WQ0033724_Application (FTSE)_20081231

USE THE TAB KEY TO MOVE FROM FIELD TO FIELD!
Application Number:
(to be completed by DWQ)
NFORMATION
Z
lh. 919-552-6264 1
QTelephone Facsimile
U 2. Project (Facility) Information:
1. Owner/Permittee:
1 a Senter's Rest Home
Full Legal Name (company, municipality, HOA, utility, etc.)
1 b. Diane McLamb, Manger
Signing Official Name and Title (Please review 15A NCAC 2T .0106 (b) for authorized signing officials!)
1 c. The legal entity who will own this system is:
❑ Individual ❑ Federal ❑ Municipality ❑ State/County ❑ Private Partnership ® Corporation ❑ Other (specify):
ld. 40 Rawls Club Road 1e. Fuquay-Varina
Mailing Address City
1f. North Carolina
State
lg. 27526
lj.
Zip Code
E-mail
J 2a. Senter's Rest Home Wastewater Pump Station 2b. Harnett
f Brief Project Name (permit will refer to this name)
a
Q 3 Contact Person:
:................................................................................................
Q 3a. John F. Phillips, Project Engineer
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. 919-467-9972 3c. [e-mail]
County Where Project is Located
Phone Number E-mail
1. Project is ® New ❑ Modification (of an existing permit) If Modification, Permit No.:
2. Owner is ❑ Public (skip to Item B(3)) ® Private (go to Item 2(a))
2a. If private, applicant will be:
® 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))
2b. If sold, facilities owned by a (must choose one)
❑ Public Utility (Instruction C)
❑ Homeowner Assoc./Developer (Instruction D)
Z
O 4a.
2ce 5a.
0
LL 6.
County of Harnett
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
Lillington WWTP 4b.
Name of WWTF
WWTF Permit No.
5b.
County of Harnett
36"
Owner of Downstream Sewer Receiving Sewer Size
The origin of this wastewater is (check all that apply):
❑ Residential Subdivision
® Gravity
❑ Force Main
5c.
Permit # of Downstream Sewer (Instruction E)
❑ Retail (Stores, shopping centers)
100 % Domestic/Commercial
DIEHL & PHILLIPS PA
PH. 919-467-9972
219 E CHATHAM ST
CARY, NC 27511-3474
TO THE N C D
ORDER OF
F i4 I-t (A N i it E I C N I j 4. Ivb / l ou
BB&T
BRANCH BANKING AND TRUST COMPANY
1-800-BANK BBT BBT.com
DATE 1213U/ 08
10435
66-112/531
BRANCH 13201
$ 4 9a. '
DOLLARS
LT !
FOR
SLtiit`• t J tiwt Hormr

vP

c�O State of North Carolina
D�A,�� Department of Environment and Natural Resources
,v `616 Division of Water Quality
-mac ®�`A' QQY FAST -TRACK APPLICATION
VvQ (FTA 12/07 ver5)
D for GRAVITY -SEWERS, PUMP -STATIONS, FORCE—M*INS
(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. state. nc. us/peres/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 MUN'r'P.ALITY UPON
COMPLETION, FORM DEV 02/03 IS REQUIRED.
® E. Downstream Sewer, WWTF Capacity and Flow Tracking/Acceptance — FORM FTSE 10107 (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.

G.
❑ H
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.
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
[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, 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.
FTA 12/07

