WQ0037173_Sewer Extension_20140530

DENR--FRCS State of North Carolina
T%WR MAY 3 0 2014 Department of Environment and Natural Resources
Division of Water Resources
�w® FAST -TRACK APPLICATION (FTA 08-13)
Division of Water Resources 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 Surface Water Section's Collection Systems 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 6).
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 08-13):
® Submit the completed and appropriately executed Fast -Track (FTA 08-13) 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):
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 01-12 is required.

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 08-13)
❑ Submit the completed and appropriately executed Watershed Classification Attachment form
(WSCAS 08-13) 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)
I. Environmental Assessments (Projects subject to an Environmental Assessment (EA)):
➢ Projects involving an Environmental Assessment per 15A NCAC 01C .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.

THE COMPLETED APPLICATION AND SUPPORTING DOCUMENTATION (ORIGINAL AND COPY) SHALL BE
SUBMITTED TO THE APPROPRIATE REGIONAL OFFCE:
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional Office
2090 US Highway 70
Avery, Buncombe, Burke, Caldwell, Cherokee,
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,
Fayetteville, North Carolina 28301-5094
Montgomery, Moore, Robeson, Richmond,
[phone]
Sampson, Scotland
[phone] Fax
Mooresville Regional Office
610 E. Center Avenue, Suite 301
Alexander, Cabarrus, Catawba, Cleveland,
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,
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,
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
Wilmington, North Carolina 28405
Hanover, Onslow, Pender
[phone]
[phone] Fax
Winston-Salem Regional Office
585 Waughtown Street
Alamance, Alleghany, Ashe, Caswell, Davidson,
Winston-Salem, North Carolina 27107
Davie, Forsyth, Guilford, Rockingham, Randolph,
[phone]
Stokes, Surry, Watauga, Wilkes, Yadkin
[phone] Fax

.
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD Application Number: WQo((to
be completed by DWR) /J''73
1.
Owner/Permittee:
la.
City of Lumberton
Full Legal Name (company, municipality, HOA, utility, etc.)
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1 b.
Wayne Horne, City Manager
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):
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1 d.
PO Box 1388 le. Lumberton
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Mailing Address City
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1 f.
NC 1 g. 28359
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State Zip Code
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1 h.
[phone] 1 i. [phone] 1 j. [e-mail]
QTelephone
Facsimile E-mail
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2.
Project (Facility) Information:
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2a.
Gibson Cancer Center Sewer Main 2b. Robeson
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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.
Sam Powers, Design Engineer
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 ski to Item 8 3 ❑ Private (skip O) (go to Item 2(a))
j
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.
City of Lumberton
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Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
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4a.
City of Lumberton WWTF 4b. NCO024571
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Name of WWTF WWTF Permit No.
5a.
City of Lumberton 15b. 12" ® Gravity 5c. WQCS00024
OOwner
of Downstream Sewer Receiving Sewer Size ElForce Main Permit # of Downstream Sewer (Instruction F)
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6.
The origin of this wastewater is (check all that apply):
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❑ Residential Subdivision ❑ Retail (Stores, shopping centers) 100% Domestic/Commercial
❑ Apartments/Condominiums ❑ Institution o
/o Industrial
❑ Mobile Home Park ® Hospital
❑ School ❑ Church (Attach Description)
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❑ Restaurant ® Nursing Home % Other
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® Office ❑ Other (specify):
i (Attach Description)
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7.
Volume of wastewater to be allocated or permitted for this particular project: 4,840 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)

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 13(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).
FUTURE FLOW: 5.50 acres x 880 gpd/acre = 4,840 gpd
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches)
8"
Length (feet) New Gravity or Additional
Force Main
800 New Gravity
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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: (self chosen - as shown on plans/map for reference)
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Longitude: Latitude:
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Design Flow
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Z Pump Station Location ID:
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Longitude:
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Operational Point Power Reliability Option
GPM @TDH 1 -permanent generator w/ATS; Force Main Size Force Main Length
2 - portable generator w/MTS
Latitude:
(self chosen - as shown on plans/map for reference)
Design Flow Power Reliability Option
a (MGD) Operational Point 1 -permanent generator w/ATS; Force Main Size Force Main Length
m GPM @TDH 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 2nd 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, 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

