WQ0034812_Application (FTSE)_20100608

OF 1 A7-�c9 State of North Carolina
PG Department of Environment and Natural Resources
y Division of Water Quality
FAST -TRACK APPLICATION
(FTA 12/07 )
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 plans and specifications unless you respond NO to Item B(13).
Separate applications 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 WACAS-12107) If any portion of the
project boundary is within 100 feet of any surface water or wetlands, the Watershed Classification Attachment
must be completed.
El 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(1b). 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
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 28301-5094
[phone]
[phone] Fax
Anson, Bladen, Cumberland, Harnett, Hoke,
Montgomery, Moore, Robeson, Richmond,
Sampson, Scotland
Mooresville Regional Office
610 E. Center Avenue
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, please visit our web site at: http://h2o.enr.state.nc.us/peres/
or contact the Regional Office serving your county.
FTA 12/07

USE THE TAB KEY TO MOVE FROM FIELD TO FIELD! Application Number: (to be completed by DWQ) Y V '�/
Q 0 Q$ i A
1. OwnerlPermittee:
1 a. Town of Elizabethtown
Full Legal Name (company, municipality, HOA, utility, etc.)
Z 1 b. Eddie Madden, Town Manager
Q lc.
0
0 1 d.
Signing Official
The legal entity
IIIIndividual
PO Box 716
Name and
who will
• Federal
Title (Please review
own this system
Municipality
is:
■
15A NCAC
State/County
2T .0106 (b) for authorized
■ Private Partnership
le. Elizabethtown
■
signing officials!)
Corporation
■
Other (specify):
LL Mailing
Z 1f. North
Address City
Carolina 1g. 28337
Z State
0 lh. 910-862-2066
Zip Code
1 i. 910-862-7117 1 j. [e-mail]
QTelephone
V 2. Proiect
Facsimile E-mail
(Facility) Information:
J 2a. Swanzy
Ridge Apartments 2b. Bladen
aBrief
Q 3. Contact
Project Name (permit will refer to this name) County Where Project is Located
Person:
J.
Michael Stocks
Q3a.
Name
3b. 252-459-8196
and Affiliation of Someone Who Can Answer Questions About this Application
3c. mstocks©stocksengineering.com
Phone
Number E-mail
1. Project
is
r New
■
Modification (of an existing permit) If Modification, Permit No.:
2. Owner
is
►5 Public (skip to Item B(3))
■
Private (go to Item 2(a))
2a. If
will be: 2b. If sold, facilities owned by a (must choose one)
■
■
■
private, applicant
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 C)
Homeowner Assoc./Developer (Instruction D)
3. Elizabethtown
Z Owner
of Wastewater Treatment Facility (VWVfF) Treating Wastewater From This Project
0 4a. Town
of Elizabethtown WWTF 4b. NC 0026671
Name
Q
of WTF WTF Permit No.
WW
2 5a. Elizabethtown
b. 8-inch
►1
Gravity
5c.
OOwner
LL 6. The
Z
of Downstream Sewer
origin of this wastewater is
Receiving
(check
Sewer Size
all that apply):
■ Force Main
Permit # of
Downstream Sewer (Instruction E)
100 % Domestic/Commercial
I—
■
Z4
Residential Subdivision
Apartments/Condominiums
•
IN
Retail (Stores, shopping centers)
Institution
% Industrial (attach
2
Ct
LLI
0-
■
■
III
■
Mobile Home Park
School
Restaurant
Office
•
■
■
■
Hospital
Church
Nursing Home
Other (specify): sp eci
description.)
(RO: contact your Regional Office
Pretreatment staff)
m
% Other (specify):
7.
Volume
of wastewater to be allocated
or permitted for this particular project: 10.635
gallons per day
8.
*Do
If the
■
■
not include future flows or previously permitted allocations
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

9. Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2T .0114 for
the value in Item B(7) AND/OR the design flow for line or pump station sizing if a reduced or zero flow is being requested in
Item B(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).
(32 Units of land 2 bedroom X 240 GPD = 7,680 GPD) + (8 units of 3 bedroom X 360 GPD = 2,880 GPD) + (Office with 3
employees X 25GPD per employee = 75 GPD) = 10,635 Total GPD
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches) Length (feet)
8"
New Gravity or Additional
Force Main
1,015 Gravity
0 11. Summary of Pump Stations w/ associated Force Mains to be Permitted (attach additional sheets as necessary)
W
Pump Station Location ID (self chosen - as shown on plans/map for reference)
Z
F- Design Flow Operational Point Power Reliability Option
Z (MGD) GPM @TDH 1 - permanent generator w/ATS; Force Main Size Force Main Length
2 - portable generator w/MTS
0
Z
0
QPump Station Location ID (self chosen - as shown on plans/map for reference)
2 Design Flow Operational Point Power Reliability Option
cc (MGD) GPM @TDH 1 - permanent generator w/ATS; Force Main Size Force Main Length
0 2 - portable generator w/MTS
LL
H
ixPump Station Location ID (self chosen - as shown on plans/map for reference)
EL Design Flow Power Reliability Option
(MGD) Operational Point 1 - permanent generator w/ATS; Force Main Size Force Main Length
Cli GPM @TDH 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 ® No If Yes, permit number of 2nd treatment facility
(RO — if "yes" to 6,12 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?
® 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
FTA12/07

