WQ0030768_Application_20060915

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,-TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 3
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD! Application Nu WO00307 68
(to be completed t -
1. Owner.
1 a. Town of Clarkton
Full Legal Name (company, municipality, HOA, utility, etc.)
1b. Arthur Whedbee, Mayor
Signing Official Name and Title (Please review 15A NCAC 2H .0206(b) for authorized signing officials!)
1c. The legal entity who will own this system is:
❑ Individual ❑ Federal Z Municipality ❑ State/County ❑ Private Partnership ❑ Corporation ❑ Other (specify):
1d. 81 North Elm Street le. Clarkton
Street Address City
1f. North Carolina 1g. 28433
State Zip Code
1 h. [phone] 1 i. [phone] 1j.
Telephone Facsimile
2. Project (Facility) Information:
2a. Roscoe Lennon Drive Sewer Extension 2b.
Brief Project Name (permit will refer to this name)
3. Contact Person:
E-mail
County Where Project is Located
3a. Alton Boswell, Public Works Director, Town of Clarkton
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. [phone] 3c.
Phone Number
E-mail
1. Project is Z New ❑ Modification (of an existing permit) If Modification, Permit No.:
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.
2. Owner is Z 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 III)
❑ Leasing units (lots, townhomes, etc. - skip to Item B(3)) ❑ Homeowner Assoc./Developer (Instruction IV)
❑ Selling units (lots, townhomes, etc. - go to Item B(2b))
3. Town of Clarkton
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
TOWN OF CLARKTON
P O BOX 307
CLARKTON, NC 28433
DATE q / (o /O(o
2807
66-112/531
BRANCH 60201
PAY
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BRANCH BANKING AND TRUST COMPANY
1-800-BANK BBT BBandT.com
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FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 1
�pF WA-r 9Q State of North Carolina
Department of Environment and Natural Resources
co Division of Water Quality
o FAST -TRACK APPLICATION
DENR-FAY for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
(Pressure sewers 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. This form may be photocopied for use as an original.
® I. Application Form - Submit one original and one copy of the completed and appropriately executed application
form. 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(12).
II. Application Fee - Submit a check in the amount of $400 made payable to: North Carolina Department of
Environment and Natural Resources (NCDENR). Checks shall be dated within 90 days of application submittal.
❑ III. 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(2a) of this application.
❑ IV. Operational Agreements — Submit one original and two copies of a properly executed operational agreement if
the sewer extension is permitted 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
homeowners' association, use Form HOA 02/03. If the applicant is a developer, use Form DEV 02/03. EVEN IF
THE PROJECT WILL BE TURNED OVER TO A MUNICIPALITY, FORM DEV 02/03 IS REQUIRED.
❑ V. Flow Acceptance Letters — If the owner of the downstream sewers and/or WWTF is different from the applicant,
submit two copies of a flow acceptance letter from the owner of the downstream sewers and WWTF, if different.
Flow acceptance letters must contain the following minimum information: applicant and project name, amount of
flow accepted, and name and permit number of the receiving sewers/WWTF. The flow acceptance must not
expire prior to permit issuance and must be dated less than a year prior to the application date.
Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific flow acceptance
letter.
® VI. Map — Submit an 8.5-inch by 11-inch COLOR copy of the portion of a 7.5-minute USGS Topographic Map along
with this form. The map should identify the entire project area location as well as the closest downslope surface
waters as clearly as possible. Each map portion must be labeled with the map name and number, the identified
location of the sewer line and pump stations, and be of clear and reproducible quality. For instance, if the project
involves 4 miles of interceptor sewer that traverses over or near several different waterbodies (or counties,
basins, etc.), the map should have location ID's shown for each different waterbody (where the sewer line is within
100 feet of such waterbody - see Instruction VII). This location ID is self chosen and used to cross reference the
location in Section C of the permit application.
❑ VII. Stream Classifications — Section C
If any portion of the project is within 100 feet of any down slope surface water, Section C must be completed
for the pertinent sections.
If the entire project area is a minimum of 100 feet away from any down slope surface waters BUT there is a
pump station involved where a history of power outage is to be used to provide adequate design storage
instead of dual feed or permanent or portable generator, Section C must be completed to demonstrate that
the closest down slope surface water is Class C (see 15A NCAC 2H .0219(h)(3)(D)).
