WQ0033688_Sewer Extension_20081212

USE THE TAB KEY TO MOVE FROM FIELD TO FIELD! Application Number:
(to be completed by DWQ)
1.
Owner/Permittee:
1 a.
Town of Maxton
Full Legal Name (company, municipality, HOA, utility, etc.)
1 b.
Katrina Y. Tatum, Town Manager
0
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):
0
1 d.
201 McCaskill Ave. 1 e. Maxton
U_
Mailing Address City
Z
1f.
NC 1g. 28364-1827
Z
State Zip Code
0
1 h.
[phone] 1 i. [phone] 1j. ktatum ci.maxton.nc.us
QTelephone
Facsimile E-mail
V
2.
Project (Facility) Information: j
_ _
2a.
2008 CDBG Sewer & Street Improvements 2b. Robeson
1J
0-
Brief Project Name (permit will refer to this name) County Where Project is Located
Q3.
Contact Person: -i
3a.
Chad Easter, The Wooten Company
Q
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 C)
❑ Leasing units (lots, townhomes, etc. - skip to Item B(3)) ❑ Homeowner Assoc./Developer (Instruction D)
❑ Selling units (lots, townhomes, etc. - go to Item B(2b))
3.
Town of Maxton
Z
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
_
4a.
Maxton Wastewater Treatment Plant 4b. NCO027120
QName
of WWTF WWTF Permit No.
5a.
Town of Maxton 15b. 8-inch I® Gravity 15C. Unknown
Owner of Downstream Sewer !Receiving Sewer Size ❑ Force Main Permit # of Downstream Sewer (Instruction E)
0
6.
The origin of this wastewater is (check all that apply):
one yc
TOWN OF MAXTON
201 McCASKILL AVE., MAXTON, NC 28364
W
This disbursement has been approved as required by the
Local Government Budget and Fiscal Control Act."
c, fr Hundred
Eighty Dollars and 00 Cents
LUMBEE GUARANTY BANK
PEMBROKE, NORTH CAROLINA
66-368/531
DATE
NCDENR 12/05/2008
ITHE DIVISION OF WATER QUALITY
IDER 1617 MAIL SERVICE CENTER
RALIEGH NC 27699-1617
n'n c a 1 n a r ❑ 3• n c 3nnn c a l is
23091
CHECK NO.
23091 0
0
AMOUNT
$480, 00
U
GENERALkUND �NN.
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AUTHORIZE IGNATURE NP .
— t ` ,L
J' AUTHORIZED s1NATURE W

Central Files: APS SWP
12/19/08
Permit Number WQ0033688
Permit Tracking Slip
Program Category
Status
Project Type
Non -discharge
Active
New Project
Permit Type Fast l rack
Version
Permit Classification
Gravity Sewer Extension, Pump Stations, & Pressure Sewer
1.00
Individual
Extensions
Primary Reviewer
Permit Contact
Affiliation
trent.allen
Permitted Flow
0
Facility
Facility Name
2008 CDBG Sewer & Street Improvements
Location Address
Owner Name
Town of Maxton
Major/Minor Region
Major Fayetteville
County
Robeson
Facility Contact Affiliation
Owner Type
Government - Municipal
Owner Affiliation
Katrina Tatum
201 Maccaskill Ave
Maxton
NC 283641827
Dates/Events
Scheduled
Orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
12/19/08 12/12/08 12/19/08 12/19/08
Regulated Activities Requested/Received Events
Wastewater collection Additional information received
Additional information requested
Outfall NULL
Waterbody Name Stream Index Number Current Class Subbasin