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?
Sedimentation and Erosion Control Plan?
Stormwater?
❑ Yes ❑ No
® Yes ❑ No
❑ Yes ❑ No
® N/A
❑ N/A
® N/A
15. Does this project include any high priority lines, [see 15A NCAC 02T .0402 (2)] involve aerial lines, siphons, or interference
manholes)? These lines will be considered high priority and must be checked once every six months
Check if Yes: 0 and provide details
1. Owner/Permittee's Certification: (Signature of Signing Official and Project Name)
1, Eddie Madden , attest that this application for Swanzv Ridge Apartments 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 retumed 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, 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
$25,0000peper violation.
Signing Official Signature Date
1 a.
ENGINEERING DESIGN DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL OF THIS
APPLICATION. THESE DOCUMENTS MUST INCLUDE PLAN AND PROFILE OF SEWERS, THEIR PROXIMITY
CO TO OTHER UTILITIES, DESIGN CALCULATIONS. ETC. REFER TO 15A NCAC 02T .0305
Z
0
Q2. Professional Engineer's Certification: (Signature of Design Engineer and Project Name)
V / attest that this application for Swanzv Ridge Apartments 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
f — 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,
W and the Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains adopted June 1, 2000
V 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 1 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. J. Michael Stocks, PE
Professional Engineer Name
2b. Stocks Engineering, PA
Engineering Firm
2c. PO Box 1108
Mailing Address
2d. Nashville
City
2g. 252-459-8196
2h. 252-459-8197
Telephone Facsimile
2e. NC 2f. 27856
State Zip
2i. [e-mail]
E-mail
1voilt is;•
SoRtit ..\r°,
,
..''• ....'.°•t
IC ...)lp1••.,
•�
.QO•
o
....cC-ri
�!
• • 192,43
• 4 • 4
c,,C r`F�o,•`t
/• O
NC PE Seal, Signature & Date
FTA12/07

USE THE TAB KEY TO MOVE FROM FIELD TO FIELD! Application Number: `,
(to be completed by DWQ) '
vV 61 00 3445 i e
1. Owner!Permittee:
1 a. Town of Elizabethtown
Full Legal Name (company, municipality, HOA, utility, etc.)
0 1 b. Eddie Madden, Town Manager
Q 1 c.
a
0 1 d.
Signing
The
is
PO
Official
legal entity
Individual
Box 716
•
Name and
who will
Federal
own
Title (Please review
this system
Municipality
15A NCAC
is:
■ State/County
2T .0106 (b) for authorized
■ Private Partnership
le. Elizabethtown
•
signing officials!)
Corporation
■ Other (specify):
LL. Mailing Address City
Z If. North Carolina 1g. 28337
Z State Zip Code
0 1 h. 910-862-2066 1 i. 910-862-7117 1j. [e-mail]
QTelephone Facsimile E-mail
0 2. Project (Facility) Information:
2a. Swanzy Ridge Apartments 2b. Bladen
_I
G. Brief Project Name (permit will refer to this name) County Where Project is Located
0-
Q 3. Contact Person:
3a. J. Michael Stocks
Q Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. 252-459-8196 3c. [e-mail]
Phone Number E-mail
1. Project is
►A 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.
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))
If
•
■
sold, facilities owned by a (must choose one)
Public Utility (Instruction C)
Homeowner Assoc./Developer (Instruction D)
3. Elizabethtown
Z Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
0 4a. Town of Elizabethtown WWTF 4b. NC 0026671
I— Name of WWTF WWTF Permit No.
Z5a. Elizabethtown
5b. 8-inch
0 Gravity
5c.
IX Owner of Downstream Sewer
0 R Tha nrinin of this wactPwater is
Receiving Sewer Size
(check all that annlvL•
• Force Main
Permit # of Downstream Sewer (Instruction E)
PAY
TO THE
ORDER OF
STOCKS ENGINEERING, P.A.
P.O. BOX 1108
NASHVILLE, NC 27856
[phone]
NCDENR
Four Hundred Eighty and 00/100
MEMO
NCDENR
SouthernBank
Mount Olive
66-258-531
6/7/2010
**480.00
10788
DOLLARS
1
8
Swanzy Ridge

