WQ0029397_Application (FTSE)_20051011

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE 3
A. APPLICATION INFORMATION
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD!
i. Owner:
le- To w,J of Lt udrltciTtin1
Full Legal Name (company, municipality, HOA, utility, etc.)
lb. TOM Wawa - Tow4 NUw1AtaER
Application Number:
(to be completed by DWQ)
WQ0029397
Signing Official Name and Title (Please review 15A NCAC 2H .0206(b) for authorized signing officials!)
lc. The legal entity who will. this system is:
❑ individual 0 Federal ix Municipality ❑ State/County ❑ Private Partnership 0 Corporation 0 Other (specify):
1d. P. o. P,ox 29(o
Mailing Address
1f. 140tu14 C R.oI I,1A
State
l e. Liu-IF-tarot-1
City
1 g. 2-7541,
Zip Code
lh. Ito-893-Zb54- li• lj-
Telephone Facsimile E-mail
2. Project (Facility) Information:
2a. SPW4(114tU, 42uibctVl'7t0,.1 - pI4A4 1 2b. 1-iagr.terr
Brief Project Name (permit will refer to this name)
3. Contact Person:
3a. *Er-A.41 6 L. 400.11?-14 , PE — SPAVLD1r1644 4cRR15 PA
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. 9l9 - 854-?990
Phone Number
County Where Project is Located
3c- 4epho..t ► e C spu,iddnalortl`S .cn,+1
E-mbil
r, ORIGINAL CHECK HAS AN ARTIFICIAL WATERMARK ON REVERSE SIDE - HOLD AT AN ANGLE TO VIEW
Keystone Builders Resource Group, as Purchasing Agent for
Lockridge-Raleigh, LLC
1207 RosehsathRoad
Richmond, VA 23230
[phone]
Four Hundred and No/100 Dollars
DAY,
r© THE
3RDER
North Carolina Department of Environmental &
Natural Resources
919 N. Main Street
Mooresville, NC 28115-
Wachovia Bank, N.A.
West Broad Branch
3601W. Broad St.
Richmond, VA 23230
68A41/510.
250123
9/26/2005 $400.00
0'250123o
\C..7tg41 CO II
❑ Office
Li INUI (II nuuia
❑ Other (specify):
VOID AFTER 180 DAYS
% Other (specify):
7. Volume of wastewater to be allocated for this particular project gallons per day
*Do not indude previously permitted allocations 18, 000 CPD
8. If the permitted flow is zero, indicate why:
❑ Interceptor Line - 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
N`l'A 02/03 - Rev. 3 04/05

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE I
)4la
P4/4
CF'N ATF� State of North Carolina
��OG �tment of Environment and Natural Resources
7 ��' Division of Water Quality
r
t vw�`� < =It ` T ' 1 200� FAST -TRACK APPLICATION
for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
1�) sure sewers 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. This form may be photocopied for use as an original.
VI I.
Application Form - Submit one original and one copy of the completed and appropriately executed application
form. 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(12).
• II. Application Fee - Submit a check in the amount of $400 made payable to: North Carolina Department of
Environment and Natural Resources (NCDENR). Checks shall be dated within 90 days of application submittal.
❑ III. 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(2a) of this application.
❑ IV. Operational Agreements — Submit one original and two copies of a properly executed operational agreement if
the sewer extension is permitted 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
homeowners' association, use Form HOA 02/03. If the applicant is a developer, use Form DEV 02/03. EVEN IF
THE PROJECT WILL BE TURNED OVER TO A MUNICIPALITY, FORM DEV 02/03 IS REQUIRED.
COue1T`( .4 V. Flow Acceptance Letters — If the owner of the downstream sewers and/or WWTF is different from the applicant,
submit two copies of a flow acceptance letter from the owner of the downstream sewers and VVWTF, if different.
Flow acceptance letters must contain the following minimum information: applicant and project name, amount of
flow accepted, and name and permit number of the receiving sewers/WWTF. The flow acceptance must not
expire prior to permit issuance and must be dated less than a year prior to the application date.
Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific flow acceptance
letter.
Map — Submit an 8.5-inch by 11-inch COLOR copy of the portion of a 7.5-minute USGS Topographic Map along
with this form. The map should identify the entire project area location as well as the closest downslope surface
waters as clearly as possible. Each map portion must be labeled with the map name and number, the identified
location of the sewer line and pump stations, and be of dear and reproducible quality. For instance, if the project
involves 4 miles of interceptor sewer that traverses over or near several different waterbodies (or counties,
basins, etc.), the map should have location ID's shown for each different waterbody (where the sewer line is within
100 feet of such waterbody - see Instruction VII). This location ID is self chosen and used to cross reference the
location in Section C of the permit application.
tRz VII. Stream Classifications — Section C
• If any portion of the project is within 100 feet of any down slope surface water, Section C must be completed
for the pertinent sections.
• If the entire project area is a minimum of 100 feet away from any down slope surface waters BUT there is a
pump station involved where a history of power outage is to be used to provide adequate design storage
instead of dual feed or permanent or portable generator, Section C must be completed to demonstrate that
the closest down slope surface water is Class C (see 15A NCAC 2H .0219(h)(3)(D)).
• Use the guidance document entitled, "Determining Watershed Classifications for Form FTA 02/03 (Fast -Track
Sewer Systems)" available from http://h2o.enr.state.nc.us/percs or by contacting the appropriate regional
office.
VIA 02/03 - Rev. 3 04/05