Use the guidance document entitled, "Determining Watershed Classifications for Form FTA 02/03 (Fast -Track
Sewer Systems)" available from http:Hh2o.enr.state.nc.us/peres or by contacting the appropriate regional
office.
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FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 2
❑ V%III. Environmental Assessments — If this project is subject to an Environmental Assessment (EA) [15A NCAC
01C], this application can not be used. Send the project application on Form PSFMGSA 10/99 to the PERCS
Unit, 1617 Mail Service Center, Raleigh, NC 27699-1617. Applications can not 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.
® IX. Certifications — Section D
The application must be certified by both the applicant and a North Carolina Registered Professional Engineer
(PE). The applicant signature must match the signing official listed in Item A(1b). The PE should NOT certify the
application if he/she is unfamiliar with 15A NCAC 2H .0200, 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. Certification by a PE who is unfamiliar with these documents
is subject to NC Board referral.
® X. Downstream Sewer & Wastewater Treatment Plant Capacity
The applicant has assured downstream pipe, pump station and treatment plant capacity. The addition of new
sources of wastewater from this project has been evaluated along the route to the receiving treatment plant. 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. If the applicant is not the owner of the
downstream sewer or receiving treatment plant, submittal of flow acceptance letter(s) indicates that owner has
adequate capacity and will not violate G.S. 143-215.67(a).
THE COMPLETED FTA 02103 APPLICATION PACKAGE, INCLUDING ALL SUPPORTING DOCUMENTS AND $400
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,
Swannanoa, North Carolina 28778
Cherokee, Clay, Graham, Haywood,
[phone]
Henderson, Jackson, Macon, Madison,
[phone] Fax
McDowell, Mitchell, Polk, Rutherford,
Swain, Transylvania, Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Harnett,
Fayetteville, North Carolina 28301
Hoke, Montgomery, Moore, Robeson,
[phone]
Richmond, Sampson, Scotland
[phone] Fax
Mooresville Regional Office
610 E. Center Avenue, Suite 301
Alexander, Cabarrus, Catawba,
Mooresville, North Carolina 28115
Cleveland, Gaston, Iredell, Lincoln,
[phone]
Mecklenburg, Rowan, 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,
919 571-4718 Fax
Wake, Warren, Wilson
Washington Regional Office
943 Washington Square Mall
Beaufort, Bertie, Camden, Chowan,
Washington, North Carolina 27889
Craven, Currituck, Dare, Gates, Greene,
[phone]
Hertford, Hyde, Jones, Lenoir, Martin,
[phone] Fax
Pamlico, Pasquotank, Perquimans, Pitt,
Tyrrell, Washington, Wayne
Wilmington Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin,
Wilmington, North Carolina 28405
New Hanover, Onslow, Pender
[phone]
[phone] Fax
Winston-Salem Regional Office
585 Waughtown Street
Alamance, Alleghany, Ashe, Caswell,
Winston-Salem, North Carolina 27107
Davidson, Davie, Forsyth, Guilford,
[phone]
Rockingham, Randolph, Stokes, Surry,
[phone] Fax
Watauga, Wilkes, Yadkin
For more information, visit our web site at: http://h2o.enr.state.nc.us/peres/
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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) �A(Q��O'7�$
...... _
1. Owner.
la. Town of Clarkton
Full Legal Name (company, municipality, HOA, utility, etc.)
Z
0 1b. Arthur Whedbee, Mayor
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 ❑ Federal ® Municipality ❑ State/County ❑ Private Partnership ❑ Corporation ❑ Other (specify):
0 1d. 81 North Elm Street le. Clarkton
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Mailing Address City
1f. North Carolina 1g. 28433
State Zip Code
1h. 910-647-5961 1i. 910-647-0013 1j.
Telephone Facsimile E-mail i
2. Project (Facility) Information:
2a. Roscoe Lennon Drive Sewer Extension 2b. Bladen
Brief Project Name (permit will refer to this name) County Where Project is Located
3. Contact Person:
3a. Alton Boswell, Public Works Director, Town of Clarkton
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. 910-647-5961 3c.
