WQ0031008_Application (FTSE)_20061113

4ST-TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE 3
1
OM FIELD TO FIELDI
Application Number:
USt Iris IAtintr IvrvivvaFR (to be completed by DWQ) -- --- -'--'.....
. Owner:
a. Town of Angier
Full Legal Name (company, municipality, HOA, utility, etc.)
b. Coley B. Price — Town Manager
Signing Official Name and Title (Please review 15A NCAC 2H .0206(b) for authorized signing officials!)
c. The legal entity who will own this system is:
• Individual • Federal Municipality ■ State/County • Private Partnership ■ Corporation ■ Other (specify):
d. P.O. Box 278 1 e. Angier
Mailing Address City
If. NC 1 g. 27501
State Zip Code
I h. 919-639-2071 1 i. 919-639-6130 1j. [e-mail]
Telephone Facsimile E-mail
?. Project (Facility) Information:
?a. AutoZone Store #3921 2b. Harnett
Brief Project Name (permit will refer to this name) County Where Project is Located
3. Contact Person:
3a. Chris Bostic, Project Manager
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. 919-653-2927 3c. [e-mail]
Phone Number E-mail
1. Project is F2 New ❑ Modification (of an existing permit) If Modification, Permit No.:
For modifications, attach a separate sheet clearly explaining 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 in B(7) and B(10-11) that has already been included in the original permit.
2. Owner is Public (skip to item B(3)) ■ Private (go to Item 2(a))
be: 2b. If sold, facilities owned by a (must choose one)
2a. If private, applicant will
III)
• Retaining Ownership (i.e. store, church, single office, etc.) or IN Public Utility (Instruction
■ Leasing units (lots, townhomes, etc. - skip to Item B(3)) ■ Homeowner Assoc./Developer (Instruction IV)
■ Selling units (lots, townhomes, etc. - go to Item B(2b))
3. Town of Angier
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
4a. Town of Angier Wastewater Treatment Facility 4b. NC0082597
Name of WWTF WWTF Permit No.
58 Town of Anaier 15b. 8-inch . RI Gravity 65c
MO.
DAY
YR.
EXACTLY
TO
ORDER
1ESSEE BANK GREENEVILLE, TENNESSEE

//// toZtme
P.O. BOX 2198
MEMPHIS, TN 38101
901-495-7031
DOLLARS and CENTS
No. 848349
AMOUNT OF CHECK
Ilvta on@
VOID AFTER 180 DAYS
87-434
642

F,4ST-TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 1
NOV 13 2006
COPY
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
FAST -TRACK APPLICATION
for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
(Pressure 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.
® 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.
❑ 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 WWTF, 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.
® VI. 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 clear 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.
❑ 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.
FTA 02/03 - Rev. 3 04/05

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 2
❑ 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(1b). 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.
® 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, 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
[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]
[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, visit our web site at: http://h2o.enr.state.nc.us/peres/
FTA 02/03 - Rev. 3 04/05

Fi ST-TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE 3
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD!
Application Number: WQ003 1 008
(to be completed by DWQ)
1. Owner:
la. Town of Angier
Full Legal Name (company, municipality, HOA, utility, etc.)
Z
0 1 b. Coley B. Price - Town Manager
H
Elc.
W
0 1 d.
Signing Official Name and
The legal entity who will
■ Individual • Federal
P.O. Box 278
Title (Please review
own this system
►i Municipality
15A NCAC
is:
■ State/County
2H .0206(b) for authorized
• Private Partnership
1 e. Angier
■
signing officials!)
Corporation
■ Other (specify):
Li.
Z
Mailing
Address
City
— 1f.
NC 1g. 27501
Z
State
Zip Code
1 h.
919-639-2071 1 i. 919-639-6130 1j. [e-mail]
Q
O 2.
_I 2a.
Telephone Facsimile E-mail
Project (Facility) Information:
AutoZone Store #3921 2b. Harnett
a.
a
Brief Project Name (permit will refer to this name) County Where Project is Located
<
3.
Contact Person:
Q3a.
Chris Bostic, Project Manager
3b.
Name and Affiliation of Someone Who Can Answer Questions About this Application
919-653-2927 3c. [e-mail]
Phone Number E-mail
1.
Project is New
•
Modification (of an existing permit) If Modification, Permit No.:
For
phase,
duplicate
modifications, attach a separate sheet clearly explaining the reason for the modification (i.e. adding another
changing line size/length, etc.). Only include the modified information in this permit application - do not
project information in B(7) and B(10-11) that has already been included in the original permit.
2.
Owner is
Public (skip to Item B(3))
■ Private (go to Item 2(a))
2a.
If private, applicant will be: 2b. If sold, facilities owned by a (must choose one)
Z
0
IN
•
•
Retaining Ownership (i.e. store, church, single office, etc.) or
Leasing units (lots, townhomes, etc. - skip to Item B(3))
Selling units (lots, townhomes, etc. - go to Item B(2b))
■ Public Utility (Instruction III)
■ Homeowner Assoc./Developer (Instruction IV)
I—
3. Town of Angier
<
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
ce
4a. Town of Angier Wastewater Treatment Facility 4b. NC0082597
0
Name of WWTF WWTF Permit No.
LL
5a. Town of Angier
5b. 8-inch
►""I Gravity
5c.
Z
Owner of Downstream Sewer
Receiving Sewer Size
■
Force Main
Permit Number of Downstream Sewer (if known)
F-
6. The origin of this wastewater is (check all that apply):
2
Ce
W
0-
■
■
■
■
Residential Subdivision
Apartments/Condominiums
Mobile Home Park
School
• Car Wash
■ Institution 100 % Domestic/Commercial
■ Hospital
■ Church % Industrial
m
II Restaurant
■ Nursing Home
►Z� Other (specify): Retail Auto Parts % Other (specify):
■Office
Store
7.
Volume of wastewater to be allocated for this particular project: 700 gallons per day
`Do not include previously permitted allocations
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
FTA 02/03 - Rev. 3 04/05

