WQ0036818_Application_20131030

OF W ATFR DENR FIIV' State of North Carolina
OG Department of Environment and Natural Resources
�
Division of Water Quality
o ()WQ FAST -TRACK APPLICATION
(FTA 12/07 very)
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 glans and soecifications unless you respond NO to Item B(13).
Separate aoolications 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.
FTA 12/07

❑ _ G. Stream Classifications — Watershed Classification Attachment (Form WSCAS-12/07) If any portion of the
sewer system project is within 100 feet of any surface water or wetlands, the Watershed Classification Attachment
may need to be completed. A variance must be requested for encroachment within required setbacks or buffers
pursuant to 2T .0305 (f) and be indicated in Item B-13 with supporting documentation/justification provided.
❑ 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 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(1 b). 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.Ilh2o.enr. state.nc. us/peres/Collection%20Systems/CollectionSystemsHome.html
or contact the Regional Office serving your county.
Ff A 12/07

- USE THE TAB KEY TO MOVE FROM -FIELD TO FIELD! - Application Number o
(to be completed by DWQ) Q(73 d
1 nianar/Parmittaa• — —
Z
O
I --
a
LL
Z
lW
a
1a. Town of Wadesboro
Full Legal Name (company, municipality, HOA, utility, etc.)
1b.
Hugh James, Public Services Director
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 697 1 e. Wadesboro
Mailing Address City
1f.
North Carolina ig. 28170-0697
State Zip Code
1h.
704-694-5171 1i. 704-695-1331 1j. [e-mail]
Telephone Facsimile E-mail
2.
Proiect (Facility) Information:
2a.
Lewis Street Water and Sewer Improvements 2b. Anson
Brief Project Name (permit will refer to this name) County Where Project is Located
3.
Contact Person:
3a.
Mark Lacy, PE
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b.
910-420-1437 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.
Anson Count
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
4a.
Anson County WWTP 4b. NC0041408
Name of WWTF WWTF Permit No.
5a.
Town of Wadesboro 5b. 8" I® Gravity 15c. Not Available
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):
i
100 % Domestic/Commercial
® Residential Subdivision ElRetail (Stores, shopping centers)
❑ Apartments/Condominiums ❑ Institution % Industrial (attach
❑ Mobile Home Park ❑ Hospital description.)
❑ School El Church (RO: contact your Regional Office
❑ Restaurant ❑ Nursing Home
El Office ❑ Other (specify): Pretreatment staff)
% Other (specify):
7.
Volume of wastewater to be allocated or permitted for this particular project: 21,960 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
permit is required)
FTA 12/07

.-%
0
LL!
D
Z
H
0
U
Z
O
H
Q
O
LL
Z
LL1
a
ii
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).
The requested permit flow is based on a total of 61 residential customers (30 existing and 31 future) @ 360 GPM each
for a total flow of 21,960 GPD. A portion of the total requested flow is not tributary to the proposed pump station.
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches)
8-inch
4-inch
Length (feet) New Gravity or Additional
Force Main
4,900 New Gravity
1,560 New Forcemain
11. Summary of Pump Stations w/ associated Force Mains to be Permitted (attach additional sheets as necessary)
Pump Station Location ID PS-1 (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
2 - portable generator w/MTS
0.020 100 GPM @ 84.17'
4
1,560
Pump Station Location ID NA (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
2 - portable generator w/MTS
Pump Station Location ID NA (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
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 Z No If Yes, permit number of 2"d 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?
Z 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
FT'A 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)? No
Check if Yes: ❑ and provide details
1. Owner/Permittee's Certification: (Signature of Signing Official and Project Name)
1, _Hugh James. Public Services Director , attest that this application for the Lewis Street Water and 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 143-215.68, 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
e4eeed $10,Q0 as well as civil penalties up to $25,000 per violation. _
Date
ENGINEERING DESIGN DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL OF THIS
APPLICATION. THESE DOCUMENTS MUST INCLUDE PLAN AND PROFILE OF SEWERS, THEIR PROXIMITY
TO OTHER UTILITIES, DESIGN CALCULATIONS. ETC. REFER TO 15A NCAC 02T .0305
PA
Professional Engineer's Certification: (Signature of Design Engineer and Project Name)
1, Mark Lacy, PE, attest that this application for the Lewis Street Water and Sewer Improvements 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 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 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.
rk
P.E. oW
2a Professional Engineer Name �\\��N ��AROI/ /,,-
o . FEssio • ti
2b. LKC Engineering, PLLC 2•• p
Engineering Firm = ; 0- E L _
2c. 200B Westgate Drive — 3
Mailing Address
2d. West End 2e. NC 2f. 27376 �� Zj • . • • . • • �\
City
2g. 910-420-1437
Telephone
2h. 910-420-1438
Facsimile
State Zip �igRKl A i LPG
2i. [e-mail] /O - 2-1- 13
E-mail NC PE Seal, Signature & Date _ _ __
FTA 12/07

