WQ0031945_Sewer Extension_20070712

USE THE TAB KEY TO MOVE FROM FIELD TO FIELDI Application Number:
(to be completed by DWQ)
1. Owner:
la. Town of Red Springs Public Works
Full Legal Name (company, municipality, HOA, utility, etc.)
lb. c F r r- / 'rowrl Mana 4r
Signin6 Official Name and Title (Please review 15A NCAC 2H .0206(b) for authorized signing officials!)
1 c. The legal entity who will own this system is:
Individual Federal 4Munici alit State/County Private PartnershipCorporation Other (specify):
1 d. 217 South Main Street
Ile. Red Springs
Mailing Address
! City
if. North Carolina
�1g. 28377
State 7Zip
1h. 910-843-5849 11. 910-843-4248
Code
`lj. PublicWorksDir reds rin s.or
Telephone Facsimile
E-mail
2. Project (Facility) Information:
2a. Red Springs CVS 2b. Robeson
Brief Project Name (permit will refer to this name) County Where Project is Located
3. Contact Person:-
3a. Hanna Casswell/Robertson, Loia, Roof
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. 770-674-2600 3c. [e-mail]
Phone Number j E-mail
1. Project is 4 New Modification (of an existing permit) If Modification, Permit No.:
r modifications, attach a separate sheet clearly explaining the reason for the modification (i.e. adding another
ase, changing line size/length, etc.). Only include the modified information in this permit application - do not
Eduplicate 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))
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3.
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
`4a.
4b.
Name of WWTF
WWTF Permit No.
,5a. Red S rin s Public Works
15b. 8"
IReceiving Sewer Size
Gravity
Force Main
5c. unKnown
Owner of Downstream Sewer
Permit Numb4;oYVo re wns am Sewer (if known)
16. The origin of this wastewater is (check all that apply):
ROBERTSON&OIA/ROOF, P. C.
3460 PRESTON RIDGE ROAD, STE 275
ALPHARETTA,GA 30005
WACHOVIA
Wachovia Bank, N.A.
wachovia.com
30822
64-22/610
BRANCH "079
DATE u LY 1007
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FOR
1160308220 406100022742000
2375433811'

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State of North Carolina
Department of Environment and Natural Resources
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/addressed the following list of required application package
items by checking the space provided next to each applicable item. Failure to submit all required items will lead
to your application being returned as incomplete. This form may be photocopied for use as an original.
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).
Application Fee - Submit a check in the amount of $400 made payable to: North Carolina Department
of Environment and Natural Resources (NCDENR). Checks shall be dated within 90 days of application
submittal.
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://h2o.enr.state.nc.us/peres or by contacting the
appropriate regional office.
Vlll. Environmental Assessments — If this project is subject to an Environmental Assessment (EA)
[15A NCAC 01C], this application can not be used. Send the project application on Form
PSFMGSA 10/99 to the PERCS Unit, 1617 Mail Service Center, Raleigh, NC 27699-1617. Applications
can not be accepted 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.
X. Downstream Sewer & Wastewater Treatment Plant Capacity
The applicant has assured downstream pipe, pump station and treatment plant capacity. The addition
of new sources of wastewater from this project has been evaluated along the route to the receiving
treatment plant. 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. If the
applicant is not the owner of the downstream sewer or receiving treatment plant, submittal of flow
acceptance letter(s) indicates that owner has adequate capacity and will not violate G.S. 143-215.67(a).
THE COMPLETED FTA 02103 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
2090 US Highway 70
Avery, Buncombe, Burke, Caldwell,
Swannanoa, North Carolina 28778
Cherokee, Clay, Graham, Haywood,
[phone]
Henderson, Jackson, Macon, Madison,
[phone] Fax
McDowell, Mitchell, Polk, Rutherford,
Swain, Transylvania, Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Harnett,
Fayetteville, North Carolina 28301
Hoke, Montgomery, Moore, Robeson,
[phone]
Richmond, Sampson, Scotland
[phone] Fax

Mooresville Regional Office
610 E. Center Avenue, Suite 301
Alexander, Cabarrus, Catawba,
Mooresville, North Carolina 28115
Cleveland, Gaston, Iredell, Lincoln,
[phone]
Mecklenburg, Rowan, 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,
[phone] Fax
Wake, Warren, Wilson
Washington Regional Office
943 Washington Square Mall
Beaufort, Bertie, Camden, Chowan,
Washington, North Carolina 27889
Craven, Currituck, Dare, Gates, Greene,
[phone]
Hertford, Hyde, Jones, Lenoir, Martin,
[phone] Fax
Pamlico, Pasquotank, Perquimans, Pitt,
Tyrrell, Washington, Wayne
Wilmington Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin,
Wilmington, North Carolina 28405
New Hanover, Onslow, Pender
[phone]
[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, Surry,
[phone] Fax
Watauga, Wilkes, Yadkin
For more information, visit our web site at: http://h2o.enr.state.nc.us/peres/

