WQ0032789_Sewer Extension_20090625

�OF W A rF,9 p State of North Carolina
�O G Department of Environment and Natural Resources
Division of Water Quality
o FAST -TRACK APPLICATION
(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 % 20Systems/CollectionSystemApplications. 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 6t13).
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.
NA 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.
NA 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.
FTA 12/07

NA'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.
NA H Environmental Assessments — If this project is subject to an Environmental Assessment (EA) [15A 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.
NA 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, Harnett, 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. http://h2o.enr.state.nc.us/peres/
or contact the Regional Office serving your county.
FTA 12/07

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USE THE TAB KEY TO MOVE FROM FIELD TO FIELD! Application Number:
(to be completed by DWQ)( 78
1.
Owner/Permittee:
1 a.
Town of Dobbins Heights
Full Legal Name (company, municipality, HOA, utility, etc.)
1 b.
Antonio Blue, Mayor
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):
1 d.
PO Box 151 1 e. Hamlet
Mailing Address City
1 f.
North Carolina 1 g. 28345-0151
State Zip Code
1 h.
[phone] 1 i. [phone] 1j. [e-mail]
Telephone Facsimile E-mail
2.
Project (Facility) Information:
2a.
2006 CDBG Sewer Improvements 2b. Richmond I
Brief Project Name (permit will refer to this name) County Where Project is Located
3.
Contact Person: _ -
3a.
Chad Easter, The Wooten Company
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b.
(36) 626-5322 3c. [e-mail]
Phone Number E-mail
1.
Project is ❑ New ® Modification (of an existing permit) If Modification, Permit No.: WQ0032789
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.
----- - - - -- -... ................ ...... ... ---
City of Hamlet
_
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
4a.
City of Hamlet, WWTF 4b. NCO047562 j
Name of WWTF WWTF Permit No.
5a.
_ - -0-inch - - Gravity -- _ _..._...... __...._..... _ ....
5b®
. 1_
Town of Dobbins Heights 5c. 10-inch, WQ0016794
diameter El Force Main
Owner of Downstream Sewer Receiving Sewer Size Permit # of Downstream Sewer (Instruction E)
6.
The origin of this wastewater is (check all that apply):
® Residential Subdivision ElRetail (Stores, shopping centers) 100 %Domestic/Commercial
❑ Apartments/Condominiums ❑ Institution % Industrial (attach
❑ Mobile Home Park ❑ Hospital description.)
❑ School ❑ Church
El Restaurant El Nursing Home (RO: contact your Regional Office
❑ Office El Other (specify): Pretreatment staff)
% 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. WQ0032789
❑ Rehabilitation or replacement of existing sewer with no new flow expected (see 15A NCAC 02T .0303 to determine if a
permit is required)
FTA 12/07

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).
NA
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches) Length (feet) New Gravity or Additional
Force Main
8 400 Gravity
11. Summary of Pump Stations w/ associated Force Mains to be Permitted (attach additional sheets as necessary)
LU
'Pump Station Location ID (self chosen - as shown on plans/map for reference)
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Design Flow i Operational Point' Power Reliability Option
Z (MGD) GPM @TDH - Permanent generator w/ATS; Force Main Size Force Main Length
Q 2 - portable generator w/MTS
V _
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QPump Station Location ID (self chosen - as shown on plans/map for reference)
Design Flow Operational Point' Power Reliability Option
(MGD) GPM @TDH 1 - Permanent generator w/ATS; Force Main Size Force Main Length
Q 2 - portable generator w/MTS
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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 2"d treatment facility
;RO — if "yes" to 6,12 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
FTA 12/07

