WQ0034898_Application (FTSE)_20100714

RECEIVE State of North Carolina
Department of Environment and Natural Resources
( Division of Water Quality
bitEft
FAST -TRACK APPLICATION
JUL � 41 (FTA 12/07 )
D
1 S 20fOr 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 ha' 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.
® B.
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.
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.
FTA12/07

❑ G. Stream Classifications — Watershed Classification Attachment (Form WSCAS-12/07) If any portion of the
sewer system project is within 100 feet of any surface water or wetlands, the Watershed Classification Attachment
may need to be completed. A variance must be requested for encroachment within required setbacks or buffers
pursuant to 2T .0305 (f) and be indicated in Item B-13 with supporting documentation/justification provided.
❑ H Environmental Assessments — If this project is subject to an Environmental Assessment (EA) [15A NCAC
01C], this application cannot be used. Send the project application on the most current version of Form
PSFMGSA to the Design Management Unit, 1633 Mail Service Center, Raleigh, NC 27699-1633. Applications
cannot be accepted until a Finding of No Significant Impact (FONSI) or Environmental Impact Statement (EIS)
has been issued. A copy is to be submitted with that permit application.
❑ I. Flow Direction — Many wastewater treatment systems are entering into agreements for regionalization efforts
and emergency treatment capacity. Parts of the system are installed so that the wastewater flow can be directed
to more than one treatment facility. If this is the case with this project, please indicate in B(12) and give the permit
number of the second treatment facility.
® J.
Certifications — Section C
The application must be certified by both the applicant and the design engineer who is a North Carolina
Registered Professional Engineer (PE). The applicant signature must match the signing official listed in Item
A(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://www.nccgl.net/En_gineerinq/Sewer%2OPermits.html
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) fry 00.5 4-25713
NFORMATION
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—1
a.
1. Owner/Permittee:
1 a. Town of Spring Lake, NC
Full Legal Name (company, municipality, HOA, utility, etc.)
1 b. Michael Uskiewicz
Signing Official Name and Title (Please review 15A NCAC 2T .0106 (b) for authorized signing officials!)
lc. The legal entity who will own this system is:
0 Individual ❑ Federal 0 Municipality 0 State/County 0 Private Partnership ® Corporation 0 Other (specify):
Id. PO Box617 le. Spring Lake
Mailing Address City
If. North Carolina lg. 28390
State Zip Code
lh. 910.436.0241 li. 910.436.2667
Telephone Facsimile
2. Project (Facility) Information:
2a. Skeet Range on Manchester Road
Brief Project Name (permit will refer to this name)
3. Contact Person:
3a. Greg Atkins, PE
1j.
E-mail
2b. Cumberland
County Where Project is Located
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. 910.486.0700 3c. [e-mail]
Phone Number E-mail
1. Project is ® New 0 Modification (of an existing permit) If Modification, Permit No.:
2. Owner is ® Public (skip to Item B(3))
2a. If private, applicant will be:
❑ Retaining Ownership (i.e. store, church, single office, etc.) or
0 Leasing units (lots, townhomes, etc. - skip to Item B(3))
❑ Selling units (lots, townhomes, etc. - go to Item B(2b))
3. Town of Spring Lake, NC
❑ Private (go to Item 2(a))
2b. If sold, facilities owned by a (must choose one
0 Public Utility (Instruction C)
0 Homeowner Assoc./Developer (Instruction D)
Z Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
• 4a. Spring Lake Waste Water Treatment Plant 4b. NPDES Permit No. NC0030970
Q WW
TF of WWTF Permit No.
M 5a. Town of Spring Lake 5b. 30-inch ® Gravity ;5c. WQCS 00105
Ce Owner of Downstream Sewer Receiving Sewer Size 0 Force Main Permit # of Downstream Sewer (Instruction E)
0 6. The origin of this wastewater is (check all that apply):
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2
ce
G.
m
❑ Residential Subdivision
❑ Apartments/Condominiums
❑ Mobile Home Park
❑ School
O Restaurant
O Office
❑ Retail (Stores, shopping centers)
❑ Institution
❑ Hospital
0 Church
0 Nursing Home
® Other (specify): Bath House
7. Volume of wastewater to be allocated or permitted for this particular project:
*Do not include future flows or previously permitted allocations
8. If the permitted flow is zero, indicate why:
100 % Domestic/Commercial
% Industrial (attach
description.)
(RO: contact your Regional Office
Pretreatment staff)
Other (specify):
4,750 gallons per day
❑ 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).
See attached spreadsheet.
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches) Length (feet)
8
New Gravity or Additional
Force Main
1,676 New Gravity
11. Summary of Pump Stations wl associated Force Mains to be Permitted (attach additional sheets as necessary)
Pump Station Location ID
Design Flow
(MGD)
(self chosen -
Operational Point 1
GPM @TDH
Power Reliability Option
- permanent generator w/ATS;
2 - portable generator w/MTS
as shown on plans/map for reference)
Force Main Size Force Main Length
Pump Station Location ID (self chosen - as shown on plans/map for reference)
Design Flow
(MGD)
Operational Point Power Reliability Option
GPM @TDH 1 - permanent generator w/ATS;
2 - portable generator w/MTS
Force Main Size Force Main Length
Pump Station Location ID
Design Flow
(MGD)
(self chosen - as shown on plans/map for reference)
Operational Point Power Reliability Option
GPM @TDH 1 - permanent generator w/ATS; Force Main Size Force Main Length
2 - portable generator w/MTS
12. Will the wastewater flow in the proposed sewer lines or pump stations be able to be directed to another treatment facility?
❑ Yes ® 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? ❑ Yes 0 No ® N/A
Sedimentation and Erosion Control Plan? 0 Yes ❑ No ® N/A
Stormwater? 0 Yes ❑ No ® N/A
15. Does this project include any high priority lines, [see 15A NCAC 02T .0402 (2)] involve aerial lines, siphons, or interference
manholes)? 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 a.
1, Michael Uskiewicz , attest that this application for Skeet Range on Manchester Road has been reviewed by me and
is accurate and complete to the best of my knowledge. I understand that if all required parts of this application are not
completed and that if all required supporting documentation and attachments are not included, this application package
is subject to being returned as incomplete. Note: In accordance with North Carolina General Statutes 143-215.6A and
143-215.68, any person who knowingly makes any false statement, representation, or certification in any application
shall be guilty of a Class 2 misdemeanor, which may include a fine not to exceed $10,000 as well as civil penalties up to
$25,000 per • latio
Signing Official Signature
Date
ENGINEERING DESIGN DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL OF THIS
APPLICATION. THESE DOCUMENTS MUST INCLUDE PLAN AND PROFILE OF SEWERS, THEIR PROXIMITY
• TO OTHER UTILITIES, DESIGN CALCULATIONS. ETC. REFER TO 15A NCAC 02T .0305
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0
- 2. Professional Engineer's Certification: (Signature of Design Engineer and Project Name)
C.) 1, Gregory K. Atkins, attest that this application for Skeet Range on Manchester Road 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
W adopted February 12, 1996, and the Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force
✓ Mains adopted June 1, 2000 and the watershed classification in accordance with Division guidance. Although other
professionals may have developed certain portions of this submittal package, inclusion of these materials under my
(.� signature and seal signifies that 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 143-215.68, 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.
2a. Gregory K. Atkins
Professional Engineer Name
2b. Call Sign Engineers, PA
Engineering Firm
2c. 104 Gillespie Street
Mailing Address
2d. Fayetteville 2e. NC 2f. 28301
City State Zip
2g. 910.486.0700 2h. 910.486.8900 2i. [e-mail]
Telephone Facsimile E-mail NC PE Seal, Signature & Date
FTA 12/07

