WQ0012156_Application (FTSE)_19960313

THIS APPLICATION PACKAGE WILL NOT BE ACCEPTED BY THE DIVISION OF ENVIRONMENTAL
MANAGEMENT UNLESS ALL OF THE APPLICABLE ITEMS ARE
INCLUDED WITH THE SUBMITTAL
Required Items
One original and one copy of the completed and appropriately executed application form. If modifications to the form at
required as a result of additional information requests by the Division, the additional information must be transmitted undo
the signature of the applicant and the actual modification must be initialed by the NC Professional Engineer.
b. Two (2) sets of detailed plans and specifications signed and sealed by a North Carolina Professional Engineer. The plans mu
include a general location map, a plan view of the sewer extension, a profile of the sewer extension, and must show tt
proximity of the sewer extension to other utilities and natural features. Specifications may be omitted for delegate
authorities. Each sheet of the plans and the first page of the specifications must be signed and sealed. Two (2) copies of tt
existing permit if a modification. The plans and specifications must not contain phrases (such as: FOR REVIEW ONLY
NOT FOR CONSTRUCTION, etc.) that indicate that they are anything other than final plans and specifications. Howeve
the plans and specifications may contain: FINAL DESIGN - NOT RELEASED FOR CONSTRUCTION.
c. The appropriate permit processing fee, in accordance with 15A NCAC 2H .0205(c)(5). The fee for sewer extensions fi
nondelegated municipalities is $400. The fee for sewer extensions for delegated municipalities (applies only to tha
governmental jurisdictions that have specific delegation review authority, as granted by the Environmental Manageme
Commission) is $200. Name changes without other modifications are $100.
d. If the owner/authority of the wastewater treatment facility (WWTF) that will be accepting the wastewater flow from th
project is different from the applicant of the project, then a letter must be provided from the owner/authority of the WW1
specifying the volume of flow that will be accepted. The letter should be a recent letter and should refer to the project by tl
same name as that identified on the application and the plans,/specifications.
e. If the application is being submitted in the name of a privately owned public utility, evidence must be submitted from tl
Utilities Commission which demonstrates that the utility is authorized to hold the franchise for the area to be served. In tl
case of contiguous service areas, evidence must be provided from the Utilities Commission acknowledging these areas a
covered under an existing franchise.
f. A properly executed Operational Agreement (original and one copy - form provided by DEM) must be submitted if the sew
extension will be serving single family residences, condominiums, mobile homes, or town houses and if the subject sew
extension is owned by the individual residents, a homeowners association, or a developer.
g. A cover letter, which briefly describes the project, should be included with each application package. If necessary for clarit
feel free to include attachments to the application form. Such attachments will be considered as part of the application a
should be numbered to correspond to the section to which they refer.
h. All materials and fees submitted in support of this request for a permit become the property of the Division of Environmen
Management; therefore, if the permit is not issued for any reason, the Division will return submitted materials only at
option.
FORM: GSA 11/93 Page 4 of 6