PAY
TO THE
ORDER OF
STOCKS ENGINEERING, P.A.
P.O. BOX 1108
NASHVILLE, NC 27856
[phone]
NCDENR
Souther nBank
Mount Olive
66-258-531
Four Hundred Eighty and 00/100**************************************************
MEMO
NCDENR
Swanzy Ridge
t,
1NQ 06.3481;
6/7/2010
**480.00
10788
DOLLARS
8

STOCKS ENGINEERING, P.A.
NCDENR
8325 • Permit Fees
Swanzy Ridge -Sewer Permit
n •.
6/7/2010
10788
480.00
Southern Bank - Chec Swanzy Ridge
480.00

Permit Number WQ0034812
Central Files: APS SWP
06/15/10
Permit Tracking Slip
Program Category
Non -discharge
Permit Type Fast Track
Gravity Sewer Extension, Pump Stations, & Pressure Sewer
Extensions
Primary Reviewer
trent.allen
Coastal SW Rule
Permitted Flow
10635
Facility
Status
Active
Project Type
New Project
Version Permit Classification
1.00 Individual
Permit Contact Affiliation
Facility Name
Swanzy Ridge Apartments
Location Address
Owner
Major/Minor
Major
Region
Fayetteville
County
Bladen
Facility Contact Affiliation
Owner Name
Town of Elizabethtown
Dates/Events
Owner Type
Government - Municipal
Owner Affiliation
Eddie Madden
Manager Town
PO Box 716
Elizabethtown NC 28337
Orig Issue
06/15/10
App Received
06/08/10
Regulated Activities
Wastewater collection
Outfall NULL
Draft Initiated
Scheduled
Issuance
Public Notice Issue Effective
06/15/10 06/15/10
Requested/Received Events
Additional information requested
Additional information received
Expiration
Waterbody Name Stream Index Number Current Class Subbasin

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
Flow Tracking/Acceptance for Sewer Extension Permit Applications
(FTSE —10/07)
Project Applicant Name:
Project Name for which flow is being requested: S.
More than one FTSE-10/07 may be required for a single project if the owner of the WWTP is not reaponsible for all
pump stations along the route of the proposed wastewater flow.
1. Complete this section only if you are the owner of the waste
a Zvi I 1
a. WWTP Facility Name:
b. WWTP Facility Permit #:
too
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
—e J aeifl �s actual-av w
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
yr� v
ater treatment plant.
All flows are in MGD
_—(. 2 S
—o—
Q. of
to I
t{q.$ 7a
NIIMMMIMPLLILILINK
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 connection point and the WWTP
Pump Station Name Approx. Capacity, MGD Approx. Current Avg.
(Firm/Design) Daily Flow, MGD
. r/62. .C'O2-
.SiA42y s L
Loop., ,Vs Q. /5,
III. Certification Statement:
I, TAT 't-j�E 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 flow from this project is not anticipated to cause any capacity
related sanitary sewer overflows or overburden any downstream pump station en route to the receiving
treatment plant under normal circumstances. This analysis has been performed in accordance with local
established policies and procedures using the best available data. This certification applies to those items
listed above in Sections 1 and 11 for which 1 am the responsible party. Signature of this form indicates
ace of this waste ater flow.
�� /).i44t
Signing Official Signature Date

FORM WSCAS-12/07
WATERSHED CLASSIFICATION ATTACHMENT
FOR SEWER SYSTEMS
Applicant Name
Project Name
Town of Elizabethtown
Swanzy Ridge Apartments
Professional Engineer Name
Engineering Firm Name
J. Michael Stocks, PE
Stocks Engineering, PA
Location
ID
Name of Waterbody'
County
River
Basin
Waterbody Stream
Index No.
Waterbody
Classification
1
Unnamed Trib to Browns
Creek
Bladen
Cape Fear
18-45
C
1
If unnamed, indicate "unnamed tributary to X", where X is the named waterbody to which the unnamed tributary joins.
I certify that as a Registered Professional Engineer in the State of
North Carolina that I have diligently followed the Division's instructions
for classifying waterbodies and that the above classifications are
inclusive of the stated project, complete and correct to the best of my
knowledge and belief.
PE Seal, Signature and Date ►
*** END OF FORM WSCAS-12/07 ***
FORM: WSCAS-12/07
Page 1 of 1

0
0
0.75 MI
4000 Ft
Map provided by MyTopo.com