WQ0023944_Application_20040520

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:
completed by DWQ)
1. Owner:
la. TARHEELCAMPGROUND
Full Legal Name (company, municipality, HOA, utility, etc.)
Z 1 b. HOWARD NAYLOR
Q Signing Official Name and Title (Please review 15A NCAC 2H .0206(b) for authorized signing officials!)
a ;1 c. The legal entity who will own this system is:
■ Individual 0 Federal 13 Municipality 0 State/County • Private Partnership III Corporation ■ Other (specify):
id. 2400 MINGO CHURCH ROAD 1 e. DUNN
0 Street Address City
LL
Z '1f. NORTH CAROLINA 19. 28334
z • State Zip Code
0 1 h. 910-567-2704 1 i. 1 j.
Q Telephone Facsimile E-mail
V 2. Project (Facility) Information:
d2a. TARHEEL CAMPGROUND 2b. BLADEN
p, Brief Project Name (permit will refer to this name) County Where Project is Located
Q 3. Contact Person:
Q 3a. LARRY ANDERSON, ANDERSON ENGINEERING & ASSOCIATES, PA.
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b.
HOWARD
NAYLOR PH. 910-567-2704 884
NAYLOR
1957609
MINGO CHURCH RD. S _ 1-1 - 2.03� 66-112/531
CONNIE
1. DL
Fc 2400
DUNN,
PI'
dL
--
2a.
NC 28334
NCQZQR2. 1$ oo
t
f /
I 0
(* __
_
4 3.
2
Q 4a.

F- Owner of Downstream Sewer i Receiving Sewer Size Permit Number of Downstream Sewer (if known)
6. The origin of this wastewater is (check all that apply):
C • Residential Subdivision ■ Car Wash
W ■ Apartments/Condominiums
C" ■ Mobile
• Institution 100 % DomestidCommercial
Home Park ■ Hospital
m ■ School
■ Church % Industrial
• Restaurant
• Office
• Nursing Home % Other (specify):
13 Other (specify): RV CAMPGROUND
7. Volume
of wastewater to be permitted in this project: 2400 gallons per day
8. If the
permitted flow is zero, indicate why:
Line - Flow will be permitted is subsequent permits that connect to this line
has already been allocated in Permit No.
■ Interceptor
• Flow
• Rehabilitation
or replacement of existing sewer with no new flow expected
FTA 02/03 - Rev. 2 04/04

•
N.
FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE I
5(IAT6;
DENR-FRO
• MAY 13 21'
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
FAST -TRACK APPLICATION
for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
DWQ
(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.
• 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).
x❑ II. Application Fee - Submit a check in the amount of $400 made payable to: North Carolina Department of
Environment and Natural Resources (NCDENR).
x❑ 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.
x❑ 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.
FTA 02/03 - Rev. 2 04/04

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
01C .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.
0 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.
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
2090 US Highway 70
Swannanoa, North Carolina 28778
[phone]
[phone] Fax
Avery, Buncombe, Burke, Caldwell,
Cherokee, Clay, Graham, Haywood,
Henderson, Jackson, Macon,
Madison, McDowell, Mitchell, Polk,
Rutherford, Swain, Transylvania,
Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Fayetteville, North Carolina 28301
[phone]
[phone] Fax
Anson, Bladen, Cumberland, Harnett,
Hoke, Montgomery, Moore, Robeson,
Richmond, Sampson, Scotland
Mooresville Regional Office
919 N Main Street
Mooresville, North Carolina 28115
[phone]
[phone] Fax
Alexander, Cabarrus, Catawba,
Cleveland, Gaston, Iredell, Lincoln,
Mecklenburg, Rowan, Stanly, Union
Raleigh Regional Office
1628 Mail Service Center
Raleigh, North Carolina 27699-1628
[phone]
[phone] Fax
Chatham, Durham, Edgecombe,
Franklin, Granville, Halifax, Johnston,
Lee, Nash, Northampton, Orange,
Person, Vance, Wake, Warren,
Wilson
Washington Regional Office
943 Washington Square Mall
Washington, North Carolina 27889
[phone]
[phone] Fax
Beaufort, Bertie, Camden, Chowan,
Craven, Currituck, Dare, Gates,
Greene, Hertford, Hyde, Jones,
Lenoir, Martin, Pamlico, Pasquotank,
Perquimans, Pitt, Tyrrell, Washington,
Wayne
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, North Carolina 28405
[phone]
[phone] Fax
Brunswick, Carteret, Columbus,
Duplin, New Hanover, Onslow,
Pender
Winston-Salem Regional Office
585 Waughtown Street
Winston-Salem, North Carolina 27107
[phone]
[phone] Fax
Alamance, Alleghany, Ashe, Caswell,
Davidson, Davie, Forsyth, Guilford,
Rockingham, Randolph, Stokes,
Surry, Watauga, Wilkes, Yadkin
For more information, visit our web site at: http:11h2o.enr.state.nc.uslndpul
FTA 02/03 - Rev. 2 04/04