Phone Number E-mail
1. Project is ® New ❑ Modification (of an existing permit) If Modification, Permit No.:
- --------- --- - _..--- -- ............ ... _... .._.. --- . _..... .- -- . _... _------------ - __ _ _ _ __ _ _ ..— _.
For modifications, attach a separate sheet clearly explaining the reason for the modification (i.e. adding another 1
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.
2. Owner is ® Public (skip to Item B(3)) ❑ Private (go to Item 2(a))
_2 a. If private, applicant will be: 2b. If sold, facilities owned by a (must choose one)
i
❑ Retaining Ownership (i.e. store, church, single office, etc.) or ❑ Public Utility (Instruction III)
❑ Leasing units (lots, townhomes, etc. - skip to Item B(3)) ❑ Homeowner Assoc./Developer (Instruction IV)
❑ Selling units (lots, townhomes, etc. - go to Item B(2b))
3. Town of Clarkton
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
4a. Town of Clarkton WWTP 4b. NPDES No. NC 0021610
Name of WWTF WWTF Permit No.
5a. Town of Clarkton b. 8 5c. WQCS 00252 System Permit
Owner of Downstream Sewer Receiving Sewer Size I❑ Force Main Permit Number of Downstream Sewer (if known) i
6. The origin of this wastewater is (check all that apply).
® Residential Subdivision ❑ Car Wash
❑ Apartments/Condominiums ❑ Institution 100 % Domestic/Commercial
❑ Mobile Home Park ❑ Hospital
❑ School ❑ Church % Industrial
❑ Restaurant ❑ Nursing Home
❑ Office Other ❑(specify):%Other (specify):
7. Volume of wastewater to be allocated for this particular project: 2160 gallons per day
"Do not include previously permitted allocations
__. ....... ..._.... .......... — --—_---------
8 If the permitted flow is zero, indicate why. ,
❑ Interceptor Line - 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
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FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 4
1
9. Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2H
.0219(1) for Item B(7) or the design flow for line or pump station sizing if zero flow in the space below. Values other than
that in 15A NCAC 2H .0219(I)(1-2) must be supported with actual water or wastewater use data in accordance with 15A
NCAC 2H .0219(I)(3).
6 homes x 360 gpd = 2160 gpd
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches)
Length (feet)
8" 225
Gravity or Force Main
(use the pull down menu)
Gravity
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Z ENTER TOTAL LINE LENGTH IN MILES 0.0426
U 11. Summary of Pump Stations to be Permitted (attach additional sheets as necessary)
0 Z Location ID Power Reliability Option
(self chosen - as shown on Design Flow Operational Point (1- dual line feed; 2- permanent generator w/ATS; 3-
Qplans for cross-reference) (MGD) GPM @ TDH portable generator w/telemetry; 4-wet well storage)
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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?
W ® Yes ❑ No If no, please reference the pertinent minimum design criteria or regulation and indicate why a
a variance is requested. SUBMIT TWO COPIES OF PLANS, SPECIFICATIONS OR CALCULATIONS
PERTINENT TO THE VARIANCE WITH YOUR APPLICATION
m
13. Have the following permits/certifications been submitted for approval?
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
14. Does this project involve aerial lines or siphons? Check if yes: ❑
These lines will be considered hiah priority and must be checked once every six months
15. Does this project have gravity sewer lines designed at minimum slopes?IVI
Be aware that the Division will not accept installed lines more than 10% flatter than the minimum slope. Lines installed outside this tolerance should be
corrected prior to submitting the final engineering certification..
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FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 5
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1. Use the Division's guidance document entitled, "DETERMINING STREAM CLASSIFICATIONS FOR FORM FTA 02/03
(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
regional office (see instructions for addresses) OR indicate the following:
® A Stream Classification is not needed because all parts of the project are at least 100 feet away from any down slope
waterbody; AND,
® A Stream Classification is not needed because the design does not depend on wet well storage as a power reliability
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
map for cross-reference) Waterbody County River Basin Index Classification
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:
1, Arthur Whedbee, Mayor, attest that this application for Roscoe Lennon Drive Sewer Extension
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required
parts of this application are not completed and that if all required supporting documentation and attachments are not
included, this application package is subject to being returned as incomplete. Note: In accordance with North Carolina
General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement, representation, of
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.
1a.
