WQ0032806_Application (FTSE)_20090225

kid Q op 3 Z so {p 1 7 o I0 State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
FAST -TRACK APPLICATION
(FTA 12/07 ver5)
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. sta te. nc. us/percs/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 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, Hamett, 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
(9,10) 796-7215
[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/Collection% 20Systems/CollectionSystemsHome.html
or contact the Regional Office serving your county.
FTA12/07

Application Number: 2
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD! (to be completed b y DWQ ) OD7 $ D (O
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1. Owner/Permittee:
Rail Corporation, Heritage Shores
Full Legal Name (company, municipality, HOA, utility, etc.)
1b. Willaim C. Stillwagon, P/C -President
FEB 25 2009
Signing Official Name and Title
lc. The legal entity who will own this
(Please
system
review 15A NCAC 2T .0106 (b) for authorized signing officials!)
is:
■ Individual • Federal • Municipality
■ State/County ■ Private Partnership ►1 Corporation
!le. Merry Hill
MIOther (specify):
1d. Rail Corporation, PO Box 248
Mailing Address City
If. NC ,1 g. 27957
State i Zip Code
?1 h. [phone] 11 i. [phone] ,1 j. N/A
Facsimile � E-mail
._._ _.________.TM ._.._._.__. _____
___
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2.IProject (Facility) Information:
2a. Temporary Clubhouse 2b. Bertie
Brief Project Name (permit will
,3 Contact Person:
refer to this name) i County Where Project
is Located
David T. Upchurch
jName and Affiliation of Someone Who Can Answer Questions About this Application
l3b. [phone] 13c. [e-mail]
Phone Number 1 E-mail
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j1. Project is ■ New /1 Modification
(of
an existing permit)
If Modification, Permit No.: WQ0032806
8(3))
(go to Item 2(a))
2. Owner is • Public (skip to Item
Private
2a. If private, applicant will be:
1 2b.
church, single office, etc.) or !
etc. - skip to Item B(3))
etc. - go to Item B(2b))
If sold, facilities
owned by a (must choose one)
(Instruction C)
Assoc./Developer (Instruction D)
■ Retaining Ownership (i.e. store,
■ Public Utility
• Leasing units (lots, townhomes,
►1 Homeowner
►1 Selling units (lots, townhomes,
3. Rail Corporation, Heritage Shores
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
'4a. Innsbrook Golf and Marina WWTP 4b. WQ0029653
Name of WWTF
WWTF Permit No.
5a. Rail Corportaion
5b. N/A
■ Gravity
• Force Main
5c.
( Owner of Downstream Sewer
Receiving Sewer Size
Permit # of Downstream Sewer (Instruction E)
16 The origin of this wastewater is
I
(check
all that apply):
(Stores, shopping centers)
Home
(specify):
100 % Domestic/Commercial
# ►1 Residential Subdivision
■ Retail
% Industrial (attach
■ Apartments/Condominiums
■ Mobile Home Park
■ Institution
• Hospital
description.)
(RO: contact your Regional Office
Pretreatment staff)
% Other (specify):
■ School
■ Church
■ Restaurant
■ Nursing
j ■ Office
7. Volume of wastewater to be allocated
■ Other
or permitted for
this particular project: 720_gallons
allocations
will be permitted in subsequent
per day
permits that connect to this line
NCAC 02T .0303 to determine if a
*Do not include future flows
8. If the permitted flow is zero, indicate
or previously
why:
in
of existing
permitted
Line where flow
Permit No.
• Pump Station, Outfall or Interceptor
• Flow has already been allocated
• Rehabilitation or replacement
permit is required)
sewer with no new flow expected (see 15A
OlD
FTA12/07

