WQ0036425_Application (FTSE)_20130314

DENR-FRCS
4 IR 14 2013
DwQ
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
FAST -TRACK APPLICATION
(FTA 12/07 very)
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 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/percs/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 MUNICIPALITY UPON
COMPLETION, FORM DEV 02/03 IS REQUIRED.
® E. Downstream 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

❑ '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.
El 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, 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: (..W '' (R °O3 [..!�
(to be completed by DWQ) K
N FORMATION
Owner/Permittee:
la. H&S Properties Investments, LLC
Full Legal Name (company, municipality, HOA, utility, etc.)
1 b. Hugh Surles, Manager
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:
O Individual ❑ Federal 0 Municipality ❑ State/County 0 Private Partnership ® Corporation ❑ Other (specify):
1 d. 126 Brandon Drive
Mailing Address
1f. NC
1 e. Lillington
City
1 g. 27546
Z State
0
1 h. 910-422-7065 1 i.
Zip Code
...........
[e-mail]
- Telephone Facsimile E-mail
• 2. Project (Facility) Information.
J 2a. Campbell Village Townhomes
a Brief Project Name (permit will refer to this name)
Q 3. Contact Person:
Q3a. C. Tyrus Clayton, Jr, PE, Project Engineer
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. 910-897-7070
Phone Number
2b. Harnett
County Where Project is Located
3c. [e-mail]
E-mail
Project is ® New 0 Modification (of an existing permit) If Modification, Permit No.:
2. Owner is 0 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)
3. Harnett County
Z Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
H • 4a. �for+h Harnett fit? tmat �)tr; 4b. ►JC Oo 2163c.
Q Name of WWTF WWTF Permit No.
M 5a. Harnett County 5b. 2" '❑ Gravity 5c.
)Y Owner of Downstream Sewer Receiving Sewer Size Force Main Permit # of Downstream Sewer (Instruction E)
LL • 6. The origin of this wastewater is (check all that apply):
Z
❑ Residential Subdivision ❑ Retail (Stores, shopping centers)
® Apartments/Condominiums 0 Institution
O Mobile Home Park ❑ Hospital
O School ❑ Church
O Restaurant ❑ Nursing Home
❑ Office ❑ Other (specify):
100 % Domestic/Commercial
Industrial (attach
description.)
(RO: contact your Regional Office
Pretreatment staff)
% Other (specify):
Volume of wastewater to be allocated or permitted for this particular project: 4,320 gallons per day
*Do not include future flows or previously permitted allocations
If the 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).
12 units x 3 bedrooms x 120 gpd = 4,320 gpd
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches)
Length (feet)
New Gravity or Additional
Force Main
Ca 11. Summary of Pump Stations w/ associated Force Mains to be Permitted (attach additional sheets as necessary)
D Pump Station Location ID 001 (Grinder Pumps)
Z
0
U
Design Flow
(MGD)
Operational Point
GPM @TDH
(self chosen - as shown on plans/map for reference)
Power Reliability Option
1 - permanent generator w/ATS; Force Main Size Force Main Length
2 - portable generator w/MTS
.004 60 GPM @ 22 2 2" +/- 484 ft
Z
O
Q ▪ Pump Station Location ID (self chosen - as shown on plans/map for reference)
2 Design Flow Power Reliability Option
(MGD) Operational Point; 1 - permanent generator w/ATS, Force Main Size Force Main Length
0 GPM @TDH 2 - portable generator w/MTS
LL
Z
B. PERMIT
Pump Station Location ID (self chosen - as shown on plans/map for reference)
Design Flow Operational Point: Power Reliability Option
(MGD) GPM @TDH 1 - permanent generator w/ATS; Force Main Size Force Main Length
2 - portable generator w/MTS
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 2rd 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?
® 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 ❑ No ® N/A
Sedimentation and Erosion Control Plan? ❑ Yes ❑ No ® N/A
Stormwater? ❑ 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, attest that this application for Ca ) (L ))QNe IbLen )-►avne 5 has been
reviewe by me and is accurate and complete to the best of my knowledge. 1 un erstand that if all required parts of this
application are not completed and that if all required supporting documentation and attachments are not included, this
application package is subject to being retumed as incomplete. Note: In accordance with North Carolina General
Statutes 143-215.6A and 143-215.68, any person who knowingly makes any false statement, representation, or
certification in any ap •lication shall be guilty of a Class 2 misdemeanor, which may include a fine not to exceed $10,000
as well a ci yjl penal s up o $25, 000 per violation.
la. ! ' jLt
Signing Offic Signature
/)V/i3
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
Z
O
Q2. Professional EngineerslCertification: (Signature of Design Engineer and Project Name)
V ,, 0, TV" C(ayi�t�r 'pc) QC attest that this application for CCirn f ieII 1 / j n)''ay.- e 5 has been
LL reviewed -by me and is accurate, complete and consistent with the informat on in the erfgineering plans, calculations, and
all other supporting documentation to the best of my knowledge. 1 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
V J 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
V 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 143-215.68, 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.
.:0
149
2a. C. Tyrus Clayton, Jr., PE
Professional Engineer Name
2b. C. T. Clayton, Sr., PE, Inc.
Engineering Firm
2c. 46 W. Washington St.
Mailing Address
2d. Coats
2e. NC 2f. 27521
City
2g. 910-897-7070
Telephone
2h. 910-897-6767
Facsimile
State Zip
2i. [e-mail]
E-mail
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NC PE Seal, Signature & Date
FTA 12/07

