WQ0030457_Permit (Issuance)_20060630 (2)

PAGE 3
,WRYACAPPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD!
Application Number W00030457
( (to a comp e e y )
1. Owner:
1a. Town of White Lake
Full Legal Name (company, municipality, HOA, utility, etc.)
Z
0 1b. Goldston Womble
H
a 1 c.
re
0 Id.
Signing Official
The legal entity
■ Individual
1879 White Lake
IN
Name and Title (Please review
who will own this system
Federal 0 Municipality
Drive
is:
■
15A NCAC
State/County
2H .0206(b) for authorized
■ Private Partnership
le. White Lake
■
signing officials!)
Corporation
■
Other (specify):
LL
Z
If.
Mailing Address City
North Carolina lg. White Lake
Z
1 h.
State Zip Code
910-862-4800 1 i. 1j. 28337
H
(aj 2.
.J 2a.
Telephone Facsimile E-mail
Project (Facility) Information:
White Lake Townes on Tyner Dr. 2b. [e-mail]
EL
EL
a 3.
Q 3a.
Brief Project Name (permit will refer to this name) County Where Project is Located
Contact Person:
Greg Bagley, Engineer
3b.
Name and Affiliation of Someone Who Can Answer Questions About this Application
919-552-1600 3c. [e-mail]
Phone Number E-mail
1.
Project is
e
New ■ Modification (of an existing permit) If Modification, Permit No.:
For
phase,
duplicate
modifications, attach a separate sheet clearly explaining the reason for the modification (i.e. adding another
changing line size/length, etc.). Only include the modified information in this permit application - do not
project information in B(7) and B(10-11) that has already been included in the original permit.
2.
Owner is
e Public (skip to Item B(3))
IN
Private (go to Item 2(a))
2a.
If private, applicant will be: 2b. If sold, facilities owned by a (must choose one)
Z
0
■
•
•
Retaining Ownership (i.e. store, church, single office, etc.) or
Leasing units (lots, townhomes, etc. - skip to Item B(3))
Selling units (lots, townhomes, etc. - go to Item B(2b))
•
•
Public Utility (Instruction III)
Homeowner Assoc./Developer (Instruction IV)
II— 3. Town of White Lake
<Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
4a. White Lake WWTP 4b. NC0023353
ce
B. PERMIT INFO
Iill I rn1
-1
88-358/531
IBRAHIM OUDEH 0(65204782 1 5 7
TILGHMAN DRIVE 910-892-8700
i Sewer (if known) 71
801
DUNN, NC 28334 �i t 0 C
DATE J
I
a PAY TO ORDER //777 I s C(6 0
r 7
:,ommercal
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few /� DOLLARS 8 tea-
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,pacify):
4FidelityBank
u 1000 E. Cumberland SI.,4.,9(40-ta---Dn, NC 28334
MEMO '�Wt!� 1Ar:0
5 31CJ"315 �5':15 li 21I' 3.0
U Rehabilitation or replacement of existing sewer with no new flow expected

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 1
COPY
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
3 FAST -TRACK APPLICATION
for GVITY 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 retumed as incomplete. This form may be photocopied for use as an original.
L Application Form - Submit one original and one copy of the cornpleted and appropriately executed application
form. Any changes to this form will result in the application being retumed. 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 soecificationiunless you respond NO to Item B(12).
® III. 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.
❑ IL Certificates of Public Convenience and Necessity - !f 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.
0 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 sewerslWWTF. The flow acceptance must not
expire prior to permit issuance and must be dated Tess 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.
Vt. 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 flttD://h2o.enr.state.nc.us/peres or by contacting the appropriate regional
office.

