WQ0042113_Application (FTSE)_20201117

State of North Carolm*a
L APPLICANT INFORMATION:
1. Applicant's name- Hoke County Public Works (company, municipality, HOA, utility, etc.)
2. Applicant type: El Individual R Corporation FJ General Partnership R Privately -Owned Public Utility
1 vi:u
V
R Federal R State/County E Municipal F] Other
DEn-- u3. Signature authority's name: Hilton Villines per11 5ANCACO2T-010q-�) w IN R
Title: Utilities Director NOV 17 20120
4. Applicant's mailing address: PO Box 240
City: Raeford State: ITC Zip: 28376- WQROS-
FA TT ILI-E RF910NNALOFFICE
5. Applicant's contact information: YE
Phone number- [phone] Email Address- [e-mail]
1. Project name: Wood Lake 11
2. Application/Project status: Z Proposed (New Permit) E] Existing Permit/Project
If a modification, provide the existing permit number: WQOO and issued date:
If new construction but part of a master plan, provide the existing permit number: WQOO
3. County where project is located: Hoke
4. Approximate Coordinates (Decimal Degrees): Latitude: 34.99819' Longitude: -.79.146010'
5. Parcel ID (if applicable): 494550001063
a se -we-'
kor.rarcel U3 to closest 'ownstream --1 r)
M. CONSULTANT INFORMATION:
1. Professional Engineer: C. Scott Brown License Number: 027452
Firm: 4D Site Solutions, In
Mailing address: 409 Chicago Drive, Suite 112
City: Fayetteville State: NC Zip: 28306-
Phone number: [phone] Email Address: sbrown(@ ,-,,4dsitesolutions.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION.0
U^t-,a XXTUFM 'XJ(1AAQ01 '7A
x ' 4%, JL JL JL Ly -LidJ=%.,. xx0r,%, k.,yunux V'V VV JLX- I whin L,4UtJL1V%,1.
Owner Name: Hoke County Public Works
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ Downstream (Receiving) Sewer Size: 24 inch
WQCS.00352
Owner Namve(s): Hoke County
FORM: FTA 04-16 Page 1 of 5

17-F
GENERAL REQUIREMENTS
I - If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
[:1 Yes [-]No E_]N/A
opens I ;I ii " been attached?
2. If the Applicant is a Developer of lots to be sold, has a Devell . )er' reemell 'FORTMV-
LkhVBhL1D2EhyVj
F] Yes F]No, FIN/A
3, If the Applicant is a Home/Property Owners- Association has an 0-ocratlonal Aareement (FORTTV: HOA) been attached?
9;1
R Yes ❑No ❑ITT/A
4. Origin of wastewater: (check all that apply):
E Residential Owned F1 Retail (stores, centers, malls) ❑+Car Wash
El Residential Leased ❑ Retail with food preparation/service 0 Hotel and/or Motels
School / preschool / day care ❑ Medical / dental / veterinary facilities ❑ Swimming Pool /Clubhouse
❑ Food and drink facilities R Church FJ Swimming Pool/Filter Backwash
El Businesses / offices / factories [:] Nursing Home EJ Other (Explain in Attachment)
5. Nature of wastewater: 100 % Domestic/Commercial % Commercial
% Industrial (See 15A :CAC 02T .010
Is there a Pretreatment Program in effect? El Yes FJ No
6. Hasa flow reduction been approved under 15A.NCAC 02T. 011 ? N Yes ❑ No
Ifyes, rovide a cops of flow reduction app oval letter
7. Summarize wastewater generated by project:
Establishment Type (see . 02T.OILI Uf) Daily Design Flow 'b I No. of .Tnits Flow
Residential 480 gal/day/lot 12 51760 GPD
gal/ GPD
gal/ GPD
gal/ GPD
gal/ GPD
gal/ GPD
Total 57760 GPD
a See 15 A NCAC 0`2T .0 1 14(h),(d"(e f!) and fje' 021 for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use
areas, and
I residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals
as defined in G. S. 42A-4).
b Per 15A NCAC 02T .0 1 14(c), design flow rates for establishments not identified [in table 15A NCAC, 02T. 0 1141 shall
be determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. wastewater
generatea by project: 5 760GPD (Per 15A NCI AC 02T .01 14,
Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
F] Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
E] Flow has already been allocated in Permit Number:
Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain):
FORM: FTA 04-16 Page 2 of 5