USE THE TAB KEY TO MOVE FROM FIELD TO FIELD!
Application Number: WQ0033 724
(to be completed by DWQ)
i.
1 a.
O 1 b.
Q lc.
a■
O 1 d.
LL
1f.
Z
_ 1 h.
QTelephone
0 2.
j 2a.
a
Q.
Q 3.
Q 3a.
3b.
Owner/Permittee:
Senter's Rest Home
Full Legal Name (company, municipality, HOA, utility, etc.)
Diane McLamb, Manger
Signing Official Name and Title (Please review 15A NCAC 2T
.0106
Private
(b) for authorized signing officials!)
The legal entity who will own this
system
is:
Individual ■ Federal ■ Municipality
40 Rawls Club Road
■ State/County ■
Partnership Corporation
le. Fuquay-Varina
• Other (specif-y):
Mailing Address
North Carolina
City
lg. 27526
State
919-552-6264 1 i.
Zip Code
1j.
Facsimile E-mail
Project (Facility) Information:
Senter's Rest Home Wastewater Pump Station 2b. Harnett
Brief Project Name (permit will refer to this name) County Where Project is Located
Contact Person:
Engineer
John F. Phillips, Project
Name and Affiliation of Someone Who Can Answer Questions About this Application
919-467-9972 3c. [e-mail]
Phone Number E-mail
1.
Project is ►/ New ■ Modification
(of
an existing permit)
If Modification, Permit No.:
2.
B(3))
Private (go to Item 2(a))
Owner is • Public (skip to Item
►l
2a.
If private, applicant will be:
church, single office, etc.) or
etc. - skip to Item B(3))
etc. - go to Item B(2b))
2b. If sold facilities owned by a (must choose one)
(Instruction C)
Assoc./Developer (Instruction D)
Retaining Ownership (i.e. store,
■ Public Utility
IN Leasing units (lots, townhomes,
• Homeowner
• Selling units (lots, townhomes,
3.
County of Harnett
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
Z
0 4a.
Lillington WWTP 4b.17,7) 2 j(a 3C4,
Name of WWTF WWTF Permit No.
Q
E
5a.
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CO
County of Harnett
5b.
36"
Gravity
Main
5c.
• Force
Owner of Downstream Sewer
The origin of this wastewater is
Receiving
(check
Sewer Size
all that apply):
• Permit # of
Downstream Sewer (Instruction E)
(Stores,
Home
(specify):
shopping centers)
100 % Domestic/Commercial
■ Residential Subdivision
IN Retail
% Industrial (attach
• Apartments/Condominiums
• Institution
■ Hospital
• Mobile Home Park
description.)
(RO: contact your Regional Office
Pretreatment staff)
% Other (specify):
IN School
■ Church
■Restaurant
►1 Nursing
• Office
■ Other
7. Volume of wastewater to be allocated or permitted for this particular project: 4,800
*Do not include future flows or previously permitted allocations
If the permitted flow is zero, indicate why:
gallons per day
❑ Pump Station, Outfall or Interceptor Line where flow will be permitted in subsequent permits that connect to this line
El Flow has already been allocated in Permit No.
El Rehabilitation or replacement of existing sewer with no new flow expected (see 15A NCAC 02T .0303 to determine if a
permit is required)
FTA 12/07

B. PERMIT INFORMATION (CONTINUED)
9. Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2T .0114 for
the value in Item B(7) AND/OR the design flow for line or pump station sizing if a reduced or zero flow is being requested in
Item B(7). Values other than that in 15A NCAC 2T .0114 (b) and (c) must be supported with actual water or wastewater use
data in accordance with 15A NCAC 2T .0114 (f).
Previously Permitted (NPDES Permit NC0048101) - 40 beds X 120 gal./bed/day = 4,800 GPD
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches)
Length (feet)
New Gravity or Additional
Force Main
2 ! 302 FM
11. Summary of Pump Stations w/ associated Force Mains to be Permitted (attach additional sheets as necessary)
Pump Station Location ID Senter's Rest Home (self chosen - as shown on
Design Flow
(MGD)
Operational Point
GPM @TDH
Power Reliability Option
1 - permanent generator w/ATS;
2 - portable generator w/MTS
Force Main Size
Force Main Length
0048 29 GPM @ 91' 1 2 8,466
x Z.5 s r7
Pump Station Location ID 1 `�000 (self chosen - as shown on plans/map for reference)
Design Flow
(MGD)
Operational Point
GPM @TDH
Power Reliability Option
1 - permanent generator w/ATS;
2 - portable generator w/MTS
Force Main Size
Force Main Length
Pump Station Location ID (self chosen - as shown on plans/map for reference)
Design Flow
(MGD)
Operational Point
GPM @TDH
Power Reliability Option
1 - permanent generator w/ATS;
2 - portable generator w/MTS
Force Main Size Force Main Length
12. Will the wastewater flow in the proposed sewer lines or pump stations be able to be directed to another treatment facility?
❑ Yes ® No If Yes, permit number of 2nd treatment facility
(RO — if "yes" to B,12 please contact the Central Office PERCS Unit)
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
FTA i 2/07