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE 3
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD!
1. Owner:
la. TARHEEL CAMPGROUND
Full Legal Name (company, municipality, HOA, utility, etc.)
Application Number: 2 p�
(to be completed by DW J -! (�
Z 1 b. HOWARD NAYLOR
O Signing Official Name and Title (Please review 15A NCAC 2H .0206(b) for authorized signing officials!)
Qlc. The legal entity who will own this system is:
® Individual 0 Federal 0 Municipality 0 State/County 0 Private Partnership 0 Corporation 0 Other (specify):
c 1 d. 2400 MINGO CHURCH ROAD 1 e. DUNN
0 Street Address
Z If. NORTH CAROLINA
Z State
• lh. 910-567-2704 1 I.
Q Telephone Facsimile E-mail
V 2. Project (Facility) Information:
City
1 g. 28334
Zip Code
1j.
J
a
a
2a. TARHEEL CAMPGROUND
Brief Project Name (permit will refer to this name)
3. Contact Person:
2b. BLADEN
3a. LARRY ANDERSON, ANDERSON ENGINEERING & ASSOCIATES, P.A.
County Where Project is Located
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. 910-671-9530
Phone Number
_.._..........................................._........
1. Project is ® New 0 Modification (of an existing permit)
3c. [e-mail]
E-mail
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 0 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)
0 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)) 0 Homeowner Assoc./Developer (Instruction IV)
0 ❑ Selling units (lots, townhomes, etc. - go to Item B(2b))
2
0
LL
Z
1—
re
W
m
3. WHITE LAKE
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
4a. TOWN OF WHITE LAKE WWTF 4b. 23353
Name of WWTF WWTF Permit No.
5a. 15b.
Owner of Downstream Sewer Receiving Sewer Size
The origin of this wastewater is (check all that apply):
❑ Residential Subdivision
0 Apartments/Condominiums
❑ Mobile Home Park
❑ School
❑ Restaurant
❑ Office
c.
Permit Number of Downstream Sewer (if known)
O Car Wash
❑ Institution
❑ Hospital
❑ Church
0 Nursing Home
© Other (specify): RV CAMPGROUND
7. Volume of wastewater to be permitted in this project 2400 gallons per day
100 % Domestic/Commercial
% Industrial
% Other (specify):
8. If the permitted flow is zero, indicate why:
0 Interceptor Line - Flow will be permitted is subsequent permits that connect to this line
❑ Flow has already been allocated in Permit No.
O Rehabilitation or replacement of existing sewer with no new flow expected
FTA 02/03 - Rev. 2 04/04

