WQ0037956_Sewer Extension_20150803

RECEN=J LZ'NFJDWR State of North Carolina
WaterQel,il?hrRefta) Department of Environment and Natural Resources
nWR AW 0 3 2015 Division of Water Resources
tiarab ns-saCt n FAST -TRACK APPLICATION (FTA 10-14)
Division of Water ResourcF#y v"!6pW'Ona'Oft 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 Water Quality Permitting Section's 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):
Y 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 08-13 is required.
INSTRUCTIONS FOR APPLICATION FTA 10-14 & 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 01-15)
❑ Submit the completed and appropriately executed Watershed Classification Attachment form
(WSCAS 01-15) 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 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,
[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,
Water Quality Section
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,
Water Quality Section
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,
Water Quality Section
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,
Water Quality Section
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
Water Quality Section
Wilmington, North Carolina 28405
Hanover, Onslow, Pender
[phone]
[phone] Fax
Winston-Salem Regional Office
450 W. Hanes Mill Road
Alamance, Alleghany, Ashe, Caswell, Davidson,
Water Quality Section
Suite 300
Davie, Forsyth, Guilford, Rockingham, Randolph,
Winston-Salem, North Carolina 27105
Stokes, Surry, Watauga, Wilkes, Yadkin
[phone]
INSTRUCTIONS FOR APPLICATION FTA 10-14 & SUPPORTING DOCUMENTATION Page 3 of 6

USE THE TAB KEY TO MOVE FROM FIELD TO FIELD
Application Number:
(to be completed by DWR)
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1. Owner/Permittee:
1 a. Moore Countv
Full Legal Name (company, municipality, HOA, utility, etc.)
1 b. Randv G. Gould. PE
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):
1 d. P.O. Box 1957 1 e. Carthage
Mailing Address
1 f. NC
State
City
1 g. 28327
Zip Code
1 h. [phone] 1 i. [phone] 1 j. rgould @ n
Telephone Facsimile E-mail
2. Project (Facility) Information:
2a. Pine Forest Pump Station and Force Main 2b.
Brief Project Name (permit will refer to this name)
3. Contact Person:
3a. Fred M. Hobbs
County Where Project is Located
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. [phone] 3c. f.hobbs@hobbsupcl
Phone Number E-mail
1. Project is ® New ❑ Modification (of an existing permit) If Modification, Permit No.:
urch.com
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)) ❑ Homeowner Assoc./Developer (Instruction E)
❑ Selling units (lots, townhomes, etc. - go to Item B(2b))
3.
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
4a. Moore County Water Pollution Control Plant 4b. NC 0037508
Name of WWTF WWTF Permit No.
5a. Moore County �5b. 15" ®Gravity c. NC 0037508
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 ❑ Retail (Stores, shopping centers) 100% Domestic/Commercial
❑ Apartments/Condominiums ❑ Institution % Industrial
❑ Mobile Home Park ❑ Hospital
❑ School ! ❑ Church (Attach Description)
❑ Restaurant ❑ Nursing Home o Other
❑ Office ® Other (specify): Resort Hotel ��
(Attach Description)
7. Volume of wastewater to be allocated or permitted for this particular project: 0 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

9. Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2T .0114 for
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).
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches) Length (feet) New Gravity or Additional
Force Main
6 30,313 New FM & PS
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H 11. Summary of Pump Stations w/ associated Force Mains to be Permitted (attach additional sheets as necessary)
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0 Pump Station Location ID: Pine Forest PS (self chosen - as shown on planstmap for reference)
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Longitude: 79 ° 30'50.82"
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Design Flow
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(MGD)
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Pump Station Location ID:
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Longitude:
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Design Flow
(MGD)
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Latitude: 35 °14'26.12"
Operational Point Power Reliability Option
GPM @TDH 1 - permanent generator w/ATS; Force Main Size Force Main Length
2 - portable generator w/MTS
277 @ 105'
Latitude:
1
6.09" 30,313'
(self chosen - as shown on planstmap for reference)
Operational Point Power Reliability Option
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 2"d treatment facility :
(RO — if "yes" to 13,12 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 j
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?
Wetland/Strearn Crossings - General Permit or 401 Certification? ❑ Yes ❑ No ® N/A
Sedimentation and Erosion Control Plan? ❑ Yes ® No ❑ WA
Trout Buffer Waiver?
Stormwatert
❑ Yes ❑ No ®N/A
❑ Yes ❑ No ® WA
15. Does this project include any high priority lines (15A NCAC 02T .0402 (2)) involve aerial sines, siphons, or interference
manholes)? These lines will be considered high priority and must be chm*ed once every six months
Check N Yes: ❑ and provide details:
1. Owner/Permittee's Certification: (Signature of Signing Official and Project Name)
1, Randy G. Gould, PE. attest that this application for Pine Forest Pump Station and Force Main 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. Note: In accordance with North Carolina General Statutes t43-
215.6A and 143 215.68, any person who knowingly makes any false statement, representation, or certification in any
application all be guilty of a Class 2 misdemeanor, which may include a fine not to exceed $10.000 as well as civil
penald up $25,000 per violation.
57
/Si$ing Official ` � � Date
ENGINEERING DESIG1q DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL OF THiS
APPLICATION. THESE DOCUMENTS MUST INCLUDE PLAN AND PROFILE OJ SEWERS, THEIR PROXIMITY
TO OTHER UTILITIES, DESIGN CALCULATIONS, ETC. REFER TO 15A NCAC 02T .0305
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Q2' Professional Engineer's Certification: (Signature of Design Engineer and Project Name)
rL f, John Barry King ,attest that this application for Pine Forest Pumg Station and Force Main has been reviewed by
P me and is accurate, complete and consistent write the it fomnalion in the engineering plans, calculations, and all other
Q supporting documentation to the best of my knowledge. i further attest that to the best of my knowledge the proposed
W design has been prepared in accordance with the applicable regulations, Gravity sewer Minimum Design Criteria for
U Gravity Sewers adopted Febmaiy 12, 1996, and the Aginimum 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.
(j Although other professionals may have developed certain portions of this submittal package, inclusion of these materials
under my signature and seal signifies that 1 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 143-215.66, any person who '
knowingly makes any false statement representation, or certification in any application shaft be guilty of a Class 2
misdemeanor which may include a fine not to exceed $10, 000 as well as civil penalties up to $2A000 per violation.
2a, John Barry Kingi►iilil!
Professional Engineer Name
; ��1 CA/;h�//���'' -
2b. SK Environment & Engineering PLLC
Engineering Firm
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2c, 303 alde Point Loop
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Mailing Address
2d• Hampstead 2e. NC 2f. 28443`�©������
City
State Zip
2g. 910 6a5 3528 2h. 2i. johnbarrykingQskenveng.corn
Telephone Facsimile E-mail
E &Date

