WQ0031009_Application (FTSE)_20061113

AST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE 3
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD! Application Number: W0003 1009
(to be completed by DWQ)
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1. Owner.
1a. '-OW - oc 1 a6.tE=—
Full Legal Name (company, municipality, HOA, utility,
etc.)
e.e
1b. l trr K!".���g}-
va. , %o,... ,1 . of,,
Signing Official Name and Title (Please review 15A NCAC 2H .0206(b) for authorized signing officials!)
lc. The legal enti who will own this system is:
■ Individual Federal5 Municipalitty ■ State/County
■ Private Partnership • Corporation • Other(specify):
lift 27$',1e. A r4 Q DER
Id. 55 tj,. 59-6ap Sign. w Po
Mailing Address City
If. vJ4 Ig. 27 E, , t
State Zip Code
1h. (em- 26 --1 t Ii• (0M- 40.1 3o .Ij•
Telephone Facsimile E-mail
2. Project (Facility) Information:
2a. W s,-4>E7s-t o,.1 E %id E.6- :?b. 1-1 AP .1E17
Brief Project Name (permit will refer to this name)
County Where Project is Located
AssociAres
r
3 Contact Person:
ti3a. RAor t.4„....E-a- i'aAv..cesoa
Name and Affiliation of Someone Who Can Answer Questions
About this Application
;3c. V . Wee, to t64 , ^ k. r-c
3b. 511 - o B 08
Phone Number E-mail
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LOwner
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If Modification, Permit No.:
1. Project is 71 New ■ Modification (of an existing permit)
1 For modifications, attach a separate sheet clearly explaining
phase, changing line size/length, etc.). Only include
duplicate project information in B(7) and B(10-11) that
i
the reason for the modification (i.e. adding another
the modified information in this permit application - do not
has already been included in the original permit.
;
(go to Item 2(a))
2. Owner is g Public (skip to Item B(3)) ■ Private
2a. If private, applicant will be:
2b. If sold, facilities owned by a (must choose one)
• Retaining Ownership (i.e. store, church, single office, etc.) or ■ Public Utility (Instruction III)
• 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. T w rt OF AvIsier
of Wastewater'treatment Facility (WWTF) Treating Wastewater From This Project
ThisjA op. iSv oj.i bAAt'tF 4b. jvco0 0 9.511
Name of WWTF WWTF Permit No.
s�.
5a.i ,.. of Rheit r
gravity I5c.
I5b.
11 ...n9r orl f n ,r, * mom Rawar IReceivina Sewer Size
• Force Main I Permit Number of Downstream Sewer (if known)
MONTAGUE DEVELOPMENT, LLC
10305 PENNY RD.
RALEIGH, NC 27606
DATE 66-46-531
PAY TO THE
ORDER OF " " / V ��;--- I $ 01
v - /
FOR
000
8
by

12/16/2006 17:56 9195770609
THOMPSON ASSOC PAGE 01
THOMPSON & ASSOCIATES, PA
153 HOLLY SPRINGS ROAD
HOLLY SPRINGS, NC 27540
PHONE: [phone]
FAX: [phone]
WWW.THOMPSONASSOCIATES.BIZ
FACSIMILE TRANSMITTAL SHEET
TO: FROM:
Irtn� lien .151„\ci M ller
COMPANY: DATE:
I 2.113 I O to
FAX NUMBER: TOTAL NO. OF PAGES INCLUDING COVER:
Q10 -Ngb- 0g07
PHONE NUMBER: SENDER'S REFERENCE NUMBER,
RE: YOUR REFERENCE NUMBER:
URGENT FOR REVIEW PLEASE COMMENT PLEASE REPLY PLEASE RECYCLE
NOTES/COMMENTS:
If you do not receive all pelres indicated or if document is unreadable, please
contact us immediatcly. Thank you.
ENGINEERING - SURVEYING - LAND PLANNING

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 1
OF WAT ,9
kiir
DENR-FRO
> 1 -+ NOV 13 2006
0
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
FAST -TRACK APPLICATION
DWOr 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.
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).
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.

