WQ0032790_Application (FTSE)_20080228

w`caV State of North Carolina
DOArS5 Department of Environment and Natural Resources
0 'i. ' ',_ AA Division of Water Quality
O�Q► `O 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
&KA. 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.
[v]/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 LI/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

Stream Classifications — Watershed Classification Attachment (Form WACAS-12/07) If any portion of the
project boundary is within 100 feet of any surface water or wetlands, the Watershed Classification Attachment
must be completed.
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.
lLJ 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
N 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(1 b). 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

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USE THE TAB KEY TO MOVE FROM FIELD TO FIELD! Application Number: W00032790
(to be completed by DWQ)
1. Owner/Permittee:
la. Murphy Oil U.S.A., Inc.
Full Legal Name (company, municipality, HOA, utility, etc.)
Ib. Cho,ylts GOjw,s
Signing Official Name and Title (Please review 15A NCAC 2T .0106 (b) for authorized signing officials!)
1 c. The legal entity who will own this system is:
• Individual • Federal ■ Municipality ■ State/County ■ Private Partnership 0 Corporation • Other (specify):
ld. 200 Peach Street le. El Dorado
Mailing Address City
If. Arkansas lg. 71730
State Zip Code ............
lh. 1i. 1j. -TOM.-.(Benda)
Telephone Facsimile
2. Project (Facility) Information:
E-mail
Cumberland
2a. Murphy Express Spring Lake 2b.
Brief Project Name (permit will refer to this name)
3. Contact Person:
County Where Project is Located
3a. Eric Rasmussen (Kimley-Horn and Associates, Inc.)
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. 404-419-8700 3c. [e-mail]
Phone Number E-mail
1. Project is 0 New ■ Modification (of an existing permit) If Modification,
Permit No.:
2(a))
2. Owner is • Public (skip to Item 8(3)) Private (go to Item
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 C)
■ Leasing units (lots, townhomes, etc. - skip to Item B(3))
• Homeowner Assoc./Developer (Instruction D)
• Selling units (lots, townhomes, etc. - go to Item B(2b))
3. Town of Spring Lake
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
4a. Town of Spring Lake Regional Wastewater Treatment Facility 4b. NC0030970
Name of WWTF WWTF Permit No.
5a. Town of Spring Lake 15b. 8" 0 Gravity
5c.
Owner of Downstream Sewer Receiving Sewer Size ;■ Force Main
Permit # of Downstream Sewer (Instruction E)
100 % Domestic/Commercial
6. The origin of this wastewater is (check all that apply):
• Residential Subdivision 1 Retail (Stores, shopping
centers)
% Industrial (attach
• Apartments/Condominiums • Institution
• Mobile Home Park • Hospital
description.)
(RO: contact your Regional Office
Pretreatment staff)
• School • Church
• Restaurant ■ Nursing Home
■ Office • Other (specify):
7. Volume of wastewater to be allocated or permitted for this particular
% Other (specify):
project: 1,000 gallons per day
*Do not include future flows or previously permitted allocations
8. If the permitted flow is zero, indicate why:
in subsequent permits that connect to this line
• Pump Station, Outfall or Interceptor Line where flow will be permitted
• 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).
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches)
8"
Length (feet)
42
New Gravity or Additional
Force Main
New Gravity
New Gravity
• 11. Summary of Pump Stations wl associated Force Mains to be Permitted (attach additional sheets as necessary)
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• Pump Station Location ID
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Design Flow
(MGD)
Operational Point
GPM @TDH
(self chosen - as shown on plans/map for reference)
Power Reliability Option
1 - permanent generator w/ATS;
2 - portable generator w/MTS
Force Main Size Force Main Length
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Q Pump Station Location ID (self chosen - as shown on plans/map for reference)
2 Design Flow
O (MGD)
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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)
Operational Point 1
GPM @TDH
(self chosen -
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
12. Will the wastewater flow in the proposed sewer lines or pump stations be able to be directed to another treatment facility?
❑ Yes d No If Yes, permit number of 2nd treatment facility
(RO — if "yes" to B,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
FTA 12/07

1.4. 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 ❑ No ® N/A
Sedimentation and Erosion Control Plan? ® Yes ❑ No ❑ N/A
Stormwater?
® 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: ❑ and provide details
1. Owner/Permittee's Certification: (Signature of Signing Official and Project Name)
1, C ha' l is G anus , attest that this application for Murphy Express Spring Lake 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- I
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.
Qla.
Signing Official Signature
?442-4 2-�7/06
Date
ENGINEERING DESIGN DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL OF THIS
APPLICATION. THESE DOCUMENTS MUST INCLUDE PLAN AND PROFILE OF SEWERS, THEIR PROXIMITY'
u) TO OTHER UTILITIES, DESIGN CALCULATIONS. ETC. REFER TO 15A NCAC 02T .0305
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Q2. Professional Engineer's Certification: (Signature of Design Engineer and Project Name)
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I, Julie Holmes , attest that this application for Murphy Express Spring Lake 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 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 $/0,000 as well as civil penalties up to $25,000 per violation.
2a. Julie Holmes
Professional Engineer Name
2b. Kimley-Hom & Associates, Inc.
Engineering Firm
2c. 817 West Peachtree Street Suite 601
Mailing Address
2d. Atlanta
2e. GA 2f. 30308
City State Zip
2g. 404-419-8700 2h. 404-419-8701 2i. [e-mail]
Telephone Facsimile E-mail
NC PE Seal, Signature & Date
FTA 12/07