1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
VC
8 L213 P C
Section H & III of the MDC for Permitting
of Gravity Sewers contains information related to design criteria
Section III contains information related to minimum slopes for gravity sewer(s)
);;l Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
VHI. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T.0305 & MDC Wumv Stations/Force Mal'
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
11 0 0
"Ca. Approximate Coordinates (Decimal Degrees): Latitude: Longitude- -
3. Design flow of the pump station: millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): — gallons per minute at feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size finches) Length f1eet) Material
q! 1111 1 : ll ill I llllilli��l 111 -
❑ Standby power source or pump with automatic activation and telemetry - 15ANCAC 02T.0305(h)(1)(B)*1
Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
Must be permanent to facility
Or if the pump station has an average daily flow less than 15,000 gallons per day:
Q Portable power source with manual activation, quick -connection receptacle and telemetry - 15A NCAC 02T
.0305(h)(1)(C)
❑ Portable pumping unit with plugged emergency pump connection and telemetry - 15A NCAC 02T .0305(h)(1)(C):
It -shall bedemon-strated to the Division that the portable source is owned or contracted by the applicant �draft agreement)
and is compatible with the station.
If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations'
storage capacities and the rotation schedule of the portable power source or pump, including travel timeframes, shall be
provided in the case of a multiple station power outage.
FORM: FTA 04-16 Page 3 of 5

SETBACKS & SEPARATIONS — (02B.0200 & 15A NCAC 02T.0305(f))*-
1. Does the preject comply with all separations found in 15A NC A-C. 02T.0305JDA_�'g E Yes El No
�> 15ANCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
24 inches
Water mains (vertical -water over sewer including in benched trenches)
18 inches
Water mains (horizontal)
10 feet
Reclaimed water lines (vertical - reclaimed over sewer)
18 inches
Reclaimed water lines (horizontal - reclaimed over sewer)
2 feet
* *Any private -or public water supply source, including -any -kvelhs, W.S-I waters of Class I -or
Class 11 i1gounded reservoirs used as a source of drinking water
100 feet
"Waters classified WS (except WS-1 or WS-V), B, SA, ORW, HQW, or SB from normal
high water or tide elevation) and wetlands (see item IX.2)
50 feet
"Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches
10 feet
AM building foundation
5 feet
Any basement
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
An swimming pools
10 feet
Final earth grade (vertical)
36 inches
15A NCA C 0.2',T.0305J,.g) contains alternatives withere separations. in 02T.0305(f) cannot be achieved.
>
-ins e "Stream classifications can be identified using the Division's NC Sul ace Water ClasS ficatiowelbpag
If noncompliance with 02'.T.03.0sin 01 (,p),, see SP -.5ct`-n X oft lt;on
iv Is aDp-ica
X
Yes Z No E, N/_A�_
r%,,), I ect co an a,-- 4--ion
Does the P mply with separatrion requirements for- wettla ds? '50 fbet of separati
See the ivD* 's'on"s dift separation requi e--ents foi- siitu�ations -,i;vnere separation cannot be meet il I a 1V Ir. 111 %;
No variance is required if the alternative design criteria specified is utilized in design and construction
As built documents should reference the location of areas effected
3. Does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? Yes R No N/J
);- This would include Trout Buffered Streams per J 5A NCAC 2B. 0-`2`0-9,
4. Does the project require coverage/authonization under a 404 Nationwide or Yes F-1 No
individual permits or 401 Water Quality Certifications?
5. Does project comply with 115ANCAC 0`20T.01057(
L 5(c Yes R No )J�) (additional permits/certifications)?,
Per 15A NCAC 02T.0105(c)(6), directly related environmental permits or certification applications are being prepared, havv
been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion and
sedimentation control plans, storrnwawer mana ement. plans, etc.).
9
!F 1)
Per !'A NCAC 02T.0402. "high -priority sewer means"anv aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer.
F-1 Yes F-1 No Z N/A
If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at least once every slix-months and
0
inspections documented per 15A NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit.
FORM: PTA 04-16 Page 4 of 5