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE 4
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9. 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(I)(1-2) must be supported with actual water or wastewater use data in accordance with 15A
NCAC 2H .0219(I)(3).
Stores without food service- 100 gallons/1,000 sf= 6815 sf/1000 sf x 100 gallons = 700 GPD
10. Summary of Sewer Lines to be Permitted
Size (inches)
(attach additional sheets if necessary)
Length (feet)
Gravity or Force Main
(use the pull down menu)
8-inch 1 274
Gravity
ENTER TOTAL LINE LENGTH IN MILES
Summary of Pump Stations to be Permitted
0.05 miles
(attach additional sheets as necessary)
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 w/telemetry; 4-wet well storage)
-
— —a
Does the sewer system comply
Mains (latest version), the
with the Minimum
Gravity Sewer
reference
is requested.
TO THE VARIANCE
i
Design Criteria
Minimum Design Criteria
the pertinent minimum
SUBMIT TWO COPIES
WITH YOUR APPLICATION
for the Fast Track
(latest version) and
design criteria
OF PLANS, SPECIFICATIONS
Permitting of Pump Stations and Force
15A NCAC 2H .0200 as applicable?
or regulation and indicate why a
OR CALCULATIONS
►� Yes • No If no, please
variance
PERTINENT
Have the following permits/certifications
Wetland/Stream Crossings
Sedimentation and Erosion
Stormwater?
L
14. Does this project involve aerial
These lines will be considered hiah priority
Does this project have gravity
Be aware that the Division will not
corrected prior to submitting the final
been submitted for approval?
- General Permit or 401 Certification?
Control Plan?
• Yes • No ►Z4 N/A
0 Yes • No • N/A
Yes • No ■ N/A
lines or siphons? Check if yes: •
and must be checked once every six months
sewer lines designed at minimum slopes?'®
accept installed lines more than 10% flatter than the minimum slope. Lines installed outside this tolerance should be
engineering certification..
FTA 02/03 - Rev. 3 04/05

F1\ST-TRACK 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 additional 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 indicate 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)
Name of
Waterbody
County
River Basin
Waterbody Stream
Index
Waterbody
Classification
Submit the 8.5" x 11" COLOR topographic map as required in Instruction VI
regardless of whether a classification is provided!
1. Applicant's Certification:
1, Coley B. Price, attest that this application for AutoZone Store #3921 has been reviewed by me and is accurate and
complete to the best of my knowledge. 1 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 retumed as incomplete. Note: In accordance with North Carolina General Statutes 143-215.6A 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.
1 a.
/2-AotICA•
Signing OfficiI Signature
2. Professional Engineer's Certification:
Z
0
F o 6
Date
I attest that this application for AutoZone Store #3921 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
II-- my knowledge. 1 further attest that to the best of my knowledge the proposed design has been prepared in accordance
Q with the applicable regulations, Gravity Sewer Minimum Design Criteria for Gravity Sewers adopted February 12, 1996,
0 and the Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains adopted June 1, 2000
L.T. and the watershed classification in accordance with Division guidance. Although certain portions of this submittal package
H, may have been developed by other professionals, inclusion of these materials under my signature and seal signifies that I
Ce have reviewed this material and have judged it to be consistent with the proposed design. Note: In accordance with NC
uJ General Statutes 143-215.6A and 143-215.68, any person who knowingly makes any false statement, representation, or
0 ) 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 $25,000 per violation.
6
2a. Jeffrey Wing, P.E.
i Professional Engineer Name
�b.-Kimley-Horn and Associates, Inc.
Engineering Firm
2c. 3001 Weston Parkway
Mailing Address
2d. - Cary
?__
City
2e. NC
2g. 919-653-2951 2h. 919-678-4176 2i.
Telephone
State
,M�t►etiNy44
:p.co Ali
}qv-
2f. 27513 �•$ 4
•� tt/7/o6
Zip
[e-mail]
Facsimile E-mail
Seal, Signature & Date
FTA 02/03 - Rev. 3 04/05

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