WQ0022562_Sewer Extension_20030505

pF WATF9 State of North Carolina
0� 4�G Department of Environment and Natural Resources
r Division of Water Quality
FAST -TRACK APPLICATION
for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
(Pressure sewers systems are not to be included as part of this application package)
INSTRUCTIONS: Indicate that you have included the following list of required application package items by checking the
space provided next to each item. Failure to submit all required items will lead to your application being returned as
incomplete or additional processing and review time. This form may be photocopied for use as an original.
® I. Application Form - Submit one original and one copy of the completed and appropriately executed application
form. Any changes to this form will result in the application being returned. The Division of Water Quality
(Division) will only accept application packages that have been fully completed with all applicable items
addressed. You do not need to submit detailed plans and specifications unless you respond NO to Item 1302).
® II. Application Fee - Submit a check in the amount of $400 made payable to: North Carolina Department of
Environment and Natural Resources (NCDENR).
❑ III. Certificates of Public Convenience and Necessity — If the application is being submitted in the name of a
privately -owned public utility, submit two copies of the Certificate of Public Convenience and Necessity (CPCN)
which demonstrates that the public utility is authorized to hold the utility franchise for the area to be served by the
sewer extension. If a CPCN has not been issued, provide two copies of a letter from the North Carolina Utilities
Commission's Public Staff that states that an application for a franchise has been received, that the service area
is contiguous to an existing franchised area, and/or that franchise approval is expected. The project name in the
CPCN or letter must match that provided in Item A(2a) of this application.
❑ IV. Operational Agreements — Submit one original and two copies of a properly executed operational agreement if
the sewer extension will be serving residential or commercial lots (e.g., houses, condominiums, townhomes,
outparceis, etc.) that will be owned by a homeowners' association or developer (Item B(2b)). If the applicant is a
homeowners' association, use Form HOA 02/03. If the applicant is a developer, use Form DEV 02/03. EVEN IF
THE PROJECT WILL BE TURNED OVER TO A MUNICIPALITY, FORM DEV 02/03 IS REQUIRED.
❑ V. Flow Acceptance Letters — If the owner of the downstream sewers and/or WWTF is different from the applicant,
submit two copies of a flow acceptance letter from the owner of the downstream sewers and WWTF, if different.
Flow acceptance letters must contain the following minimum information: applicant and project name, amount of
flow accepted, and name and permit number of the receiving sewers/WWTF. The flow acceptance must not
expire prior to permit issuance and must be dated less than a year prior to the application date.
Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific flow acceptance
letter.
® VI. Map — Submit an 8.5-inch by 11-inch copy of the portion of a 7.5-minute USGS Topographic Map along with this
form. The map should identify the entire project area location as well as the closest downslope surface waters as
clearly as possible. Each map portion must be labeled with the map name and number, the identified location,
and be of clear and reproducible quality. For instance, if 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 100 feet of such waterbody - see Instruction VII).
® VII. Watershed Classifications — Section C
• If any portion of the project is within 100 feet of any down slope surface water, Section C must be completed
for the pertinent sections.
If the entire project area is a minimum of 100 feet away from any down slope surface waters BUT there is a
pump station involved where a history of power outage is to be used to provide adequate design storage
instead of dual feed or permanent or portable generator, Section C must be completed to demonstrate that
the closest down slope surface water is Class C (see 15A NCAC 2H .0219(h)(3)(D)).
Use the guidance document entitled, "Determining Watershed Classifications for Form FTA 02/03 (Fast -Track
Sewer Systems)" available from http://h2o.enr.state.nc.us/ndpu or by contacting the appropriate regional
office.
INSTRUCTIONS FOR FORM FTA 02/03

