WQ0031583_Application_20110709

USE THE TAB KEY TO MOVE FROM FIELD TO FIELD!
__ _
Application Number: ——
(to be completed by DWQ)
1.
Owner/Permittee:
1a.
City of Clinton
Full Legal Name (company, municipality, HOA, utility, etc.)
Z
1b.
John Connet, City Manager
H
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):
IX
i
0
1d.
221 Lisbon Street
le. Clinton
LL
Mailing Address
City
Z
1f.
North Carolina
1g. 28329
Z
State
Zip Code
1 h. [phone] 1 i. [phone]
1 j. [e-mail]
Q
Telephone Facsimile
E-mail
2.
Project (Facility) Information:
J
2a.
Clinton - Pugh Road Water & Sewer Improvements
2b. Sampson
C-
Brief Project Name (permit will refer to this name)
County Where Project is Located
a
Q
3.
Contact Person:
Q
3a.
Jeff Vreugdenhil, Public Works & Utilities Director
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b.
[phone] ext 3052
3c. [e-mail]
Phone Number
E-mail
1.
Project is ❑ New ® Modification (of an existing permit) If Modification, Permit No.: W00031583
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 Clinton
Z Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
4a. Larkins Water Pollution Control Facility 4b. NCO020117
~ Name of WWTF WWTF Permit No.
5a. City of Clinton 5b. 8" ® Gravity ,5c. W00031583
Owner of Downstream Sewer Receiving Sewer Size ❑ Force Main Permit # of Downstream Sewer (Instruction E)
49376
WITHERS & RAVENEL, INC.BW
111 MACKENAN DRIVE NORTH CAROLINA
CARY, NC 27511 66-112-531
CHECK DATE June 8, 2011
C
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a
PAY Four Hundred Eighty and 00/100 Dollars
AMOUNT $480.00 �
TO NC Department of Environmental & Natural Resources 8
1628 Mail Service Center
Raleigh NC 27699-1617
AUTHORIZ ATURE

0
�0F W A TF,QpG ccpp//�� State of North Carolina
DENR-1—RO Department of Environment and Natural Resources
v DivisionQuality
JUN 0 9 2011 of Water
o c FAST -TRACK APPLICATION
DWQ (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 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-10107 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

❑ 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) [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.
❑ 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 13(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

USE THE TAB KEY TO MOVE FROM FIELD TO FIELD! —
Application Number:
(to be completed by DWQ) ((� _—_-
1.
Owner/Permittee:
1a.
City of Clinton
Full Legal Name (company, municipality, HOA, utility, etc.)
Z
1 b.
John Connet, City Manager
H
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
1d.
221 Lisbon Street
le. Clinton
LL
Mailing Address
City
Z
1f.
-
North Carolina
1g. 28329
Z
State
Zip Code
0
1h. [phone] 1i. [phone]
1j. [e-mail]
Telephone Facsimile
E-mail
V2.
Project (Facility) Information:
Zi
2a.
Clinton — Pugh Road Water & Sewer Improvements
2b. Sampson
Brief Project Name (permit will refer to this name)
County Where Project is Located
a
Q
3.
Contact Person:
Q
3a.
Jeff Vreugdenhil, Public Works & Utilities Director
Name and Affiliation of Someone Who Can Answer Questions About
this Application
3b.
[phone] ext 3052
3c. [e-mail]
Phone Number
E-mail
1.
Project is ❑ New ® Modification (of an existing permit) If Modification, Permit No.: W00031583
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))
0
H
Q
0
U.
Z
H
LLI
a
Ti
3. City of Clinton
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
4a. Larkins Water Pollution Control Facility 4b. NCO020117
Name of WWTF WWTF Permit No.
5a. City of Clinton 5b. 8" '® Gravity 15c. W00031583
Owner of Downstream Sewer 'Receiving Sewer Size ❑ Force Main Permit # of Downstream Sewer (Instruction E)
6. The origin of this wastewater is (check all that apply):
® Residential Subdivision
❑ Apartments/Condominiums
❑ Mobile Home Park
❑ School
❑ Restaurant
❑ Office
❑ Retail (Stores, shopping centers)
❑ Institution
❑ Hospital
❑ Church
❑ Nursing Home
❑ Other (specify): Commercial
100 % Domestic/Commercial
% Industrial (attach
description.)
(RO: contact your Regional Office
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. W00031583
❑ 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 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).
Additional sewer services due to sewer extension = 5 residential connections to be included within pump station allocated ADF
flow of 103,650 gpd permitted in W00031583.
* Volume of wastewater to be tributary to this sewer extension = 5 houses * 360 gallons per day / connection = 1,800 gpd
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches) Length (feet) New Gravity or Additional
Force Main
8" Gravity Line 682 Gravity
0 11. Summary of Pump Stations w/ associated Force Mains to be Permitted (attach additional sheets as necessary)
LU
0
Pump Station Location ID
(self chosen - as shown on plans/map for reference)
Z
H
Design Flow
Operational Point
Power Reliability Option
Z
(MGD)
GPM @TDH
1 - permanent generator w/ATS; Force Main Size Force Main Length
0
2 - portable generator w/MTS
U
Z
0
aPump
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
0
2 - portable generator w/MTS
LL
Z
H
Pump Station Location ID
(self chosen - as shown on plans/map for reference)
LU
a
Design Flow
Operational Point
Power Reliability Option
(MGD)
GPM @TDH
1 -permanent generator w/ATS; Force Main Size Force Main Length
m
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 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?
i
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, John Connet attest that this application for Clinton — Pugh Road Water & Sewer Improvements has been reviewed by
me and is accurate and complete to the best of my knowledge. 1 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
pejuad.ties up to $25, 000 per viola gn.
1 a. C
Signing icial 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,
(j) TO OTHER UTILITIES, DESIGN CALCULATIONS. ETC. REFER TO 15A NCAC 02T .0305
0
Q2. Professional Engineer's Certification: (Signature of Design Engineer and Project Name)
V_ 1, David A. McClure attest that this application for Clinton — Pugh Road Water & Sewer Improvements has been reviewed
LL by me and is accurate, complete and consistent with the information in the engineering plans, calculations, and all other
F= supporting documentation to the best of my knowledge. I further attest that to the best of my knowledge the proposed
IX design has been prepared in accordance with the applicable regulations, Gravity Sewer Minimum Design Criteria for
W 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. David A. McClure, RE
Professional Engineer Name
2b. Withers & Ravenel
Engineering Firm
2c. 111 MacKenan Drive
Mailing Address
2e. NC 2f. 27511
City
2g. [phone] 2h. [phone] 2i
Telephone Facsimile
State Zip ''% 'q ' I**"* \3�� o`McCVer
[e-mail] ��
E-mail NC PE Seal, Signature & Date
FTA 12/07