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 2
rj/A ❑ VIII. Environmental Assessments — If this project is subject to an Environmental Assessment (EA) [15A NCAC
01C], this application can not be used. Send the project application on Form PSFMGSA 10/99 to the PERCS
Unit, 1617 Mail Service Center, Raleigh, NC 27699-1617. Applications can not 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.
IX. Certifications — Section D
The application must be certified by both the applicant and 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 2H .0200, 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. Certification by a PE who is unfamiliar with these documents
is subject to NC Board referral.
Tnt•.1..1 10 X. Downstream Sewer & Wastewater Treatment Plant Capacity
The applicant has assured downstream pipe, pump station and treatment plant capacity. The addition of new
sources of wastewater from this project has been evaluated along the route to the receiving treatment plant. 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. If the applicant is not the owner of the
downstream sewer or receiving treatment plant, submittal of flow acceptance letter(s) indicates that owner has
adequate capacity and will not violate G.S. 143-215.67(a).
THE COMPLETED FTA 02/03 APPLICATION PACKAGE, INCLUDING ALL SUPPORTING DOCUMENTS AND $400
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, Gay, Graham, Haywood,
Henderson, Jackson, Macon, Madison,
McDowell, Mitchell, Polk, Rutherford,
Swain, Transylvania, Yancey
FayettevNie Regional Office
225 Green Street Suite 714
Fayetteville, North Carolina 28301
[phone]
[phone] Fax
Anson, Bladen, Cumberland, Harnett,
Hoke, Montgomery, Moore, Robeson,
Richmond, Sampson, Scotland
Mooresville Regional Office
610 E. Center Avenue, Suite 301
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]
(919) 5714718 Fax
Chatham, Durham, Edgecombe, Franldin,
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, Marlin,
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, visit our web sale at: hftpl/h2o.enr.sfete.nc.us/peres/
F1'A 02/03 - Rev. 3 04/05

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE 3
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD! Application Number:
(to be completed by DINQ) WQ0029397
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1. Owner:
la- To w.J of Lt ut.ubTD4
Full Legal Name (company, municipality, HOA, utility, etc.)
1b TOM 1aot26 - T0144 MAt &ER
Signing Official Name and Titie (Please review 15A NCAC 2H .0206(b) for authorized signing officals!)
1 c. The legal entity who will own this system is:
■
Individual ■ Federal Municipality ■ State/Co ■ Private Partnership ■ Corporation IN Other (specify):
Id. P.O- Pox 2910 le• la 61,14 ,a-o4
Mailing Address City
'1f. lg. ZT54(
O RN C,►ftp Lt..IA
State Zip Code
1h. .110-893 -2b54 1i. 1j.
Telephone Facsimile E-mail
2. Project (Facility) Information:
2b. I- Err
2a. SPFt44Cal4ILl. 47u10,12tvt'i(Owl — PWASE 1 bri4
Brief Project Name (permit will refer to this name) County Where Project is Located
3. Contact Person:
3a. 4r ..lt E L. t .Rt4 PE — SPAUI�(rleI 4 pSORRt4 , PA
,
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. 9t9 - 854-1940 3c. 44eppherh i e e4pau(dinerorr 4.cL
Phone Number E-mhil
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1. Project
(of an existing permit) If Modification, Permit No.:
is'New ■ Modification
For modifications, attach a separate
phase, changing line size/length,
duplicate project Information In
sheet dearly explaining the reason
etc.). Only include the modified information
B(7) and B(10-11) that has already been
for the modllication (Le. adding another
in this permit application - do not
included in the original permit.
2. Owner is X Public (skip to Item
2(a))
B(3)) ■ Private (go to Item
2a. If private, applicant will be:
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)
■ Retaining Ownership (i.e. store,
• Public Utility (Instruction III)
• Leasing units (lots, townhomes,
■ Homeowner Assoc./Developer (Instruction IV)
■ Selling units (lots, townhomes,
3. 14ARJlE1T Ca)#ITY Ripiuc tirt t l T1 Eci
Owner
4a
of Wastewater Treatment Facility (VWVTF) Treating Wastewater From This Project
1.4u4Nica o4 413- (JG oo2.1,49 (o
Name of WWTF VWVTF Permit No.
5a. ToW,J of Lit.t,tNicIroNi
5b. & Gravity
5c.
Owner of Downstream Sewer
Receiving Sewer Size Ij Force Main
Permit Number of Downstream Sewer (if known)
6. The origin of this wastewater is (check all that apply):
Residential Subdivision
Apartments/Condominiums
■ Mobile Home Park
100 % lom=-- c'Commercial
■ Car Wash
• Institution
■ Hospital
% Industrial
■ School • Church
• Restaurant ■ Nursing Home
% Other (specify):
■ Office
■ Other (specify):
_
7. .
Volume of wastewater to be allocated for this particular project gallons per day
*Do not indude previously permitted allocations 181000 EiPD
8.
If the permitted flow is zero, indicate
why:
be permitted in subsequent permits that
in Permit No.
connect to this line
expected
• Interceptor Line - Flow will
❑ Flow has already been allocated
• Rehabilitation or replacement
of existing sewer with no new flow
1'" 1'A 02/03 - Rev. 3 04/05