Signing Official Signature
2. Professional Engineer's Certification:
Date
I attest that this application for Town of Clarkton Roscoe Lennon Drive Sewer Extension
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 certain portions of this submittal package may have been developed by other professionals,
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. Michael C. Wicker, PE
Professional Engineer Name
2b. Withers & Ravenel, Inc.
Engineering Firm
2c. 111 MacKenan Drive
Mailing Address
2d. Cary 2e. NC 2f. 27511
City State Zip
2g. 919-469-3340 2h. 919-238-2099 2i. [e-mail]
Telephone Facsimile E-mail
Seal, Signature & Date
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Name: CLARKTON Location: 0340 28' 28.2" N 078° 39' 43.48" W
Date: 9/11/2006 Caption: Town of Clarkton
Scale: 1 inch equals 2000 feet Roscoe Lennon Drive
Gravity Sewer Extension
Copyright (C) 1998, Maptech, Inc

FHST-TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 1
OF W ATF9 FRState of North Carolina
�Ot QG ®�� ` Department of Environment and Natural Resources
r COPY Division of Water Quality
p m r) FAST -TRACK APPLICATION
lAri dRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
(Pressure sewers systems are not to be included as part of this application package)
INSTRUCTIONS: Indicate that you have included the following list of required application package items by checking the
space provided next to each item. Failure to submit all required items will lead to your application being returned as
incomplete or additional processing and review time. This form may be photocopied for use as an original.
21. Application Form - Submit one original and one copy of the completed and appropriately executed application
form. 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(12).
® II. Application Fee - Submit a check in the amount of $400 made payable to: North Carolina Department of
Environment and Natural Resources (NCDENR).
❑ III. 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(2a) of this application.
❑ IV. Operational Agreements — Submit one original and two copies of a properly executed operational agreement if
the sewer extension is permitted 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
homeowners' association, use Form HOA 02/03. If the applicant is a developer, use Form DEV 02/03. EVEN IF
THE PROJECT WILL BE TURNED OVER TO A MUNICIPALITY, FORM DEV 02/03 IS REQUIRED.
❑ V. Flow Acceptance Letters — If the owner of the downstream sewers and/or WWTF is different from the applicant,
submit two copies of a flow acceptance letter from the owner of the downstream sewers and WWTF, if different.
Flow acceptance letters must contain the following minimum information: applicant and project name, amount of
flow accepted, and name and permit number of the receiving sewers/WWTF. The flow acceptance must not
expire prior to permit issuance and must be dated less than a year prior to the application date.
Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific flow acceptance
letter.
® VI. Map — Submit an 8.5-inch by 11-inch COLOR copy of the portion of a 7.5-minute USGS Topographic Map along
with this form. The map should identify the entire project area location as well as the closest downslope surface
waters as clearly as possible. Each map portion must be labeled with the map name and number, the identified
location of the sewer line and pump stations, and be of clear and reproducible quality. For instance, if the project
involves 4 miles of interceptor sewer that traverses over or near several different waterbodies (or counties,
basins, etc.), the map should have location ID's shown for each different waterbody (where the sewer line is within
100 feet of such waterbody - see Instruction VII). This location ID is self chosen and used to cross reference the
location in Section C of the permit application.
❑ VII. Stream Classifications — Section C
• If any portion of the project is within 100 feet of any down slope surface water, Section C must be completed
for the pertinent sections.
• If the entire project area is a minimum of 100 feet away from any down slope surface waters BUT there is a
pump station involved where a history of power outage is to be used to provide adequate design storage
instead of dual feed or permanent or portable generator, Section C must be completed to demonstrate that
the closest down slope surface water is Class C (see 15A NCAC 2H .0219(h)(3)(D)).
• Use the guidance document entitled, "Determining Watershed Classifications for Form FTA 02/03 (Fast -Track
Sewer Systems)" available from http://h2o.enr.state.nc.us/ndpu or by contacting the appropriate regional
office.

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 2
❑ VIII. Environmental Assessments — If this project is subject to an Environmental Assessment (EA) [15A NCAC
01 C .0500], this application can not be used. Send the project application on Form PSFMGSA 10/99 to the
Non -Discharge Permitting Unit, 1617 Mail Service Center, Raleigh, NC 27699-1617. Applications can not be
processed 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.