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(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(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(1)(3).
20ftV LOTS @ 120 GPD = 2400GPD
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches) Length (feet)
8"o
W
2
Z'.
V
•
OENTER TOTAL LINE LENGTH IN MILES .07
.a Location ID 11. Summaryof PumpStations to be Permitted (attach additional sheets as necessary)
Power Reliability Option
CZ (self chosen - as shown on Design Flow Operational Point (1- dual line feed; 2- permanent generator w/ATS; 3-
LO plans for cross-reference) (MGD) GPM @ TDH portable generator w/telemetry; 4-wet well storage)
Z
H
A
w
CL
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:
! 347
Gravity or Force Main
(use the pull down menu)
GRAVITY
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 0 No ❑X N/A
Sedimentation and Erosion Control Plan? ® Yes ❑ No 0 N/A
Stormwater? ❑ Yes ❑ No ® N/A
FTA 02/03 - Rev. 2 04/04

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE 5
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
Oregional office (see instructions for addresses) OIL 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
Qwaterbody; AND
V ® 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.
IJ.
CI) Location ID on Map
N (self chosen - as shown on Name of Waterbody Stream Waterbody
5 map for cross-reference) Waterbody County River Basin Index Classification
V
C. STREAM
Submit the 8.5" x 11" COLOR topographic map as required in Instruction VI
regardless of whether a classification is provided!
Applicant's Certification:
1, HOWARD NAYLOR attest that this application for ,TARHEEL CAMPGROUND
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 retumed as incomplete. Note: In accordance with North Carolina I
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 exceed $10,000
as well as civil penalties up to $25,000 per violation.
Sigrfing Official Signature
2. Professional Engineer's Certification:
2a.
2b.
2c.
2d.
2g.
Date
1 attest that this application for TARHEEL CAMPGROUND 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 143-215.68, 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
exceed $10,000 as well as civil penalties up to $25,000 per violation.
LARRY W. ANDERSON
Professional Engineer Name
ANDERSON ENGINEERING & ASSOCIATES, P.A.
Engineering Firm
305 N. CHIPPEWA STREET
Address
LUMBERTON
City
910-671-9530
Telephone
�HH
0•• ESS% •.•
eo OyS.
E i a SEAL
• 13325
Ilfr
e�i4W ANDS
� V��
���a1�9kZre & Date
2h. 910-618-0838
Facsimile
2e. NC 2f. 28358
State Zip
2i. anderson(carolina.net
E-mail
FTA 02/03 - Rev. 2 04/04

3-D TopoQuads Copyright ®1999 DeLorme Yarmouth, ME 04096 Source Data: USGS I
1000 ft Seale: 1 : 25,000 Detail: 13-0 Datum: WGS84
1

Anderson Engineering & Assoc., P.A.
P.O. Box 1736
305 North Chippewa
Lumberton, N.C. 28359
May 18, 2004
NCDENR
Division of Water Quality
225 Green Street Suite 714
Fayetteville, NC 28301
Re: Fast -track Application for Tarheel Campground
White Lake, NC
To Whom It May Concern,
Please find enclosed the following for your review and approval:
1) A Fast -Track Application for Gravity Sewers Package
2) $400 Check for Application Fee
Should you have any questions, please do not hesitate to contact me.
Sincerely,
Anderson Engineering & Associates, P.A.
Renee Warren
Drafting Technician
RW/pr
Enclosures
Larry Anderson, P.E.
President
Nh^�"
MAY 2 0 2004
0 National Society of
Professional Engineers®
Maud Memba
Phone: [phone] • Fax: [phone] • Email: [e-mail]

TOWN
OF
WHITE
LAKE
March 10, 2004
Larry W. Anderson, P.E.
Anderson Engineering & Associates, P.A.
P.O. Box 1736
Lumberton, NC 28359
Ref: Howard Naylor
Tar Heel Campground Project
Request for Additional GPD WaterNVastewater
Dear Mr. Anderson:
Re4tzt
cc nA4 0 Isoa,
Pursuant to your request on February 25, 2004, the Town of White Lake
Board of Commissioners at their March 09, 2004 meeting agreed to furnish water
and receive the wastewater for treatment for 8 additional lots with each lot
generating 120 gpd (for a total of 960 gpd) of wastewater. Enclosed is a
Certificate of Recording Officer regarding the Board's action.
Should you need additional information or if I may be of further assistance
to you, please feel free to contact me at 910-862-4800.
Cc: Tim :Frush, Public Works Director
Mr. Howard Naylor
Enclosure
Sincerely,
Brenda Clark, CMC
Town Clerk
P.O. Box 7250
White Lake, NC 28337-7250 Phone [phone] Fax [phone]

