WQ0028801_Sewer Extension_20050506

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 1
OF W ATFR'p, State of North Carolina
Department of Environment and Natural Resources
yr Division of Water Quality
o pFr 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 B(12).
® 11. 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 is permitted by a private applicant and will be serving residential or commercial lots (e.g.,
houses, condominiums, townhomes, outparcels, etc.) that will be sold to another entity. 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 COLOR 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 of the sewer line and pump stations, 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 shown for each different waterbody (where the sewer line is within
100 feet of such waterbody - see Instruction VII). This location ID is self chosen and used to cross reference the
location in Section C of the permit application.
® VII. Stream 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:/lh2o.enr.state.nc.us/ndpu or by contacting the appropriate regional
office.

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 2
❑ Vill. Environmental Assessments — If this project its subject to an Environmental Assessment (EA) [I SA NCAC
01C .05001, 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(1b). 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
Avery, Buncombe, Burke, Caldwell,
2090 US Highway 70
Cherokee, Clay, Graham, Haywood,
Swannanoa, North Carolina 28778
Henderson, Jackson, Macon,
[phone]
Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania,
Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Hamett,
Fayetteville, North Carolina 28301
Hoke, Montgomery, Moore, Robeson,
[phone]
Richmond, Sampson, Scotland
[phone] Fax
Mooresville Regional Office
919 N Main Street
Alexander, Cabarrus, Catawba,
Mooresville, North Carolina 28115
Moor N
Cleveland, Gaston, Iredell, Lincoln,
66ille,
Mecklenburg, Rowan, Stanly, Union
[phone] Fax
Raleigh Regional Office
1628 Mail Service Center
Chatham, Durham, Edgecombe,
Franklin, Granville, Halifax, Johnston,
Raleigh, North Carolina 27699-1628
Lee, Nash, Northampton, Orange,
(919) 571-47
Person, Vance, Wake, Warren,
[phone] Fax
Wilson
Washington Regional Office
Beaufort, Bertie, Camden, Chowan,
943 Washington Square Mall
Craven, Currituck, Dare, Gates,
Washington, North Carolina 27889
Greene, Hertford, Hyde, Jones,
[phone]
Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington,
Wayne
Wilmington Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus,
Wilmington, North Carolina 28405
Duplin, New Hanover, Onslow,
[phone]
Pender
[phone] Fax
Winston-Salem Regional Office
585 Waughtown Street
Alamance, Alleghany, Ashe, Caswell,
Winston-Salem, North Carolina 27107
Davidson, Davie, Forsyth, Guilford,
[phone]
Rockingham, Randolph, Stokes,
[phone] Fax
Surry, Watauga, Wilkes, Yadkin
For more information, visit our web site at: http://`h2o.enrstate.nc.us/ndpu/

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 3
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USE THE TAB KEY TO MOVE FROM FIELD TO FIELD! Application Number: �� DOa
(to be completed by DWQ) 6�
1. Owner.
1 a. Public Works Department of City of Lumberton
Full Legal Name (company, municipality, HOA, utility, etc.)
1 b. Dixon Ivey City Manager
Signing Official Name and Title (Please review 15A NCAC 2H .0206(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. PO Box 1388
Street Address
1f. NC
State
1 e. Lumberton
City
1 g. 28359
Zip Code
1 h. 910-671-3851 1 i. 910-671-3884 1 j.
Telephone Facsimile E-mail
2. Project (Facility) Information:
2a. The Oaks -Phase V 2b. Robeson
Brief Project Name (permit will refer to this name) County Where Project is Located
3. Contact Person:
3a. James M. Kizer, PE - MOORMAN, KIZER & REITZEL, INC.
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. 910-484-5191 3c. [e-mail]
Phone Number E-mail
1. Project is ® New ❑ Modification (of an existing permit) If Modification, Permit No.:
For modifications, attach a separate sheet clearly explaining the reason for the modification (i.e. adding another
phase, changing line sizellength, etc.). Only include the modified information In this permit application - do not
duplicate project information in B(7) and B(10-11) that has already been included in the original permit.
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 III)
❑ Leasing units (lots, townhomes, etc. - skip to Item B(3)) ❑ Homeowner Assoc./Developer (Instruction IV)
❑ Selling units (lots, townhomes, etc. - go to Item B(2b))
3. Public Works Department of City of Lumberton
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
4a. Lumberton WWTP 4b. NCO024571
Name of WWTF WWTF Permit No.
5a. City of Lumberton 5b. 12" 5c•
Owner of Downstream Sewer Receiving Sewer Size Permit Number of Downstream Sewer (if known)
6. The origin of this wastewater is (check all that apply):
® Residential Subdivision ElCar Wash
W ❑ Apartments/Condominiums ElInstitution /00 % Domestic/Commercial
CL ❑ Mobile Home Park ❑ Hospital % Industrial
❑ School ❑ Church
❑ Restaurant ❑ Nursing Home % Other (specify):
❑ office ❑ Other (specify):
7. Volume of wastewater to be permitted in this project: 28,200 gallons per day
8. 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 flow expected