Oct 1$1307:31a Wwtp
act, so i� u[:a i p �n� cnymvenny, r���.
704 694 2972 p.1
J { V-+Lt.-1'ti/V N.L
State of North Carolina
Department of Environment and Natural Resources
Di -vision of Water Quality
)Flow Tracking(Acceptance for Sewer Extension Permit Applications
(FTSE—10/07)
Project Applicant Name: Town of Wadesboro
Project Name for which flow is being requested: Lewis Street Water and Sewer Improvers
afore than one ME--IW7 may be required for a single project rf she owner of the i*V rp is not respwrsible for all
pump stations along the route of the proposed ►utstmorer jlow-
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Anson county Regional WWTP
b. WWTP Facility Permit4: NC0041408
All Bows w in MOD
c. VN'WTP facility's permitted flow ''�
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow f' r ,n q �41
f. Total flow for this specific request 0.022
g. Total actual and obligated flows to the facility 2 Z'r
h. Percent of permitted flow used 10
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 connectioa point and the WWTP
Pump Station Name Approx. Capacity, MGD Approx. Cuntnt Avg.
Ss �% (FirnVDesign) Daily Flow, NIGD
0.4 rOd t~i
Post-itg Fax Note 7671
pages
To
fc
[�%d
e L f L ti
i O. li i v
Phone I t7 — G _ -� - 3,E)1
F
I11. Certification Statement:
1, Leon Gatewood, ORC, 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 flour from this project is not anticipated to cause any capacity related
sanitary sewer overflows or overburden any downstream pump station en route to the teceiving treatment
plant under normal circumstances. This analysis has been performed is accordance with local established
policies and procedures using the best available data. This certification applies to those items listed above
in SectVn3VMAd!S--K�—.
and r which I ant the responsible party. Signature of this form indicates atance
ccepof
this wao« 1(j/1
Signature

Nov071311:17a Wwtp
Oct 3'1 1;310'25a LKC Engineering, PLLC
704 694 2972 p.2
910-420-1438 p.2
State of North Carolina
`C QG Department of Environment and Natural Resources
y Dlvision of Water (Quality
r
p -t Flow Tracking/Acceptance for Sewer Extension Permit �SEt� Applications
Project Applicant Name: Town of Avadesboro
project Narne for which flow is being requested: Lewis St. Sewer Improvements
More rhar. one FTSE inay be required far a single project i- the o►tnier of the WWTP Lt not respow0te for aff pump
stations along the route of the pmposed wasimloterftow.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. wwTP Facility Name: Anson County Be i� onal WWTP
b. WWTP Facility Permit #: NCO041408
AtlJloxs are in 1Li+GD
c. NVWTP facility's permitted flow 3.500
d. Estimated obligated flow not yet tributary to the WWTP 0.000
e. WWTP facility's actual avg. flow 1.100
f. Total flour for this specific request 0.022
g. Total actual and obligated flows to the facility 1.122
b. Percent of peen fitted flow used 31.4%
11. Complete this section for each pumpte station you aresponsible for along the route of this
proposed wastewater flow.
List pump stations located bet«roen the project connection point and the WWTP:
(A) (B) (C)
Design Obligated,
Pump Avetagc Daily ApproK, Not Yet Touil Currcnt
Station Firrn Flow** Current Ave. Tributary stow Plus
(Name or Capacity," (Ferret / pf), Daily Flow, Daily Flow. Obligated Available
Number) MCI) MOD
Iti4GD MOD Flow Capaciq**"
52 North 31 C J"4 y_ 0.850 0.00 0.850 0.5'9
The Firm Capacity of any pump station is defined as the maidmum pumped now that
can be achieved with the largest pump take#' out Of service.
** fern capacity of the pump station divided by a pestWng
Design Average Daily Floe► is the
factor (pD not less titan 25.
"* A Planning Assessment Addendum shall be attached for eadt pump station located
between the project connection point and the WWTP where the Ati-a&ble Cspadty is <a.
Page I of 6
Ft'SE 06-13

Nov 071311:17a Wwtp 704 694 2972 p.3
Oct 31 1310:25a LKC Engineering, PLLC 910-420-1438 P•3 _.
Certification Statement:
�` �4vt/G� d. �` certif to the best of my knowledge that the addition of
�;C
y the route to the
the volume of wastewater to be permitted in this project has been evaluated along
receiving wastewater treatment facility and that the flow from this project is not anticipated to
cause any capacity related sanitary sewer averhows 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 with local established policies and procedures rasing
the best available data.. This certifization applies to those items listed abo,%-o in Sections I and II
plus all attached planning assessment addendums for which I am the responsible party.
Signature of this form indicates acceptance of this wastewater flow.
Page 2 of 6
E'TSE 0643