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
1. Owner/Permittee's Certification: (Signature of Signing Official and Project Name)
1, Antonio Blue, attest that this application for Town of Dobbins Heights, 2006 CDBG Sewer 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 per violation.
.1 a. /� c
igning 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
CI) TO OTHER UTILITIES, DESIGN CALCULATIONS. ETC. REFER TO 15A NCAC 02T .0305
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Q2. Professional Engineer's Certification: (Signature of Design Engineer and Project Name)
V 1, John C. Grey, PE, attest that this application for Town of Dobbins Heights, 2006 CDBG Sewer Improvements has been
LL 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
W for Gravity Sewers adopted February 12, 1996, and the Minimum Design Criteria for the Fast -Track Permitting of Pump
0 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 1 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. John C. Grey, PE st°aef°+aes
Professional Engineer Name CARS{'�ye9
2b. The Wooten Company a•�• E S •
Engineering Firm '
2c. 350 N Cox St, Ste 26 807
Mailing Address }
2d. Asheboro 2e. NC 2f. 27203
••!•1F�t�- �S
City State Zip
2g. [phone] 2h. [phone] 2i. [e-mail]'
Telephone Facsimile E-mail NC PE Seal, Signature & Date
FTA 12/07

Permit Number WQ0032789 j1 1
Central Files: APS SWP
07/09/09
Permit Tracking Slip
Program Category
Status
Project Type
Non -discharge
Active
Major modification
Permit Type Fast Track
Version
Permit Classification
Gravity Sewer Extension, Pump Stations, & Pressure Sewer
1.20
Individual
Extensions
Primary Reviewer
Permit Contact
Affiliation
trent.allen
Coastal SW Rule
Permitted Flow
12900
Facility
Facility Name
2006 CDBG Sewer Improvements
Location Address
Owner
Major/Minor Region
Major Fayetteville
County
Richmond
Facility Contact Affiliation
Owner Name Owner Type
Town of Dobbins Heights Government - Municipal
Owner Affiliation
Antonio Blue
Mayor
PO Box 151
Hamlet NC 28345
Scheduled
Orig Issue App Received Draft Initiated Issuance
03/17/08 07/09/09
Reaulated Activities
Subdivision
Wastewater collection
Outfall
Public Notice Issue Effective Expiration
07/09/09 07/09/09
Reauested/Received Events
Additional information received
Additional information requested
Waterbody Name Stream Index Number Current Class Subbasin

June 24, 2009
NC DENR
THE Division of Water Quality
225 Green Street Suite 714
WOnOTEnN Fayetteville NC 28301
COMPANY PAI VY Subject: Fast Track Application
Town of Dobbins Heights
E N G I N E E R I N G 2006 CDBG Sewer Improvements - Rose Street
TWC No.: 2681-V
PLANNING
Gentleman:
ARCHITECTURE
On behalf of the Town of Dobbins Heights, The Wooten Company is submitting a Fast
Track Application for a gravity sewer lines extension. Form FTSE 10/07 from the City of
Hamlet was submitted on 10/25/08. Since no increase in flow is requested that form is
still applicable. The following documents are enclosed:
1. Application Forms, one original and one copy
2. Application fee, check for $480.00
3. Map of the Project Area
4. Project Narrative, located in the following paragraph of this letter
Narrative:
The currently permitted (Permit No. WQ0032789) Town of Dobbins Heights 2006
CDBG Sewer Improvements Project proposes to provide public sanitary sewer service
to existing residential areas within the Town's corporate limits. All existing homes to
be served by the project are currently served by individual septic systems. Within the
Pump Station No. 2 service area approximately 23 existing homes will served by the
project. Ultimately the service area can include an additional 42 lots and about 20
acres of undeveloped land. Within the Pump Station No. 3 service area approximately
20 existing homes will be served by the project. Ultimately the service area can
include an additional 27 lots and about 42 acres of undeveloped land. In October of
2008 the permit was revised to include additional improvements to provide public
sanitary sewer service to another 53 existing homes currently served by individual
septic systems, and one church that has a kitchen and a seating capacity of 125. All
total, service to 96 homes and one church have been permitted (totaling 97), but only
91 service connections, including the church were installed. The 400 linear feet of 8-
inch gravity included in this revision will serve 6 existing homes, therefore we are not
requesting additional flow in this permit.
Should you have any questions, please give me a call at [phone].
Sincerely,
THE WOOTEN COMPANY
350 North Cox Street Suite 26
Asheboro NC 27203 John C. Grey, PE
/aik
336.626.5322 Enclosures
fax [phone] cc: Antonio Blue, Mayor

