WQ0024860_Application_20050207

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 3
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD!
Application Number:
(to be completed by DWQ)
11
Owner:
_
i1 a.
-- --
own Newton Grove
------ —'--- -,
Full Legal Name (company, municipality, HOA, utility, etc.)
---
ra ar en lfayor
Z
1 b.
e (�
Signing Official Name and Title (Please review 15A NCAC 2H .0206(b) for authorized signing officials!)
H '
1 c.
The legal entity who will own this system is:
Q
❑ Individual ❑ Federal} Municipality ❑ State/County El
Private Private Partnership❑ Corporation ❑the Or(specify):
z
_
_ ..__... .__ _..._)'--_...... .
1d.
304 Weeksdale Street
le. Newton Grove
LL '
Street Address
City
Z
1f
North Carolina
1g. 28366
Z .'V "`
State
Zip Code
Q
1 h.
910-594-0827 1;, 190-594-0827
1j. NA
Telephone Facsimile
E-mail
V
j2_
Project (Facility) Information:
G.
a.
o r — w e V'c % r S �� C b. Sams n
Briet Project Name (permit will refer to this name)
County Where Project is Located
Q '.3
- — _
Contact Person_:
Q
Tew (Project �p iA
L
j3a.--Glenn
Name and Affiliation of Someone Who Can Answer Questions About this Application
f
b.
_ _
C.
Phone Number
-mail
Y ,
TAYLOR-MADE PROPERTIES, LLC 07-99 1096
PH. 252-492-0181
P.O. BOX 137
136 PARTIN ST. `
HENDERSON, NC 27536 DATE / ' ss Is/53o NC
3901
PAY
/UC 13 ,� I $ADD /xu
TO HE
ORDER OF
DOLLARS B
Bankof America.
J.
FOR A

I IIV UI iynl uI t1 110 waatcrvatVI w k%A10t n au uIat
❑ Residential Subdivision
❑ Apartments/Condominiums
❑ Mobile Home Park
❑ School
❑ Restaurant
❑ Office
❑ Car Wash
❑ Institution
❑ Hospital
❑ Church
❑ Nursing Home
© Other (specify): _ Service
Volume of wastewater to be permitted in this project: 7-Q> gallons per day
8. If the permitted flow is zero, indicate why:
i ❑ Interceptor Line - Flow will be permitted is 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
% Domestic/Commercial
% Industrial
% Other (specify):
T-rA 09r01 - R ev 9 04m4

;FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 3
j_._..._.... - 7-........ - ----- - .-...... _-....- ._...---------.._.._..._ .._.._....... --...... -............ -...._-----..._..-_-..._...APplication Number: /_.•-,_.._......._.._...... ............. - ... _...r�
E USE THE TAB KEY TO MOVE FROM FIELD TO FIELD! (to be completed by DWQ) ICJ )6 afro
"" 1. Owner:
11 I1 a Town of Newton Grove ----- -- -- - -—__—_.-�-�
A - Full Legal Name (company, municipality, HOA, utility, etc.)- - �- _--_ ----
1 b. Geraldar en Mayor -
i Signing Official Name and Title (Please review 15A NCAC 2H .0206(b) for authorized signing officials!)
- _...--- --.._.........._._..._.......... _._._..._.. .-_. .. --.........._.._.._..__.._....._.._.._..........._....__._._..._....__.._
Q ;:1 c. The legal entity who will own this system is:
❑ Individual ❑ FederalE5 Municipality ❑ State/County ❑ Private Partnership ❑ Corporation ❑ Other (specify)
_..__.._._...............__..._.__._...._..... ___._ ..... {
:1d. 304 Weeksdale Street 1e. Newton Grove
Street Address City
..-.... _...... ... ....... -... _._........._................... . _ ....._..__......_ .._........................- . _......... ....... _._........ _.._ ...... ._...._.._..-- - - _.._..__.._...---..._..._._...._.... _._.._.... _ .......... __.._.............................. ---... ......
1f. North Carolina 1g. 28366
Z State Zip Code
1h. 910-594-0827 1; 190-594-0827 1j- NA
Telephone Facsimile E-mail j
- --- - _ . - --- ......... ___..... -- - -- -.. _._._ .. - - -- - - ._.._.._.... -----
;e2 Project (Facility) Information:
--- .._...__._.._..-- ..__.._..__..._._.-....- - .. -------------._.._................. -_....... -...... _._._..._....
s' a. o a^ - c� J e No i e S �� C b. Sampson
Briet Project Name (permit will refer to this name) County Where Project is Located
Q ....... Contact Person: I
Q
Glenn Tew (Project 3a.�P6�iA �eY'�i
Name and Affiliation of Someone Who Can Answer Questions About this Application
b c.
anley@aarthl ink not:
Phone Number -mail
1. Project is [3 New ❑ Modification (of an existing permit) If Modification, Permit No.: i
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.
•
�. Owner is ® Public (skip to Item B(3)) ❑ Private (go to Item 2(a))
a. 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 III)
Z ' ❑ Leasing units (lots, townhomes, etc. - skip to Item B(3)) ❑ Homeowner Assoc./Developer (Instruction IV)
Q ❑ Selling units (lots, townhomes, etc. - go to Item B(2b))
).... --- --- -- -- ----
n ove -i
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
a. Town of Newton Grove WWTP 4b. NC 0072877
© Name of WWTF WWTF Permit No.
Z ;5a, own o Newton rove b. c.
F Owner of Downstream Sewer Receiving Sewer Size Permit Number of Downstream Sewer (if known)
( 16. The origin of this wastewater is (check all that apply):
❑ Residential Subdivision ❑ Car Wash ?
❑ Apartments/Condominiums El Institution % Domestic/Commercial
. ❑ Mobile Home Park ❑Hospital I
m :! El School ❑ Church %Industrial
❑ Restaurant ❑Nursing Home
11i11 °
€ ❑Office Other s eci Seri•ic� c /° Other (specify):
® (p ty): . I
i
7. Volume of wastewater to be permitted in this project: 7.56 gallons per day
" 8. If the permitted flow is zero, indicate why:
❑ Interceptor Line - Flow will be permitted is 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
FTA 02/03 - Rev. 2 04/04

