WQ0038386_Sewer Extension_20160331

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DEQ/DWR
USE THE TAB KEY TO WHIR F3R0F4P,6LD TO FIELD Application Number:
(to be completed by DWR) W�
1. Owner/Permittee:
1 a. Town of Southern Pines WQRQR
Full Legal NanF8�&#1 MGA kPApAA4t, etc.)
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1 b. Brent Lockamy PE, Town Engineer
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. 140 Memorial Paris Court 1 e
Mailing Address
1f. NC
State
1h. 910-692-1983 1i. N/A
Telephone Facsimile
2. Proiect (Facility) Information:
2a. Clark Street Subdivision
1g
Southern Pines
City
28387
Zip Code
1j. [e-mail]
E-mail
2b. Moore
Brief Project Name (permit will refer to this name) County Where Project is Located
3. Contact Person:
3a. M. Shane Sanders, PE, PLS
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. 910-246-0038 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 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. Moore County
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 i5b. ® Gravity bc. 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
❑ 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: 2,400 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 08-13 APPLICATION Page 5 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 13(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).
5 Lots X 480 GPD = 2,400 GPD
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10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches) Length (feet) New Gravity or Additional
Force Main
8" 348 New Gravity
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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:
VLongitude:
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~ Design Flow
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Pump Station Location ID:
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Longitude:
LU Design Flow
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(self chosen - as shown on plans/map for reference)
Latitude:
Operational Point Power Reliability Option
GPM @TDH 1 -permanent generator w/ATS; Force Main Size Force Main Length
2 - portable generator w/MTS
(self chosen - as shown on plans/map for reference)
Latitude:
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 fad lity
(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, 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 6 of 6

1i. 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? ❑ 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 oriority 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 a.
1, Brent Lockamy. PE attest that this application for Clark Street Subdivision 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 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
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Date
ENGINEERING DESIGN DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL OF THIS
APPLICATION. THESE DOCUMENTS MUST INCLUDE PLAN AND PROFILE OF SEWERS, THEIR PROXIMITY
CO) 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)
V 1, M. Shane Sanders, PE, PLS attest that this application for Clark Street Subdivision has been reviewed by me
LL, and is accurate, complete and consistent with the information in the engineering plans, calculations, and all other
F- 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
W Gravity Sewers adopted February 12, 1996, and the Minimum Design Criteria for the Fast -Track Permitting of Pump
0 Stations and Force Mains adopted June 1, 2000 and the watershed classification in accordance with Division guidance.
V 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 143-215.68 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 $ 000 per violation.
2a. M. Shane Sanders, PE, PLS
Professional Engineer Name ��` C
2b. SNS Engineering, Inc. •,QQ, q:•.,
Engineering Firm
SEAL
2c. 275 S. Bennett St, Ste A 3624
Mailing Address '.�. �G `
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2d. Southern Pines 2e. NC 2f. 28387 11;6',5 y�►NE¢'�P;'`
City State Zip ""'4've SA��,�'
2g. 910-246-0038 2h. N/A 2i. [e-mail]
Telephone Facsimile E-mail NC PE Seal. Sicnature & Date
FTA 08-13 APPLICATION Page 7 of 6

State of North Carolina
DWR
Department of Environment and Natural Resources
Division of Water Resources
Divtslon of Water Resources Watershed Classification Attachment (WSCAS 08-13)
The Division of Water Resources (Division) will not consider this attachment form to be
complete unless all the instructions are followed. Failure to follow the instructions or to
submit all of the required items will lead to additional application processing and review
time.
For more information or for an electronic version of this form, visit our web site at:
hftp://Portal.ncdenr.org/web/wq/swp/ps/cs/ext
INSTRUCTIONS TO THE APPLICANT:
A. Attachment Form:
✓ If the sewer system project area is a minimum of 100 feet from any surface water or wetlands, this
classification is NOT necessary. If any portion of the sewer system project is within 100 feet of any
surface water or wetlands, this form must be completed if there are proposed design conflicts with
setbacks or buffers as listed in 2T .0305 ft.
✓ Do not submit this attachment form for review without a corresponding permit application (Form
FTA 08-13) unless requested by the Division.
✓ Any changes to this attachment form will result in the application package being returned.
B. Prepare the attachment form with the requested information for each portion or location of the
sewer system that is in conflict with a waterbody or wetlands.
✓ Use the Division's guidance document entitled, "DETERMINING STREAM CLASSIFICATIONS
FOR FORM WSCAS 08-13 (SEWER SYSTEMS)" to collect the stream classification data. This
document is available from our web site at the address shown above or by contacting the
appropriate Division of Water Resources regional office.
✓ The same Professional Engineer who certified the permit application form should seal this form.
Different Professional Engineering seals may be accepted from engineers within the same firm.
✓ 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. For instance, the
project involves 4 miles of interceptor sewer that traverses over or near several different
waterbodies (or counties, basins, etc.). The map should have location ID's for each different
waterbody (where the sewer line is within the setback/buffer) and corresponding classifications
should be recorded.
C. Include the attachment form and the map portions with the permit application for submittal to
the appropriate regional office.
✓ A list of the Division's regional offices, their county coverage, and their contact information may be
downloaded from the web site at: http://Portal.ncdenr.org/web/wq/home/ro
***THESE INSTRUCTIONS DO NOT NEED TO BE SUBMITTED'
INSTRUCTIONS FOR FORM: WSCAS 08-13

