WQ0014644_Application (FTSE)_19971105

state or lrortn t.,aroiina
Department of Environment, Health and Natural Resources
Division of Environmental Management
NON -DISCHARGE PERMIT APPLICATION
GRAVITY SEWER COLLECTION SYSTEMS
This form may be photocopied for use as an original. Pump Stations, force mains and low pressure sewers
(including S.T.E.P. systems) are not to be included as part of this application package.
Any changes made to the content of this form shall not be allowed and will result in the
application being returned.
This application will not be accepted by DEM unless all of the applicable items are included
with the submittal.
I. REQUIRED ITEMS CHECKLIST:
Please indicate that you have read the following list of application requirements by signing your initials in the space provided
next to each item.
A li n ' I ' i
1. One original and one copy of the completed and properly executed application form.
2. The appropriate permit processing fee, in accordance with 15A NCAC 2H .0205(c)(5). The fee for
sewer extensions is $400. The fee for sewer extensions by partially delegated municipalities iLL)
(applies only to those governmental jurisdictions that have specific delegation review authority,
as granted by the Division of Environmental Management) is $200.
3. If the owner/authority of the wastewater treatment facility (WWTF) and/or collection system that will be
accepting the wastewater flow from this project is different from the applicant of the project, then a letter(s)
must be provided from the owner/authority of the WWTF and/or collection system specifying the
volume of flow that will be accepted. The letter(s) should be recent (within one [1] year) and should
refer to the project by the same name as that identified on the application and the plans/specifications. __LLAL
4. If the application is being submitted in the name of a privately owned public utility, written
documentation must be submitted from the Utilities Commission which demonstrates that the utility
is authorized to hold the franchise for the area to be served. In the rase of contiguous service areas,
written documentation must be provided from the Utilities Commission acknowledging these areas
are covered under an existing franchise. N/ A
5. One original and two copies of a properly executed Operational Agreement must be submitted if the
sewer extension will be serving single family residences, condominiums, or town houses AND if the
subject sewer extension is owned by the individual residents, a homeowners association, or a developer. N/A
II. PERMIT INFORMATION:
1. Application Number (will be completed by DEM):
SOC Project: Yes No.
ICJ Q CO 14104 4
2. Specify whether project is: X new modification.
3. If this application is being submitted as a result of a modification to an existing permit, please complete:
existing permit number and permit issue date
4. Specify whether the applicant is: X public private.
5. Application Date: 10 / 2 9 / 9 7
6. Fee Submitted: $ 40 0 .0 0
7. County(ies) where project is located: Harnett
8. Applicant's Name (Please specify the name of the municipality, corporation, individual, etc.):
Harnett County
FORM: GSPA 02/96 Page 1 of 4
1,400 copies of this document were printed at a cost of $117.32, or $0.084 per copy.

III. GENERAL INFORMATION:
1. Print Owners or Signing Official's name and tide (the person who is legally responsible for the facility and its compliance):
Neil Emory County Manager
2. Mailing address: P.O. Box 1119
City: Lillington State: NC Zip: 27546-1119
Telephone Number. ( 910 ) 8 9 3- 7 5 7 5
3. Project Name (Please specify the name of the subdivision, facility, or establishment. The name should be consistent with
the project name on plans, specifications, letters of flow acceptance, Operational Agreements, etc.):
Collins Park - Phase I
IV. INFORMATION ON WASTEWATER:
1. Nature of Wastewater. 100 % Domestic/Commercial % Industrial
% Other (specify)
2. Volume of wastewater generated by this project: 5760 gallons per day.
3. Explanation of how wastewater volume was determined: 16 units with 3 bedrooms e a c h
(2 buildings / 8 Units Per Bldg.) C 360 gpd
4. Name of wastewater treatment facility receiving wastewater. B u i e s Creek /Coats Wastewater Treat -
ment Plant
Owner of wastewater treatment facility: Harnett County
Facility Permit Number. NCO() 30091
or WQ
5. Indicate any parameters (and their concentrations) which will be greater than normal domestic levels:
N/A
6. If wastewater is not domestic in nature, what level of pretreatment has been provided to ensure protection of the receiving
wastewater treatment facility? N / A
7. If a pretreatment permit is required, has one been issued? Yes X No. If Yes, please attach a copy of
the pretreatment permit. If No, when will one be issued?
FORM: GSPA 02/96 Page 2 of 4

V . DESIGN INFORMATION:
1. Summary of GRAVITY SEWER to be permitted, by diameter and length:
Diameter (inches) •
Length (linear feet)
12
1612
8
241
2. Are there any sections of the Gravity Sewer Minimum Design Criteria or 15A NCAC 2H .0200 with which the subject
wastewater collection system will not be able to comply? X Yes No. If Yes, please identify and explain:
IMPORTANT:
If you responded Yes to question V.2 above, the completed application package,
including two (2) copies of plans. specifications. supporting information and
any other materials, should be submitted for an individual permit.
FORM: GSPA 02/96 Page 3 of 4

VI. CERTIFICATIONS:
Name and Complete Address of Engineering Firm: We t h e r i l l Associates, Inc.
4915 Waters Edge Drive, Suite 295
City: Raleigh
Telephone Number. ( 919
State: NC Zip: 2 76 0 6
851-8077
Professional Engineer's Certification:
I, Edward G. W e t h e r i l l, PE , attest that this application for Collins Park
Phase I
has been reviewed by me and is accurate and complete. I further attest the proposed design has been prepared in accordance with the
applicable regulations and the North Carolina Gravity Sewer Minimum Design Criteria adopted February 12, 1996. Although certain
portions of this submittal package may have been developed by other professionals, inclusion of these materials under my signature
and seal signifies that I have reviewed this material and have judged it to be consistent with the proposed design.
North Carolina Professional Engineer's Seal, Signature, and Date:
Applicant's Certification:
1, Neil Emory
, attest that this application for Coll ins Park — Phase I
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 information and attachments are not included, this application package
will be returned to me as incomplete. Upon approval and completed construction, I will operate this system in accordance with the
North Carolina was water collection permit requirements.
Signature
Date
THE COMPLETED APPLICATION PACKAGE, INCLUDING ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DIVISION OF ENVIRONMENTAL MANAGEMENT
WATER QUALITY SECTION
PERMITS AND ENGINEERING UNIT
POST OFFICE BOX 29535
RALEIGH, NORTH CAROLINA 27626-0535
TELEPHONE NUMBER: [phone]
FORM: GSPA 02/96 Page 4 of 4