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 4
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9. Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2H
.0219(1) for Item B(7) or the design flow for line or pump station sizing if zero flow in the space below. Values other than
that in 15A NCAC 2H .0219(1)(1-2) must be approved prior to submittal of this application. Submit a separate request to
the Division of Water Quality, Non -Discharge Permitting Unit, 1617 Mail Service Center, Raleigh, NC 27699-1617 in
accordance with 15A NCAC 2H .0219(l)(3).
71 Single Family Lots with 3,4 & 5 Bedroom homes. 75% will be 3 bedroom (53), 20% will be 4 bedroom (14) and 5% will
be 5 bedroom (4). Therefore 53x3 + 14x4 + 4x5 = 159 + 56 + 15 = 235 bedrooms x 120 gpd = 28,200 gpd. The
percentages were supplied by the developer.
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches) Length (feet)
12 4601
ENTER TOTAL LINE LENGTH IN MILES 0.87
11. Summary of Pump Stations to be Permitted (attach additional sheets as necessary)
Gravity or Force Main
(use the pull down menu)
Gravity
Location ID Power Reliability Option
(self chosen - as shown on Design Flow Operational Point (1- dual line feed; 2- permanent generator WATS; 3-
plans for cross-reference) (MGD) GPM @ TDH portable generator w/telemetiy; 4-wet well storage)
12. Does the sewer system comply with the Minimum Design Criteria for the Fast Track Permitting of Pump Stations and Force
Mains (latest version), the Gravity Sewer Minimum Design Criteria (latest version) and 15A NCAC 2H .0200 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
13. Have the following permits/certifications been submitted for approval?
Wetland/Stream Crossings - General Permit or 401 Certification? ❑ Yes ❑ No ® N/A
Sedimentation and Erosion Control Plan? ® Yes [:]No ❑ N/A
Stormwater? ❑ Yes ❑ No 0 N/A

FAST-TRgCK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 5
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Use the Division's guidance document entitled, "DETERMINING STREAM CLASSIFICATIONS FOR FORM FTA 02/03
(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:
® A Stream Classification is not needed because all parts of the project are at least 100 feet away from any down slope
waterbody; AND,
® A Stream 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 on Map
(self chosen - as shown on Name of
map for cross-reference) Waterbody County
NW Lumberton Ivey Branch Robeson
Waterbody Stream Waterbody
River Basin Index Classification
Lumber 14-12-6-1 C;Sw
Submit the 8.5" x 11" COLOR topographic map as required in Instruction VI
regardless of whether a classification is providedl
1. Applicant's Certification:
1, Dixon Ivey, attest that this application for The Oaks — Phase V 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 civlpenatties up to $25,000 per violation.
la. � Gi
Signing Officid Signature
Professional Engineer's Certification:
� oS�
I attest that this application for The Oaks — Phase V 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. 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 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. James M. Kizer, PE '�•.,
Professional Engineer Name ��.'� O��s ,o• ��iy •
2b. MOORMAN, KIZER & REITZEL, INC. �• a o 7 ,
Engineering Firm
2c. PO Box 53774 83 ,
Address
1 P e
2d. Fayetteville 2e. NC 2f. 28305 �'•,� q :.�.: .�41
City State Zip o
�'•,�FS M .
2g. 910-484-5191 2h. 910-484-0388 2i. [e-mail] $ lose58bsp%
Telephone Facsimile E-mail Seal, Signature & Date