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(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.
❑ 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, Hamett,
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/

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!
Application Number:
(to be completed by DWQ)
W00031009
1. Owner:
1 a. -rook c .A a
Full Legal Name (company, municipality, HOA, utility, etc.)
1 b. � .mitt %i.� � /'te . f, r "
Signing Official Name and Title (Please review 15A NCAC 2H .0206(b) for authorized signing officials!)
lc. The legal entity who will own this system is:
❑ Individual 0 Federal F Municipality 0 State/County 0 Private Partnership 0 Corporation ❑ Other (specify):
ld. 55 A. 5424,Afl War Po Act 27Ble. Ar4c, -
Mailing Address City
lf. NC lg. 2-7 i
State
1h. td?S. Zc`'1
Telephone
Facsimile
2. Project (Facility) Information:
2a. �3E WES--(
4,130
1j.
Zip Code
E-mail
2b. iA�JE"f
Brief Project Name (permit will refer to this name) County Where Project is Located
3. Contact Person:
3a. tZAa D ( �-l� �..�-a— j u �c � SOC.tA-tE�
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. 511 - ,fd E3 0 /3 3c. trA .11,Pr, ie_ (t E'c * ��r l • .4
.r[
Phone Number E-mail
1. Project is /A 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 p 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)
❑ Retaining Ownership (i.e. store, church, single office, etc.) or
Z ❑ Leasing units (lots, townhomes, etc. - skip to Item B(3))
Q ❑ Selling units (lots, townhomes, etc. - go to Item B(2b))
CC4a. ToW A 0 F / v oj.i 14ruil F
O Name of WWTF
LL 5a. %.n‘OF J pqj r 5b.
Z
H
Residential Subdivision
ie 0 Apartments/Condominiums
W ❑ Mobile Home Park
IZ ❑ School
m ❑ Restaurant
0 Office
❑ Public Utility (Instruction III)
❑ Homeowner Assoc./Developer (Instruction IV)
1-- I-77 4n DF Aitr
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
4b. JC00 % - s91
WWTF Permit No.
ravity 15c.
Owner of Downstream Sewer Receiving Sewer Size (❑ Force Main
$1�
6. The origin of this wastewater is (check all that apply):
Permit Number of Downstream Sewer (if known)
❑ Car Wash
❑ Institution
❑ Hospital
❑ Church
❑ Nursing Home
❑ Other (specify):
% Domestic/Commercial
Industrial
% Other (specify):
. Volume of wastewater to be allocated for this particular project: gallons per day
*Do not include previously permitted allocations 2C 1b0 G PO
•
If the permitted flow is zero, indicate why:
O 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

FAST -.TRACK APPLICATION for GRAVITY SEWERS, PUMP STATKiNS, AND FORCE MAINS PAGE 4
9. Provide the wastewater flow calculations used in determining the permitted flow In accordance with 15A NCAC 2H
.0219(I) for Item B(7) or the design Sow for line or pump station sizing if zero flow in the space below. Values ocher than
that in 15A NCAC 2H .021 9(I)(1-2) must be supported with actual water or wastewater use data in accordance with 15A
NCAC 2H .021 9(1)(3).
. S.I.. . L0-f x 3 13Q JLa 7 v. 12.0 CrPC) / wt. z
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
8lze (Inches) Length (feet)
34I
29, ihd C. pp
Gravity or Force Main
(use the pull down menu)
ENTER TOTAL LINE LENGTH IN MILES 0, 15
ii• 11. Summary of Pump Stations to be Permitted (attach additional sheets as necessary)
Location ID Power Reliability Option
relf (schosen - as shown on Design Flow Operational Point (1- dual line fed; 2- permanent generator w/ATS; 3-
plans for cross-reference) (MOD) GPM ! TDH portable generator w/tslemetry; 4-wet well storage)
Z
2
'12. 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?
if r$ Yes 0 No If no, please reference the pertinent minimum design order's or regulation and indicate why a
variance Is requested. SUBMIT TWO COPIES OF PLANS, SPECIFICATIONS OR CALCULATIONS
PERTINENT TO THE VARIANCE WITH YOUR APPLICATION
id
13. Have the following permits/certifications been submitted for approval?
Welland/Stream Crossings - General Permit or 401 Certification? J Yes ❑ No ❑ N/A
Sedimentation and Erosion Control Plan? RI Yes ❑ No 0 N/A
Stormwater? E Yes ❑ No ❑ N/A
14. Does this project involve serial Tines or siphons? Check if yes: d'
Thasalinsa adodsi ammgt latshadtad.00carntttnv sit.months _
15. Does this project have gravity sewer lines designed et minimum slopes? VI
Be were that the Division wig not swept Noshed ilnss more bin 1 t1% dotter then the rnimmufn slops. Lines Instead °talkie Ihls tolerance Mould be
corrected prior b submitting the Anti engineering cerIMlca1on..
00 39Vd
•-.w • AI. w Ao A, • la.
DOSSV NOSdWOHl 6999LL96I6 95:LI 990Z/9I/ZI