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE 2
EA)
18A NCAC
[] 1Plii. MCI this application
Assessments if this be used.
oject Ses nd the project application on Form ct to an Environmental
PS SA 10199 to the PERCS
MCI this
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.
® X. Certifications — Section D
The application must be certfIed 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.
0 X. Downstream Sewer & Wastewater Treatment Plant CapacltY The addition of new
The applicant has assured downstream pipe, pump station and treatment plant capacity.
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 02/'03 APPLICATION PACKAGE, INCLUDING ALL SUPPORTING DOCUMENTS AND 3400
FEE, SHOULD BE SENT TQ Tyre, Perrrcurrawr c rwvrV
Mir %a,. %OF IF1VG
REGIONAL OFFICE
ADDRESS
COUN71ES SERVED
Asheville Regional OMkos
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 OMcs
610 E. Center Avenue, Suite 301
Mooresville, North Carolina 28115
[phone]
[phone] Fax
Alexander, Cabarrus, Catawba,
Cleveland, Gaston, Iredeli, Lincoln,
Mecklenburg, Rowan, Stanly, Union
Raleigh Regional °Rice
1628 Mail Service Center
Raleigh, North Carolina 27899-1628
[phone]
919) 571-4718 Fax
Chatham, Durham, Edgecornbe, Franicia-cam
Granville, Halifax, Johnston, Lee, Nash,
Northampton, Orange, Person, Vance,
Wake, Warren, Wilson
Washington RsgksrW OMica
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,
Pamlloo, 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
Wk eton-Salem Regional Office
585 Waughtown Street
Winston-Salem, North Carolina 27107
[phone]
[phone] Fax
Alamance, Allegheny, Ashe, Caswell,
Davidson, Davie, Forsyth, Guilford,
Rockingham, Randolph, Stokes, Surry,
Watauga, Wilkes, Yadkin
For more i formation, visit our web .site at: http:i/h2e.enr.state.nc.usfperes/

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. Town of White Lake
i Full Legal Name (company, municipality, HOA, utility, etc.)
0 1 b. Gokiston Womble
p Signing Offiaai Name and Title (Please review 15A NCAC 2H .0206(b) for authorized signing officials!)
g1 c. The legal who will n this system is:
re [Individuate owFederal ® Municipality ❑ State/County 0 Private Partnership 0 Corporation 0 Other (specify):
Q ld. 1879 White Lake Drive
le. White Lake
U. Mailing Address City
Z If. North Carolina lg. White Lake
Z State Zip Code
O lh. 910-862-4800 1 i. 11. 28337
aTelephone Facsimile E-mail
C.) 2. Project (Facility) Information:
J 2a. White Lake Townes on Tyner Dr. 2b. bciarknwhitela enc.com
dBrief Project Name (permit will refer to this name) County Where Project is Located
• 3, Contact Person:
4 3a. Greg Bagley, Engineer
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. 919-552-1600 3c. [e-mail]
Application Number:
(to be completed by DWQ)
W00030457
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0
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1
(of an existing permit) If Modification, Permit No.:
1. Project is ® New • Modification
For modifications, attach a separate sheet clearly explaining the reason for the modification (i.e. adding another
phase, changing Tine sla llength, etc.). Only include the modified information in this permit application - do not
duplicate project information In B(T) and B(10-11) that has already been included in the original permit.
(go to Item 2(a))
2. Owner is *_ Public (skp to Item 8(3)) ■ Private
2a. If private, applicant will be:
0 Retaining Ownership (Le. store,
2b.
church, single office, etc.) or
etc. - skip to Item 8(3))
etc. - go to Item B(2b))
If Ng, , facilities owned by a (must choose rn )
■ Public Utility (Instruction NI)
• Leasing units (lots, townhomes,
■ Homeowner Assoc./Developer (instruction IV)
• Selling units (lots, townhomes,
3. Town of White Lake
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
,4W a. White Lake WTP 4b. NC0023353
' Name of WWTF WWTF Permit No.
5a. Town Of White Lake
5b.
Receiving Sewer Size
Gravity
M Force Main
c.
Owner of Downstream Sewer
Permit Number of Downstream Sewer (if known)
6. The origin of this wastewater is (check all that apply):
0 Car Wash
Home
(specify):
1%1 % Domestic/Commercial
►_ Residential Subdivision
0 Apartments/Condominiums • Institution
in Mobile Home Park B Hospital
%Industrial
■ School 0 Church
■ Restaurant ■ Nursing
% Other (specify):
• Office ■ Other
7. Volume of wastewater to be allocated for this particular project: 1200 gallons per day
'Do not include previously permitted allocations
8. if the permitted flow is zero, indicate
why:
be permitted in subsequent permits that
in Permit No.
connect to this line
expected
■ Interceptor Line - Flow will
■ Flow has already been allocated
❑ Rehabilitation or replacement
of existing sewer with no new flow