® IX. Certifications — Section D
The application must be certified by both the applicant and 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 2H .0200, 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. Certification by a PE who is unfamiliar with these documents
is subject to NC Board referral.
THE COMPLETED FTA 02/03 APPLICATION PACKAGE, INCLUDING ALL SUPPORTING DOCUMENTS AND $400
FEE, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional Office
Avery, Buncombe, Burke, Caldwell,
2090 US Highway 70
Cherokee, Clay, Graham, Haywood,
Swannanoa, North Carolina 28778
Henderson, Jackson, Macon,
[phone]
Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania,
Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Fayetteville, North Carolina 28301
Anson, Bladen, Cumberland, Harnett,
[phone]
Hoke, Montgomery, Moore, Robeson,
[phone] Fax
Richmond, Sampson, Scotland
Mooresville Regional Office
919 N Main Street
Moor
M
Mooresville, North Carolina 28115
Alexander, Cabarrus, Catawba,
663-169
Cleveland, Gaston, Iredell, Lincoln,
[phone] Fax
Mecklenburg, Rowan, Stanly, Union
Raleigh Regional Office
1628 Mail Service Center
Chatham, Durham, Edgecombe,
Raleigh, North Carolina 27699-1628
Franklin, Granville, Halifax, Johnston,
[phone]
Lee, Nash, Northampton, Orange,
[phone] Fax
Person, Vance, Wake, Warren,
Wilson
Washington Regional Office
Beaufort, Bertie, Camden, Chowan,
943 Washington Square Mall
Craven, Currituck, Dare, Gates,
Washington, North Carolina 27889
Greene, Hertford, Hyde, Jones,
[phone]
Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington,
Wayne
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, North Carolina 28405
Brunswick, Carteret, Columbus,
[phone]
Duplin, New Hanover, Onslow,
[phone] Fax
Pender
Winston-Salem Regional Office
585 Waughtown Street
Alamance, Alleghany, Ashe, Caswell,
Winston-Salem, North Carolina 27107
Davidson, Davie, Forsyth, Guilford,
[phone]
Rockingham, Randolph, Stokes,
[phone] Fax
Surry, Watauga, Wilkes, Yadkin
For more information, visit our web site at: http://h2o.enr.state.nc.us/ndpu/
n A nnin' n_ n nA in

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 3
_....................--
... _........._.......__..._.........._..--
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD! Application Ni WQ00307 68
-._...................._.......................... .........._.... (to be completed
1.
Owner:
1 a.
Town of Clarkton
Full Legal Name (company, municipality, HOA, utility, etc.)
_ ........ ........ . ...._. ...... _. _ _ _ _ ......... .._....... .......
Z
1b.
Arthur Whedbee,Mayor
0
Signing Official Name and Title (Please review 15A NCAC 2H .0206(b) for authorized signing officials!)
H
1c.
The legal entity who will own this system is:
❑ Individual ❑ Federal ® Municipality ❑ State/County ❑ Private Partnership ❑ Corporation ❑ Other (specify):
1d.
81 North Elm Street le. Clarkton
0
Street Address City
LL
............. ....._.... ......................... _........ ............ _...................... ................ _._...._.......... ........... ....
Z
1f.
North Carolina 1g. 28433
Z
State Zip Code
0
...... ........ ......._....... ...... ..- .......... __ ..
1 h.
[phone] 1 i. [phone] 1 j.
~
Telephone ; Facsimile E-mail
......._..__...... ._........... _ ._. _._..---._........
()
2. _
Project (Facility) Information: ..................... .................................. ................................. ............. ._......
_
11
2a.
Roscoe Lennon Drive Sewer Extension 2b. Bladen
(L
Brief Project Name (permit will refer to this name) County Where Project is Located
3.
Contact Person:
Q
3a.
Alton Boswell, Public Works Director, Town of Clarkton
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b.
[phone] 3c.
Phone Number E-mail
1.
Project is ® New ❑ Modification (of an existing permit) If Modification, Permit No.:
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.
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 III)
Z
❑ Leasing units (lots, townhomes, etc. - skip to Item B(3)) ❑ Homeowner Assoc./Developer (Instruction IV)
0
❑ Selling units (lots, townhomes, etc. - go to Item B(2b))
H
Q
3.
