WQ0040543_Sewer Extension_20181221

Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number:
(to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
l . Applicant's name: Town of Carthage (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State/County ® Municipal
3. Signature authority's name: Kevin Kimball per i 5 \ `.CC AC O'l' .(, i 061 h )
Title: Public Works Director
4. Applicant's mailing address: 4396 Hwy 15-501 (Town Hall)
City: Carthage State: NC Zip: 28327-
5. Applicant's contact information:
Phone number: 9(Q 947-5041 Email Address: kkimball.pwdna,townofcartha e.org
II. PROJECT INFORMATION:
❑ Privately -Owned Public Utility
❑ Other RLL;L1VtU
DEQIDWR
DE!_; k 1 2018
WQROS
FAYETM!,? I c pEe,_Ir o�A! OFFICE
1. Project name: Southbury Subdivision Phase 1
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ00 and issued date:
If new construction but part of a master plan, provide the existing permit number: WQ00
3. County where project is located: Moore
_
iYCi iV�E�I r
FIRST B/CNK
296
.5 -.
SOt1YHERM,PINES ANC 2838.
PERRY D%VE
SbUTCtRN PINES, N&28387
66-456/631
12/14/2018
y, TO 1 HF
%f�¢ER o NC,DE# ' `�\ �: ,��
$ „480.00.
,, \, :.
Four Hundred Eighty andDOLLARS
v7
AUTHORIZED SIGNATURE
S\Stem, \\ I& CA ['-:ii, 11 it \L1111rck. 1 (Ii WQCS
Owner Name(s):
FORM: FTA 04-16 Paget of 5

DEQr®wR
State of North Carolina
DEC 2 12018 Department of Environmental Quality ,-WRDivision of Water Resources
;
2T .0300— FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Re"�' I; . ( CE FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: I , &60yasW (to be completed by MkIR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
l . Applicant's name: Town of Carthage (company, municipality. HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ® Municipal ❑ Other
3. Signature authority's name: Kevin Kimball per _13.A \C' AC 02l .0106(h)
Title: Public Works Director
4. Applicant's mailing address: 4396 Hwy 15-501 (Town Hall)
City: Carthage State: NC Zip: 28327-
5. Applicant's contact information:
Phone number: (9� 947-5041 Email Address: kkimball.nwdna,townofcarthalze.org
11. PROJECT INFORMATION:
1. Project name: Southbury Subdivision Phase 1
2. Application.1'Project status: ® Proposed (New Permit) ❑ Existing PermitTroject
If a modification, provide the existing permit number: WQ00 and issued date:
If new construction but part of a master plan, provide the existing permit number: WQ00
3. County where project is located: Moore
4. .Approximate Coordinates (Decimal Degrees): Latitude: 35.329105° Longitude:-79.411454=
5. Parcel ID (if applicable):
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: M. Shane Sanders License Number: 36249
Firm: SNS Engineering Inc.
Mailing address: 180 Perry Drive
City: Southern Pines State: NC Zip: 28387-
Phone number: 910 246-0038 Email Address: shane(asnsengineers.com
IRS. WASTEWATER TREATMENT FACILITY (« WTF) INFORMATION:
1. Facility Name: Moore County Collection System Permit Number: WOCS00034
Owner Name: Moore County Public Utilities
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): )N'Q Downstream (Receiving) Sewer Size: inch
SN-stem \1 idc: Collection System Permit \umbers) ot'aphlicable): WQCS
Owner Name(s):
FORM: FTA 04-16 Page] of 5

�' VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes [:]No ®N/A
2. If the Applicant is a Developer of lots to be sold, has a DeN elooer's Operatiunal-\ui-eement ( FOR\i DEV) been attached?
❑ Yes ❑No ®N/A
3. If the Applicant is a Home Prouert\ Owners' Association. has an Opera[ional Agreemem ( FORM HO J been attached?
❑ Yes ❑No ®N/A
4. Origin of wastewater: (check all that apply):
® Residential Owned ❑ Retail (stores, centers, malls) ❑ Car Wash
❑ Residential Leased ❑ Retail with food preparation/service ❑ Hotel and/or Motels
❑ School / preschool / day care ❑ Medical / dental / veterinary facilities ❑ Swimming Pool /Clubhouse
❑ Food and drink facilities ❑ Church
❑ ❑Swimming Pool/Filter Backwash
Businesses /offices /factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 % Domestic/Commercial % Commercial
% Industrial (See 15 \ \C \C 0T 010 3(201)
�, Is there a Pretreatment Program in effect? ❑ Yes ® No
6. Hasa flow reduction been approved under 15 \ \C \C 02T .01 14(f)? ❑ Yes ®No
> If yes, provide a cony of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114�
Daily Design Flow •.b
No. of Units
Flow
4 Bedroom House per Lot
120 gal/bedroom
30
14,400 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
14,400 GPD
a See 15 1 NCAC 02T .01 14(b). (d) (e)( I ( and (r)(2) for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use areas;
and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in G.S. 42A-4).
b Per 15A NCAC 02T .0I 14(c), design flow rates for establishments not identified (in table 15 \ \C. \C 02T.01 14] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 14.400 GPD (per 15 _ \C . \(' 0"T .0 l 14)
> Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
❑ Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit Number:
❑ Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain):
FORM: FTA 04-16 Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & .NIDC (Gra%its Se%%ers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 2,198 SDR35-PVC
> Section II & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
> Section III contains information related to minimum slopes for gravity sewer(s)
> Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — (121 .0305 & NIDC (Pump Stations/Force Nlains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: -
3. Design flow of the pump station: millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): gallons per minute at feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
6. Power reliability in accordance with 1 iA \( \C o_1 I .0, o5iL1 I r
❑ Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(h)(1 XB);
> Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
> Must be permanent to facility
Or if the pump station has an average daily flow less than 15,000 gallons per day:
❑ Portable power source with manual activation, quick -connection receptacle and telemetry - 15A NCAC 02T
.0305(h)(1)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry - 15A NCAC 02T .0305(h)(1)(C):
> It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant (draft agreement)
and is compatible with the station.
> If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel timeframes, shall be provided
in the case of a multiple station power outage.
FORM: FTA 04-16
Page 3 of 5