State of North Carolina
Department of Environment and Natural Resources
7 Division of Water Quality
_-►
Flow Tracking/Acceptance for Sewer Extension Permit Applications
(FTSE —10/07)
Project Applicant Name: H&S Properties Investments, LLC
Project Name for which flow is being requested: Campbell Village Homes 12 Townhomes
360gpd/home x 12 = 4320gpd
More than one FTSE-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: North Harnett Regional WWTP
b. WWTP Facility Permit #: NC0021636
c. WWTP facility's permitted flow
Fuquay Varina Allocated Flow
Lillington Allocated Flow
Harnett County
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
Erwin Obligated Flow NYT
e. WWTP facility's actual avg. flow
FV Actual Flow
Lillington Actual Flow
HC Actual Flow
Angier Actual Flow
Erwin Actual Flow
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
FV Actual Avg. + Obligated Flow
Lillington Actual Avg. + Obligated Flow
HC Actual Avg. + Obligated Flow + Request
Angier Actual + Obligated Flow
Erwin Actual Avg. + Obligated NYT
h. Percent of permitted flow used
Fuquay Varina - (1.413207 MGD / 2.6 MGD)
Lillington — (0.772800 MGD / 1.2 MGD)
HCDPU - (0.559510 MGD / 1.8 MGD)
5.6 MGD
2.60 MGD
1.20 MGD
1.80 MGD
1.008 MGD
1.068 MGD
0.584207 MGD
0.163800 MGD
0.176510 MGD
0.050950 MGD
0.092880 MGD
2.972 MGD
0.974 MGD
0.609 MGD
0.379 MGD
0.440 MGD
0.570 MGD
0.004 MGD
3.770 MGD
1.413207 MGD
0.772800 MGD
0.559510 MGD
0.490950 MGD
0.662880 MGD
67.32% (Overall)
54.35%
64.40%
31.08%

Angier — (0.490950 MGD/ 1.008 MGD)
Erwin — (0.662880 MGD/ 1.2 MGD)
48.70%
55.24%
*Erwin Flow is now tributary to NHR WWTP flows were averaged for this calendar year.
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 SLS # 10B
HCDPU Regional SLS # 120
2.6MGD 0.321 MGD
13.0 MGD 1.957 MGD
III. Certification Statement:
I, _Steve Ward — 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 responsible party. Signature of this form indicates acceptance of this
wastewater flow.
Signing Official Signature
3—//V
Date

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USE THE TAB KEY TO MOVE FROM FIELD TO FIELD! Application Number:
(to be completed by DWQ)
Owner/Permittee:
la. H&S Properties Investments, LLC
Full Legal Name (company, municipality, HOA, utility, etc.)
lb. Hugh Surles, Manager
Signing Official Name and Title (Please review 15A NCAC 2T .0106 (b) for authorized signing officials!)
DENR-FRC'
MAR _.1...4....2013. '
lc. The legal entity who will own this system is:
0 Individual 0 Federal 0 Municipality ❑ State/County ❑ Private Partnership ® Corporation 0 Other (specify):
1 d. 126 Brandon Drive
Mailing Address
1f. NC
State
1 h. 910-422-7065
Telephone
Facsimile
2. Project (Facility) Information:
2a. Campbell Village Townhomes
Brief Project Name (permit will refer to this name)
3. Contact Person:
3a. C. Tyrus Clayton, Jr, PE, Project Engineer
Z
O 4a. Not+h Harnett iie •,gal W Vi 4b. NC Qo 2163c.
le. Lillington
City
1 g. 27546
Zip Code
1j. [e-mail]
E-mail
2b. Harnett
County Where Project is Located
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. 910-897-7070
Phone Number
1. Project is ® New 0 Modification (of an existing permit) If Modification, Permit No.:
3c. [e-mail]
E-mail
® Private (go to Item 2(a))
2b. If sold, facilities owned by a (must choose one)
❑ Public Utility (Instruction C)
['Homeowner Assoc./Developer (Instruction D)
2. Owner is ❑ Public (skip to Item B(3))
2a. If private, applicant will be:
0 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))
3. Harnett County
Owner of Wastewater Treatment Facility (WVVTF) Treating Wastewater From This Project
HUGH SURLES BUILDERS LLC
126 BRANDON DRIVE
LILLINGTON, NC 27546
919-422-7065
PAY TO THE NCDENR
ORDER OF
Four Hundred Eighty and 00/100***********.******.**.*********************************************************************
FIRST BANK
UWNGTON. NORTH CAROUNA 27546
66-456-531
3/13/2013
NCDENR
MEMO
$ **480.00
DOLLARS ..-
5)
N
D SIGNATURE
FTA l 2/07

Permit Number WQ0036425
Central Files: APS SWP
03/18/13
Permit Tracking Slip
Program Category Status Project Type
Non -discharge Active New Project
Permit Type Fast Track Version Permit Classification
Gravity Sewer Extension, Pump Stations, & Pressure Sewer 1.00 Individual
Extensions
Primary Reviewer Permit Contact Affiliation
trent.allen
Coastal SW Rule
Permitted Flow
4320
Facility
Facility Name
Campbell Vilalge Townhomes
Location Address
Owner
Major/Minor Region
Minor Fayetteville
County
Harnett
Facility Contact Affiliation
Owner Name
H&S Properties Investments LLC
Dates/Events
Owner Type
Non -Government
Owner Affiliation
Hugh Surles
126 Brandon Dr
Lillington
NC 27546
Orig Issue
03/18/13
App Received
03/14/13
Draft Initiated
Scheduled
Issuance
Public Notice Issue Effective
03/18/13 03/18/13
Regulated Activities Requested/Received Events
Wastewater collection Additional information requested
Additional information received
Outfall NULL
Expiration
Waterbody Name Stream Index Number Current Class Subbasin