Town of Clarkton
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
0
4a.
Town of Clarkton WWTP 4b. NC0021610
LL
Name of WWTF WWTF Permit No.
................... ........................... .... 1se..? :....Y..... o.......Est.r_Z,ll'..;r!
Z
5a.
......../ .
Town of Clarkton 8 inch Tfic. Unknown original system
Pb.
Owner of Downstream Sewer Receiving Sewer Size I Permit Number of Downstream Sewer (if known)
6.
The origin of this wastewater is check all that apply):
W®Residential
Subdivision ❑ Car Wash
0.
❑Apartments/Condominiums El Institution 100 % Domestic/Commercial
—
❑ Mobile Home Park ❑ Hospital
❑ School ❑ Church % Industrial
❑ Restaurant ❑ Nursing Home
(specify):
El Office El Other(specify):%Other
7.
Volume of wastewater to be permitted in this project: 2160 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
--A A� /A' T__. � AA/AA

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 4
9. Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2H
.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
that in 15A NCAC 2H .0219(1)(1-2) must be approved prior to submittal of this application. Submit a separate request to
the Division of Water Quality, Non -Discharge Permitting Unit, 1617 Mail Service Center, Raleigh, NC 27699-1617 in
accordance with 15A NCAC 2H .0219(l)(3).
6 homes x 360 gpd = 2160 gpd
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
........ _ . .. ...
Size (inches)
Length (feet)
8" 225
Gravity or Force Main
(use the pull down menu)
Gravity
Z Location ID Power Reliability Option
_ (self chosen - as shown on Design Flow Operational Point (1- dual line feed; 2- permanent generator MATS; 3-
0 i
plans for cross-reference) (MGD) GPM @ TDH portable generator w/telemetrv; 4-wet well storage)
12. Does the sewer system comply with the Minimum Design Criteria for the Fast Track Permitting of Pump Stations and Force
m Mains (latest version), the Gravity Sewer Minimum Design Criteria (latest version) and 15A NCAC 2H .0200 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
13. Have the following permits/certifications been submitted for approval?
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
nm n�in' n_ I nA/nA

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 5
a
w
A
1. Use the Division's guidance document entitled, "DETERMINING STREAM CLASSIFICATIONS FOR FORM FTA 02/03
(FAST -TRACK SEWER SYSTEMS)" to collect and record the stream classification data below (attach additional sheets a
necessary). This document is available from our web site or by contacting the appropriate Division of Water Quality
regional office (see instructions for addresses) OR indicate the following:
® A Stream Classification is not needed because all parts of the project are at least 100 feet away from any down slope
waterbody; AND,
❑ A Stream Classification is not needed because the design does not depend on wet well storage as a power reliability
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
map for cross-reference) Waterbody County River Basin Index Classification
_ _..
i
......... ..... .........
Submit the 8.5" x I I" COLOR topographic map as required in Instruction VI
regardless of whether a classification is providedl
I. Applicant's Certification:
i
1, Arthur Whedbee, attest that this application for Roscoe Lennon Drive Sewer Extension
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
j General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement, representation, c
certification in any application shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed $10,000
i as well as civil penalties uD to $25.000 Der violation.
a.
Signing Official Signature
Professional Engineer's Certification:
Q ,70(
Date
I attest that this application for Town of Clarkton Roscoe Lennon Drive Sewer Extension
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
i 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 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
I 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 Michael C. Wicker
Professional Engineer Name �N(�
2b. Withers & Ravenel, Inc. SS
Engineering Firm
2c. 111 MacKenan Drive
Address 11325
2d Cary 2e. NC 2f. 27511
City State Zip
2h. [phone] 2i. mwickerawithersravenel.com
2g. [phone] � pG
C.
Telephone Facsimile E-mail Seal, Signature & Date
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Name: CLARKTON Location: 034.28' 39.4" N 078° 39' 45.61" W
Date: 8/25/2006 Caption: Town of Clarkton
Scale: 1 inch equals 2000 feet Roscoe Lennon Drive
Gravity Sewer Extension
Copyright (C) 1998, Maptech, Inc

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Name: CLARKTON Location: 034' 28' 39.4" N 078' 39' 45.61" W
Date: 8/25/2006 Caption: Town of Clarkton
Scale: 1 inch equals 2000 feet Roscoe Lennon Drive
Gravity Sewer Extension
Copyright (G) 1998, Maptech, Inc.