SST-TIRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 4
A
9. Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2H i
.0219(I) for Item 13(7) or the design flow for line or pump station sizing if zero flow in the space below. Values other than
z' that in 15A NCAC 2H .0219(I)(1-2) must be approved prior to submittal of this application. Submit a separate request to i
the Division of Water Quality Non -Discharge Permitting Unit, 1617 Mail Service Center, Raleigh, NC 27699-1617 in
accordance with 15A NCAC 2H .0219(I)(3).
C_)oSe + _ 7570 per
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary) j
Size (inches) A Length (feet) Gravity or Force Main —
(use the pull down menu)
8" - 653 ' Gravity
_....._.._._._._.._._...---_._...._._._.._.....__._._._......---- --....--....---....-__.._..._..._..----.._..---.._._.___.._._..------..._.__.....__.__..----- ._.__.—._.._._....--------=
i
_..... _._...__.... ----....__..._._.......... ----....... ........ _... -..... _._.......----..._..._...........--........... __... _........ _.................................... _ --- _ ._.._..--_...__...-...... _....-._.........._..._.__.._....._...
- - ---- ..._._.. -._....._._...__...__..... ..... —._..__...- ---
ENTER TOTAL LINE LENGTH IN MILES- 0.12 '
11. Summary of Pump Stations to be Permitted (attach additional sheets as necessary)
Location ID Power Reliabilify Option
I
self chosen - I - • 2- permanent generator w/ATS• 3-
plans as shown on Design Flow Operational Point 1 dual line feed
P ( Pe 9
s 9 ,
for cross-reference) MGD ; GPM TDH portable generator w/telemet ; 4-wet well stora e
---...._..._.__.._..---...._" _.._._._._.. �._ ._..._._ �...__._._� ._....._.._:.._.._. _._._._.....— Cal_......__...._..........-- - P ._... -- - .._._._...-.._-.......__rY ......... .. _..---.__............_......._...... .._
i
I
I
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?
]C Yes ❑ No If no, please reference the pertinent minimum design criteria or regulation and indicate why a
variance is requested:
i
SUBMIT TWO COPIES OF PLANS, SPECIFICATIONS OR CALCULATIONS PERTINENT TO THE VARIANCE WITH YOUR APPLICATION
i
13. Have the following permits/certifications been submitted for approval?
Wetland/Stream Crossings - General Permit or 401 Certification? ❑ Yes ❑ No ® N/A
A
Sedimentation and Erosion Control Plan? ❑ Yes []No FE] N/A
Stormwater? ❑ Yes ❑ No IL N/A
FTA 02/03 - Rev_ 2 04/04