•CF WATF DENR'r�'`' State of North Carolina
�O� QG 2 ZQQ$ Department of Environment and Natural Resources
> r E� Division of Water Quality
o �
q�r FAST -TRACK APPLICATION
G (FTA 12/07 )
for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
(Pressure & Vacuum sewer 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. Forms are available from the web site or by calling the Regional Office serving your county:
http.//h2o. enr. state. nc. us/peres/Collection % 20SystemsICollectionSystemApplications. html
® A. Application Form - Submit one original and one copy of the completed and appropriately executed application
form. The application should include a project narrative describing the final build -out 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.). Only
include the modified information in this permit application - do not duplicate project information that has already
been included in the original permit.
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(13)
Separate applications should be made for non-contiguous sewer systems.
® B. Application Fee - Submit a check in the amount of $480 made payable to: North Carolina Department of
Environment and Natural Resources (NCDENR). Checks shall be dated within 90 days of application submittal.
❑ C. 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(2)a of this application.
❑ D. Operational Agreements — Submit one original and two copies of a properly executed operational agreement, as
per 15A NCAC 02T .0115, if the application is submitted 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 home or property owner's association, use Form HOA 02/03. If the applicant is a developer,
use Form DEV 02/03. EVEN IF THE PROJECT MAY BE TURNED OVER TO A MUNICIPALITY UPON
COMPLETION, FORM DEV 02/03 IS REQUIRED.
® E. Downstream Sewer, WWTF Capacity and Flow Tracking/Acceptance — FORM FTSE 10/07 (Flow
Tracking/Acceptance for Sewer Extension Permit Applications) is required with every application. The applicant
(and owners of downstream sewers, pump stations and/or treatment facilities submitting FORM FTSE-10/07)
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 10/07
from the owner of the downstream sewer and owner of the WWTF, if different. The flow acceptance indicated in
FORM FTSE-10/07 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-10/07 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 project -specific FTSE 10/07.
® F Map — Submit an 8.5-inch by 11-inch COLOR copy of a USGS Topographic Map of sufficient scale to identify the
entire project area and the closest surface waters. Each map or maps must show the location of the sewer line
and pump stations and be of reproducible quality. Include a street level map showing the downstream connection
point, and the permit number for the downstream sewer, if known.
FTA12/07

❑ ,G.. Stream Classifications — Watershed Classification Attachment (Form WACAS-12/07) If any portion of the
project boundary is within 100 feet of any surface water or wetlands, the Watershed Classification Attachment
must be completed.
❑ H Environmental Assessments — If this project is subject to an Environmental Assessment (EA) 115A NCAC
01C], this application cannot be used. Send the project application on the most current version of Form
PSFMGSA to the Design Management Unit, 1633 Mail Service Center, Raleigh, NC 27699-1633. Applications
cannot 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.
❑ I. 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 this project, please indicate in B(12) and give the permit
number of the second treatment facility.
® J. 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(lb). 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 Fast -Track
Permitting of Pump Stations and Force Mains (most recent version), as applicable to the project.
THE COMPLETED FTA 12/07 APPLICATION PACKAGE, INCLUDING ALL SUPPORTING
DOCUMENTS AND $480.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, 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, Hamett, Hoke,
Fayetteville, North Carolina 28301-5094
Montgomery, Moore, Robeson, Richmond,
[phone]
Sampson, Scotland
[phone] Fax
Mooresville Regional Office
610 E. Center Avenue
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
For more information, please visit our web site at. htta://h2o.enr.state.nc.us/peres/
or contact the Regional Office serving your county.
FTA12/07