❑ Vill. Environmental Assessments — If this project is subject to an Environmental Assessment (EA) ]15A NCAC
01C .0500], this application can not be used. Send the project application on Form PSFMGSA 10/99 to the
Non -Discharge Permitting Unit, 1617 Mail Service Center, Raleigh, NC 27699-1617. Applications can not be
processed until a Finding of No Significant Impact (FONSI) or Environmental Impact Statement (EIS) has been
issued. A copy is to be submitted with that permit application.
® IX. Certifications — Section D
The application must be certified by both the applicant and 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 2H .0200, the Gravity Sewer Minimum Design Criteria (most
recent version) and the Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains
(most recent version), as applicable to the project. Certification by a PE who is unfamiliar with these documents
is subject to NC Board referral.
THE COMPLETED FTA 02/03 APPLICATION PACKAGE, INCLUDING ALL SUPPORTING DOCUMENTS AND $400
FEE, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional Office
59 Woodfin Place
Avery, Buncombe, Burke, Caldwell,
Asheville, North Carolina 28801
Cherokee, Clay, Graham, Haywood,
Henderson, Jackson, Macon, Madison,
[phone]
McDowell, Mitchell, Polk, Rutherford, Swain,
[phone] Fax
Transylvania, Yancey
Fayetteville Regional Office
Anson, Bladen, Cumberland, Hamett, Hoke,
225 Green Street Suite 714
Montgomery, Moore, Robeson, Richmond,
Fayetteville, North Carolina 28301
Sampson, Scotland
[phone]
[phone] Fax
Mooresville Regional Office
919 N Main Street
Alexander, Cabarrus, Catawba, Cleveland,
Mooresville, North Carolina 28115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
Raleigh Regional Office
Chatham, Durham, Edgecombe, Franklin,
1628 Mail Service Center
Granville, Halifax, Johnston, Lee, Nash,
Raleigh, North Carolina 27699-1628
Northampton, Orange, Person, Vance, Wake,
[phone]
Warren, Wilson
[phone] Fax
Washington Regional Office
Beaufort, Bertie, Camden, Chowan, Craven,
943 Washington Square Mall
Currituck, Dare, Gates, Greene, Hertford,
Washington, North Carolina 27889
Hyde, Jones, Lenoir, Martin, Pamlico,
[phone]
Pasquotank, Perquimans, Pitt, Tyrrell,
[phone] Fax
Washington, Wayne
Wilmington Regional Office
Brunswick, Carteret, Columbus, Duplin, New
127 Cardinal Drive Extension
Hanover, Onslow, Pender
Wilmington, North Carolina 28405
[phone]
[phone] Fax
Winston-Salem Regional
585 Waughtown Street
Alamance, Alleghany, Ashe, Caswell,
Office
Winston-Salem, North Carolina
Davidson, David, Forsyth, Guilford,
27107
Rockingham, Randolph, Stokes, Suny,
[phone]
Watauga, Wilkes, Yadkin
[phone] Fax
For more information, visit our web site at: http://h2o. enr. state. nc. us/ndpu/
INSTRUCTIONS FOR FORM FTA 02/03

05/05/2003 10:56 9104379923 ALLEN, ALLEN,& ASSOC PAGE 03
FAST -TRACK APPLICATION for GRAVITY SEWERS, PUW STATIONS, AND FORCE MAINS
PAGE 1
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD! Appcompleted by DWC) _;
lication Number:
(to
Owner.
Full Legal Name (company,municipality, HOA, utility, etc.)
. ........
..."ilb Will!am er
i.' i Todd Powell Cftv Manag
SigningOfficial ocial Name and Title (Please review 15A NCAC 2H.0206(b) for authorized signitg official L,'
1 c. The legal entity who will own this system is:
IndMdualState/County [Jqc!rp
Partnership
P.O, Box 1388 le. Lumberton
Street Address City
.11 f- North Carolina I g. 28358
State Zip Code
'[phone] 1i. [phone]
Telephone Facsimile E-mail
.... ...... .
Project (Facility)) Informaftn: - -----
�2a James Musslewhite �b. Robeson
ty
Brief Pruiect-NaCounWhere Project is Located
—me (permit will refer to this name)
a �13. Contact Person:
3a William Todd Powell, City Manager
Name and Affiliation of Someone Who Can Answer Questions About this Application
.3b. (910) 671 - 3806
Phone Number E-mail
•
1. Project lsXNew [] Modification (of an existing permit) If Modification, Permit No.,
Owner is 9 Public (sWp to Item B(3)) ❑ Private (go to Item 2(a))
if private,applicant will be: 2b. If sold facilities owned by a (must choose one) . C;J
Retaining ownership (i.e. store, church, single office, etc.) ❑ Public Utility (Instruction 111)
❑ Leasing units (lots, townhomes, etc. - skp to Item B(3)) C] Homeowner Assoc./Developer (Instruction IV)
J Selling units (lots, townhomes, etc. - go to Item B(2b))
'
`::'a. City of Lumberton
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
City of Lumberton, WWTF 4b. NCO024571
Name of WWTF WWTF Permit No.
Be. City of Lumberton �b, 12
Owner of Downstream Sewer Receiving Sewer Size
6. The origin of this wastewater is (check all that apply):
unknown
Permit Number of Downstream Sewer
Residential Subdivision ❑ Car Wash
Apartments/Condominiums ❑ InsftAon wo % Domestic/Commercial
Mobile Home Park ❑ Hospital
❑ % Industrial
School ❑ Church
J X Restaurant ❑ Nursing Home %Other (specify);
❑ Office X Other (specify). Retail
— ----------
7. Volume of wastewater to be pe
rmitted in this project, 12400 gallons per day
If the permitted flow is zero, indicate why,
❑ Interceptor Line - Flow will be permitted is subsequent permits that connect to this line
❑ Flow has already been allocated in Permit No.
❑ Rehabilitation or replacement of existing sewer with no new flaw expected