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 4
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(1)(3).
8 Lo1 $ X 132L.a-t x I2a 4P0 J (52 T.
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches) Length (feet)
39 1
0
W
Z
H
OENTER TOTAL LINE LENGTH IN MILES
V11. Summary of Pump Stations to be Permitted (attach additional sheets as necessary)
B. PERMIT
Gravity or Force Main
(use the pull down menu)
Location ID Power Reliability Option
(self chosen - as shown on Design Flow Operational Point (1- dual line feed; 2- permanent generator w/ATS; 3-
plans for cross-reference) (MGD) GPM @ TDH portable generator w/telemetry; 4-wet well storage)
12. 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?
[I 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
13. Have the following permits/certifications been submitted for approval?
Wetland/Stream Crossings - General Permit or 401 Certification? I Yes 0 No 0 N/A
Sedimentation and Erosion Control Plan? RI Yes 0 No 0 N/A
Stormwater? 5 Yes 0 No 0 N/A
14. Does this project involve aerial lines or siphons? Check if yes: 0
These lines will be considered high Priority and must be checked once every six months
15. Does this project have gravity sewer lines designed at minimum slopes?
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..

• FAST -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 Name of
map for cross-reference) Waterbody
Waterbody Stream Waterbody
County River Basin Index Classification
Submit the 8.5" x 11" COLOR topographic map as required in Instruction VI
regardless of whether a classification is provided!
1.
la.
Applicant's Certification:
I, SIGNING OFFICIAL NAME, attest that this application for PROJECT NAME
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 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 143-215.6B, 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.
P-44/01
i
Signing Offi6al Signature
2. Professional Engineer's Certification:
�oCA/ /17q"►4g�•�
2a.
2b.
2c.
2d.
2g.
%O- 2-OC
Date
1 attest that this application for 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 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 February
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 / 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 m jq a fine not to
exceed $10,000 as well as civil penalties up to $25,000 per violation.
Professional Engineer Name
"r/-10,-..p.Soul k A650(,AfES
Engineering Firm
/ 52 14a
Mailing Address
/-n LL
City
51) -'Fo3 2h. 57') - o40CJ 2i.
Telephone Facsimile
.0 24G5 KeAD
2f. -17 540
State Zip
/'fP z' *, ea.r-th /0 4. n e7
E-mail
tffik CAR IA,
rrr
� e
I. 1• ) ti jtJ�l
'13i ' °G7Q3
6
f5- s
4s. 'ILL'+„; \ok.,`�.
Seal, Signature & Date