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ENGINEERS •
PLANNERS
SURVEYORS
MOOnom m i , KIZER i REIIZEL, K
May 6, 2005
Mr. Grady Dobson
Division of Water Quality
NCDENR
Water Quality Section
225 Green Street
Suite 714, Systel Building
Fayetteville NC 28301
Re: The Oaks, Phase V and "Oak Pointe"
Robeson County, NC
Dear Mr. Dobson:
Enclosed are two copies of the Fast -Track Applications and fees for an extension of the
Oaks subdivision for the BG French development in Lumberton. The two projects are
adjacent to each other but are being submitted as two separate projects. Your review would
be greatly appreciated and let us know if you need anything else.
Sincerely,
ie /z 0-,,eIz
RONALD S. WILLIAMS
MOORMAN, KIZER & REITZEL, INC.
rsw.: rsw
Ends.
c.c. Mr. Dixon Ivey, PWC Director, Lumberton N.C.

Central Files: APS SWP_
05/06/05
Permit Number WQ0028801
Permit Tracking Slip
Program Category
Status Project Type
Non -discharge
In review New Project
Permit Type Fast Track
Version Permit Classification
Gravity Sewer Extension, Pump Stations, & Pressure Sewer
Individual
Extensions
Primary Reviewer
Permit Contact Affiliation
mike.lawyer
Permitted Flow
28200
Facility
Facility Name
Major/Minor Region
The Oaks -Phase V
Major Fayetteville
Location Address County
Robeson
Facility Contact Affiliation
Owner
Owner Name Owner Type
City of Lumberton Government - Municipal
Owner Affiliation
William Powell
PO Box 1388
Lumberton NC 28358
Dates/Events
Scheduled
Orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
05/06/05 5l /Uf 0,$
Regulated Activities Requested/Received Events
Subdivision Additional information requested
Wastewater collection Additional information received
Outfall NULL
Waterbody Name Stream Index Number Current Class Subbasin

AST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 3
20
USt`_ THE TAB KEY TO MOVE FROM FIELD TO FIELD! Application Number: ) T
(to be completed by DWQ)
Owner:
1. OWne- --
1a. Public Works Department of City of Lumberton
Full Legal Name (company, municipality, HOA, utility, etc.)
1 b. Dixon Ivey, City Manager
Signing Official Name and Title (Please review I SA NCAC 2H .0206(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. PO Box 1388
Street Address
1f. NC
State
1 e. Lumberton
City
1 g. 28359
Zip Code
1 h. 910-671-3851 1 i. 910-671-3884 1 j.
Telephone Facsimile
2. Project (Facility) Information:
E-mail
2a. The Oaks -Phase V 2b. Robeson
Brief Project Name (permit will refer to this name) County Where Project is Located
3. Contact Person:
3a. James M. Kizer, PE - MOORMAN, KIZER & REITZEL, INC.
Name and Affiliation of Someone Who Can Answer Questions About this Application
Lv 6V UQ a-V-4-4 l
1 115 Broadloot Ave. BRANCH BANKING AND TRUST COMPANY
ENGINEERS P.O. Box 53774 FAYETTEVILLE, NORTH CAROLINA
22014
PLANNERS ♦ Fayetteville, NC 28305 66-112-531
00022014
SURVEYORS
t4Ari irlii [phone]
MOORMAN, KIZER & REITZEL, INC.
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FOUR HUNDRED & 00/100 DOLLARS
PAY
DATE
AMOUNT
05/03/05
********$400.00
TO THE NCDENR
m
ORDER
OF:
b;
French/The
Oaks V/Sewer Application Fee
yl
01-2157-01

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® Residential Subdivision ❑ Car Wash
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❑ Apartments/Condominiums ❑ Institution
/o o Domestic/Commercial
❑ Mobile Home Park Hospital
m
❑ School ❑ Church
% Industrial
❑ Restaurant ❑ Nursing Home
% Other (specify):
❑ Office ❑ Other (specify):
7.
Volume of wastewater to be permitted in this project: 28,200 gallons per day
8.
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 flow expected