DENIR-FRO
LKCngineering,pUc
October 28, 2013
Mr. Trent Allen,
NCDENR Fayetteville Regional Office
225 Green Street, Suite 714
Fayetteville, NC 28301
Re: Town of Wadesboro, Lewis Street
Water and Sewer Improvements
Mr. Allen,
j� 13 0 2013
11WO
Please find enclosed one original and one copy of the Fast Track Application package and a check for the
appropriate fee for the above referenced project.
The project consists of the installation of approximately 3,040 If of 6-inch water main, 650 If of 2-inch water main,
5,000 If of 8-inch gravity sewer, 1,600 If of 4-inch forcemain, pump station, and associated appurtenances. The
proposed project will provide sewer service to 30 existing residences and have potential to serve an additional 31
customers in the near future. A project layout map is included with the enclosed permit application.
Please do not hesitate to contact me with any questions or comments.
Sincerely,
LKC Engineering, PLLC
Mark Lacy, P.E.
200 Westgate Drive, Suite B, West F,nd, North Carolina 27376 * PI I: 910/420-1437 * PAX: 910/420-1438
License No. P-1095

USE THE TAB KEY TO MOVE FROM FIELD TO FIELD. Application Number: Lim
(to be completed by DWQ)
1.
Owner/Permittee: -
1a.
Town of Wadesboro
Full Legal Name (company, municipality, HOA, utility, etc.)
Z
1b.
Hugh James, Public Services Director
O
Signing Official Name and Title (Please review 15A NCAC 2T .0106 (b) for authorized signing officials!)
H
1 c.
The legal entity who will own this system is:
❑ Individual ❑ Federal ® Municipality ❑ State/County ❑ Private Partnership ❑ Corporation ❑ Other (specify):
cc
0
1 d.
PO Box 697 1 e. Wadesboro
ILL
Mailing Address City
Z
1f.
North Carolina 1g. 28170-0697
Z
State Zip Code
0
1h.
704-694-5171 1i. 704-695-1331 1j. [e-mail]
QTelephone
Facsimile E-mail
U
2.
Proiect (Facility) Information:
,J
2a.
Lewis Street Water and Sewer Improvements 2b. Anson
a
Brief Project Name (permit will refer to this name) County Where Project is Located
a
a
3.
Contact Person:
3a.
Mark Lacy, PE
Q
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b.
910-420-1437 3c. mark@lkcen ineerin .com
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.
Anson Count
Z
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
O
4a.
Anson County WWTP 4b. NCO041408
Q
Name of WWTF WWTF Permit No.
5a.
Town of Wadesboro 5b. 8" ® Gravity 5c. Not Available
.._ ._..._
_ n..... Receiving Sewer Size Force Main
- 9 � Permit # of Downstream Sewer (Instruction E)
L NA00ve'"'101
lx
engineering, pllc 200 8 WESTGATE DR ; Fidelity
WEST END, NC 27376 RIGHrayyoU
[phone] ,o.s
66-358-531
PAY TO THE
ORDER OF NCDENR 10/15/2013
Four hundred eighty and 00/100**•*•**•*~******,*****#***************�*****
*"480.00
NCDENR
MEMO
Fast Track Permit Fee - Wbro-12.01 �—
-'-��=�--a- AUTHORIZ D SIGNAT
5425
DOLLARS
13

Central Files: APS SWP
11 /08/13
Permit Number WQ0036818
Permit Tracking Slip
Program Category
Status Project Type
Non -discharge
Active New Project
Permit Type Fast Track
Version Permit Classification
Gravity Sewer Extension, Pump Stations, & Pressure Sewer
1.00 Individual
Extensions
Primary Reviewer
Permit Contact Affiliation
trent.allen
Coastal SW Rule
Permitted Flow
21960
Facilitv
Facility Name
Lewis Street Water and Sewer Improvements
Location Address
Owner
Major/Minor Region
Minor Fayetteville
County
Anson
Facility Contact Affiliation
Owner Name Owner Type
Town of Wadesboro Government - Municipal
Owner Affiliation
Hugh James
PO Box 697
Dates/Events
Wadesboro NC 28170
Scheduled
Orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
11 /08/13 10/30/13 11 /08/13 11 /08/13
Regulated Activities Requested/Received Events
Wastewater collection Additional information requested 10/30/13
Additional information received 11/07/13
Outfall NULL
Waterbody Name Stream Index Number Current Class Subbasin