e
PAY
TO
WITHERS & RAVENEL, INC.
111 MACKENAN DRIVE
CARY, NC 27511
Four Hundred Eighty and 00/100 Dollars
49376
BBf�
NORTH CAROLINA
66-112-531
CHECK DATE June 8, 2011
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AMOUNT $480.00
NC Department of Environmental & Natural Resources 8
kjwved�— -
kurHoFvzt6mdkATURE
1628 Mail Service Center
Raleigh NC 27699-1617

WITHERS & RAVENEL, INC.
49376
Invoice Number
Date
Voucher
Amount
Discounts
Previous Pay
Net Amount
02061155.07 6/8/11
6/8/11
0061243
480.00
0.00
0.00
480.00
NC Department of Environmental &
Natural Resources Totals
480.00
0.00
0.00
480.00
BBT-CHECK 2 NCDENR
-
s
jut, 09 2011

Clinton North - Clinton South
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State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
Flow Tracking/Acceptance for Sewer Extension Permit Applications
(FTSE—10/07)
Project Applicant Name: City of Clinton
Project Name for which flow is being requested: _Pugh Road Water & Sewer Improvements
More than one FTSE-10/07 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: _Larkins Water Pollution Control Facility
b. WWTP Facility Permit #: NC0020117
All flows are in MGD
c. WWTP facility's permitted flow S.0
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow 2.53
f. Total flow for this specific request 0
g. Total actual and obligated flows to the facility 2 S 3 .
h. Percent of permitted flow used S'o. 6
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
Pump Station Name Approx. Capacity, MGD Approx. Current Avg.
(Firm/Design) Daily Flow, MGD
Clinton PUD PS ADF, 0.103 m d 0. UO + 7 �3
III. Certification Statemgnt:
F. � n e V , certify that, to the best of my knowledge, 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. 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 for which I am the responsible party. Signature of this form indicates
ace'eStunce of this-wastew&ter flout.--, —
Official
Date