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?
Sedimentation and Erosion Control Plan?
Stormwater?
❑ Yes ❑ No
® Yes ❑ No
❑ Yes ❑ No
® N/A
❑ N/A
® N/A
I5. 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
1.
1 a.
Owner/Permittee's Certification: (Signature of Signing Official and Project Name)
1, Diane McLamb , attest that this application for Senter's Rest Home Wastewater Pump Station
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 returned 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.
/)(10t Athri
Signing Official Signature
ra(i5f 0'
Date
ENGINEERING DESIGN DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL OF THIS
APPLICATION. THESE DOCUMENTS MUST INCLUDE PLAN AND PROFILE OF SEWERS, THEIR PROXIMITY
co TO OTHER UTILITIES, DESIGN CALCULATIONS. ETC. REFER TO 15A NCAC 02T .0305
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2. Professional Engineer's Certification: (Signature of Design Engineer and Project Name)
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I, John F. Phillips , attest that this application for Senter's Rest Home Wastewater Pump Station _ 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 other professionals may have developed certain portions of this submittal package, 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 143-215.68, 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.
2a. John F. Philips
Professional Engineer Name
2b. Diehl & Phillips, P.A.
Engineering Firm
2c. 219 E. Chatham St.
Mailing Address
2d. Cary
City
2g. 919-467-9972
Telephone
2e. NC '2f. 27511
State Zip
2h. 919-467-5327 2i. [e-mail]
Facsimile E-mail
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NC PE Seal, Signature & Date
SEAL _
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FUDUAY-VARiNA QUADRANGLE
NORTH CAROLINA
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7.5 MINUTE SERIES (TOPOCiRAPH1C)
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W ATF9 State of North Carolina
P Department of Environment and Natural Resources
7 Division of Water Quality
—1
-c Flow Tracking/Acceptance for Sewer Extension Permit Applications
(FTSE —05/07)
Project Applicant Name: Harnett County Department of Public Utilities
Project Name for which flow is being requested: Senter's Rest Home
Amount of flow requested for this project: 4.800 GPD = 0.0048 MGD
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: North Harnett Regional WWTP
b. WWTP Facility Permit #: NC0021636
c. WWTP facility's permitted flow
Fuquay Varina Allocated Flow
Lillington Allocated Flow
Harnett County Allocated Flow
Angier Allocated Flow
d. Estimated obligated flow not yet tributary to the WWTP
FV Obligated Flow NYT
Lillington Obligated Flow NYT
HC Obligated Flow NYT
Angier Obligated Flow NYT (To Angier's WWTP)
e. WWTP facility's actual avg. flow
FV Actual Flow
Lillington Actual Flow
HC Actual Flow
Angier Actual Flow (To Angier's WWTP)
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
FV Actual Avg. + Obligated Flow + Request
Lillington Actual Avg. + Obligated Flow
HC Actual Avg. + Obligated Flow
Angier Actual Avg. + Obligated Flow
h. Percent of permitted flow used
Fuquay Varina - (0.991 MGD / 2.6 MGD)
Lillington — (0.801 MGD / 1.2 MGD)
HCDPU - (0.576 MGD / 1.8 MGD)
Angier — (0.370 MGD/ 1.08 MGD)
5.6 MGD
2.60 MGD
1.20 MGD
1.80 MGD
1.08 MGD
*
0.467 MGD
0.259 MGD
0.142 MGD
0.066 MGD
0.035 MGD *
1.967 MGD
0.732 MGD
0.659 MGD
0.576 MGD
0.335 MGD *
0.0048 MGD
2.4388 MGD
0.991 MGD
0.801 MGD
0.6468 MGD
0.00 MGD *
43.55 (Overall)
38.12%
66.75%
32.00%
34.26%

II. Complete this section for each pump station you are responsible for along the route of this
proposed wastewater flow.
List pump stations located between the project connection point and the WWTP
Pump Station Name Approx. Capacity, MGD Approx. Current Avg.
(Firm/Design) Daily Flow MGD
HCDPU Regional SLS # 120 13.0 MGD 1.327 MGD
III. Certification Statement:
I, Rodney M. Tart — Director of Public Utilities_, certify that the addition of the volume of
wastewater to be permitted in this project has been evaluated along the route to the receiving
wastewater treatment facility and that the flow from this project will not cause any capacity related
sanitary sewer overflows or overburden any downstream pump station en route to the receiving
treatment plant. This certification applies to those items listed above in Sections I and II for which I
am the respo . le party/",Signature of this form indicates acceptance of this wastewater flow.
Signin Official gnature ate
Remaining Capacity at WWTP facility
NHR WWTP
Fuquay Varina
Lillington
HCDPU
Angier
(5.6 MGD — 2.4388 MGD)
(2.6 MGD — 0.991 MGD)
(1.2 MGD — 0.801 MGD)
(1.8 MGD — 0.576 MGD)
(1.08MGD — 0.370 MGD)
3.1612 MGD
1.609 MGD
0.399 MGD
1.224 MGD
0.710 MGD
(61.88%)
(33.25%)
(68.00%)
(65.74%)
Note: The Town of Angier has not added any actual flow to the NHRWWTP at this time.
The Town of Angier will apply for the permits to extend gravity and force main sewer
to the North Harnett Regional WWTP before any flow will be added to the plant but,
the projected flows are being tracked for informational purposes at this time.