X. CERT1 FIC
1_4
'M Deskon Critltzria fOr tile 11�­, 1_15 of Pit t n S
1. J)Oi-S tile StIbIll'tteki �\��Steljl C()lllp 5: ULf " I E 4A
tile MillitmA. 111 tations
A -1 versB.,-)n-) as applicable?
ij i i d ­- a 1 -,
n - k t;--st, versioll). fand the SexN-fCt- N;Iinimul i Design Cril, -ia hates
Ex] 0 0
It' NNo. coniplete and subtillt the \-�',Ct.rt,tltice.Alteriiative Dessigyn Ri��qtjcst application (VNDC 10-14) tind supportlill(T documents
fior re-i6ie. ..-iLr o ubm'ftal tile NTrIack Auc:4oapot.
t—i -11
documents.
2. Prol, s,,,tional F*nglineer's ("t--i-tificat loll:
ttest that thrs. application ror
(Profe,_s,sional EngnnecCsi tiame rroill Application Iteill HLL)
L
11*1ls been rev iel.\I-ed bv tile land is accurate, complete and consistent vvitll tile ill tbrill4at loll supplied in tile plans. spec i ficat 1011 S
ell(litleerill"t), calculations. and all other supportino documentation to the best cif ,- knoMed.cre. urther attest that to the best
otmv knowledge the. proposed desitun has been prepared in accordance with the applicable regulations, C;rtavlty Se�ver
k1ininlum Desion ("riterla !'(.)I- Gravity Se��wS (latest version), and the Mlininiuni Design Criteria 110r tile Fast-,rrack
Permitting of Punip Stations and F"orce INVlains (latest version). Althou h other prof siiontals may, have developed certain
portions, ofter. submittal package, inclusion of these materials under mv siat.i t.rr and sea[ s-iggnifie_� tli,.t I have rep ieved thi.
material and have judged it to be consistent with the proposed desh, n.
ation per 1 5A NCAC 0_2 F �O : I 06k b'l
Appficant's Cet I ic 'A A 1 1 A Af .4
4; - /I // I / - /I // I - � 7 1
attest that this application Rir
-1 . )
Authori(y"s na-ppl rile & title from Aication Item 1.3
!--,,as been reviewed by the and is accuriate and complete to the bie-st of my knmvled(._-1-,_-*. I Understand that 4'4,ill reqUired parts of
this application are not completed and that ifall required SUpporting dOCLInientation and at t(ach tile tit s; are not included. this
d,
t­ me%kzter o us n-on-
,!R,t,)t%fiicat1on nackrwe IS S-1,111,110A til be;ntr returne(Ill as unc­onlple- cl , I I t ri is, t
lancit2mrstand timat alPy th- 411�
liitce xv,�,lttlins or dhe I i ss u It I n an -n i i e d 'a -- f - fo - i I e 1111 (,�Ictfon thar. t i it y i ue 1U.1 c( I e c, pl,
i Ie tilt LC• C-1
disd SN'%'Will it s e 1 and likdll
I* ndoCtl11il or, .anclaH 1 a
L1.ea ia on of V
lC1M1- niwater
RL i r s u 1 aat,riiAi( oa .101 11 1 C7 Adif;�--n c%0 V3OWCCI. also, understand thnt 111 ia I recT u t red pa t s o 1� this application -a c k a , 01'"D
COMIRIO, 01 I -Ills I)CIA1,11t PC 1 7;
pporl itil, tkk L :K. t - e xtv I be ro-turned sto
iret-i S, t i ;"41 k 4 1 It! 0. Ilot uICI . I
t io r i i a t aitacl-imienfs ;-sr,- APM11-M to !I I
all requi si R 411 411
i
NOTIE4 ­ till accordance witrz Gencrit it Statutes 14_3-2115,,6A and 114-3-215.,611. any persont who knowingiv makes zativ fialse
St" ! - a flass 2 misdenneanor. --,x;hich nvay UtelueH., rell";1P.C'.1sentation, or 1­erti ical ion ill anv antilicatlon Packav shall be guiltv ol
include ca fine not to exec--ed $ 10,000 as �vell as civil penattle{icy up to S-15,00 per violation.
f
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F 0 R, %V - 1 -. F-J` A 0 16