,if M. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations found in 15 \ \C \(' U21 .a �U5t t) & �)
> I SA NCAC 02T.0305(fl eontainc minimum ePn� t;^" rl.�t �L..,n I.-
❑ Yes ® No
--------••----- ---—.---..•... ...... ouzo. v�. ,V,JuGu Jul JGWGL
Setback Parameter*
J SLCMS:
Separation Required
Storm sewers and other utilities not listed below vertical
24 inches
Water mains vertical -water over sewer including in benched trenches
18 inches
Water mains horizontal
10 feet
Reclaimed water lines vertical - reclaimed over sewer
18 inches
Reclaimed water lines horizontal - reclaimed over sewer
2 feet
"Any private or public water supply source, including any wells, WS-I waters of Class I or
Class 11 impounded reservoirs used as a source of drinking water
100 feet
"Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal
high water or tide elevation and wetlands see item IX.2
50 feet
"Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches
10 feet
Any building foundation
5 feet
Any basement
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade vertical
36 inches
> I � \ \C.\C 02T.03,05(_) contains alternatives where separations in 02T U,05i f cannot be achieved.
> "Stream classifications can be identified using the Division's \C surface \N atrCla;citications %�ebpaee
> If noncompliance with 02T.0 305(fi or i _). see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ❑ Yes ® No ❑ N/A
> See the Division's draft separation requirements for situations where separation cannot be meet
> No variance is required if the alternative design criteria specified is utilized in design and construction
> As built documents should reference the location of areas effected
3. Does the project comply with setbacks found in the river basin rules per I � -\ \C aC U2R .U20n:' ❑ Yes ❑ No ® N/A
> This would include Trout Buffered Streams per I �.\ V :\(' 2R.0 102
4. Does the project require coverage/authorization under a 404 Nationwide or ❑ Yes ® No
individual permits or 401 Water Quality Certifications?
> Information can be obtained from the 401 & Buft�r Pern,inin_ Branch
5. Does project comply with 1 z \ \U \ C (!'T.0) U V c )t 6) (additional permits/certifications)? ® Yes ❑ No
Per 1 � \ \CAC 02T.0105(c)i6), directly related environmental permits or certification applications are being prepared, have
been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion and
sedimentation control plans, stormwater management plans, etc.).
6. Does this project include any sewer collection lines that are deemed "high -priority?"
Per 1 ; \ \C \C U2T.U-tO-'. "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes ® No ❑ N/A
> If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at least once every six -months and inspections
documented per 15A NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit.
FORM: FTA 04-16 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with II :% NC AC 02T. the Minimum lleNwn Criteria for the Permitting of Pump Station.
and Force Main. ( latest \ ersion). and the Gray it\ Se,.N er Minimum Design Criteria ( latest \ er. ioW as applicable?
® Yes ❑ No
If No. complete and submit the Variance Alternative Design Request application (VADC 10-14) and supporting documents for
review. Awrov al of the request is required prior to submittal of the Fast Track Application and supporting documents
2. Professional Engineer's Certification:
attest that this application for
(Professional Engineer's name from Application Item 111.1.)
has been reviewed by me and is accurate. complete and consistent with the information supplied in the plans. specifications.
engineering calculations. and all other supporting documentation to the best of my knowledge. I further attest that to the best
of my knowledge the proposed design has been prepared in accordance with the applicable regulations. Gravity Sewer
Minimum Design Criteria for Gravity Sewers (latest version). and the Minimum Design Criteria for the Fast -Track Permitting
of Pump Stations and Force Mains (latest version). .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 General Statutes 143-215.6A and 143-215.613. any person who knowingly makes any false
statement. representation. or certification in an application package 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 S25.000 per violation.
North Carolina Professional Engineer's seal, signature, and date: '
SEAL
36249
..........
AN��'� `
.. ............. _..._............. ..... ....................... ._;
Applicant's Certification per I5A NCAC 02T .0106(b):
t. tyi:.J �sM,BALc. f 6/ t- Wagks !>%r« �o,e
_ _attest that this application for
(Signature Authority's name & title from Application Item I.3.)
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. 1 understand that any discharge of wastewater from this non -
discharge system to surface waters or the land will result in an immediate enforcement action that may include civil penalties.
injunctive relief, and or criminal prosecution. I will make no claim against the Division of Water Resources should a condition
of this permit be violated. 1 also understand that if all required parts of this application package are not completed and that if
all required supporting information and attachments are not included. this application package will be returned to me as
incomplete.
NOTE - In accordance with General Statutes 143-215.6A and 143-215.613. any person who knowingly makes any false
statement. representation. or certification in any application package shall be guilty of a Class 2 misdemeanor. which may
include a fine not to exceed S10.000 as well as civil penalties up to S25.000 per violation.
Signature: /C t����i�/ Date: ��` �Q' !�
FORM: FTA 04-16 Page 5 of 5

g State of North Carolina
f4 Department of Environmental Qualify
?ft' Division of Water Resources
TN
Division of Water Resources Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: Town of Carthage
Project Name for which flow is being requested: Southbury Subdivision Phase 1 Sewer
More than one ME 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
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
All f1'ows are in MGD
10
0.39121
5.35967
0.01440
5.76528
57.6528
H. 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)
(DY(B+P (ESA-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.
Downstream Facility Name (Sewer): Moore County Public Utilities
Downstream Permit Number: WQCS00034
Page 1 of 6
FTSE 04-16

III. Certification Statement:
I Randy Gould, PE, Public Works certify to the best of my knowledge that the addition of
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 H
plus all attached planning assessment addendums for which I am the responsible party.
Signature of this form indicates acceptance of this wastewater flow.
, �/� �z� � � , 4 -// 014?, -0 (1 V,
Signing
Page 2 of 6
Date
FTSE 04-16

