WQ0033909_Application (FTSE)_20090316

USE THE TAB KEY TO MOVE FROM FIELD TO FIELD!
1. Owner/Permittee:
1a. Town of Lillington
Full Legal Name (company, municipality, HOA, utility, etc.)
Application Number:
(to be completed by DWQ)
• lb. Tommy Bums, Town Manager
Signing Official Name and Title (Please review 15A NCAC 2T .0106 (b) for authorized signing officials!)
lc. The legal entity who will own this system is:
0 Individual 0 Federal ® Municipality 0 State/County 0 Private Partnership ❑ Corporation 0 Other (specify):
O 1 d. 106 West Front Street 1 e. Lillington
LL Mailing Address City
lf. NC 1g. 27546
Z State Zip Code
O lh. 910-893-3607 1 i. [phone] 1 j. [e-mail]
QTelephone Facsimile E-mail
V 2. Project (Facility) Information:
_j 2a. Dry Creek Apartment Homes 2b. Harnett
O. Brief Project Name (permit will refer to this name) County Where Project is Located
Q 3. Contact Person:
Q3a. Paul D. Smith, PE (Stocks Engineering) — Civil Engineering Consultant
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. 919-821-2440 3c. [e-mail]
Z r
O 4a. �1t1 C' VAT:kr n Rt 10 rY&I MAIIT 4b.
Name of WWTF
2
5a. Town of Lillington 5b. 8" ® Gravity 5c.
Owner of Downstream Sewer Receiving Sewer Size 0 Force Main
Phone Number E-mail
Project is ® New 0 Modification (of an existing permit) If Modification, Permit No.:
2. Owner is ® Public (skip to Item B(3)) 0 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 ❑ Public Utility (Instruction C)
❑ Leasing units (lots, townhomes, etc. - skip to Item B(3))
0 Selling units (lots, townhomes, etc. - go to item B(2b))
3. -T-olf:EillInglee rf f+
0 Homeowner Assoc./Developer (Instruction D)
Owner of Wastewater reatment Facility (WVVfFJreating Wastewater From This Project
WWTF Permit No.
Permit # of Downstream Sewer (Instruction E)
STOCKS ENGINEERING, P.A.
P.O. BOX 1108
NASHVILLE. NC 27856
PH [phone]
PAY (�
TO THE (� f * n► !.
ORDER OF
vIEMO
l-/b fi-7
f-s :r{ (tP-i/r
i
ak
Sord/rer nBank
Nashville -Barnes St.
66-258-531
6651003780
8564 1
1
DOLLARS
8
AUTHORIZED SIGNATURE

OL.i\ Fhu
r MAii I61U3
DWQ COPY
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
FAST -TRACK APPLICATION
(FTA 12/07 ver5)
for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
(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 retumed 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-contiquous 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 MUNICIPALITY UPON
COMPLETION, FORM DEV 02/03 IS REQUIRED.
® E. Downstrea_nt+, Sewer, WWTF Capacity and Flow Tracking/Acceptance — FORM FTSE 10/07 (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.
FTA 12/07

D. G. , 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.
❑ H 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, Harnett, 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, Allegheny, 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.
FTA12/07