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE 4
Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2H
.0219(1) for Item B(7) or the design flow for line or pump station sizing if zero flow in the space below. Values other than
that in 15A NCAC 2H .0219(1)(1-2) must be supported with actual water or wastewater use data in accordance with 15A
NCAC 2H .0219(1)(3).
PI4A4 E 1. = 50 LOTS
_p1{ AS E 1 Fwb l = 50 Lop, (3A,Q ? (LoT) = 181000 Gt'n
10. Summary of Sewer Lines to be Permitted (attach addtional sheets if necessary)
ENTER TOTAL UNE LENGTH IN MILES
6.-i(o MI
Gravity or Force Main
(use the pull down menu)
11. Summary of Pump Stations to be Permitted (attach additional sheets as necessary) iqA
Location ID
(self chosen - as shown on
plans for cross-reference)
Power Reliability Option
Design Flow Operational Point ; (1-dual line feed; 2- permanent generator w/ATS; 3-
(MGD) GPM @ TDH portable generator woltelemetry; 4-wet well storage)
2. 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 2H .0200 as applicable?
X1Yes ❑ 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
13. Have the following permits/certifications been submitted for approval?
Wetland/Stream Crossings - General Permit or 401 Certification?
Sedimentation and Erosion Control Plan?
Stormwater?
❑ Yes ❑ No
❑ Yes �, No
❑ Yes ❑ No
14 N/A
❑ N/A Ta bE 4uhM 1 TTE 17 TO
N/A
rk.pEt 4it Wt 1o(5t (05
14. Does this project involve aerial lines or siphons? Check if yes: ❑ t,1%A
IheJlneswiltbe_consideredbiahnriority_and_mustbe_checkedonceeverv_sixmaths
15. Does this project have gravity sewer Tines designed at minimum slopes?g
Be aware that the Division will not accept installed lines more than 10% flatter than the minimum slope. Lines installed outside this tolerance should be
corrected prior to submitting the final engineering certification..
1-,"1'A 02/03 ----Rev. 3 04/05

• FASTTRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 5
1. Use the Division's guidance document entitled, "DETERMINING STREAM CLASSIFICATIONS FOR FORM FTA 02/03
(FAST -TRACK SEWER SYSTEMS)" to collect and record the stream classification data below (attach addtional sheets as
necessary). This document is available from our web site or by contacting the appropriate Division of Water Quality
regional office (see instructions for addresses) OR indcate the following:
❑ A Stream Classification is not needed because all parts of the project are at least 100 feet away from any down slope
waterbody; AND
❑ A Stream Classification is not needed because the design does not depend on wet well storage as a power reliability
option for any pump station near a Class C down slope waterbody.
Location ID on Map
(self chosen - as shown on
map for cross-reference)
SBE ATTAC-NED MAQ
Name of
Waterbody County River Basin
CREEK ow? E I-iAR+JETT CAFE raiz 18 -17- 5 WS - IV
Waterbody Stream Waterbody
Index Classification
Submit the 8.5" x 11" COLOR topographic map as required in Instruction VI
regardless of whether a classification is provided!
. Applicant's Certification:
1, -Tµot+nAS Q. l4o6G , attest that this application for
has been reviewed by me and is accurate and complete to the best of my knowledge. 1 understand that if al 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 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 $10,000
as well as civil penalties up to $25,000 per violation.
1 a.
Signing Official Signature
2. Professional Engineer's Certification:
I attest that this application for Sr c,(,J& ULt. CV6d• -14407E 1 has been reviewed by me and is accurate, complete
and consistent with the information in the engineering plans, calculations, and al 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 Febniary
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 certain portions of this submittal
package may have been developed by other professionals, 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 $10,000 as well as civil penalties up to $25,000 per violation.
?� 561) 0 5
2a. 4 j'Up{-ihtf.11 E L • tJ Oi &i' ,
Professional Engineer Name
2b. 4PAuwi,.V 4 go(i:.(zt',, PA
Engineering Firm
2c. 112 TP.. MTY ROD
Mailing Address
2d. R&l.E iCa 4 2e. IBC. 2f.
City State
2g. 9(9-854-i99 0 2h. 9 t9 -854---n z5 2i.
Telephone Facsimile
Date
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48
Z7601
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Zip ;E;
.„,;,,,-
y(erkomie@4 udirgnorris.cnti. N\
Eail Seal. Signature & Date
F1'A 02/03 - Rev. 3 04/05