14. Have the following permits/certifications been submitted for approval for the system or project to be served?
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Wetland/Stream Crossings - General Permit or 401 Certification? ❑ Yes ❑ No ® N/A
Sedimentation and Erosion Control Plan? ® Yes ❑ No ❑ N/A
Trout Buffer Waiver?
Stormwater?
❑ Yes ❑ No ® N/A
❑ 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 priority 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, Wayne Horne, attest that this application for SpringHill Suites 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
Date
ENGINEERING DESIGN DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL OF THIS
APPLICATION. THESE DOCUMENTS MUST INCLUDE PLAN AND PROFILE OF SEWERS, THEIR PROXIMITY
TO OTHER UTILITIES, DESIGN CALCULATIONS, ETC. REFER TO 15A NCAC 02T .0305
2. Professional Engineer's Certification: (Signature of Design Engineer and Project Name)
1, Samuel J. Powers ,attest that this application for SpringHill Suites 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. 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
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 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 143-215.6B, 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. Samuel J. Powers, P.E.
Professional Engineer Name
2b. Anderson Engineering & Associates, P.A. /0 ••�
Engineering Firm • �� yy•,9 j
2c. PO Box 1736
Mailing Address
2d. Lumberton
City
2e. NC 2f. 28359
State Zip
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2g. [phone] 2h. [phone] 2i. [e-mail] 111111 +/Z5 �1
Telephone Facsimile E-mail {{{
p NC PE Seal, Signature & Date

PART I: GENERAL INFORMATION
PROJECT DESCRIPTION:
The purpose of this project is to install approximately 3,133 linear feet of 12" water main to
provide fire protection to Gibson Cancer Center. The existing Gibson Cancer Center facility is
housed in a 18,883 S.F. facility that is type V-B construction. It is also proposed to construct a
5,300 S.F. building addition to this existing facility, bringing the total square footage for the
building to 24,183 S.F. The City of Lumberton Fire Department (in conjunction with the
Planning & Inspections Departments) required that the Owner provide adequate fire protection
for this facility in accordance the latest NC Fire Prevention Code. This proposed 12" water main
loop should provide the minimum 4,250 gpm required by the City of Lumberton and NC Fire
Prevention Code. A hydrant flow model was created and analyzed by Bartlett Engineering &
Surveying, PC to show that this water main loop would provide 4,400 gpm with the lowest
residual pressure equal to 20.42 psi (see Appendix A).
The Owner has also elected to install an 8" gravity sewer main during the phase of construction
on the Gibson Cancer Center project to serve future areas on the eastern portion of the 11.47
acre site. The property area used in the calculation for future flows on this proposed 8" sewer
main was 5.50 acres. There will be no flow contributing to this sewer main at this time. It is
planned to install this sewer main to avoid having to demolish the current construction in the
future when additional development occurs on the eastern portion of the property.
EXISTING CONDITIONS:
Water and sewer utilities currently exist adjacent to the proposed site. An existing 8" water
main is located in the western portion of Pine Run Drive. There is also an existing 12" water
main approximately 2,000 linear feet south of the site which parallels Ivey's Branch canal. An
existing 12" gravity sewer main is located in Pine Run Drive and flows to the existing Wesley
Pines lift station approximately 2,100 linear feet southwest of the site along Pine Run
Dr./Wesley Pines Dr. Storm water currently flows to an existing drainage canal along the
northern property boundary, and then discharges into a 24" RCP at the northeastern corner of
the property. This 24" RCP discharges into an existing drainage canal which runs along the
eastern boundary of the site and ultimately discharge into the existing Ivey's Branch canal to
the south of the site.
Water utilities are currently owned and operated by the City of Lumberton. Hydrant pressure
test information was collected and supplied by the City of Lumberton Fire Department on the
existing fire hydrants nearest the site (this data is included in the Bartlett Engineering &
Surveying, PC report in Appendix A to this report).
The existing 12" gravity sewer main at Pine Run Drive and Wesley Pines lift station are owned
and operated by the City of Lumberton.
1