THOMPSON & ASSOCIATES, P.A.
NEW LOCATION
153 Holly Springs Road
Holly Springs, NC 17540
Phone: [phone] — Fax: [phone]
WE ARE SENDING YOU:
Shop Drawings
Copy of Letter
Attached
Prints
Change Order
LETTER OF TRANSMITTAL
DATE: 1 1 1 D
1 D(Q
JOB No.:
ATTENTION:
RE:
Under separate cover via the following items:
Plans
Other
_ Samples
Specifications
'sj �fiAw ., h"FV
*4;��a�, n . a ��:::. +Y.�as U,
..'�•; d*.. ,.
s x'M1Y_ �$1i i 5.1. £a. .G...fi ,3Ha✓ F. A�4' '`1t`&.�a .�`v r.. .<�i Ty
/��'�{C�Y.-s,
DIrI\\\V
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cab* +tack. AppV‘c.a- io;v
Chem 'Foo ,00
$'/z xr1 i(o0QP
THESE ARE TRANSMITTED•as checked below:
For Approval
For Your Use
As Requested
For Review & Comment
FOR BIDS DUE
REMARKS:
Approved as Submitted
Approved as Noted
Returned for Corrections
Other
Resubmit Copies for Approval
Submit _ Copies for Distribution
Return Corrected Prints
20
PRINTS RETURNED AFTER LOAN To US
roc o`ni CAu€SiiOns o-C e.crwcy*S
aun be, trec1/40he6 c GIG - 5 77- 01308
(Di E ^ rno;, — rnk 1ler. Pe @
COPY To SIGNED I(kf\ M 1 I ler
If enclosures are not as noted, please notify us at once.

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 1
,C, A 7- ,9 State of North Carolina
O: G Department of Environment and Natural Resources
> COPY Division of Water Quality
o - NOV 1 3 2006
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.
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).
QiII. 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.
QIVI. 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/peres or by contacting the appropriate regional
office.

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: W010031009
(to be completed by DWQ)
1. Owner:
l a. 1 ov- tic ©F A ►16.t Et1. -
Full Legal Name (company, municipality,HOA,utility, etc.)
Z
O 1b. �4 I iv_c , �i.✓.1 /le? ik0.q (-4
H Signing Official Name and Title (Please review 15A NCAC 2H .0206(b) for authorized signing officials!)
lc1 c. The legal entity who will own this system is:
2 ■ Individual • Federal W! Municipality • State/Country • Private Pa rtnership • Corporation i• Other (specify):_
O 1d. 55 IA. . j P- AD S`rt e-r wE•-lr Pbror 27a ie. A rI C 1ER.
U- Mailing Address City
Z
— lf. N(.. 1g. 27 Se) $
Z State Zip Code
,-20 ! 1i (o 4,130 1j.
Q Telephone Facsimile E-mail
acility) ProjectFa Information:
O 2. (F
J 2a. W NE7S-T v a E W E S-1" 2b• 1-k Ae-ok-r-r
Brief Project Name (permit will refer to this name) County Where Project is Located
u.
< 3. Contact Person:
Q 3a. Rosa AY Nt.(t...ea— j.40 1..cPspri .. Iptssoc-IA-tes
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. 5-11- 0806 3c. m.11fr. eC [© .6.t...V_, ne t.
Phone Number
E-mail
(of an existing permit) If Modification, Permit No.:
1. Project is yl New • Modification
For modifications, attach a separate
phase, changing line size/length,
duplicate project information in
sheet clearly explaining
etc.). Only include
B(7) and B(10-11) that
the reason for the modification (i.e. adding another
the modified information in this permit application - do not
has already been included in the original permit.
2. Owner is p Public (skip to Item
Private (go to Item 2(a))
B(3)) •
2a. If private, applicant will be:
church, single office,
etc. - skip to Item
etc. - go to Item B(2b))
2b. If sold, facilities owned by a (must choose sm_te)
• Retaining Ownership (i.e. store,
etc.) or; • Public Utility (Instruction 111)
Z ■ Leasing units (lots, townhomes,
B(3)) • Homeowner Assoc./Developer (Instruction IV)
0 ■ Selling units (lots, townhomes,
1— 3. Tou, n o F. Avtaier
Owner of Wastewater Treatment Facility (WWfF) Treating Wastewater From This Project
g 4a. Tate n o F Avqi.t to rust F 4b. f UGoo 8 O159-1
0 Name of WWTF WWTF Permit No.
IL 5a: of Artie f 5b.
$"
Receiving Sewer Size
a 3ravity I5c.
Z Owner of Downstream Sewer
❑ Force Main I Permit Number of Downstream Sewer (if known)
H 6. The origin of this wastewater is (check all that apply):
Residential Subdivision
WM Apartments/Condominiums
IN Mobile Home Park
% Domestic/Commercial
• Car Wash
■ Institution
• Hospital
% Industrial
a • School
m ■ Restaurant
• Church
■ Nursing
Home % Other (specify):
■ Office ■ Other
(specify):
7. Volume of wastewater to be allocated for this particular project: gallons per day
*Do not include previously permitted allocations 29 II fop 6 PO
8. If the permitted flow is zero, indicate
why:
be permitted in subsequent permits that connect to this line
in Permit No.
of existing sewer with no new flow expected
• Interceptor Line - Flow will
• Flow has already been allocated
• Rehabilitation or replacement