State of North Carolina
Division of Water Resources
Flow Tracking for Sewer Extension AP lications
Division of Water Resources P I
(FTSE 10- •,
beingEntity Requesting Allocation: Hoke County ublic Utilities
Proiect Name for which flow is requested: Woodlake II Subdivision
More titan one FTSE may be requiredfor a singleproject l tlae owner of the HWTP as not responsiblefor alIPUMP
stations along tlae route of liie proposed w st ester ow.
1. Complete this section only it You are the owner of the wastewater treatment plant.
IV
a. WWTP Facility Name: Hoke Coun!y WWTF
b. WWTP Facility Permit i: NCO089176
AlIflows are in MGD
c. WWTP facility's permitted flow 1.500 MUD`
d. Estimated obligated flow not yet tributary to the WWTP 0.262 MGD
e. WWTP facility's actual s
f Total flow for this specific request 0.0065 MGD
. flow 0,533 MGD
h. Percent of permitted flow used 53.4%
IL 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:
Design Obligated,
Pump Pump Average Approx. Not Yet Total Current
Station Station Firm Daily Current Tributary
(Name Capacity, a • Daily Daily Flow, Obligated Available
Number)Flow, MGD MGD, Flow Capac*
Regional..
CapacityThe Firm flow)of pump stationis*# as the maximum pumped
that can be achieved with the largest pump taken out of service.
Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor
(pf) not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
A Planning Assessment Addendum shall be attached for each pump station located
between the p 'ect connection point and the WWTP where the Available Capacity is < 0*
Downstream Facility Name (Sewer).- Hoke CouUt
Downstream Pen -nit Number:
Page
F - 18

III. Certification Statement:
I Hilton Villines, Utilities Director certify to the best of my knowledge that the addition of
the volume of wastewater to be permitted in this project has been evaluated along the route to the receiving
vickstex1rater
proceduresrela t I ed sanitary sewer ove I rflows or overburden any downstream pump station en route to the receiving
treatment plant under normal circumstances, given the implementation of the planned 'improvements
identified in the planning assessment where applicable. This analysis has been performed in accordance
w ith local established policies and available
those items listed above 'in assessment addendums for which I
Sections planning
Signatuream the responsible party.
adequateworks has proposed
,+� � .. 1 _ . � ._-� ` rid►.
rir
Page
FTSE 1 r 18

t 2
Submit a planning assessment aaaendum for each pump station listed in Section 11 where Available Capacity is <
0.
Pump Station (Name or Number):
Uiven that:
a. The proportion and amount of Obligated, Not Yet Tributary Daily Flow (C) accounts for
% and MGD of the Available Capacity (E) in Pump Station
and that
b. The rate of activation of thi's obligated, not yet tributary capacity is currently avproximately
MGD per year; and that
c. A funded Capital Project that will provide the required planned capacity, namely
0
is in design or under construction with
planned completion in and/or
d. The following applies:
Therefore:
Given reasonably expected conditions and planning information, there is sufficientjustiffication to allow
this flow to be permitted, without a significant likelihood of over -allocating capacity in the system
0
infrastructure.
I understand that this does not relieve the collection system owner from complying with G.S. 143-
215.67(a) which prohibits the introduction of any waste in excess of the capacity of the waste disposal
system.
Page 3 of 6
FTSE

Instructions for Flow Tracking form (FTSE) and Planning Assessment Addendum (PAA)
Section I
a. WWTP Facilijy Name: Enter the name of the WWTP that will receive the wastewater now.
b. WWTP Facilily Permit#: Enter the NPDES or Non -Discharge number for the WWTP receiving the
wastewater flow.
0
c. WWTP facilijy's permitted flow. MGD: From WWTP owner's NPDES or Non -Discharge permit.
d. Estimated obligated flow not yet tribuLaa 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
Hed their flow records, to the best of their ability, so it is known how much flow has been obligated and
reconct
4
is not yet been made tributary to the WWTP, in accordance with local policies and procedures employed by the
reporting entity.
e. WWTP facilitv's actual avg. flow. MGD: Previous 12 month average.
f. Total flow for this a c reguest. MGD: Enter the requested flow volum
g. Total actual and obligated flows to the facil MGD Equals [d + e + f]
h. Percent of permitted flow used: Equals [(g / c)* 100]
For examp
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. There i's a
proposed flow expansion of 0.0 IS MGD.
The first Form FTSE 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. 5 3.6 %
The next For FTSE may be updated like this with a proposed flow expansion of 0. 102 MGD-0
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 FTSE form will be updated in the same manner.
Page 4 of 6
FTSE 10- 18