lcation
• USE THE TAB KEY TO MOVE FROM FIELD TO FIELD! (Ato bpelcomplet d
by'Q)WQ0033909
1. Owner/Permittee:
la. Town of Lillington
Full Legal Name (company, municipality, HOA, utility, etc.)
Z lb. Tommy Bums, Town Manager
F-
Q lc.
aIIIIndividual
0 ld.
Signing
The
106
Official
legal entity
West Front
IIIFederal
Name and
who will
Street
own
►Z�
Title (Please review
this system
Municipality
15A NCAC
is:
■ State/County
2T
■
.0106 (b) for authorized
Private Partnership
le. Lillington
signing officials!)
IIICorporation
IIOther (specify):
LL Mailing Address City
Z 1f. NC lg. 27546
Z State Zip Code
0 1 h. 910-893-3607 1 i. [phone] 1 j. [e-mail]
QTelephone Facsimile E-mail
o 2. Project (Facility) Information:
_I 2a. Dry Creek Apartment Homes 2b. Hamett
aBrief Project Name (permit will refer to this name) County Where Project is Located
Q 3. Contact Person:
Q3a. Paul D. Smith, PE (Stocks Engineering) - Civil Engineering Consultant t
Name and Affiliation of Someone Who Can. Answer Questions About this Application
3b. 919-821-2440 3c. [e-mail]
Phone Number E-mail
1. Project is
New
■ Modification (of an existing permit) If Modification, Permit No.:
2. Owner is
►Zi
Public (skip to Item B(3))
•
Private (go to Item 2(a))
2a.
If private, applicant will be: 2b.
■ 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))
If
■
•
sold, facilities owned by a (must choose one)
Public Utility (Instruction C)
Homeowner Assoc./Developer (Instruction D)
3. lllagiew 1rri'e
+ COOCty
OOwner of Wastewater Treatment Facility (NWVTF reating Wastewater From This Project
4a.
Noyvh 'Yhe-4 (i lotvaJ WW1'? 4b. Me_a n 2114314
I—
W
Name of WTF j
a
W WTF Permit No.
M 5a. Town of Lillington
b. 8
Gravity
5c.
OOwner
tL 6. The
Z
■
of Downstream Sewer
origin of this wastewater is
Residential Subdivision
Receiving(
(check
Sewer
all that
Size
apply)
■
Force Main
Permit # of
Downstream Sewer (Instruction E)
100 %Domestic/Commercial
I— 0
Apartments/Condominiums
pa%
MI
•
Retail (Stores, shopping centers)
Institution
Industrial (attach
2 ■
IIIL11
II
a ■
Mobile Home Park
School
Restaurant
Office
III
■
■
•
Hospital
Church
Nursing Home
Other (specify):
description.)
(RO: contact your Regional Office
Pretreatment staff)
m
% Other (specify):
7. Volume
of wastewater to be allocated
or permitted for this particular project:-1•41460-
gallons per day
*Do
8. If the
■
•
not include future flows or previously permitted allocations L(o 30
permitted flow is zero, indicate why:
Pump Station, Outfall or Interceptor Line where 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 (see 15A NCAC 02T .0303 to determine if a
permit is required)
FTA 12/07

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).
16-one bedroom units @ 240 gpd = 3,840
28-two bedroom units @ 240 gpd = 6,720
16-three bedroom units @ 360 gpd = 5,760
Total = 16,320 gpd
• 10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
) Length (feet) •
(inches)
(
New Gravity or Additional
Force Main
8" 874 j
New Gravity
I
0
11. Summary of Pump Stations wl associated Force Mains to be Permitted (attach additional sheets as necessary)
W
n
Pump Station Location ID (self chosen - as shown on plans/map for reference)
Z
F
Z
0
Design Flow Operational Point;
(MGD) GPM @TDH
Power Reliability Option
1 - permanent generator w/ATS;
2 - portable generator w/MTS
Force Main Size
Force Main Length
(.)
Z
_..____ _---_________.__.__
0
I
____.__�_._
Pump Station Location ID
(self chosen -
as shown on plans/map for reference)
2
CC
0
LL
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
`Z
ct 'Pump
Station Location ID
(self chosen -
as shown on plans/map for reference)
W
a
oi
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 6,12 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?
►�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
FTA 12/07

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? ❑ Yes El No
Sedimentation and Erosion Control Plan?
Stormwater?
®N/A
® Yes ❑ No ❑ N/A
® Yes ❑ No ❑ N/A
15. 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- Owner/Permittee's Certification: (Signature of Signing Official and Project Name)
1, Tommy Bums , attest that this application for Dry Creek Apartment Homes 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
143-215.6B, 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.
la.
ing Official
ignature
42-ma —.Do
Date
ENGINEERING DESIGN DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL OF THIS
APPLICATION. THESE DOCUMENTS MUST INCLUDE PLAN AND PROFILE OF SEWERS, THEIR PROXIMI
u) TO OTHER UTILITIES, DESIGN CALCULATIONS. ETC. REFER TO 15A NCAC 02T .0305
Z
0
I— 2. Professional Engineer's Certification: (Signature of Design Engineer and Project Name)
U 1, Paul D. Smith, PE , attest that this application for Dry Creek Apartment Homes has been reviewed by me
LL. and is accurate, complete and consistent with the information in the engineering plans, calculations, and all other
f.. supporting documentation to the best of my knowledge. I further attest that to the best of my knowledge the proposed
Ce design has been prepared in accordance with the applicable regulations, Gravity Sewer Minimum Design Criteria for
W 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.
V Although other professionals may have developed certain portions of this submittal package, inclusion of these materials
under my signature and seal signifies that i have reviewed this material and have judged it to be consistent with the
proposed design. 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.
2a. Paul D. Smith, PE
Professional Engineer Name
2b. Stocks Engineering, P.A.
Engineering Firm
2c. 3344 Hillsborough Street Suite 250
Mailing Address
2d. Raleigh
City
2g. 919-821-2440 2h. 919-821-2210
Telephone Facsimile
2e. NC 2f. 27607
State Zip
2i. [e-mail]
E-mail
CAf'047.,e
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1 ♦ 1 837 • i
-/fit ......••.... NO,
—�• 5,
�rq�1N74 al, ture & Date
FTA 12/07

Copyright (C) 1998, Maptech, Inc.