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USE THE TAB KEY TO MOVE FROM FIELD TO FIELD! Application Number:
(to be completed by DWQ)
1.
Owner/Permittee:
1a.
Town of Dobbins Heights
Full Legal Name (company, municipality, HOA, utility, etc.)
1 b.
_ _ _ _- .......
Antonio Blue, Mayor
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: I
❑ Individual ❑ Federal ® Municipality ❑ State/County ❑ Private Partnership ❑ Corporation ❑ Other (speclfy�_
1d.
PO Box 151 1e. Hamlet
Mailing Address City
:1 f.
.. . --_..—_..... __;
North Carolina 1g. 28345-0151
State Zip Code
1 h.
..-..--
[phone] 1 i. [phone] 1j. [e-mail] y
Telephone Facsimile E-mail
2.
— ------ _ —--------- ..— -- ....... _....
Proiect (Facility) Information:
2a.
2006 CDBG Sewer Improvements 2b. Richmond
Brief Project Name (permit will refer to this name) I County Where Project is Located
3.
Contact Person:
---
3a.
-- --- ..... — - --- - ---- -
Chad Easter, The Wooten Company j
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b.
[phone] 33c. [e-mail]
Phone Number E-mail
.1.
Project is ❑ New ® Modification (of an existing permit) If Modification, Permit No.: W00032789 j
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 i ❑ Public Utility (Instruction C)
❑ Leasing units (lots, townhomes, etc. skip to Item B(3)) I ❑ Homeowner Assoc./Developer (Instruction D)
❑ Selling units (lots, townhomes, etc. - go to Item B(2b))
3.
City of Hamlet
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
4a.
City of Hamlet, WWTF i4b. NCO047562
Name of WWTF WWTF Permit No.
5a.
5b 10 Inch ® Gravity
Town Dobbins Heights
of diameter �❑ Force Main 5c. 10-inch, W00016794
w nwner of nnnstraam gawar n o......... c:_� I Qo it -H of rin,ernofr — Qou 11, +­ -+;-- MN
CENTURA HANK 4 2 g 6
TOWN OF DOBBINS HEIGHTS HAMLET, NC 28345
ILI 66-85/53I
P.0_ BOX 151 CHECK NO.
HAMLET, N.C. 28345
14296
Four Hundred Eighty Dollars and 00 Cents
06/18/2009 $480.00
PROVISIONS FOR THE PAYMENT OF THIS WARRANT FOR ORDER)
HAS BEEN MADE BY AN APPROPRtATION DULY MADE OR A BOND OR c
T E NCDENR NOTE DULY AUTHORIZED, AS REQUIRED BY'LOCA!_ GOVERNMENT
BUDG DFISCAL CONTROL AGr
on°Fn WATER QUALITY SECTION ��j' E1
P O BOX 29534 -= _:e--
RALEIGH NC 27626-0534
_ - --
- AUTHORIZED SI 'NAT NIP
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TOWN OF DOBBINS HEIGHTS
pate Inv No.\Desc.
06/18/2009 TWC #2681-V/ROSE ST PERMIT
Check - 14296 06/18/2009
P.O. No. Amt
480.00
Total Amt: 480.00
14296
Amt 14296
50.00
Check - 14296 06/18/2009 Total Amt: 480.00
r
CENTURA BANK 14296
HAMLET, NC 28345
TOWN OF DOBBINS HEIGHTS
P.O. BOX 151
HAMLET, N.C. 28345
Four Hundred EG, hi3 Dollars and 00 Cents
Lw
TO NCDENR
ORDER WATER QUALITY SECTION
OF
P O BOX 29534
RALEIGH NC 27626-0534
66-85/531
CHECK NO.
14296 0
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06/18/2009 $480.00
PROVISIONS FOR THE PAYMENT OF THIS WARRANT (OR ORDER) `
HAS BEEN MADE BY AN APPROPRIATION DULY MADE OR A BOND OR
NOTE DULY AUTHORIZED, AS REQUIRED BY `LOCAL GOVERNMENT -
BUDG D FISCAL CONTROLL ACT'
AUTHORIZED S11 NAT ryP
001L,29611' j:0S31008S0i:083000S2491''