■a&Aw w--
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD! Application Number: UIUSS MW
(to be completed by DWQ)
- -- . .... -- - ---
1.
Owner/Permittee:
la.
Town of Maxton -
Full Legal Name (company, municipality, HOA, utility, etc.)
Z
1 b.
Katrina Y. Tatum, Town Manager
0
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):
O
1d.
201 McCaskill Ave. 1e. Maxton
U.
Mailing Address City
Z
1f.
NC 1g. 28364-1827
Z
State Zip Code
0
1h.
[phone] 1i. [phone] 1j. ktatum ci.maxton.nc.us
QTelephone
Facsimile E-mail
V
2.
Pro/ect (Facility) Information:
..J
2a.
2008 CDBG Sewer & Street Improvements 2b. Robeson
0-
Brief Project Name (permit will refer to this name) County Where Project is Located
a
3.
Contact Person:
Q3a.
Chad Easter, The Wooten Company
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 C)
❑ Leasing units (lots, townhomes, etc. - skip to Item B(3)) ❑ Homeowner Assoc./Developer (Instruction D)
❑ Selling units (lots, townhomes, etc. - go to Item B(2b))
3.
Town of Maxton
ZZ
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
_
4a.
Maxton Wastewater Treatment Plant 4b. NCO027120
QName
of WWTF WWTF Permit No.
5a.
Town of Maxton b. 8-inch ® Gravity 5c. Unknown j
Owner of Downstream Sewer Receiving Sewer Size ❑Force Main Permit # of Downstream Sewer (Instruction E) j
0
0
6.
The origin of this wastewater is _(check all that apply):
-f
Z
�
100 % Domestic/Commercial
®Residential Subdivision El Retail (Stores, shopping centers)
❑ Apartments/Condominiums ❑ Institution % Industrial (attach
❑ Mobile Home Park ❑ Hospital i description.)
'
L11
❑School ❑ Church
(RO: contact your Regional Office
❑ Restaurant El Nursing Home
C'
❑ Office ❑ Other (specify): I Pretreatment staff)
m
% Other (specify):
7.
Volume of wastewater to be allocated or permitted for this particular project: 0 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 j
permit is required)
i
FTA 12/07

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9. Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2T .0114 for
the value in Item B(7) AND/OR the design flow for line or pump station sizing if a reduced or zero flow is being requested in
Item B(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).
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches)
8-inch
4-inch
Length (feet)
825
412
New Gravity or Additional
Force Main
Gravity
Force Main
11. Summary of Pump Stations w/ associated Force Mains to be Permitted (attach additional sheets as necessary)
......__.._._.
Pump Station Location ID
Design Flow
(MGD)
Pump Station Location ID
Design Flow
(MGD)
(self chosen - as shown on plans/map for reference)
Operational Point Power Reliability Option
GPM @TDH 1 -permanent generator w/ATS; Force Main Size Force Main Length
2 - portable generator w/MTS
(self chosen - as shown on plans/map for reference)
Operational Point Power Reliability Option
GPM @TDH 1 - permanent generator w/ATS; Force Main Size Force Main Length
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 B,12 please contact the Central Office PERCS Unit)
13. 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 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
FTA12/07

, , 14. Have the following permits/certifications been submitted for approval for the system or project to be served?
Wetland/Stream Crossings - General Permit or 401 Certification? ❑ Yes ❑ No ® N/A
Sedimentation and Erosion Control Plan? ❑ Yes [:]No ® N/A
Stormwater?
❑ Yes ❑ No ® N/A
15. Does this project include any high priority lines, [see 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
Owner/Permittee's Certification: (Signature of Signing Official and Project Name)
1, Katrina Y. Tatum attest that this application for 2008 CDBG Sewer & Street Improvements 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 perviolatiov,--.
1 a. cauL­a LLT 1� % �
Signir(g Official Signature Date
ENGINEERING DESIGN DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL OF THIS
APPLICATION. THESE DOCUMENTS MUST INCLUDE PLAN AND PROFILE OF SEWERS, THEIR PROXIMITY
Cn TO OTHER UTILITIES, DESIGN CALCULATIONS. ETC. REFER TO 15A NCAC 02T .0305
Z
O
2. Professional Engineer's Certification: (Signature of Design Engineer and Project Name)
V1, Chad D. Easter, attest that this application for 2008 CDBG Sewer & Street Improvements has been reviewed by me and
LL 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
lJ.l adopted February 12, 1996, and the Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force
V 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
(j 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. Chad D. Easter
Professional Engineer Name
2b. The Wooten Company
Engineering Firm
2c. 350 N Cox St, Ste 26
Mailing Address
2d. Asheboro
City
2g. [phone] 2h. [phone]
Telephone Facsimile
2e. NC 2f. 27203
State Zip
2i. ceaster@
thewootencompany.com
E-mail
o_ SEAL
03 431!�%r/�z� i
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NC PE Seal, Signature & Date
FTA 12/07

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