USE THE TAB KEY TO MOVE FROM FIELD TO FIELD!
Application Number: ��/Qoo3 (to be completed by DWQ) ■� 0
1. Owner.'
1a Town of Red Springs Public Works
Full Legal Name (company, municipality, HOA, utility, etc.)
1b. 6;11 oe F r cr' / Town MoLna 4"
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 4Municipality State/County Private Partnership Corporation Other (specify):
3
1d. 217 South Main Street ,1e. Red Springs
Mailing Address City
1f. North Carolina 1g. 28377
State Zip Code
------ ---- ---- — - ------------- -.._.. -- - — -- ---
- - --- - — ---- -- - --------------- --------------- ------------------ ------------- - ---- �-
1 h. 910-843-5849 1 i. 910-843-4248 1 j. PublicWorksDir reds rin s.or
Telephone Facsimile E-mail
2. Project (Facility) Information:
r2a. Red Springs CVS 2b. Robeson
Brief Project Name (permit will refer to this name) County Where Project is Located
Contact Person:
3. _
3a. Hanna Casswell/Robertson, Loia, Roof
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. 770-674-2600 3c. [e-mail]
Phone Number E-mail
�1. Project is 4 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 size/length, 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 4Public (skip to Item B(3)) Private (go to Item 2(a))
3.
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
4a.
4b.
Name of WWTF
WWTF Permit No.
Red Springs Public Works
8°
Gravity4
5c. unKnown
Permit Number o owns ream Sewer (if known)
i5a.
Owner of Downstream Sewer15b.
Receiving Sewer Size
Force Main
�6. The origin of this wastewater is (check all that apply):
7. Volume of wastewater to be allocated for this particular project: 1,433 gallons per day
*Do not include previously permitted allocations

9. Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2H
.0219(I) 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 supported with actual water or wastewater use data in accordance with 15A
NCAC 2H .0219(I)(3).
11,945 SF store = 1,433 gal/day according to 120 gal/day/1000 SF (T15A: 021-1.0200, p.39)
Calculations = (120 X 11,945)/1000 = 1,433
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches)
Length (feet)
Gravity or Force Main
(use the pull down menu)
8" relocation
353
gravity
ENTER TOTAL LINE LENGTH IN MILES
0.067
11. Summary of Pump Stations to be Permitted (attach additional sheets as necessary)
-- - - - -............ ---- ---- --------- ..._......... ....- ----- -- --- ----- - ----- - - - -- -- -- ----- --------- - -- --- -- -
Location ID Power Reliability Option
(self chosen - as shown on Design Flow Operational Point (1- dual line feed; 2- permanent generator w/ATS; 3-
plans for cross-reference) —(MGD) GPM @ TDH portable generator w/telemetry; 4-wet well storageL
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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 SIN/A
Sedimentation and Erosion Control Plan? 4Yes No N/A
Stormwater? 4Yes No N/A
114. Does this project involve aerial lines or siphons? Check if yes:
15. Does this project have gravity sewer lines designed at minimum slopes?
Be aware that the Division will not accept installed lines more than 10% flatter than the minimum slope. Lines installed outside this tolerance should be
corrected prior to submitting the final engineering certification..

1. Use the Division's guidance document entitled, "DETERMINING STREAM CLASSIFICATIONS FOR FORM FTA 02103
(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:
4A Stream Classification is not needed because all parts of the project are at least 100 feet away from any down slope
waterbody; AND,
_ - -- ----- ----- -------- ----------- ----- - - - — - -- - ---- --- - ------------ - --- -- --- ---- - -- - -----
qA 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 Waterbody Stream Waterbodyap
fo mr cross-reference) Waterbody _ County River Basin Iex _ —Ind _ Classification
j
- -----—...... ---- -- - -
----- - - -- -
-----.---------------------- - ------
--------- - -
i
... - ------------ - ....-._.—._.....-
—----------
Submit the 8.5" x I " COLOR topographic map as required in Instruction VI
regardless of whether a classification is provided!
1. Applicant's Certification:
1, SIGNING OFFICIAL NAME, attest that this application for PROJECT NAME Red Springs CVS
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 civiLppnalties up to $25,000 per violation.
2. Professional Engine 4ertification:
I attest that this application for Red Speings CVS 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 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.
T. maV10- R0he=tse ��.•�SO ofEss%•.;%,�••,�
Professional Engineer Name •
; t
2b. Robertson, Loia, Roof A
Engineering Firm '-
2c. 3460 Preston Ridge Rd Suite 275
Mailing Address
0_7

Alpharetta 2e. GA 2f. 30005
City State Zip
770-674-2600
Telephone

TOWN OF RED SPRINGS
NORTH CAROLINA
June 21, 2007
Ms. Hanna Casswell
Robertson Loia Roof
Architects & Engineers
3460 Preston Ridge Road
Suite 275
Alpharetta, GA 30005
Dear Ms. Casswell:
I am in receipt of your request for information and water supply and sewer flow
acceptance request dated June 15, 2007.
Please be advised by way of this letter the Town does hereby agree to provide an
adequate supply of potable water to a location metered for use by CVS on the new site
located on East Fourth Avenue in the Town of Red Springs. The Town also agrees to
accept for treatment sewer meeting standards set forth in the Red Springs' Sewer Use
Ordinance, not to exceed a daily average flow of 200% of the existing CVS sewer usage.
The Town's wastewater collection system permit number is WQC500083.
The highlighted portions of the application received from you have been completed and
one enclosed for your perusal, along with a copy of the Town's Sewer Use Ordinance.
If I can be of further assistance, please do not hesitate to contact me.
Sincerely,
Billy Joe Farmer
Town Manager
/pc: Mr. Philip Smith
Public Utilities Director
/encl.
219 South Main Street, Red Springs, North Carolina 28377