1NQ ov3¢P 98
CALL SIGN ENGINEERS, PA
104 GILLESPIE STREET
FAYETTEVILLE, NC 28301
PH 910-486-0700
PAY TO THE NC DENR
ORDER OF
BB&T
BRANCH BANKING AND TRUST COMPANY
1-800-BANK BBT BBT.com
66-112/531
6/24/2010
$ **480.00
Four Hundred Eighty and 00/100*******************************************************************************************
MEMO
NC DENR
ONU.0020
AUTHORIZED SIGNATURE
1248
DOLLARS

NC DENR
4-1 Qt11-1- k'
JUL 1 4 2010
DWG)
CallSign Engineers Ch ONU.0020
6/24/2010
1248
480.00
480.00

Daily Flow Rate Total Daily Flow
Fixture Type No. of Fixtures (gpd) (gpd)
Bath House
Water Closet 6 250 1,500
Lavatory 6 250 1,500
Shower 6 250 1,500
Urinal 0 250 0
Sink 1 250 250
Sub -Total 4,750
Total Sanitary Flow 4,750
RECETVF.D

WAr,
State of North Carolina
Department of Environment and Natural Resources
r Division of Water Quality
Flow Tracking/Acceptance for Sewer Extension Permit Applications
(FTSE —10/07)
Project Applicant Name: _Old North Utility Services, Inc.
Project Name for which flow is being requested: _Skeet Range Sewer Extension
More than one FTSE-10/07 may be required for a single project if the owner of the WWTP is not responsible for all
pump stations along the route of the proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: _Town of Spring Lake
b. WWTP Facility Permit #: NC0030970
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
All flows are in MGD
1.5
.1330
.800
.0048
.9378
62.52%
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
III. Certification Statement:
I, _Byron Blumenfeld , 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 I and II for which I am the responsible party. Signature of this form indicates
--auk.vp tc, f this wastewater flow.
Signi al S�:'•��� Date

Permit Number WQ0034898
Central Files: APS SWP
07/29/10
Permit Tracking Slip
Program Category
Non -discharge
Status Project Type
Active New Project
Permit Type Fast Track Version Permit Classification
Gravity Sewer Extension, Pump Stations, & Pressure Sewer 1.00 Individual
Extensions
Primary Reviewer Permit Contact Affiliation
trent.allen
Coastal SW Rule
Permitted Flow
4750
Facility
Facility Name
Skeet Range on Manchester Road
Location Address
Owner
Major/Minor Region
Major Fayetteville
County
Cumberland
Facility Contact Affiliation
Owner Name Owner Type
Town of Spring Lake Government - Municipal
Owner Affiliation
Daniel B. Gerald
PO Box 617
Spring Lake
Dates/Events
NC 283900617
Orig Issue
07/29/10
App Received Draft Initiated
07/14/10
Scheduled
Issuance
Public Notice Issue
07/29/10
Regulated Activities Requested/Received Events
Wastewater collection Additional information requested
Additional information received
Outfall NULL
Effective Expiration
07/29/10
Waterbody Name Stream Index Number Current Class Subbasin