FORM WSCAS 08-13
WATERSHED CLASSIFICATION ATTACHMENT
ENT
FOR SEWER SYSTEMS
Location
ID
Name of Waterbody'
County
River
Basin
Waterbody Stream
Index No.
Waterbody
Classification
18-23-11-4-1
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' If unnamed, indicate "unnamed 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 class cations 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 ***
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FORM: WSCAS 08-13 Page 1 of 1

275 S. Bennett St, Ste .A
Southern Pines, NC 28387
Phone: [phone]
E N G I N E E R I N G www. snsengineers. com
Delivering efficient solutions... License # C-3791
Project Narrative
The site is an undeveloped 3.57 acre woodland parcel that is being developed as a single family
subdivision consisting of 5 lots. The construction of the project will consist of sanitary sewer
improvements. The total requested flow for the project is 2,400 GPD. Once construction is completed, all
Sewer lines will be owned by Town of Southern Pines and all waste water will flow to Moore County Water
Pollution Control Plant; WWTF # NC 0037508.

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State of North Carolina
DWR
Department of Environment and Natural Resources
Division of Water Resources
Division of Water Resources Flow TrackinWAcceptance for Sewer Extension Applications
(FTSE 08-13)
Project Applicant Name: Moore County
Project Name for which flow is being requested: Clark Street Subdivision
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 flog.
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,flows are in MGD
c. WWTP facility's permitted flow 10.0
d. Estimated obligated flow not yet tributary to the WWTP 0.50849
e. WWTP facility's actual avg. flow 4.99659
f. Total flow for this specific request 0.00240
g. Total actual and obligated flows to the facility 5.50748
h. Percent of permitted flow used 55.0748%
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:
(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***
sP#4 5 2 0.69812 0.04952 0.74764 1.25236
* 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.
SignapEgof this form indicates acceptance of this wastewater flow.
Date
Page 2 of 6
FrSE 08-13

i I VMU
DEQ/DWR_
RECEIVED
USE THE TAB KEY TO MMAQ Fft11 6161-D TO FIELD
Application Number:
(to be completed by DWR)
I.
Owner/Permittee:
_ MAR 3 12016
1 a.
_Town of Southern Pines WQRQR
Full Legal Narrr0Sr11y1 ik30 AJ%F ' F, etc.)
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1 b.
Brent Lockam PE, Town Engineer
WQROS
Signing Official Name and Title (Please review 15A NCAC 2T .0106 (b) for authorized signing o as s
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a, : ODDCiJ,•�
1 c.
The legal entity who will own this system is:
❑ Individual ❑ Federal ® Municipality ❑ State/County ❑ Private Partnership ❑ Corporation ❑ Other (specify):
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1d.
140 Memorial Paris Court
le. Southern Pines
LL
Mailing Address
City
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1f.
NC
1g. 28387
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State
Zip Code i
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1h.
910-692-1983 1i. N/A
1i. [e-mail] j
QTelephone
Facsimile
E-mail
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2.
Proiect (Facility) Information:
J
2a.
Claris Street Subdivision
2b. Moore
a
Brief Project Name (permit will refer to this name)
County Where Project is Located
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3.
_. _
Contact Person: _
_
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3a.
M. Shane Sanders, PE, PLS
Name and Affiliation of Someone Who Can Answer Questions About this Application j
-
3b.
910-246-0038
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, applica
❑ Retaining Own MICHAEL W PAGET 120
❑ Leasing units ( DIANE P PAGET
❑ Selling units (Ir PO BOX 2526 _ aa6� 66-456/531
SOUTHERN PINES, NC 28388
3. Moore of unty
Was G dd
O Owner of Wastew � O
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4a. Moore County WE AIL
~ Name of WWTF _
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5a. Moore County _ Hom neAccount
Owner of Downstr �1 ST BAAI K
O-- - " - - _ SOUTHERN PINES, NORTH CAROUNA 28387
6 The origin of this i
�.��
® Residential S 1:
C
❑ Mobile Home. _...
LJ.I El School ❑ Church (Attach Description)
El0. Restaurant ❑ Nursing Home %Other
El Office ! ❑Other (specify): (Attach Description) j
m
i
7. Volume of wastewater to be allocated or permitted for this particular project: 2,400 gallons per day
'Do not include future flows or previously permitted allocations j
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 i
❑ 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 5 of 6