05/05/2003 10:56 9104379923 ALLEN, ALLEN,& ASSOC PAGE 02
FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 2
9 Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2H
.021 9(l) for Item 8(7) or the design flow for line or pump station sizing 0 zero flow in the space below. Values other than
that in 15A NCAC 2H.0219(IX12) must be approved prior to submittal of this application. Submit aseparate request to
-Discharge Permitting Unit, 1617 Mail Service Center, Raleigh, NC 27699-1617 in
the Division of Water Quality, Non
accordance with 15A NCAC 2H.0219(IX3).
af of Retail Space 120 gpd11000 sf 12400 gpdl
i 2 Restaurants (100 seats each @ 50 gpd/seat 10,000 gpd + 20,000
-essary)
10. Summary of Sewer Lines to be Permitted (attach additional sheets If nec
Gravity Length (feet) or Form Main
Size (inches) Leng(pull down menu)
560 Gravity
8
•
Gravity
Gravity
. ... ....... ........
Gravity
Gravity
Gravity
Gravity
0.11
ENTER TOTAL LINE LENGTH IN MILE-,
ssary)
1, sunp,rdry of Pump Stations to be Permitifed (attach additional sh soft as nece
Power RelliablIfty Option
Location ID Design Flow Operational Point (dual line food. permanent generator,
(as shown on plans)._:......._C31PM.Q T�D�l _pprt ble genwator, wet wall
storage
..... ... . .....
d F
12 Does the sewer system comply with the Minimum Design Criteria for the Fast Track Permitting o Pump Stations an once
.- 't ' I
Mains (latest version), the Gravity Sewer Minimum Design Criteria (latest version) and 5A NCAC 2H .0200 as applicable?
[@Yes []No it no, please reference the pertinent minimum design criteria or regulation and indicate why a
variance Is mquested.
SUBMIT TWO COPIES OF PLANS, SPECIFICATIONS OR CALCULATIONS PERTINENT To THE VARIANCE WITH YOUR APPLICATION
:113 Have the following permlts/certific;Mons been submitted for approval?
wetlend/Stream Crossings - General Permit or 401 Certification? [3 Yes El No X N/A
Sedimentation and Erosion Control Plan? X Yes ❑ No ❑ N/A
Stormwater7 ❑ Yes [I No X N/A

FAST-TRAC-K APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 3
CO)
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Use the Division's guidance document entitled, "DETERMINING STREAM CLASSIFICATIONS FOR FORM FTA 02103 i
(FAST -TRACK SEWER SYSTEMS)" to collect and record the stream classification data below (attach additional sheets as!
necessary). This document is available from our web site or by contacting the appropriate Division of Water Quality
regional office (see instructions for addresses) OR indicate the following:
X A Watershed Classification is not needed because all pants of the project are at least 100 feet away from any down
slope waterbody; AND,
X A Watershed Classification is not needed because the design does not depend on wet well storage as a power
reliability option for any pump station near a Class C down slope waterbody.
Location ID Name of Waterbody Stream Waterbody
on Map Waterbody County River Basin Index Classification
i
Submit the 8.5" x 11" topographic map as required in Instruction VI regardless of whether a classification is provided!
1. Applicant's Certification:
1 attest that this application for James Musslewhite has been reviewed by me and
is accurate and complete to the best of my knowledge. l 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 retumed 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 whi7h7 include a fine not to exceed $10, 000 as well as civil penalties up to
$25, 000 per violation. / 7
1a. William Todd Powell
4/14/03
Signing Official Signature — 0 1/ Date
2. Professional Engineer's Certification:
I attest that this application for James Musslewhite has been reviewed by me and is j
accurate, complete and consistent with the information in the engineering plans, calculations, and all other supporting
documentation to the best of my knowledge. l 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 certain
portions of this submittal package may have been developed by other professionals, inclusion of these materials under my
signature and seal signifies that / 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. Harvey H. Allen
Professional Engineer Name
2b. Allen -Allen & Associates, PA
Engineering Firm
2c. 114 Hale Street
Address
.2d. Fayetteville 2e. NC 2f. 28301
City State Zip
2g. [phone] 2h. [phone] 2i. [e-mail]
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Telephone Facsimile E-mail Seal, Signature & Date

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25

ALLEN-ALLEN & ASSOCIATES, PA
Civil • Municipal • Construction Management
Land Planning • Land Surveying
Mr. Grady Dobson
NCDENR - DWQ
225 Careen Street
Suite 714, Systel Bldg
Fayetteville, NC 28301
Date: April 29, 2003
RE: James Musslewhite - Fast Track Application
114 Hale Street
Fayetteville, NC 28301
[phone]
[phone] Fax
E-mail: [e-mail]
www.allenalleneng.com
Dear Grady:
Please find the following enclosed for your use:
r
Li-JP"R0 20o3
— One (1) check for $400.00;
one (1) copy of the subject QUAD map; L) 'y
and three (3) copies of the subject application.
Cordially:
A
Harvey Allen
enclosures

JOHNNY NOBLES & ASSOCIATES
SURVEYORS
P. O. BOX 407 PH. 910-738-6875
LUMBERTON, NC 28359
PAY
TO THE
ORDER OF
u)q o8459
66-368/531
DATE �
$ Q(,P0
_ DOLLARS
GtUR MY
FOR - -- - - -- - -. -
ll'