y
-..:.w Ar ; State of North Carolina
94� Department of Environment and Natural Resources
Division of Water Quality
Flow. Tracking/Acceptance for Sewer Extension Permit Applications,
:...::..
.ProjectApplicantName: • .
Project Name for which flow is being requested: V:X{* r€S 118 Lci
More than one FTSE-10/07 may be required for a single project f the owner,of the WWTP is not responsible for :all
:. pump stations along the route of the proposed wastewater', flow ;.
1.. Complete this section only if you are the owner, of the wastewater treatment plant.
a WWTP :y'.FacilitName: . T w A.. v . nil I~' k . tbI1 i,.'I'
,V(v.03o4;•.?t •:
•
�WTP Facility Permit
c. WWTP facility's permitted flow. :. :...
d. Estimated obligated flow not yet tributary to the WWTP
e: WWTP facility's actual avg. flow
otal flow for this specific request
g. Total actual and obligated flaws to the facility_'
h. Percent of permitted flow used;
t0474v ; rile
All flows are -in MGD
m6.;
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 WWT
Pump Station Name Approx: Capacity, MGD . '• Approx Current Avg
(Firm/Design) ... Daily Flow, MGD . .
certify that, to the best of my 'knowledge, the addition of the
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v • ume of waste . to be permitted in,'this project has been evaluated along the route t,o .thececeiving
' wastewater treae ent 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 11 for which I am the responsible party: Signature of this form indicates
acceptance of this wastewater flow..
Signing Official Signature
Date
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TOWN OF SPRING LAKE
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State of North Carolina
Department of Environment and Natural. Resour.ees . •
•t Division of Water Quality
Flow Tracking/i*eptance for:Sewer E tensioIL Permit Applications
:,• (FTSE; 10/0•
Project Naxne for which:flow is bein reque
•,. g: fed:
More thiin one F?SE-10/07 maybe'regrirred for a single project. if Ilia owner.. d• f the W F.VTP is nor responsible for all"
:pump stations' along the route ojiha pro.posed wastewater
c..WWTP facility's permitted flow
• d. Estimated obligated flow not yet tribut xy to the WWTP
e:' f WWTP ofacility's actual a'tg. flow >: Total flw fo z this specific request
g• Total actual and obligated flows to the facility..'
h. Percent of permitted flow used
•
di- Complete this section for each pump station you are.respcusibie for along the route of this
proposed wastewater flow. >
List pimp stations located between the project copniection point and the W WTP
Pump Station Name Approx. Capacity, MGD Approx. Cuncent Avg:
_ f : (FirmlDesign) ; " Daily Flow, MQD
I. Oertificatton Staternent_ '. ::•
; : : - ':.
/)p, ... G� �t� .. • _i'ceitify that, to the best of rnylc;iowledga the additio ' � .� ... n.Qftl;e�'
,, volume of wastewater to be permitted in this project has been evaluated along the route to the deceiving
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 pu
mp station en route to the receiving
treatment plant under.norinal circumstances;• This analysis has been performed iin, accordance with !Deaf .established policies and procedures using the best available data. This oertitication applies to those items
listed above in Secti. s I and II for which T a•m'thee • onsible party,. Signa re of this form,indicates ••
.• ace ce oftb Sw; -te ater fig,: . '-
Signing Official

WATERSHED CLASSIFICATION ATTACHMENT
1. Applicant's name (name of municipality, corporation, individual, etc.):
Murphy Oil USA, Inc.
2. Name and complete address of applicant:
Agent/Contact: (please contact for questions/information)
Kimley-Horn & Associates, Inc. (Attn: Julie Holmes)
817 West Peachtree Street, Suite 601
Atlanta, GA 30308
Owner/Applicant:
Murphy Oil USA, Inc.
200 Peach Street
El Dorado, AR 71730
3. Project name (name of the subdivision, facility, or establishment, etc.):
Murphy Express Spring Lake (proposed fueling station)
4. County where project is located:
Cumberland
5. Name of closest surface waters:
Unnamed wetlands
6. River basin(s) in which project is located:
Cape Fear
7. Topographic name and date:
TNC 0434 Manchester, NC
8. North Carolina Professional Engineer's seal, signature, and date:
Julie Ho
me