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USGS Map
Dry Creek Apartment Homes
March 17, 2009
MUMS 3 km NE of Lillington North Carolina, United States 01 Jul 1983
. I
��, +i` s• 4V
0'
' 2Km
0'
I
' '1Mi
Image courtesy of the U.S. Geological Survey
© 2004 Microsoft Corporation. Terms of Use Privacy Statement
Project Location
,
nL—
http://terraserver-usa.com/printimage. aspx?T=2&S=14&X=218&Y=1225&Z=17&P=3+km+NE+of+Lillington%2c+North+Carolina%2c+Unit... 3/17/2009

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
v Tra�cicinglAce for Sewer :Extension Permit Applications
(FTSE -05/07)
Project. Applicant Name: Town of LillingtonNC - Public
Project. Name for which flow is being requested: Pry re4 .Apaitments
Amount of flow requested for this project: 16.320 GPD = 0.0162 MOD
I. Complete this section only if you are the owner of the wastewater treatment plant..
a. WWTP Facility Narne: North Harnett Resiopal WWTP
b. WWTP Facility Permit #: NC0021636
c. WW1? facility's permitted flow
Fuquay Varina Allocated Flow
Liltingwn Allocated Flow
Harnett County Allocated Flow
Angier Allocated Flow
d. Estimated obligated flow not yet tributary to the W WTP
FV Obligated Flow NYT
Lillington Obligated Flow NYT
HC Obligated Flow NYT
Angier Obligated Flow NYT (To Angler's WWTP)
5.6 IMP
2.60 MGD
1.20 MGD
1.80 MGD
1.08 MOD
0.467 MGD
0.259 MOD
0.142 MOD
0.066 MGD
0.035 MGD
2.344 MGD
0.753 MGD
Flow 0.679 MGD
HC Actual Flow 0.580 MGD
Angier Actual Flow (To Angler's W1!) 0.335 MGD
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
FV Actual Avg. + Obligated Flow
Lillington Actual Avg. 4'Obiigated Flow + Request
HC Actual Avg. + Obligated Flow
Angier Actual Avg_ + Obligated Flow
h.. Percent of permitted flow used
F Vanua = (1012 MOD / 2.6 MOD)
Lillington - (0.83732 MGD / 1.2 MGD)
HCDPU - (0.646 MOD / 1.8 MGD)
Angier (0.370 MGD/ 1.08 MGD)
0.01632 MGD,
2.4934 MGD
1.012 MGD
0.83732 MGD
0.646 MGD
0.00 MGD
(Overalll
38.92%
69.78%
35.90%
34.26%

Signing
11. Complete this section for each pump station you are responsible for along the route of this
proposed wastewater flow.
List primp 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
SLS # 20
141104 MGD 0.679 MGD
111. Certification Statement:
Rodnev M. Tart — Director of Public Utilities, certify that the addition ofthe 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 ;,. lies to those items listed above in Sections I and 11 for which I
am the responsible party. S'..JA0r1.1'.11 of this form indicates acceptance of this wastewater flow.
"Pr
-'12(1.01 (14Z
4 '4 .4 •
Remaining Capacity at WWTP facility
I113. WWII'
Fuquay Varina
Lillington
FICDPU
Angier
(5.6 MGD - 2.44648 MGD)
(2.6 MGD - 1.012 MGD)
(1.2 MGD - 0.8354 MGD)
(1.8 MOD - 0.00 MGD)
(1'.081vIdD — 0.376 mop
3. 1,5352 MD
1.588 MOD (61.0'7%)
0.3646 MGD (30.35%)
1.154 MGD (64.11%)
0.710 MGD (65.74%)
Note: The Town of Angier has not added any actual flow to the INIHRWW-17 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.