Harnett
COUNTY
NORTH CAROLINA
Quo i Pr
AWWA
MFMOFR
NR
WA
Public Utilities Department
www.harnett.org
PO Box 1119
308 West Duncan Street
Lillington, NC 27546-1119
ph: 910-893-7575
fax: [phone]
October 4, 2005
Stephanie Norris
Spaulding and Norris, PA
972 Trinity Road
Raleigh, NC 27607
Re: Flow Acceptance
Dear Ms. Norris,
Harnett County Department of Public Utilities will accept 18,000 gallons per day of wastewater
flow from the Town of Lillington. Wastewater will be treated by the Regional Wastewater
Treatment Plant located in Lillington.
If you have any questions or need additional information, please contact Glenn McFadden,
Distribution and • - tion System Superintendent, at 910-814-3041. Thank you.
Respectful
Rod'ey M. Tart
H 1 PU Director
T/ckm
Cc: Glenn McFadden, Distribution and Collection System Superintendent
strong roots • new growth

Site Visit Information Packet
Project Name: SP2i140-1-Subdivision
S&N Project #: 576-05
Property Owner
Name:
Mailing Address:
Phone:
Fax:
Email:
Agent/Consultant
Name:
Company Affiliation:
Mailing Address:
Phone:
Fax:
Email:
Property Description
Mr. Jim K Sherron
408 May Court
Raleigh, North Carolina 27609
919.881.0070
Shawn F. Guyer
Spaulding & Norris, PA
972 Trinity Road
Raleigh, North Carolina 27607
919.854.7990
919.854.7925
shawn(d,spauldingnorris. com
Property Identification Number (Tax PIN): 0549-77-2324.000
County: Harnett
Nearest Town: Lillington
Directions: Traveling south on US-401, approaching Lillington, turn right onto North Main
Street/NC-27 West. After the third stoplight, turn right onto West Old Road/NC-27
West. After approximately 1.25 miles, turn right onto Samuel McKoy Lane (dirt road).
Site begins after gates.
Size (acres): 145.92
Coordinates: 78.83983 West, 35.38971 North
Nearest Waterway:
Stream ID:
Stream Classification:
River Basin:
USGS HUC:
Existing Conditions:
Poorhouse Creek; UT to Indian Branch
18-17.5; 18-20-26-1
WS-IV; WS-IV
Cape Fear (Subbasin 03-06-07; 03-06-13)
Upper Cape Fear (03030004)
The site is comprised of approximately 5-10 year old cutover, mixed pines and hardwoods. The several of
the bottoms have some larger trees and are filled with Arundinaria gigantea and Smilax. The site is
bisected by Samuel McKoy Lane, a dirt road that leads to several homes located to the west of the site. The
parcels to the south of the site consist of agricultural land and residential homes. North of the site are
agricultural/residential areas, an automobile junkyard, and an elementary school. Residential homes
dominate the area to the east of the site.

•
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hed by the Geological Survey
USCE, and North Carolina Geodetic Survey
is methods from aerial photographs
174. Map edited 1978
)ot grid ticks based on. North Carolina
Universal Transverse Mercator
927 North American Datum
lmerion Datum 1983 move
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tatted fence end held lines where
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CONTOUR INTERVAL 10 FEET
NATIONAL GEODETIC VERTICAL DATUM OF 1929
THIS MAP COMPLIES WITH NATIONAL MAP ACCURACY STANDARDS
FOR SALE BY U. 8. GEOLOGICAL SURVEY
47'30"
.
Copyright (C) 1998, Maptech, Inc.