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 aoordance 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 .02190)(1-2) must be supported with actual water or wastewater use data in accordance with 15A
NCAC 2H .02190)(3).
5 units Q 240 gal per 2 bedroom unit = 1200 gallons
10. Summary of Sewer Unss to be Permitted (attach additional sheets if necessary)
Size (inches) Length (feet)
8. 140
W
0
z
Gravity or Force Main
(use the pull down menu)
Gravity
ENTER TOTAL UNE LENGTH IN MILES :.026
O
V 11. Summary of Pump Stations to be Permitted (attach additional sheets as necessary)
z Location ID Power RellabIity Option
(self chosen - as shown on Design Flow Operational Point (1- dual line feed; 2- permanent generator WATS; 3-
I plans for _... ) (MGD) GPM TDH portable generator v alsmeby; 4-wet well storage)
� _ I
0
LL
1
▪ 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
im
13. Have the following permits/certifications been submitted for approval?
Wetland/Stream Crossings - General Permit or 401 Certification? ❑ Yes 0 No ® N/A
Sedimentation and Erosion Control Plan? ❑ Yes ❑ No ® N/A
Storrnwater? 0 Yes ❑ No ® N/A
14. Does this project involve aerial lines or siphons? Check if yes: ❑
'These Ines will be consideredbiab.slodly and mull be shacked once every sci months
15. Does this project have gravity sewer lines designed at minimum slopes? /81
Be aware that the Division will not accept installed lines more than 1O% flatter than the minimum slope. Lines instaled outside this tolerance should be
corrected prior to submitting the final engineering certification..

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE 5
C. STREAM CLASSIFICATION
1. Use the Division's guidance document enticed, "DETERMINING STREAM CLASSIFICATIONS FOR FORIM FTA 02/03
(FAST -TRACK SEWER SYSTaIS)" 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) Qfi 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;l,
3 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.
Lccailon ID on lbap
(sett chosen - as shown on
mwp for cross-raierenc s)
Narrw of
Waterbody County River Basin
Waterbody Stream Waterbody
Index Classification
Submit the 5.5" x 11" COLOR topographic map as required in instruction VI
regardless of whether a classification is provided!
D. CERTIFICATIONS
la.
Applicant's Certification:
Goktston Womble, ettest that this application for White Lake Towns on Tyner Road has been reviewed by me and is
accurate and complete to the best of my knowledge. 1 understand that if all required pads of this application we 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 Caarolina General Statutes 143-215.6A and
143-215.t38, any person who knowingly makes any false statement, representation, orcerhiication in any application
shah be guity of a Class 2 misdemeanor which may include a fine not to exceed $10, 000 as wel as civil penalties up to
$25,000 per violation
Signing C al Signature
2. Professional Engineer's Certification:
1 attest that this application for Nhte Lake Townes 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 wth
the applicebie regulations, Gawky Sewer Minimum Design Criteria for Gravky Sewers adopted February 12, 1996, and the
Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mans adopted June 1, 2000 and the
watershed classification in accordance wth 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 t 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
codification in any application shall be guilty ofa 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. C. Gregory Bagley
Professional Engineer Name
2b. Tarheel Engineering
Engineering Firm
2c. 805 Cokesbury Road
Mailing Address
2d. Fuquay Varina
City
2g. 919-552-1600 2h. 919-552-6325
Telephone Facsimile
2e. NC 2f. 27526
State Zip
2i. tarheelengineeringe
earthlink.net
a
Seel, Signature & Date
J

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