W A TF9 State of North Carolina
OG Department of Environment and Natural Resources
r Division of Water Quality
Flow Tracking/Acceptance for Sewer Extension Permit Applications
(FTSE—10/07)
Project Applicant Name: Town of Lillington
Project Name for which flow is being requested: Dry Creek Apts, LLC
More than one 1.75E-10/07 may be required for a single project if the owner of the WWTP is not responsible for all
pump stations along the route of the proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: No-;,h i�,s(r1�2i'i (2). iocyr 0 WV fT e
b. WWTP FacilityPermit #: 0 0 3 LP 0
N �i cD
All flows are in MGD
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
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
III. Certification Stat m t:
I,W , certify that, to the best of my knowledge, 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 is not anticipated to cause any capacity
related sanitary sewer overflows or overburden any downstream pump station en route to the receiving
treatment plant under normal circumstances. This analysis has been performed in accordance with local
established policies and procedures using the best available data. This certification applies to those items
listed above in Sections I and II for which I am the responsible party. Signature of this form indicates
acce of this wastewater
Signin cial Si ature
--V3-3409
Date

Instructions for: Flow Tracking/Acceptance for Sewer Extension Permit
Applications (FTSE —10/07)
Section I
a. WWTP Facility Name: Enter the name of the WWTP that will receive the wastewater flow.
b. WWTP Facility Permit #: Enter the NPDES or Non -Discharge number for the WWTP receiving the
wastewater flow.
c. WWTP facility's permitted flow, MGD: From WWTP owner's NPDES or Non -Discharge permit.
d. Estimated obligated flow not yet tributary to the WWTP, MGD: This includes flows allocated to
other construction projects not yet contributing flow to the collection system. Flows allocated through
interlocal agreements or other contracts not yet contributing flow to the collection system are also
included. For POTWs that implement a pretreatment program, include flows allocated to industrial
users who may not be using all of their flow allocation. Please contact your Pretreatment Coordinator
for information on industrial flow tributary to your WWTP.
As of January 15, 2008 the POTW should have reviewed flow allocations made over the last two
years and reconciled their flow records, to the best of their ability, so it is known how much flow has
been obligated and is not yet been made tributary to the WWTP, in accordance with local policies and
procedures employed by the reporting entity.
The obligated flow not yet tributary plus actual flow will be reconciled annually for systems at less
than 60% of permitted flow used. Annual updates shall be submitted to the appropriate Regional
Office by January 15 of each year and cover the previous calendar year.
Semi -Annual updates shall be required when the percent of permitted flow used reaches 60%. Semi-
annual time period are defined as January 1 through June 30 and July 1 through December 31. Semi-
annual updates shall be submitted to the appropriate Regional Office by July 15 and January 15 of
each year.
Quarterly updates shall be required when the percent of permitted flow used reaches 80%. Quarters
are defined as Qtrl (Jan -Feb -Mar); Qtr2 (Apr -May -Jun); Qtr3 (Jul -Aug -Sep); Qtr4 (Oct -Nov -Dec).
Quarterly updates shall be submitted to the appropriate Regional Office by April 15, July 15, October
15 and January 15 of each year.
e. WWTP facility's actual avg. flow, MGD: Previous 12 month average.
f. Total flow for this specific request, MGD: Enter the requested flow volume.
g. Total actual and obligated flows to the facility, MGD Equals [d + e + f]
h. Percent ofpermitted flow used: Equals [(g / c)* 100]

For example:
On January 15 a POTW with a permitted flow of 6.0 MGD, reported to the Regional Office that there
is 0.5 MGD of flow that is obligated but not yet tributary. The annual average flow for 2007 is 2.7
MGD.
The first Form FTSE-10/07 submitted after January 15, 2008 may have numbers like this:
c. = 6.0 MGD
d. = 0.5 MGD
e. = 2.7 MGD
f. = 0.015 MGD
g. = 3.215 MGD
h.=53.6%
The next Form FTSE-10/07 may be updated like this:
c. = 6.0 MGD
d. = 0.515 MGD
e. = 2.73 MGD
f. = 0.102 MGD
g. = 3.349 MGD
h. = 55.8 %
Each subsequent Form FTSE-10/07 will be updated in the same manner.
Section II
List the name, approximate pump station firm (design) capacity and approximate current average flow
(previous 12 months) through the pump station for each pump station that will be impacted by the
proposed sewer extension project. Include the proposed flow for this project and other flows that have
been approved for the pump station but are not yet tributary.
Firm (design) capacity is the design average daily flow of the pump station as calculated by the design
engineer or the station capacity with the largest pump out of service as per the Minimum Design Criteria
if the design capacity is unknown.
Section III
Form FTSE-10/07 must be signed by the appropriate official as per 15A NCAC 02T .0106.