WQ0037809_Application (FTSE)_20150501

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WaterQualily R9glanel
MAY 91 2015
sectla►
F�egle l�oso.
Division of Water Resources
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
FAST -TRACK APPLICATION (FTA 10-14)
for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
General — When submitting this application, please use the following instructions as a checklist in order to ensure
all required items are submitted. Adherence to these instructions and checking the provided boxes will help
produce a quicker review time and reduce the amount of requested additional information.
For more information, visit the Water Quality Permitting Section's website or;
contact the Regional Office serving your county
Unless otherwise noted, the Applicant shall submit one original and one copy of the application and supporting
documentation to the appropriate Regional Office (see page 3).
A. Cover Letter:
El Include a brief project narrative describing the final 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).
B. Application Form (FTA 10-14):
IE Submit the completed and appropriately executed Fast -Track (FTA 10-14) Application. Any unauthorized
content changes to this form shall result in the application being returned. If necessary for clarity or due
to space restrictions, attachment to the application may be made, as long as the attachments are
numbered to correspond to the section and item to which they refer. You do not need to submit detailed
plans and specifications unless you respond NO to item B(13).
® The Professional Engineer's Certification of the application shall be signed, sealed and dated by a North
Carolina licensed Professional Engineer.
® The Applicant's Certification of the application shall be signed in accordance with 15A NCAC 02T
.0106(b). Per 15A NCAC 02T .0106(c), an alternate person may be designated as the signing official if
a delegation letter is provided from a person who meets the criteria in 15A NCAC 02T .0106(b).
C. Application Fee:
® Submit a check in the amount of $480 to: North Carolina Department of Environment and Natural
Resources (NCDENR).
> Checks shall be dated within 90 days of application submittal.
D. Certificate of Public Convenience and Necessity (For Privately -Owned Public Utilities Only):
❑ Per 15A NCAC 02T .0115(a)(1), provide two copies of the Certificate of Public Convenience and
Necessity from the North Carolina Utilities Commission demonstrating the Applicant is authorized to hold
the utility franchise for the area to be served by the sewer extension, or
❑ Provide two copies of a letter from the North Carolina Utilities Commission's Water and Sewer Division
Public Staff stating an application for a franchise has been received and that the service area is
contiguous to an existing franchised area 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.
E. Operational Agreements (For Home/Property Owners' Associations and Developers of lots to be sold):
➢ Home/Property Owners' Associations
❑ Per 15A NCAC 02T .0115(c), submit the properly executed Operational Agreement (HOA 08-13).
❑ Per 15A NCAC 02T .0115(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
➢ Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(b), submit the properly executed Operational Agreement (DEV 08-13).
Even if the project may be turned over to a municipality upon completion, Form DEV 08-13 is required.
INSTRUCTIONS FOR APPLICATION FTA 10-14 & SUPPORTING DOCUMENTATION Page 1 of 6

F. Downstream Sewer, WWTF Capacity and Flow Tracking/Acceptance Form (FTSE 08-13)
® Submit the completed and appropriately executed Flow Tracking/Acceptance for Sewer Extension Permit
(FTSE 08-13) Form for all applications.
➢ The applicant (and owners of downstream sewers, pump stations and/or treatment facilities submitting
form FTSE 08-13 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 08-13
from the owner of the downstream sewer and owner of the WWTF, if different.
➢ The flow acceptance indicated in form FTSE 08-13 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 08-13 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 a project -specific
FTSE 08-13.
G. Site Map (All Application Packages):
® Submit an 8.5-inch x 11-inch color copy of a USGS Topographic Map of sufficient scale to identify the
entire project area and closest surface waters. Each map must include at a minimum:
➢ The location of the sewer line and pump stations and be of reproducible quality.
> Downstream connection points and the permit number for the receiving sewer (if known)
> Pump Station Locations and the longitude and latitude for each pump station (if applicable)
® Include a street level map showing all relevant project areas.
H. Stream Classification (WSCAS 01-15)
❑ Submit the completed and appropriately executed Watershed Classification Attachment form
(WSCAS 01-15) if any portion of the sewer system project is within 100 feet of any surface water or
wetlands.
➢ A variance must be requested for encroachment within required setbacks or buffers pursuant to 15A
NCAC 02T .0305(f)
I. Environmental Assessments (Projects subject to an Environmental Assessment (EA)):
> Projects involving an Environmental Assessment per 15A NCAC 01C .0408, must be submitted for a full
technical review and must be submitted to the PERCS Unit on application forms provided by the Division.
J. Alternative Sewer Systems
➢ Projects involving low pressure sewer systems, vacuum sewer systems and other alternative sewer
systems must be submitted for a full technical review and must be submitted to the PERCS Unit on
application forms provided by the Division.
K. 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 the project, please indicate in B(12)
and give the permit number of the second facility.
L. 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(1 b). 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 Permitting of Pump Stations and Force Mains (most recent version), as applicable to the project.
INSTRUCTIONS FOR APPLICATION FTA 10-14 & SUPPORTING DOCUMENTATION Page 2 of 6

THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional Office
Water Quality Section
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
Water Quality Section
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
Water Quality Section
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
Water Quality Section
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
Water Quality Section
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
Water Quality Section
127 Cardinal Drive Extension
Wilmington, North Carolina 28405
[phone]
[phone] Fax
Brunswick, Carteret, Columbus, Duplin, New
Hanover, Onslow, Pender
Winston-Salem Regional Office
Water Quality Section
450 W. Hanes Mill Road
Suite 300
Winston-Salem, North Carolina 27105
[phone]
Alamance, Alleghany, Ashe, Caswell, Davidson,
Davie, Forsyth, Guilford, Rockingham, Randolph,
Stokes, Surry, Watauga, Wilkes, Yadkin
INSTRUCTIONS FOR APPLICATION FTA 10-14 & SUPPORTING DOCUMENTATION Page 3 of 6

USE THE TAB KEY TO MOVE FROM FIELD TO FIELD Application Number: W 7$09
(to be completed by DWR) a
1. Owner/Permittee:
la. Harnett County Department of Public Utilities
Full Legal Name (company, municipality, HOA, utility, etc.)
Z 1b. Steve Ward, Director, Harnett County Public Utilities
Signing Official Name and Title (Please review 15A NCAC 2T .0106 (b) for authorized signing officials)
Q lc.
2
cc
0 Id.
The
•
700
legal entity
Individual
McKinney
•
Parkway
who will own this system
Federal 0Municipality
is:
■ State/County • Private Partnership
1e. Lillington
• Corporation
• Other (specify):
LL
Z 1f.
Mailing Address City
North Carolina lg. 27546
Z
0 1h.
State Zip Code
910-893-7575 li. 910-893-6643 1j. [e-mail]
QTelephone
V 2.
Facsimile E-mail
Project (Facility) Information:
J 2a.
Water and Sewer Extensions for the Campbell University Health 2b. Harnett
11
a-_,,,,.3.
Sciences Building County Where Project is Located
Contact Person:
Q3a.
Roy P. Lorenzen, Senior Project Manager, Stewart Engineering
3b.
Name and Affiliation of Someone Who Can Answer Questions About this Application
919-866-4813 3c. [e-mail]
Phone Number E-mail
1.
Project is
►.
New
■ 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: 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 D)
• Homeowner Assoc./Developer (Instruction E)
Z 3. Hamett County Public Utilities
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
Q 4a. North Harnett Regional Sewer Plant 4b. NC0021636
2 Name of WWTF WWTF Permit No.
O5a. HCDPU
5b. 8
0Gravity
5c. Ualsewrr- w&C. ., 3 5-$7
LL
Z
i=
Owner of Downstream Sewer
16. The origin of this wastewater is
• Residential Subdivision
Receiving
(check
Sewer Size
all that apply):
■ Retail
■ Force Main
(Stores, shopping
Permit # of
centers)
Downstream Sewer (Instruction F)
% Domestic/Commercial
2
• Apartments/Condominiums
• Institution
% Industrial
r
W
d
•
0
•
Mobile Home Park
School
Restaurant
IN Hospital
• Church
• Nursing Home
(Attach Description)
% Other
■
Office
• Other (specify):
CO
.
Volume of wastewater to be allocated
or permitted for this particular project: 11.950
(Attach Description)
gallons per day
8.
*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 10-14 APPLICATION
Page 4 of 6