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 4
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(1)(1-2) must be supported with actual water or wastewater use data in accordance with 15A
NCAC 2H .0219(I)(3).
0 ( Lo'7S X t3CL /La -7 . I Za GPD J j =
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches) Length (feet)
w
z
0
✓ 11. Summary of Pump Stations to be Permitted (attach additional sheets as necessary)
O Location ID
• (self chosen - as shown on Design Flow Operational Point
• plans for cross-reference) (MGD) GPM @ TDH
0
LL
Z
3 i 4 I
2-5, i&O G PD
Gravity or Force Main
(use the pull down menu)
ENTER TOTAL LINE LENGTH IN MILES
0,1G
Power Reliability Option
(1- dual line feed; 2- permanent generator w/ATS; 3-
portable generator w/telemetry; 4-wet well storage)
-g 12. 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?
w 7. Yes LI No If no, please reference the pertinent minimum design criteria or regulation and indicate why a
a variance is requested. SUBMIT TWO COPIES OF PLANS, SPECIFICATIONS OR CALCULATIONS
PERTINENT TO THE VARIANCE WITH YOUR APPLICATION
m
13. Have the following permits/certifications been submitted for approval?
Wetland/Stream Crossings - General Permit or 401 Certification? ] Yes ❑ No ❑ N/A
Sedimentation and Erosion Control Plan? Yes ❑ No ❑ N/A
Stormwater? [7 Yes ❑ No ❑ N/A
14. Does this project involve aerial lines or siphons? Check if yes: ❑
These lines will be considered hiah oriority and must be checked once every six months
15. Does this project have gravity sewer lines designed at minimum slopes?
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

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 5
Z
0
H
U
[co
—J
U
W
re
co
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 Name of Waterbody Stream Waterbody
map for cross-reference) Waterbody County River Basin Index Classification
Submit the 8.5" x 11" COLOR topographic map as required in Instruction VI
regardless of whether a classification is provided!
co
Z
0
U
IL
H
U
ci
1. Applicant's Certification:
1, SIGNING OFFICIAL NAME, attest that this application for PROJECT NAME
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 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 143-215.6B, 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. /0 4„
Signing Off ial Signature
Professional Engineer's Certification:
/i%gn45 !
/0-- 2-06
Date
I attest that this application for 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 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 February
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 / 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 max,00109., aa fine not to
exceed $10,000 as well as civil penalties up to $25,000 per violation. v.
2a. PANDAtt
Professional Engineer Name
2b• iyfp.tip oni A550CIAfES
Engineering Firm
2c. / 52 /-I: LL. y 4,¢,:.1
Mailing Address
2d. / t-t. 5p2,a6S
City
g,AD
2e. 1.1 (. 2f. Z7 S/O
State Zip
2g. 5-17-utio,5 2h. 5'7 - o(oeJ 2i. rm. //frptcPcur-tlt/•,i4..i<Z
Telephone Facsimile E-mail
41.
ESS
SE AL
19793
Seal, Signature & Date