9. Provide the wastewater
the value in Item B(7) AND/OR
flow calculations used
the design flow
in determining the permitted flow in accordance
for line or pump station sizing if a reduced or
2T .0114 (b) and (c) must be supported with
(f).
additional sheets if necessary)
with 15A NCAC 2T .0114 for
zero flow is being requested in
actual water or wastewater use
Item B(7). Values other
data in accordance with
2 Single family homes @ 360
than that in 15A NCAC
15A NCAC 2T .0114
gal/day = 720 gals.
to be Permitted (attach
10. Summary of Sewer Lines
Size (inches) Length (feet)
f
New Gravity or Additional
Force Main
8 1088
Gravity
f �
1
t
ENTER TOTAL LINE LENGTHS IN MILES 4 0.206
11. Summary of Pump Stations w/ associated Force Mains to be Permitted (attach additional sheets as necessary)
I
Pump Station Location ID (self chosen - as shown on plans/map for reference)
Design Flow
(MGD)
Power Reliability Option
Operational Point; 1 - permanent generator w/ATS;
GPM @TDH 2 - portable generator w/MTS
i
Force Main Size Force Main Length
1
;Pump Station Location ID (self chosen -
as shown
Force Main
on plans/map for reference)
!
Size I Force Main Length
1
Design Flow
(MGD)
Operational Point
GPM TDH
°e
Power Reliability Option
1 - permanent generator w/ATS;
2 - portable generator w/MTS
d
3
,Pump Station Location ID (self chosen
as shown on plans/map for reference)
Force Main Size I Force Main Length
Design Flow ! O erational Point
(MGD) E p
GPM @TDH
} i
Power Reliability Option
1 - permanent generator w/ATS;
2 - portable generator w/MTS
'12. Will the wastewater flow
in the proposed sewer
number of 2nd treatment
contact the Central
lines or pump stations be able to be directed to another treatment facility?
facility
■ Yes 0. No If Yes, permit
'(RO — if "yes" to 6,12 please
i
Office PERCS Unit)
FTA12/07

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
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 ❑ No ❑ N/A
Sedimentation and Erosion Control Plan? ® Yes El No El 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
C. CERTIFICATIONS
1. Owner/Permittee's Certification: (Signature of Signing Official and Project Name)
1, William C. Stillwagon , attest that this application for Temporary Clubhouse has
been reviewed
application
package
and 143-215.68,
shall be guilty
up to $25,000
by me and is accurate
are not completed and that
is subject to being returned
any person who
of a Class 2
per violation.
A )
and complete to the best of my knowledge. I understand
if all required supporting documentation and attachments
as incomplete. Note: In accordance with North
knowingly makes any false statement, representation,
misdem anor, which may inclu e a fine not to
that if all required parts of this
are not included, this application
Carolina General Statutes 143-215.6A
or certification in any application
exceed $10,000 as well as civil penalties
1a. /,' f. l
Signing Official Signore
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
2. Professional Engineer's Certification: (Signature of Design Engineer and Project
1, David T. Upchurch attest that this application for Temporary Clubhouse has been reviewed
Name)
by me and is accurate, complete
supporting documentation to the best of
been prepared in accordance with the
February 12, 1996, and the Minimum
June 1, 2000 and the watershed
have developed certain portions of this
I have reviewed this material and have
Statutes 143-215.6A and 143-215.68,
any application shall be guilty of a Class
up to $25,000 per violation.
and consistent with the information in the engineering plans, calculations, and all other
my knowledge. I further attest that to the best of my knowledge the proposed design has
applicable regulations, Gravity Sewer Minimum Design Criteria for Gravity Sewers adopted
Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains adopted
classification in accordance with Division guidance. Although other professionals may
submittal package, inclusion of these materials under my signature and seal signifies that
judged it to be consistent with the proposed design. Note: In accordance with NC General
any person who knowingly makes any false statement, representation, or certification in
2 misdemeanor which may include a fine not to exceed $10,000 as well as civil penalties
2a. David T. Upchurch
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Professional Engineer Name
fib. Hobbs, Upchurch & Associates. P.A.
Engineering Firm
2c. 300 S.W. Broad Street
Mailing Address
2d. Southern Pines
2e. NC
2f. 28388
City
2g. [phone] 2h. [phone]
State
2i. [e-mail]
Zip
Telephone h Facsimile
E-mail
FTA12/07

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