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).
25 gal/day for employees (98 employees)
10 gal/day for students (950 students)
25 x 98 = 2,450, 10 x 950 = 9,500, 9,500 + 2,450 = 11, 950 gal/day
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches) Length (feet)
8" DIP 410
New Gravity or Additional
Force Main
Gravity
CI
W
111. Summary of Pump Stations w/ associated Force Mains to be Permitted (attach additional sheets as necessary)
Z
0 Pump Station Location ID: (self chosen - as shown on plans/map for reference)
0
Longitude: Latitude:
Z
0
Design Flow Operational Point Power Reliability Option
Q (MGD) GPM @TDH 1 - permanent generator w/ATS; Force Main Size Force Main Length
2 2 - portable generator w/MTS
O
LL
Z Pump Station Location ID:
H
2 Longitude: Latitude:
W Design Flow Power Reliability Option
ILDesignOperational Point 1 - permanent generator w/ATS; Force Main Size Force Main Length
GPM @TDH 2 - portable generator w/MTS
(self chosen - as shown on plans/map for reference)
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 2"d 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 Permittinq 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, complete and submit the Variance/Alternative Design Request (VADC 10-14) application and supporting
documents for review. Approval of the request is required prior to submittal of the Fast Track Application and
supporting documents.
FTA 10-14 APPLICATION
Page 5 of 6

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?
Trout Buffer Waiver?
Stormwater?
❑ Yes ❑ No
® Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
® N/A
❑ N/A
® N/A
® N/A
15. Does this project include any high priority lines (15A NCAC 02T .0402 (2)) involve aerial lines, siphons, or interference
manholes)? These lines will be considered high priority and must be checked once ever, six months
Check if Yes: ❑ and provide details:
1a.
Owner/Permittee's Certification: (Signature of Signing Official and Project Name)
1, Steve Wardattest that this application for Water and Sewer Extensions for Campbell University Health Sciences
Building 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 143-215.68, any person who knowingly makes any false statement, representation, or
certification in any application shall be guilty of a Clas/2 misdemeanor, which may include a fine not to exceed $10,000 as
well as civil penalties up to $25,000 per violation.
Signing Official Signature
Date
ENGINEERING DESIGN DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL OF THIS
APPLICATION. THESE DOCUMENTS MUST INCLUDE PLAN AND PROFILE OF SEWERS, THEIR PROXIMITY
Z TO OTHER UTILITIES, DESIGN CALCULATIONS, ETC. REFER TO 15A NCAC 02T .0305
Q2. Professional Engineer's Certification: (Signature of Design Engineer and Project Name)
LL
LLI
1, Roy P. Lorenzen ,attest that this application for Water and Sewer Extensions for Campbell University Health
Sciences Building 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. 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 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 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
2a. Roy P. Lorenzen
Professional Engineer Name
2b. Stewart
Engineering Firm
2c. 421 Fayetteville Street, Suite 400
Mailing Address
2d. Raleigh
City
2g. 919-866-4813 2h. 919-380-8750
Telephone Facsimile
2e. NC 2f. 27601
2i.
State Zip
[e-mail]
E-mail
se
e
av 7'1 icr"
NC PE Seal, SKnature & Date
FTA 10-14 APPLICATION
Page 6 of 6