THOMPSON & ASSOCIATES, P.A.
NEW LOCATION
153 Holly Springs Road
Holly Springs, NC 17540
Phone: [phone] -- Fax: [phone]
N��)3Q
WE ARE SENDING YOU:
Attached
Shop Drawings _ Prints
Copy of Letter
Change Order
LETTER OF TRANSMITTAL
DATE: 1 1 J D
I OC2
JOB No.:
ATTENTION:
RE:
Under separate cover via the following items:
_ Samples Specifications
Plans
Other
Pr,n-vs
o, * -back_ lkppI;C&r o►'
C,herjc Loo ,00
$'/2. xi 1 o map
THESE ARE TRANSMITTED as checked below:
For Approval
For Your Use
As Requested
For Review & Comment
REMARKS:
Approved as Submitted
Approved as Noted
Returned for Corrections
Other
Resubmit Copies for Approval
Submit _ Copies for Distribution
Return Corrected Prints
FOR BIDS DUE 20 PRINTS RETURNED AF"I ER LOAN To Us
Fpr p,n4 C:tueskion% C c.nmacyks
C c\ toe ceaehed CL4- q-5/7"OS08
CDC E - Pc\ca% — 1Y\ %Ile ". Pe. @ e_a(-4-1\t“Rk_ n eA-
COPY To SIGNED �g►l M i t \e,'
If enclosures are not as noted, please notify us at once.

.Harnett County, North Carolina Spatial Data Explorer
Page 1 of 3
Spatial Malta [plc?rer
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Horne
Zoomin C ZoomOut C Recenter Map C Identify: (Tax Parcels
Zoom Factor: [2X Radius Search (feet) _
li
Parcel Data
Find Adjoining Parcels
Contact
• Account Number001400026203
• Owner Name: MONTAGUE DEVELOPERS
LLC
• Owner/Address 1:
• Owner/Address 2:
• Owner/Address 3: 10305 PENNY ROAD
• City,State Zip: RALEIGH ,NC 276060000
• Commissioners District: 4
• Voting Precinct: 401
• Census Tract: 401
• Determine Flood Zone(s)
• PIN: 0674-94-3592.000
• REID: 18565
• Parcel ID: 040674 0070 02
• Legal 1:25 AC JOHNNIE
CANADY
• Legal 2:
• Property Address:
1501 NC SR X
• Assessed Acres: 25.00AC
• Calculated Acres: 25.54
• Deed Book/Page: 02226/0906
• Deed Date: 2006/05/16
111153
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http://sdx.harnett.org/servlet/com.esri.esrimap.Esrimap?Name=harnett_sdx&Cmd=Clk&L... 11/8/2006

Harnett County, North Carolina Spatial Data Explorer
Page 1 of 3
NW
Spatial Data [ICpl@rer
Horne
Click on the Map to:
C' Zoomin r ZoomOut Recenter Map r` Identify: ITax Parcels)
Zoom Factor: I2X j C Radius Search (feet)10 T
Parcel Data
Find Adjoining Parcels
Contact
• Account Number:001400026203
• Owner Name: MONTAGUE DEVELOPERS
LLC
• Owner/Address 1:
• Owner/Address 2:
• Owner/Address 3: 10305 PENNY ROAD
• City,State Zip: RALEIGH ,NC 276060000
• Commissioners District: 4
• Voting Precinct: 401
• Census Tract: 401
• Determine Flood Zone(s)
• PIN: 0674-94-3592.000
• REID: 18565
• Parcel ID: 040674 0070 02
• Legal 1:25 AC JOHNNIE
CANADY
• Legal 2:
• Property Address:
1501 NC SR X
• Assessed Acres: 25.00AC
• Calculated Acres: 25.54
• Deed Book/Page: 02226/0906
• Deed Date: 2006/05/16
NE
Map L;
Draws;
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r Townshi
F Tax Parc
Aerial
Photogr;
2005 **
Aerial
Photogr
2002 **
r Fire Tax
Districts
F
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http://sdx.harnett. org/servlet/com.esri.esrimap.Esrimap?Name=harnett_sdx&Cmd=Redraw... 11 /8/2006

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