Certificate of Recording Officer
The undersigned duly qualified and acting Clerk of The Town of White
Lake does hereby certify that the following action was unanimously approved by
the White Lake Town Board of Commissioners and is a true and accurate copy of
the minutes of their regular meeting.
THAT THE REQUEST FROM HOWARD NAYLOR TO SUPPLY 960
GALLONS PER DAY OF POTABLE WATER AND SANITARY SEWER
TREATMENT BY THE TOWN OF WHITE LAKE BE APPROVED CONTINGENT
UPON PROJECT PLANS AND SPECIFICATIONS ARE STATE APPROVED,
PROJECT INSPECTED AND APPROVED BY THE TOWN'S PUBLIC WORKS
DIRECTOR AND ENGINEER, AND FURTHER UPON PROJECT
COMPLETION, ANDERSON ENGINEERING PROVIDE THE TOWN WITH AS
BUILT PLANS AND CERTIFICATION THAT THE PROJECT WAS BUILT
ACCORDING TO PLANS.
In witness whereof, I have hereunto set my hand this the 10th day of
March, 2004.
Brenda Clark, Town Clerk
Town of White Lake
TOWN
SEAL
P.O. Box 7250 White Lake, NC 28337-7250
Phone [phone] Fax [phone]

January 18, 2000
Larry W. Anderson, P.E.
Anderson Engineering & Assoc., P.A.
P. O. Box 1736
Lumberton, NC 28359
Re: Howard Naylor Resort Park
Dear Mr. Anderson:
MAYOR:
H. Goldston Womble, Jr.
COMMISSIONERS:
Thomas E. Ricl
Timothy G. Blount
E. Donald Smith, Jr.
R. Jefferson Corbett
Tracey S. Trivett
Kathryn C. Nye
Pursuant to your request of January 5, 2000, the Town of White Lake Board of
Commissioners have agreed to supply Mr. Naylor's Resort Park with potable water and accept
the domestic wastewater for treatment. Enclosed is a Certificate of Recording Officer regarding
the Board's action.
Should you need additional information, please do not hesitate to contact us.
Sincerely,
Carolyn K. Lane
Town Clerk
Enclosure
P.O. Box 7250 White Lake, NC 28337-7250 Phone [phone] Fax [phone]

CERTIFICATE OF RECORDING OFFICER
The undersigned duly qualified and acting Clerk of The Town of White Lake does hereby
certify: That the following action was unanimously approved by the Board of Commissioners of
The Town of White Lake by resolution and is a true and accurate copy of the resolution.
THAT THE REQUEST FOR THAT THE REQUEST FOR HOWARD NAYLOR'S
RESORT PARK BE APPROVED TO PROVIDE 2400 GPD POTABLE WATER AND
ACCEPT 2400 GPD WASTEWATER FOR TREATMENT PROVIDED PROJECT PLANS
AND SPECIFICATIONS ARE SATE APPROVED AND PROJECT IS INSPECTED AND
APPROVED BY THE TOWNS ENGINEERING FIRM AND PUBLIC WORKS DIRECTOR,
as regularly adopted at a legally convened meeting of the Board of Commissioners of The
Town of White Lake duly held on the 11 th day of JANUARY, 2000, and, further that such
resolution has been fully recorded in the journal of proceedings and records in my office.
IN WITNESS WHEREOF, I have hereunto set my hand this the 18th day of January,
2000.
Carolyn K< Lane, Town Clerk
Town of White Lake
File: WSDept/h-naylor