Department of Envir
Flow Tracking/Acceptance for Sewer
State of North Carolina
onment and Natural Resources
Division of Water Quality
Extension Permit Applications
(FTSE 06-13)
Project Applicant Name: Harnett County
Project Name for which flow is being requested:
Campbell Health Science Building- 11,950gpd
More than one FTSE 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
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
e. WWTP facility's actual avg. flow
FV Actual Flow
Lillington Actual Flow
HC Actual Flow
Angier 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
h. Percent of permitted flow used
All flows are in MGD
5.600 MGD
2.60 MGD
1.20 MGD
1.008 MGD
1.168 MGD
0.805000 MGD
0.163800 MGD
0.158440 MGD
0.040950 MGD
4.397 MGD
1.213 MGD
0.659MGD
2.045 MGD
0.480 MGD
0.012 MGD
5.577 MGD
2.018 MGD
0.823 MGD
2.215 MGD
0.521 MGD
99.59% (Overall)
Page 1 of 6
FTSE 06-13

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:
(A) (B) (C) (D)=(B+C) (E)=(A-D)
Design Obligated,
Average Daily Approx. Not Yet Total Current
Firm Flow** Current Avg. Tributary Flow Plus
Pump Station Capacity,* (Firm / pf), Daily Flow, Daily Flow, Obligated Available
(Name or Number) MGD MGD MGD MGD Flow Capacity***
SLS #9 0.338 0.135 0.110 0.012 0.122 0.013
HCDPU Regional 14.4
SLS # 120 (10.000enm) 5.76 2.22 0.961 3.181 2.579
* The Firm Capacity of any pump station is defined as the maximum pumped flow that
can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking
factor (pf) not less than 2.5.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < O.
III.
Certification Statement:
I Steve Ward — Director of Public Utilities certify to the best of my knowledge 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 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, given the implementation
of the planned improvements identified in the planning assessment where applicable. 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
plus all attached planning assessment addendums for which I am the responsible party.
Signature of this form inicates acceptance of this wastewater flow.
Signing Official Signature
Date
Page 2 of 6
FTSE 06-13

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STEWART
LETTER OF TRANSMITTAL
TO
FROM
NCDENR-DWR
Derick Blankenship, El
Civil Engineering Intern
[phone]
DATE
SENT VIA
04/13/2015
Mail Delivery
PROJECT NUMBER
PROJECT NAME
C13116
Campbell University - Health Science Building
COPIES
DATE
DESCRIPTION
1
-
Cover Letter
1
-
Application Form
1
-
Downstream Sewer, WWTF Capacity and Flow Tracking
Acceptance Form
2
-
Site Maps (USGS Topographic / Street Level map)
1
-
Check in the amount of $480
For approval
For review & comment
—
Returned for corrections
For your use
Approved as submitted
_
Returned after review
E
As requested
Approved as noted
C
Resubmit copies for approval
COMMENTS
Please find the enclosed submittal package for the above referenced sewer line
extension for the Campbell University Health Science Building. Please let me know if
you need any additional information or have any questions.
Thank you,
SIGNED
Derick Blankenship Engineering
Intern
Received By:
file
421 FAYETTEVILLE STREET MALL
SUITE 400
RALEIGH, NC T 919.380.8750
27601 F 919.380.8752

STEWART
April 13, 2015
Division of Water Resources
Fayetteville Regional Office
225 Green Street, Suite 714
Fayetteville, NC 28301
NCDENR Division of Water Resources - Sewer Fast Track Application
Campbell University - Health Science Building
The Campbell University Health Science building site is located approximately 1,500
linear feet west of the intersection of US 421 / NC 27 and Pearson Road along US 421
/ NC 27. The project is proposing a 410 linear feet 8" D.I.P. gravity sewer main
extension onto the proposed site. The building will be serviced by a 6" D.I.P. line tying
into a structure on the proposed main. The 6" D.I.P. service line will be providing an
approximate 11,950 gpd flow rate from the Health Science Building.
The additional flow created by the proposed building will be carried downstream by
an 8" Harnett County Department of Public Utilities permitted sewer and treated at
the North Harnett Regional Sewer Plant.
If you have any questions, feel free to contact me at your convenience.
Sincerely,
Derick Blankenship, El
Civil Engineering Intern
421 Fayetteville Street, Suite 400
Raleigh, NC 27601
P: 919-866-4758
Email: [e-mail]
STRONGER BY DESIGN
421 FAYETTEVILLE ST.
SUITE 400
RALEIGH, NC T 919.380.8750
27601 F 919.380.8752