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation:
Project Name for which flow is being requested: Southbury Subdivision Phase 1
More than one FM may be required for a single project rf 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:
b. WWTP Facility Permit #:
All Jlows are in MGD
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
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, "
(Finn f pf),
Daily Flow,
Daily Flow,
Obligated
Available
Number)
MGD
MGD
MGD
MGD
Flow
Capacity***
Hwy 22
0.4608
0.1843
0.1111
0.1255
0.0588
Cox Citgo
0.792
0.3168
0.2488
0.00
0.2632
0.0536
McCaskill 0.8539 0.3416 0.2568 .0460 0.3172 0.0244
* 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.
Downstream Facility Name (Sewer): Town of Carthage
Downstream Permit Number: WQCSD0134
Page i of 6
FTSI= 04-16

III. Certification Statement:
Icertify 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 parry.
Signature of this form indicates acceptance of this wastewater flow.
Signing
/Z-/Z
Page 2 of 6
FTSf., 04-16

PLANNING ASSESSMENT ADDENDUM (PAA)
Submit a planning assessment addendum for each pump station listed in Section 11 where Available
Capacity is < 0.
Pump Station (Name or Number):
Given that:
a. The proportion and amount of Obligated, Not Yet Tributary Daily Flow (C) accounts for
% and MG.D of the Available Capacity (E) in Pump Station
; and that
b. The rate of activation of this obligated, not yet tributary capacity is currently approximately
MGD per year, and that
c. A funded Capital Project that will provide the required planned capacity, namely
is in design or under construction with
planned completion in ; and/or
d. The following applies:
Therefore:
Given reasonably expected conditions and planning information, there is sufficient justification
to allow this flow to be permitted, without a significant likelihood of over -allocating capacity in
the system infrastructure.
I understand that this does not relieve the collection system owner from complying with G.S.
143-215.67(a) which prohibits the introduction of any waste in excess of the capacity of the
waste disposal system.
Signing Official Signature
Date
Page 3 of 6
i' FS 12 04-16

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-- - License. C-3791 Site Map
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ENGINEERING I SURVEYING I PLANNING

S
180 Perry Drive
Southern Pines, NC 28387
E N G I N E E R I N G
Delivering efficient solutions...
Phone: [phone]
www.snsengineers.com
License # C-3791
LETTER OF TRANSMITTAL
To: NCDEQ
Water Quality Section
225 Green Street Suite 714
Fayetteville, NC 28301-5094
910-433-3300
THIS TRANSMISSION INCLUDES:
Plans
®
Specifications
❑
Calculations
Comments
Other: Listed Below
®
THESE ARE TRANSMITTED AS:
RE(;EIVED
DEQ/DWR
DEC a 1 2018
7AYEnF1tuWQR0S
12/14/18 OFFICE
SNS Project # 1513601
Project Name: Southbury Subdivision
Delivered Via: UPS
Tracking #:
❑ For Review
❑ Re -Submittal ❑ For Your Record
® For Approval ❑ For Your Use
Qty.
Description
REV. #
2
Cover Letter
1
Application Fee ($480 Check#2?(,2,)
2
(Form: FTA 04-16)
2
(Form: FTSE 04-16) Moore County
2
(Form: FTSE 04-16) Town of Carthage
2
Site Map
Remarks:
M. Shane Sanders, PE, PLS
Owner

S
180 Perry Drive
Southern Pines, NC 28387
E N G I N E E R I N G
Delivering efficient solutions...
Phone: [phone]
www.snsengineers.com
License # C-3791
Project Narrative
The site is an undeveloped 11.05 acres woodland parcel that is being developed as a single
family subdivision consisting of 30 lots. The total requested flow for the project is 14,400 GPD. Once
construction is completed, all sewer lines will be owned by Moore County and all waste water will flow to
Moore County Wastewater Treatment Facility; WWTF # NC0037508.