Instructions for: Flow Tracking/Acceptance for Sewer Extension Permit
Applications (FTSE—10/07)
Section I
a. WWTP Facility Name: Enter the name of the WWTP that will receive the wastewater flow.
b. WWTP Facility Permit #: Enter the NPDES or Non -Discharge number for the WWTP receiving the
wastewater flow.
c. WWTP facility's permitted flow, MGD: From WWTP owner's NPDES or Non -Discharge permit.
d. Estimated obligated flow not yet tributary to the WWTP, MGD: This includes flows allocated to
other construction projects not yet contributing flow to the collection system. Flows allocated through
interlocal agreements or other contracts not yet contributing flow to the collection system are also
included. For POTWs that implement a pretreatment program, include flows allocated to industrial
users who may not be using all of their flow allocation. Please contact your Pretreatment Coordinator
for information on industrial flow tributary to your WWTP.
As of January 15, 2008 the POTW should have reviewed flow allocations made over the last two
years and reconciled their flow records, to the best of their ability, so it is known how much flow has
been obligated and is not yet been made tributary to the WWTP, in accordance with local policies and
procedures employed by the reporting entity.
The obligated flow not yet tributary plus actual flow will be reconciled annually for systems at less
than 60% of permitted flow used. Annual updates shall be submitted to the appropriate Regional
Office by January 15 of each year and cover the previous calendar year.
Semi -Annual updates shall be required when the percent of permitted flow used reaches 60%. Semi-
annual time period are defined as January 1 through June 30 and July 1 through December 31. Semi-
annual updates shall be submitted to the appropriate Regional Office by July 15 and January 15 of
each year.
Quarterly updates shall be required when the percent of permitted flow used reaches 80%. Quarters
are defined as Qtrl (Jan -Feb -Mar); Qtr2 (Apr -May -Jun); Qtr3 (Jul -Aug -Sep); Qtr4 (Oct -Nov -Dec).
Quarterly updates shall be submitted to the appropriate Regional Office by April 15, July 15, October
15 and January 15 of each year.
e. WWTP facility's actual avg. flow, MGD: Previous 12 month average.
f. Total flow for this specific request, MGD: Enter the requested flow volume.
g. Total actual and obligated flows to the facility, MGD Equals [d + e + f]
h. Percent of permitted flow used: Equals [(g / c)* 100]

For example:
On January 15 a POTW with a permitted flow of 6.0 MGD, reported to the Regional Office that there
is 0.5 MGD of flow that is obligated but not yet tributary. The annual average flow for 2007 is 2.7
MGD.
The first Form FTSE-10/07 submitted after January 15, 2008 may have numbers like this:
c. = 6.0 MGD
d. = 0.5 MGD
e. = 2.7 MGD
f. = 0.015 MGD
g. = 3.215 MGD
h. = 53.6 %
The next Form FTSE-10/07 may be updated like this:
c. = 6.0 MGD
d. = 0.515 MGD
e. = 2.73 MGD
f. = 0.102 MGD
g. = 3.349 MGD
h. = 55.8 %
Each subsequent Form FTSE-10/07 will be updated in the same manner.
Section II
List the name, approximate pump station firm (design) capacity and approximate current average flow
(previous 12 months) through the pump station for each pump station that will be impacted by the
proposed sewer extension project. Include the proposed flow for this project and other flows that have
been approved for the pump station but are not yet tributary.
Firm (design) capacity is the design average daily flow of the pump station as calculated by the design
engineer or the station capacity with the largest pump out of service as per the Minimum Design Criteria
if the design capacity is unknown.
Section III
Form FTSE-10/07 must be signed by the appropriate official as per 15A NCAC 02T .0106.

WITHERS .& RAVENEL
ENGINEERS I PLANNERS I SURVEYORS
iii MacKenan Drive
CARY, NORTH CAROLINA, 27511
[phone]
FAX [phone]
TO: NCDENR
DWQ Fayetteville Regional Office
225 Green Street Suite 714
Fayetteville, North Carolina 28301-5094
WE ARE SENDING YOU
❑ Shop Drawings
❑ Copy of Letter
® Attached
❑ Prints
❑ Change order
DATE 06/08/2011
108 NO. 02o611 .07
ATTENTION
PHONE#
10) 33-3300
RE: Pugh Road Water & Sewer Improvements
❑ Under separate cover via
❑ Plans ❑ Samples
❑ Diskette ❑
the following items:
❑ Specifications
COPIES
DATE
NO.
DESCRIPTION
2
06/08/2O11
1
Application Form
2
06/08/2011
2
FTSE-1O/07
2
06/08/2O11
3
Ma
1
06/08/2O11
4
Check
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 20 ❑ PRINTS RETURNED AFTER LOAN TO US
REMARKS:
❑ Resubmit
❑ Submit
❑ Return
copies for approval
copies for distribution
corrected prints
Please find attached a Fast Track Sewer Permit Application for the above referenced project. If you have
any questions or concerns please call me at the above number.
COPY TO: Jeff Vreugdenhil SIGNED: David A. McClure
If enclosures are not as noted, kindly notify as at once.