Town of Clarkton
Roscoe Lennon Drive Sewer Extension
Cost Estimate
Item
ITEM DESCRIPTION
Est.
Quan.
Unit
Unit Price
Extended Price
A.
Line S-1
1.0
8 " PVC San Sewer (0-6)
225
if
$ 35.00
$
7,875.00
2.0
4' Dia. Manhole (0-6')
1
ea.
$ 2,000.00
$
2,000.00
3.0
Tie Into Existing Manhole
1
is
$ 1,000.00
$
1,000.00
4.0
Short Service with Cleanout
6
ea.
$ 525.00
$
3,150.00
5.0
Stone for Bedding
50
tons
$ 30.00
$
1,500.00
6.0
Stone for Road
250
tons
$ 30.00
$
7,500.00
7.0
Seeding and Mulching
0.23
acres
$ 1,600.00
$
367.31
8.0
Mobilization
1.00
is
$ 950.00
$
950.00
TOTAL BASE BID
PRICE:
$
24,342.31
Engineering
Surveying
10
hrs
$ 100.00
$
1,000.00
Surveying Technician
5
hrs
$ 75.00
$
375.00
CAD Technician
8
hrs
$ 78.00
$
624.00
Project Engineer
8
hrs
$ 125.00
$
1,000.00
Construction Administration
4
hrs
$ 125.00
$
500.00
Total
$
3,499.00
Permit Fees
$
400.00
TOTAL PROJECT PRICE:
$
28,241.31
Cost Shared by 6 Residences
$
4,706.88

30 T
'Wvelell
WilalvhIGdiv, AoItIll v ValvaGisval 28433
August 25, 2006
D
SEP � 12p06
Aquifer Protection Supervisor
DWQ
North Carolina Department of Environment and Natural Resources
Fayetteville Regional Office
Division of Water Quality
225 Green Street, Suite 714 Systel Building
Fayetteville, NC 28301
Re: Fast Track Gravity Sewer Permit
Roscoe Lennon Drive Gravity Sewer Extension
Town of Clarkton, North Carolina
Dear Sirs:
Please find attached two copies of the Fast Track Application for Gravity Sewers,
Pump Stations and Force Mains for a 225 if 8" gravity sewer extension in the Town of
Clarkton to serve six existing unsewered homes. The permit application fee of
$400.00 is attached.
Should you have any questions about this matter please contact our engineer,
Michael C. Wicker, P.E. at [phone]•
Sincerely,
J44tv
Alton Boswell
Public Works Director
Cc: Michael C. Wicker, P.E., WR Project No. 205132.00
J'av�-• (97O) 647-5964 o4, (9-10) 647-3/21 Aaxv [phone]

�. Wdv 307
8 -1 A 411m 9GvelPi1
EST .ias� �Gcr�z�Go sv, �o v��ii 'Ka va/i "lal 28433
SEP 19 2006 RECEIVED
September 11, 2006
JVv``pp'' Q SEP 13 Z006
Trent Allen Withers & Ravenel
North Carolina Department of Environment and Natural Resources
Fayetteville Regional Office ...
Division of Water Quality
225 Green Street, Suite 714 Systel Building
Fayetteville, NC 28301 4
nA
Re: Fast Track Gravity Sewer Permit
Roscoe Lennon Drive Gravity Sewer Extension
Town of Clarkton, North Carolina
Dear Sir:
Please find attached two revised copies per your request of the Fast Track
Application for Gravity Sewers, Pump Stations and Force Mains for a 225 if 8" gravity
sewer extension in the Town of Clarkton to serve six existing unsewered homes. Also
the attached map more clearly indicates the location of the project. The permit
application fee of $400.00 is has already been submitted.
Should you have any questions about this matter please contact our engineer,
Michael C. Wicker, P.E. at [phone]•
Sincerely,
Alton Boswell
Public Works Director
Cc: Michael C. Wicker, P.E., WR Project No. 205132.00
�e� 7�YIPi.• [phone] " �940) 647-312-1 �990) 647-00-13