List the pump station name or number and approximate pump station finn capacity, approximate design average
daily flow (A) approximate current average daily flow (B), and the obligated, not yet tributary flow through the
pump station (C) for each pump station that will be impacted by the proposed sewer extension project. Calculate
the total current flow plus obligated flow (D=B+C) and the available capacity (E=A-D). Include the proposed flow
for this project with other obated flows that have been approved for the pump station but are not yet tributa
ligry
(C).
Firm capacity is the maximum pumped flow that can be achieved with the largest pump out of service as per the
Minimum Design Criteria.
Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor (pf) of not less thaill
If the available capacity (E) for any pump station is < 0. then prepare a planning assessment for that pump statio #7
if the system has future specific plans related to capacity that should be considered in the permitting process. I
U
Design
Firm Average
Pump Station Capacity Daily Flow
(Name or Number) MGD (Firm / pf)
U
Approx.
Current Avg.
Daily Flow,
MGD
Kaw Creek PS 0.800 0,320 0.252
Vall�y Road PS 1.895 0.758 0.472
(C) (D)--(B+C) (E)=(A-D)
Obligated.,
Not Yet
Total Current
Tributary
Flow Plus
Daily Flow,
Obligated
Available
MGD
Flow
Capacity*
0.080
0.332
-0.012
A 1 12 AZ
A 4A7
A 1 C. I
Page 5 of 6
FTSE 10- 18

Planni*nnm e Assessment Addendum Instructions
#"If Ing assessment addendum for each pump station listed in Section If where available capacity is < 0.
§oubmit a plann'
A planning assessment for Kaw Creek PS (see example data above) may be perfon-ned to evaluate whether there is
4
significant likelihood that needed improvements or reductions in obligated flows will be in place prior to activating
the flows from the proposed sewer extension project.
If the system decides to accept the flow based on a planning assessment addendum, it is responsible to manage the
flow without capacity related sanitary overflows and must take all steps necessary to complete the project or control
the rate of flow to prevent sanitary sewer overflows.
The planning assessment may identify a funded project currently in design or construction, or a planned project in
the future not yet funded but in a formal plan adopted by the system. The system should carefully weigh the
certainty of successful timely project completion for any expansion, flow management diversion or infiltration and
Inflow elimination projects that are the foundation of a planned solution to capacity tracking and acceptance
compliance.
For example:
G1*Ven that:
a. The proportion and amount of obligated, not yet tributary flow accounts for 24 % and 0.080 MGD of the
committed flow in Pump Station Kaw Creek; and that
b. The rate of activation of this obligated, not yet tributary capacity is currently approximately 0.0 1 MGD
per year; and that
c. A funded capital project that will provide the required planned capacity, namely
is in design or under construction with planned
completion in and/or
d. The following applies:
The master vlanand- ten-year -ca iital, Man contain recommended scom and fundi for a canital Droiect entitled
Mrs ItalrolizeM =00P UUMUT [01 -!KoM HMU01-91OR1449, "s, 111burl L-AJF3Wf 111 1
I i I i TO I I I 1M.
wi-M-1 Ing Wae"V iIIEWAI
rNat exceed the firm numo station caDacities identified 'in Section II above.
0
Therefore,
Given reasonably expected conditions and planning information, there is sufficientjustification to allow this 11ow
to be permitted., without a significant likelihood of over -allocating capacity in the system 'Infrastructure.
Page 6 of 6
FTSE 10-18

NCDEQ
AJL-tn.- Trent Allen
Fay
tteville,. NC
01
-....
_ems= _ -_ _` aR%ffis-a
Attached is the sanitary sewer application package for the Wood Lake 11 Subdivision. A
check for the $480 review fee is also enclosed. This letter provides the additional
information as required in Part B of the applicatiorl
I look forward to working with you on this project. If you have any questions or
concerns, please feel free to contact us..
On time, every time. wvvwADsitesotutions.cot