PART II: WATER SUPPLY
PROPOSED UTILITIES:
It is proposed to install a 12" PVC water main to provide fire flow service to the site. An
additional fire hydrant is also proposed on the site to provide the required fire protection. The
required fire flow for this facility is 4,250 gpm based on the 2012 Fire Prevention Code since the
proposed construction type is 5-A with no automatic sprinkler system provided. The existing
hydrants were analyzed in conjunction with the proposed fire hydrant by Bartlett Engineering &
Surveying, PC and it was found that the system as proposed would provide 4,400 gpm, thus
exceeding the 4,250 gpm required.
The system has been modeled by Bartlett Engineering & Surveying, PC and their
analysis/supporting calculations have been included in Appendix A to this report.
PERMIT REQUIREMENTS:
This proposed water main extension will meet the minimum requirements for permit
application to NCDWR-PWS. Plans and Engineering Reports shall be submitted to NCDWR-PWS
for review and approval. Installation and testing of this proposed water system shall be
conducted in accordance with all City of Lumberton standards and permit requirements. Upon
certification and final approval of the proposed system, ownership including maintenance and
operation of the system shall be turned over to (the applicant):
City of Lumberton
P.O. Box 1388
Lumberton, NC 28358
PART III: SEWAGE TREATMENT
PROPOSED UTILITIES:
It is proposed to install an 8" gravity sewer main to collect future sanitary sewerage flows on
the eastern 5.50 acres of the property.
PERMIT REQUIREMENTS:
NCDWQ regulations require permitting of all pump stations and public sewer mains 8" and
larger which will service multiple facilities. This proposed sewer main extension shall be owned
and operated by the City of Lumberton. This system shall comply with the minimum design
criteria and 15A NCAC 02T as applicable. Installation of this proposed sewer system shall be
conducted in accordance with all City of Lumberton standards and NCDWQ permit
requirements. Upon completion of installation and testing of the proposed sanitary sewerage
2

system, Record Drawings shall be completed verifying that the sanitary sewerage system was
installed as designed and complies with the Gravity Sewer Minimum Design Criteria (latest
version) and 15A NCAC Chapter 2T as applicable. The proposed sanitary sewerage system shall
not be placed in service until Final Approval has been received from NCDENR-DWQ and all
other regulating authorities. Upon final approval, the Owner of the proposed gravity sanitary
sewerage system shall be:
City of Lumberton
P.O. Box 1388
Lumberton, NC 28358
3

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Proposed Water and Sewer Main Extensions

- - I -
State of North Carolina
Department of Environment and Natural Resources
DWR Division of Water Resources
Division of Water Resources Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE08-13)
Project Applicant Name: City of Lumberton
Project Name for which flow is being requested: Gibson Cancer Center Sewer Main
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: City of Lumberton WWTP
b. WWTP Facility Permit #: NC0024571
All flows are in MGD
c. WWTP facility's permitted flow 20.0
d. Estimated obligated flow not yet tributary to the WWTP 1.15
e. WWTP facility's actual avg. flow 6.0
f. Total flow for this specific request 0.00484
g. Total actual and obligated flows to the facility 7.16
h. Percent of permitted flow used 36%
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)
Obligated,
Pump DesignAverage
Approx.
Not Yet
Total Current
Station Firm Daily Flow**
Current Avg.
Tributary
Flow Plus
(Name or Capacity,* (Firm / pf),
Daily Flow,
Daily Flow,
Obligated
Available
Number) MGD MGD
MGD
MGD
Flow
Capacity***
Wesley Pines 2.405 0.962
0.479
0.0048
0.484
0.478
Harrill Road 2.512 1.005
0.436
0.0048
0.441
0.564
* 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

q-
III. Certification Statement:
I R,Zmr I> �*i2r►5n�� -rA certify to the best of my knowledgethat 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.
Signing Official Signature
Date
Page 2 of 6
FTSE 08-1