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Division of Water Resources Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 08-13)
Project Applicant Name: Moore County
Project Name for which flow is being requested: Pine Forest (Pump Station)
More than one FTSE may be required for a single project if the owner of the WWTP 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 County Water Pollution Control Plant
b. WWTP Facility Permit #: NC 0037508
All f lows are in MGD
c. WWTP facility's permitted flow 6.7
d. Estimated obligated flow not yet tributary to the WWTP 0.48289
e. WWTP facility's actual avg. flow 4.914
f. Total flow for this specific request 0
g. Total actual and obligated flows to the facility 5.39689
h. Percent of permitted flow used 80.55%
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 / pf), Daily Flow, Daily Flow, Obligated Available
Number) MGD MGD MGD MGD Flow Capacity***
LS 3-4 3.600 1.440 1.438 0 1.438 0.002
* 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 1 of 6
FTSE 08-13

III. Certification Statement:
1, Randy Gould, PE, Public Works Director 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.
ial
Page 2 of 6
FTSE 08-13

Page 1 of I
Fred Hobbs
From: Fred Hobbs [[e-mail]]
Sent: Tuesday, July 14, 2015 1:37 PM
To: 'Gould, Randy'
Cc: 'Barry King'; 'David Lane'; 'Jason Harris'
Randy the flow request for Pine Forest is as follows
Hotel Rooms 300@200 gallons per room = 60,000GPD
Dining Hall/Ballroom 600seats@30gps = 181000GPD
Bars and ancillary dining 200seats@20gps= 4,000GPD
Total for Hotel = 82,000GPD
119 Resdential lots at 360 GPD = 42.840GPD
Total Request Phase I = 124,840GPD
RECE!VEUWcNRIDWR
WaterQuilltvRemonel
AUG 0 3 2015
operations se*ft
Fayetteville Regioam t?ft
7/28/2015

Along with this form, submit a color copy of a USGS Topographic Map to identify the project area and
waterbodies. Each map or maps must show the location of the sewer system and Include location
Identifiers where the system traverses over or near waterbodies. The map should have location K's for
each different waterbody and corresponding_ classifications should be recorded.
Include the completed form and map portions with the permit application for submittal to the
appropriate review agency. A list of the Division's regional offices, their county coverage, and contact
information can be obtained from. I F!pnoal.ncc�e r oi; /we .� w,�� 1�Orile =o
Location ID
Name of Waterbody'
River
Basin
Waterbody
Index No.
Waterbody
Classification
# 1
loos FoRK
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I0-23-3-1
WS - _T-T-
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ims CHEEK
CA%FiAg
is- 23- 3-l6,s
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1 If unnamed, indicate "unnarned tributary to X", where X is the named waterbody to which the unnamed tributary joins.
I 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 Seams and Date
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NORTH CAROLINA
66-112-531
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD Application Number: AUG G� 4z 1
(to be completed by DWR)
1.
Owner/Permittee: F lriRealolawo ke
la.
Moore County
Full Legal Name (company, municipality, HOA, utility, etc.)'
0
1 b.
Randy G. Gould, PE
Signing Official Name and Title (Please review 15A NCAC 2T .0106 (b) for authorized signing officials)
Q
1c.
The legal entity who will own this system is:
El Individual ❑ Federal ElMunicipality® State/County ❑ Private Partnership ❑ Corporation ❑ Other (specify):
0
1 d.
P.O. Box 1957 1 e. Carthage
IL
Mailing Address City
Z
1 f.
NC 1 g. 28327
Z
State Zip Code
0
1 h.
[phone] 1 i. [phone] 1 j. [e-mail]
QTelephone
Facsimile E-mail
V
2.
Prolect (Facility) Information:
J
2a.
Pine Forest Pump Station and Force Main 2b. Moore
dBrief
Project Name (permit will refer to this name) County Where Project is Located
Q
3.
Contact Person:
Q
3a.
Fred M. Hobbs
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
1-1 Retaining Ownershin (Le_ store. church. single office. etc.) or n D„W;: i 1QU , n..ea.....s:,... rn
14276
Dormie Club, LLC
6033 Beulah Hill Church
West End, NC 27376
[phone] 1
5
$ y so.
oC DOLLARS
Tuv�t 8 f 15
Dormie Club, LLC n
WWI'
® 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