yes ❑ No ❑ N/A 15. 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 high priority and must be checked once every six months Check if Yes: ❑ and provide details: 1. Owner/Permittee's Certification: (Signature of Signing Official and Project Name) 1, William R. Monroe, Public Works Director, attest that this application for Sanitary Sewer Improvements -Berkley Phase III 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 �J/0_civil penalties up to $25,0A/'1,_?//00 per violation.,(�1 a. e— / ne I T- 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 TO OTHER UTILITIES, DESIGN CALCULATIONS, ETC. REFER TO 15A NCAC 02T .0305 Professional Engineer's Certification: (Signature of Design Engineer and Project Name) 1, Bill Lester, Jr., P.E. ,attest that this application for Sanitary Sewer Improvements - Berkley Phase III 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 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 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. 2a. Bill Lester, Jr., P.E. Professional Engineer Name 2b. LKC Engineering, PLLC Engineering Firm 2c. 140 Aaua Shed Court Mailing Address 2d. Aberdeen City 2g. 910-420-1437 2h. 910-637-0096 Telephone Facsimile 2e. NC State 2i. CAR����i : aL SEAL 17651 • ST R \\\\� Bill@ LKCengineering.com Ia E-mail ;ANC PE Seal nature & Date 2f. 28315 Zip FTA 10-14 APPLICATION Page 6 of 6 FORM WSCAS 08-13 WATERSHED CLASSIFICATION ATTACHMENT FOR SEWER SYSTEMS Applicant Name Project Name wo"M_rti�s Professional Engineer Name Engineering Firm Name w :ftkJr LK r"ft # ! L Location ID Name of Waterbody' County River Basin Waterbody Stream Index No. Waterbody Classification ' 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 I 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 *** `\\ "� C A ROB •FSSS1O • a SEAL 17651 t / STE �`\\� FORM: WSCAS 08-13 Page 1 of 1 1 743.1-' N. C� y t ;r, t�.��e • k - l zz ZL APPROXIMATE PROJECT LOCATION LATITUDE: 35' 07' 23" LONGITUDE: 79" 25' 11" LKC Engineering, pllc SANITARY SEWER IMPROVEMENTS DATE: October 2014 Engineering 140 Aqua Shed Court BERKLEY PHASE III DESIGNED: BGL Landscape Architecture Aberdeen, NC 28315 0: 910.420.1437 CDBG NO. 1 2-C-2510 DRAWN: AGP F: 910.637.0096 TO SERVE CHECKED: BGL Planning Ikcengineering.com TOWN OF ABERDEEN NO License No. P-1095 MOORE COUNTY, NORTH CAROLINA 1 State of North Carolina Department of Environment and Natural Resources Division of Water Resources Flow Tracking/Acceptance for Sewer Extension Applications (FTSE 08-13) Project Applicant Name: Town of Aberdeen Project Name for which flow is being requested: Sanitary Sewer Impr. - Berkley Phase III More than one FTSE may be required for a single project if the owner of the WLVTP is not responsible for all pump stations along the route of the proposed wastewater flow. I. Complete this section only if you are the owner of the wastewater treatment plant. a. WWTP Facility Name: Moore Water Pollution Control Facility b. WWTP Facility Permit #: NC0037508 All flows are in MGD c. WWTP facility's permitted flow 10 d. Estimated obligated flow not yet tributary to the WWTP 2.319 e. WWTP facility's actual avg. flow 4.873 f. Total flow for this specific request 0.0144 g. Total actual and obligated flows to the facility 7.2064 h. Percent of permitted flow used 72.064% 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 Average Daily Approx. Not Yet Total Current Station Firm Flow** Current Avg. Tributary Flow Plus (Name or Capacity,* (Firm / pt), 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 I of 6 F FSE 08- 13 III. Certification Statement: I Randy Gould, PE, certify to the best of my knowledge that the addition of Public Works Director 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. Date Page 2 of 6 1'"1'SF 08- 13 November 4, 2014 Ms. Belinda Henson, Regional Supervisor DWR NCDENR Fayetteville Regional Office 225 Green Street, Suite 714 Fayetteville, NC 28301 Re: Sanitary Sewer Improvements — Berkley Phase III Fast Track Application Town of Aberdeen, North Carolina LKC No. Aber.13.05 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. The proposed project will include the installation of approximately 7,250 LF of 8" gravity sewer lines, manholes, service connections and all related appurtenances to serve the Berkley Phase III CDBG Target Area. Approximately 40 existing and future residences will be served by the improvements. If you have any questions, please do not hesitate to contact me at (910) 420-1437 or by email at Bill@ LKCengineering.com. Sincerely, LKC Engineering, PLL Bill Lester, Jr., P. . LKC Engineering, PLLC, 140 Aqua Shed Court, Aberdeen, North Carolina 28315 PH: 910/420-1437 * FAX: 910/637-0096 * License No. 11-1095 • USE THE TAB KEY TO MOVE FROM FIELD TO FIELD Application Number: (to be completed by DWR) NOV 1. Owner/Permittee: p la. Town of Aberdeen Full Legal Name (company, municipality, HOA, utility, etc.) 0 1b. William R. Monroe Public Works Director H Signing Official Name and Title (Please review 15A NCAC 2T .0106 (b) for authorized signing officials) 1 c. The legal entity who will own this system is: El Individual ❑ Federal ® Municipality, ❑ State/County ❑ Private Partnership ❑ Corporation ❑ Other (specify); 0 1 d. 115 N. Poplar Street 1 e. Aberdeen ZMailing Address City 1f. North Carolina 1g. 28315 Z State Zip Code 0 1 h. 910-944-7012 1 i. 910-944-0540 1 j. rmonroe@townofaberdeen.net QTelephone Facsimile E-mail V 2 Protect (Facility) Information J 2a. Sanitary Sewer Improvements - Berkley Phase III 2b. Moore Count a Brief Project Name (permit will refer to this name) County Where Project is Located Q 3 Contact Person a3a. Bill Lester, Jr., P.E. Name and Affiliation of Someone Who Can Answer Questions About this Application 3b. 910-420-1437 3c. Bill@LKCengineering.com 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 D) ❑ Leasing units (lots, townhomes, etc. - skip to Item B(3)) El Homeowner Assoc./Developer (Instruction E) ❑ Selling units (lots, townhomes, etc. - go to Item B(2b)) 140 AQUA SHED CT engineering, pllc ABERDEEN, NC 28315 (910) 420-1437 �Fi"Bank ® G tYYM ♦e.e-Ws . 66-358-531 11/4/2014 PAY TO THE ORDER OF NCDENR $ **480.00 Four Hundred Eighty and NCDENR f MEMO AUTHORIZED SIGN RE Aber 13.05 u riei mumtauon or replacement of existing sewer with no new flow expected (see 15A NCAC 02T .0303 to determine if a permit is required) 6853 J ;1 0 DOLLARS A FTA 10-14 APPLICATION Page 4 of 6