DATE:
TO:
11 Anderson Engineering &Assoc., P.A.
P.O. Box 1736 Larry W. Anderson, P.E.
305 North Chippewa Street President
Lumberton, N.C. 28359
Licensure No.: C-0793
LETTER OF TRANSMITTAL
MAY 23, 2013 PROJECT: Gibson Cancer Center — Lumberton NC
NCDENR — DWR Sewer System Extension Permit Application
225 Green Street I Suite 714
Fayetteville, NC 28301-5094
Attn: Trent Allen
WE ARE SENDING YOU NAttached ❑Under separate cover via USPS the following items
❑ Shop Drawings ❑ Prints * Plans ❑ Samples N Specifications
❑ Copy of letter ❑ Change Order * Engineering Report and Permit Application
COPIES
DATE
NO.
DESCRIPTION
2
04/25/2014
One original & one copy of the executed Fast -Track Application (FTA 08-13)
2
04/22/2014
One original & one copy of the executed Flow Tracking/Acceptance (FTSE 08-13)
2
05/02/2014
Engineering Report which includes the project narrative & USGS Topographic Map
2
05/23/2014
Street level map showing all relevant project areas
1
05/22/2014
Check #673088 for Application Fee ($480.00)
THESE ARE TRANSMITTED as checked below:
*For approval ❑Approved as submitted
❑ For your use ❑ Approved as noted
❑ As requested ❑ Returned for corrections
❑ For review and comment ❑
❑ FOR BIDS DUE
Remarks:
❑ Resubmit copies for approval
❑Submit copies for distribution
❑ Return corrected prints
❑ Prints returned after loan to us
Copy To: Project File SIGNED: SAMUEL J. POWERS, P.EAV—
National Society of
Professional Engineers®
Phone: [phone] Fax: [phone] • Email: andersonengineeringpa@gmail. com

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DENR-FRC
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD
Application Number:
(to be completed by DVJR) MAY (} I i;.
1.
Owner/Permittee:
la.
City of Lumberton
Owo
Full Legal Name (company, municipality, HOA, utility, etc.)
Z
0
1 b.
Wayne Home, CityManager
H
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):
0
1 d.
PO Box 1388
Lumberton
ZMailing
--le.
Address
City
—
1f.
NC
1g. 28359
Z
State
Zip Code
0
1h.
[phone] 1i. [phone]
1j. whorne@?ci.lumberton.nc.us
QTelephone
Facsimile
E-mail
V
2.
Project (Facility) Information:
J
2a.
Gibson Cancer Center Sewer Main
2b. Robeson
CL
Brief Project Name (permit will refer to this name)
County Where Project is Located
IL
Q
3.
Contact Person:
Q3a.
Sam Powers, Design Engineer
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
❑ 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.
City of Lumberton
Z
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
0
4a.
City of Lumberton WWTF
4b. NCO024571
Q
Name of WWTF
WWTF Permit No.
0
LL
Z
W
a
i
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7 ORDER SUITE 714' rr
OF FAYETTEVILLE
a NC 28301-5094
(see 'I stiC u1, .JSJs to determine
No. 67308E
Date 05/22/2014
VOID AFTER 90 DAYS
AUTHORIZED SIGNATURE

Central Files: APS _ SWP
6/9/2014
Permit Number WQ0037173 Permit Tracking Slip
Program Category Status Project Type
Non -discharge Active New Project
Permit Type Version Permit Classification
Gravity Sewer Extension, Pump Stations, & Pressure Sewer Extensions 1.00 Individual
Primary Reviewer Permit Contact Affiliation
trent.allen
Coastal SWRule
Permitted Flow
4,840
Facility
Facility Name
Gibson Cancer Center Sewer Main
Location Address
Owner
Major/Minor Region
Minor Fayetteville
County
Robeson
Facility Contact Affiliation
Owner Name
Owner Type
City of Lumberton
Unknown
Owner Affiliation
Wayne Horne
City Manager
PO Box 1388
Dates/Events
Lumberton NC 28358
Scheduled
Orig Issue App Received Draft Initiated Issuance
Public Notice Issue Effective Expiration
6/9/2014 5/30/2014
6/9/2014 6/9/2014
Regulated Activities
Requested /Received Events
Wastewater collection
Additional information requested
Additional information received
Outfall
Waterbody Name Streamindex Number Current Class Subbasin