USE THE TAB KEY TO MOVE FROM FIELD TO FIELD
Application Number:
(to be completed by DWR)
0
i—
Q
2
0
LL
Z
Z
0
i—
a
U
J
a
a
9. Owner/Permittee:
la. Harnett County Department of Public Utilities
Full Legal Name (company, municipality, HOA, utility, etc.)
1b. Steve Ward, Director, Harnett County Public Utilities
RECENEDIDENRIDWR
Water Quality Regional
MAT U1 Z015
Operabuns Simon
hlIIIe ,ran:Office
/';Ol1 . )
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:
❑ Individual ❑ Federal ® Municipality ❑ State/County ❑ Private Partnership ❑ Corporation ❑ Other (specify):
ld. 700 McKinney Parkway le. Lillington
Mailing Address
1f. North Carolina
State
1h. 910-893-7575 1i. 910-893-6643
Telephone Facsimile
City
lg. 27546
Zip Code
1j. [e-mail]
2. Project (Facility) Information:
2a. Water and Sewer Extensions for the Campbell University Health 2b.
Sciences Building
.........
3. Contact Person:
3a. Roy P. Lorenzen, Senior Project Manager, Stewart Engineering
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. 919-866-4813 3c. [e-mail]
E-mail
Harnett
Phone Number
County Where Project is Located
E-mail
1. Project is ® New ❑ Modification (of an existing permit) If Modification, Permit No.:
2. Owner is ® Public (skip to Item B(3))
2a. If private, applicant will be:
❑ Retaining Ownership (i.e. store, church, single office, etc.) o
❑ Leasing units (lots, townhomes, etc. - skip to Item B(3))
❑ Selling units (lots, townhomes, etc. - go to Item B(2b))
❑ Private (go to Item 2(a))
CAMPBELL JERRY M WALLACE ; PRESIDENT
UNIVERSITY PREEK 97
BUIES CREEK, NC 27506
PAY THE
SUM OF FOUR HUNDRED EIGHTY AND 00/100 DOLLARS
PAY NCDENR
TO THE 1634 Mail Service Center
ORDER Raleigh NC 27699-1634
OF
2b. If sold, facilities owned by a (must choose one)
❑ Public Utility (Instruction D)
❑ Homeowner Assoc./Developer (Instruction E)
❑ Rehabilitation or replacement of existing sewer with no new flow expected
(see 15A NCAC 02T .0303 to determine if a permit is required)
BB&T 66-112/531
CHECK NO 0135352
•
********480.00
CAMPBELL UNIVERSITY
,a*-712
FTA 10-14 APPLICATION
Page 4 of 6

Central Files: APS _ SWP
5/20/2015
Permit Number WQ0037809 Permit Tracking Slip
Program Category Status Project Type
Non -discharge Active New Project
Permit Type
Gravity Sewer Extension, Pump Stations, & Pressure Sewer Extensions
Primary Reviewer
trent.allen
Coastal SWRuIe
Permitted Flow
11,950
Facility
Version Permit Classification
1.00 Individual
Permit Contact Affiliation
Facility Name
Water and Sewer Extensions for Campbell University School of Osteopathic Medicin
Location Address
Owner
Major/Minor Region
Minor Fayetteville
County
Harnett
Facility Contact Affiliation
Owner Name
Harnett County Department of Public Utilities
Dates/Events
Owner Type
Government - State
Owner Affiliation
Steve Ward
Director Interim Public Utilities of
PO Box 1119
Lillington
NC 27546111
Scheduled
Orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
5/20/2015 5/1/2015 5/20/2015 5/20/2015
Regulated Activities Requested /Received Events
Wastewater collection Additional information requested
Additional information received
Outfall
Waterbody Name Streamlndex Number Current Class Subbasin