AST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 5
5( 1.
Use the Division's guidance document entitled, "DETERMINING STREAM CLASSIFICATIONS FOR FORM FTA 02/03
i
(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
i Z
regional office (see instructions for addresses) OR indicate the following:
a
A Stream Classification is not needed because all parts of the project are at least 100 feet away from any down slope
Q' ...............
_... _....waterbody; AND, ..................................... ........... _. _.... ............................ ...... .............. ................... _._...... ....... ..........
V
❑ A Stream Classification is not needed because the design does not depend on wet well storage as a power reliability
^i
LL_
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 Waterbody
for Waterbody County River Basin Index Classification
map. cross-reference) — _
(> see attached map ;Great Coharie Sampson ape Fear 18-68-1 - ....ClSW _
_.._
rK
-reeTk---
i
^�._
1
-... __ .. ..___.__
_. _.._..._._..___..._ .._......._ _-_._......__.....i __
-__............. _......._... _......_ ___ .___..._._
----
_._....__._...._
.._ ............
I
__.............................. __ __ _
i
..._.-_..................... _ ___-.___-__
_ . _.. _ ._... ........__..... .._... _ _ ....._.._....
_ _ _.__.................... ___ ___..-
-___. _ _ _...____._... _
3 V
—
'
Submit the 8.5" x 11" COLOR topographic map as required in Instruction VI
regardless of whether a classification is provided!
1.
Applicant's Certification:
/, Gerald W. Darden attest that this application for PROJECT NAME Bowers & Burrows, Inc. Lot j
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required I
parts of this application are not completed and that if all required supporting documentation and attachments are not i
included, this application package is subject to being returned as incomplete. Note: In accordance with North Carolina E
6
-
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.
W
1 .a•
Date
Signing Official Signature
2.
Professional Engineer's Certification:
Z
I attest that this application for 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
a
best of my knowledge. I further attest that to the best of my knowledge the proposed design has been prepared in
for Gravity Sewers February
accordance with the applicable regulations, Gravity Sewer Minimum Design Criteria adopted
12, 1996, and the Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains adopted June j
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/ have reviewed this material and have judged it to be consistent with the proposed design. Note: In
LU .j
accordance with NC General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement,
C) •
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.
a
Johnny Glenn Tew
�ttit>r�►ry
�s
,mow �,'� �..••�•� N
. •' `�
o d
I
2b.
Professional Engineer Name
Jordan-Tew & Associates P.A.
=2c.
Engineering Firm
.5.6C1
• 1
o %.F JL!j�-
;:; GLEN
i
Address
City State Zip
2g.
910-892-5159 2h.910-892-1893 2i. [e-mail]
0 5
Telephone Facsimile E-mail
Seal, � jna ur & Date
FTA 02/03 - Rev. 2 04/04

Eft
'EIM t
° \ V-\
J`
200
175
•
— • ! } ° �r I °
INI_ )fi / __. �•--,y, 1i it ;!J! yr t� `` \ •• •L ° ,'J �} y=�
'�. '�• \ .!"� � � • fit.. 4 l{ �` Ir ..• ;�vfens
y `� �ipr l; -�� cry �"�v ��,��.. f. � ,` {',, •d ,�` �• - � • ` ` y�, /�
'`' •:.err►- `� ins � ��� It � � t �"1 � - :�~ �' ) `.
3-D topoguadr Copyright 0 1999 DeLom Yarmouth, 4 04096 Source Data: OSSS i 950 ft Scale: 1 : 11,000 Detail: 13-3 Datm: ICSSI

Jordan Tew & Associates, P.A.
_ ._ ._:...- ENG -EEMG, SURVEIWG, MATERIALS TESTING &PLANNWG
1.02 West Broad Street <Zip 28334)
Post Office B= 249
Bunn, North Carolina 28335
Romrie E. Jordan, P.L.S.
' Phx= [phone]-
Johnny Glenn Tew, P.E. FEB J — 2005 Fax [phone]
L�R OF TRANSMITTAL DVV
To: At ke. c. LAJ ye V Date
Company: • G < _ �. t /�'!�. , Location.: e/fz h o v e IBC
WC kc,is vlA."Ce Project Nance lo, _Pk' � e
;Z5 &reeH �"Pe r4-1e_S 4 41, �
I
We Transmit: O-Herewith Q-In Accordance With Your Request
The Following 0 Drawings ❑:Preliminary' Q Test Results Other. .
For Your: O Approval 0 Use - ❑ Review & Comment 0 Record
Number of Sets or Copies
Date
Description
'SnP
�
r
L S o
I -nee c�vo 0
/
Remarks:
1Transmitted- By: j � Copies To: