WQ0023015_Application (FTSE)_20030825

08/ Z5/20133- 08:10 9104834052 LARRY KING ASSOC
FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE 02
. . . _
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD!
1. Owner
NFORMATION
Telephone Facsimile
() 2. Project (Facility) nformation:
a. ▪ ▪ 2a. Country Club North Addition
CL Brief Project Name (permit will refer to this name)
< 3. Contact Person:
lf. North Carolina
State
lh. 910-223-4740 1 i. 910-829-0203
Application Number
!). cri.7.1Pletad Dwo004)e) 6 S
1 a. at of Fayetteville Public Works Commission
Full Legal Name (company, municipality, HOA, u(ility. etc.)
Joseph E. Glass, P.E. Engineer Manger Water Resources En neerin
Signing Official Name and Title (Please review 15A NCAC 2H .0208(b) for authorized signing officials!)
The legal enti_ who will own this system is:
0 Individual ao Federal 10 Municipality 0 State/County 0 Private Partnership Ej Corporation 0 Other (specify):
955 Old Wilmington Road le. Fayetteville
Street Address
City
lg. 28301
Zip Code
PAGE I
• - •• . • -• ,•
1j. joe.glassfaypwc.com
E-mail
2b. Cumberland
County Where Project is Located
3a. Thomas S. Speight, Jr., P.E. Design Engineerg Larry Kin /I Associates R.L.S. P.A.
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. 910-483-4300 3c. tomspaighteenglneer-survey.COM
Phone Number E-mail
1. Project is tgl New 1:1 Modification (of an existing permit) If Modification, Permit No.:
2. Owner Is El Public (skip to Item B(3)) D Private (go to Nem 2(e))
2a, If private. applicant wNi
If sold, facilities owned by a (must choose one)
0 Retaining Ownership (i.e. store, church. single office, etc.) 0 Public Utility (lnstruction in)
El Leasing units (lots, townhomes. etc. - ski? t? Item B.13)) 0 Homeowner Aasoc./Developer (instruction IV)
_ _ _
PAY
TO THE
ORDER OF
n h r: c .1 nt2 t St,' ha ;. d r I t
KAMENBURY DEVELOPMENT LLC
PH. 910-488-7816
1821 MCARTHUR RD
FAYETTEVILLE, NC 28311-9004
DATE
a3ou
1102
66-112/531
I $ (1-00 dr) a
aAA- NIAACIAIOU± ("I b DOLLARS 8
BB&T
BRANCH BANKING AND TRUST COMPANY
FAYETTEVILLE, NORTH CAROLINA
FOR CC:74

83516
8. If the permitted flow is zero, indicate why:
0 Interceptor Line - Flow will be permitted Is subsequent permits that connect to this line
0 Flow has already been allocated in Permit No.
0 Rehabilitation or replacement of existing sewer with no new flow expected

19
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
FAST -TRACK APPLICATION
SEWERS, PUMP STATIONS, AND FORCE MAINS
(Pressure sewers systems are not to be included as part of this application package)
INSTRUCTIONS: Indicate that you have included the following list of required application package items by checking the
space provided next to each item. Failure to submit all required items will lead to your application being returned as
incomplete or additional processing and review time. This form may be photocopied for use as an original.
® I. Application Form - Submit one original and one copy of the completed and appropriately executed application
form. Any changes to this form will result in the application being returned. The Division of Water Quality
(Division) will only accept application packages that have been fully completed with all applicable items
addressed. You do not need to submit detailed plans and specifications unless you respond NO to Item B(12).
® II. Application Fee - Submit a check in the amount of $400 made payable to: North Carolina Department of
Environment and Natural Resources (NCDENR).
❑ III. Certificates of Public Convenience and Necessity — If the application is being submitted in the name of a
privately -owned public utility, submit two copies of the Certificate of Public Convenience and Necessity (CPCN)
which demonstrates that the public utility is authorized to hold the utility franchise for the area to be served by the
sewer extension. If a CPCN has not been issued, provide two copies of a letter from the North Carolina Utilities
Commission's Public Staff that states that an application for a franchise has been received, that the service area
is contiguous to an existing franchised area, and/or that franchise approval is expected. The project name in the
CPCN or letter must match that provided in Item A(2a) of this application.
❑ IV. Operational Agreements — Submit one original and two copies of a properly executed operational agreement if
the sewer extension will be serving residential or commercial lots (e.g., houses, condominiums, townhomes,
outparcels, etc.) that will be owned by a homeowners' association or developer (Item B(2b)). If the applicant is a
homeowners' association, use Form HOA 02/03. If the applicant is a developer, use Form DEV 02/03. EVEN IF
THE PROJECT WILL BE TURNED OVER TO A MUNICIPALITY, FORM DEV 02/03 IS REQUIRED.
❑ V. Flow Acceptance Letters — If the owner of the downstream sewers and/or WWTF is different from the applicant,
submit two copies of a flow acceptance letter from the owner of the downstream sewers and WWTF, if different.
Flow acceptance letters must contain the following minimum information: applicant and project name, amount of
flow accepted, and name and permit number of the receiving sewers/WWTF. The flow acceptance must not
expire prior to permit issuance and must be dated less than a year prior to the application date.
Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific flow acceptance
letter.
® VI. Map — Submit an 8.5-inch by 11-inch copy of the portion of a 7.5-minute USGS Topographic Map along with this
form. The map should identify the entire project area location as well as the closest downslope surface waters as
clearly as possible. Each map portion must be labeled with the map name and number, the identified location,
and be of clear and reproducible quality. For instance, if the project involves 4 miles of interceptor sewer that
traverses over or near several different waterbodies (or counties, basins, etc.), the map should have location ID's
for each different waterbody (where the sewer line is within 100 feet of such waterbody - see Instruction VII).
® VII. Watershed Classifications — Section C
• If any portion of the project is within 100 feet of any down slope surface water, Section C must be completed
for the pertinent sections.
• If the entire project area is a minimum of 100 feet away from any down slope surface waters BUT there is a
pump station involved where a history of power outage is to be used to provide adequate design storage
instead of dual feed or permanent or portable generator, Section C must be completed to demonstrate that
the closest down slope surface water is Class C (see 15A NCAC 2H .0219(h)(3)(D)).
• Use the guidance document entitled, "Determining Watershed Classifications for Form FTA 02/03 (Fast -Track
Sewer Systems)" available from http://h2o.enr.state.nc.us/ndpu or by contacting the appropriate regional
office.
INSTRUCTIONS FOR FORM FTA 02/03

❑ VIII. Environmental Assessments — If this project is subject to an Environmental Assessment (EA) ]15A NCAC
01C .0500], this application can not be used. Send the project application on Form PSFMGSA 10/99 to the
Non -Discharge Permitting Unit, 1617 Mail Service Center, Raleigh, NC 27699-1617. Applications can not be
processed until a Finding of No Significant Impact (FONSI) or Environmental Impact Statement (EIS) has been
issued. A copy is to be submitted with that permit application.
® IX. Certifications — Section D
The application must be certified by both the applicant and a North Carolina Registered Professional Engineer
(PE). The applicant signature must match the signing official listed in Item A(1 b). The PE should NOT certify the
application if he/she is unfamiliar with 15A NCAC 2H .0200, the Gravity Sewer Minimum Design Criteria (most
recent version) and the Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains
(most recent version), as applicable to the project. Certification by a PE who is unfamiliar with these documents
is subject to NC Board referral.
THE COMPLETED FTA 02/03 APPLICATION PACKAGE, INCLUDING ALL SUPPORTING DOCUMENTS AND $400
FEE, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional Office
59 Woodfin Place
Ashe i le, North8
Asheville, Carolina 28801
(828)[phone] Fax
Avery, Buncombe, Burke, Caldwell,
Cherokee, Clay, Graham, Haywood,
Henderson, Jackson, Macon, Madison,
McDowell, Mitchell, Polk, Rutherford, Swain,
Transylvania, Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Fayetteville, North Carolina 28301
[phone]
[phone] Fax
Anson, Bladen, Cumberland, Harnett, Hoke,
Montgomery, Moore, Robeson, Richmond,
Sampson, Scotland
Mooresville Regional Office
919 N Main Street
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, David, Forsyth, Guilford,
Rockingham, Randolph, Stokes, Surry,
Watauga, Wilkes, Yadkin
For more information, visit our web site at: http://h2o.enr.state.nc.us/ndpu/
INSTRUCTIONS FOR FORM FTA 02/03

08/25/2003 08:10 9104834052 LARRY KING ASSOC
FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE 02
PAGE I
ro
Z
cr ld. 955 Old Wilmington Road
la. Cy of Fayetteville Public Works Commission
Full Legal Name (company, municipality, HOA, utility, etc.)
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD! Application Number:
(to be corneieted by DWC:1)4) 6e3Q6 S
MIMS
lb. Joseph E. Glass,P.E. Engineer Manger Water Resources En "neerin
Signing Official Name and Title (Please review 15A NCAC 2H .0206(b) for authorized signing officials')
lc. The legal en* who will own this system Is:
0 Individual ID Federal (8] Municipality 0 State/County 0 Private Partnership 0 Corporation El Other (specify):
0 Street Address
LL
lf. North Carolina
State
0 lh. 910-223-4740
Telephone
0 2. Project (Facility) Information:
:3
2a. Country Club North Addition
EL Brief Project Name (permit will refer to this name)
< a Contact Person:
E-mail
2b. Cumberland
County Where Project is Located
3a. Thomas S. peight, Jr., P.E. Design Engineer a Larry King & Associates, RL.S. P.A.
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. 910-183-4300
Phone Number
•
1. Project is 181 New D Modification (of an existing permit)
2. Owner Is Public (skip to Item 8(3)) D Private (go
2a. If private. applicant will be:
Retaining Ownership (i.e. store, churdt, single office, etc.)
El Leasing units (lots, townhomes, etc. - skip to Item B(3))
CI Selling units (lots, townhomes, etc. - go to Item B(2b))
le. Fayetteville
City
lg. 28301
Zip Code
910-829-0203 1j. joe.g/assejfaypwc.com
Facsimile
O 5a. P.W.C. 5b. 12" I5c_ Not Available (1971)
LL
Owner of Downstream Sewer Receiving SeVief Size 1 Permit Number of Dovmstream Sewer
......
8_ The origin of thls wastewater is (check all that apply):
' ' - - -- " — - ----- - • --- '
2 18) Residential Subdivision 0 Car Wash
Et CI Apartments/Condominiums El Institution
11 igg__ % Domestic/Commercial
El Mobile Horne Park 0 Hospital
EL 0 School 0 Church % Industrial
Lli 0 Restaurant 0 Nursing Home
% Other (specify):
D Office ri Other (spedfy):
...._......._.......... .............._______ ... . , . . .__ __ __
3c. tomspeig_hteaengineer-survey.com
E-mail
If Modification, Permit No.:
to Item 2(a))
2b. If sold, facilities owned by a (must choose one)
0 Public Utility (lnetructIon III)
o Homeowner Assoc./Developer (Instructlori IV)
O 3. City of Fayetteville Public Works Commission
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
it( 4a. Cross Creek Waste Treatment Facility 4b. NC 0023957
0 Name of VVWTF VVWTF Permit No. ..
7. Volume of wastewater to be permitted In this project: 6,840 gallons per day
8. If the permitted flow is zero, indicate why:
0 Interceptor Line - Flow will be permitted Is subsequent permits that connect to this line
0 Flow has already been allocated in Permit No.
O Rehabilitation or replacement of existing sewer with no new flow expected

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE 2
9. Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2H
.0219(1) for Item B(7) or the design flow for line or pump station sizing if zero flow in the space below. Values other than
that in 15A NCAC 2H .0219(I)(1-2) must be approved prior to submittal of this application. Submit a separate request to
the Division of Water Quality, Non -Discharge Permitting Unit, 1617 Mail Service Center, Raleigh, NC 27699-1617 in
accordance with 15A NCAC 2H .0219(I)(3).
19 lots x 360 gpd = 6,840 gpd
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches) Length (feet)
8
W
z
H
z
0
z
0
Q 11. Summary of Pump Stations to be Permitted (attach additional sheets as necessary)
2 Power Reliability Option
Location ID Design Flow Operational Point (dual line feed, permanent generator,
O (as shown on plans) (MGD) GPM c TDH portable generator, wet well storage)
LL
2
W
▪ 12. Does the sewer system comply with the Minimum Design Criteria for the Fast Track Permitting of Pump Stations and Force
Mains (latest version), the Gravity Sewer Minimum Design Criteria (latest version) and 15A NCAC 2H .0200 as applicable?
® Yes 0 No If no, please reference the pertinent minimum design criteria or regulation and Indicate why a
variance is requested:
Gravity or Force Main
(pull down menu)
1687 Gravity
ENTER TOTAL LINE LENGTH IN MILES 0.32
SUBMIT TWO COPIES OF PLANS, SPECIFICATIONS OR CALCULATIONS PERTINENT TO THE VARIANCE WITH YOUR APPLICATION
13. Have the following permits/certifications been submitted for approval?
Wetland/Stream Crossings - General Permit or 401 Certification? 0 Yes ❑ No ® N/A
Sedimentation and Erosion Control Plan? ® Yes 0 No 0 N/A
Stormwater? 0 Yes 0 No ® N/A

, FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, ANI) FORCE MAINS PAGE 3
0
C. WATERSHED CLASS
1. Use the Division's guidance document entitled, "DETERMINING STREAM CLASSIFICATIONS FOR FORM FTA 02/03
(FAST -TRACK SEWER SYSTEMS)" to collect and record the stream classification data below (attach additional sheets as
necessary). This document is available from our web site or by contacting the appropriate Division of Water Quality
regional office (see instructions for addresses) OR indicate the following:
❑ A Watershed Classification is not needed because all parts of the project are at least 100 feet away from any down
slope waterbody; AND
® A Watershed Classification is not needed because the design does not depend on wet well storage as a power
reliability option for any pump station near a Class C down slope waterbody.
Location ID Name of
on Map Waterbody
G23SW3 UT to Cross Creek
County
Cumberland
River Basin
Cape Fear
Waterbody Stream Waterbody
Index Classification
18-27-2-(2) WS-IV
Submit the 8.5" x 11" topographic map as required in Instruction VI regardless of whether a classification is provided!
1. Applicant's Certification:
la.
2a. Thomas S. Speight, Jr.
Professional Engineer Name
2b. Larry King & Associates, R.L.S., P.A.
Engineering Firm
2c. 133 Morganton Road, Suite 201
Address
2d. Fayetteville
City
2g. 910-483-4300 2h. 910-483-4052
Telephone Facsimile
2e. N.C. 2f. 28305
State Zip
2i. tomspeight@engineer-
survey.com
1 attest that this application for Country Club North Addition has been reviewed by
me and is accurate and complete to the best of my knowledge. 1 understand that if all required parts of this application
are not completed and that if all required supporting documentation and attachments are not included, this application
package is subject to being retumed as incomplete. Note: In accordance with North Carolina General Statutes 143-
215.6A and 143-215.6B, any person who knowingly makes any false statement, representation, or certification in any
application shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed $10, 000 as well as civil
penalties u,•] o $25,00p per viol. ti•n.
Signing 0 �%al Signature
2. Professional Engineer's Certification:
Date
I attest that this application for Country Club North Addition has been reviewed by me
and is accurate, complete and consistent with the information in the engineering plans, calculations, and all other
supporting documentation to the best of my knowledge. I further attest that to the best of my knowledge the proposed
design has been prepared in accordance with the applicable regulations, Gravity Sewer Minimum Design Criteria for
Gravity Sewers adopted February 12, 1996, and the Minimum Design Criteria for the Fast -Track Permitting of Pump
Stations and Force Mains adopted June 1, 2000 and the watershed classification in accordance with Division guidance.
Although certain portions of this submittal package may have been developed by other professionals, inclusion of these
materials under my signature and seal signifies that 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.
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Seal, Signature & Date

55' 690
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FAYETTEV1LLE QUADRANGLE
NORTFI CAROLINA—CUMBERLAND CO.
7.5 MINUTE SERIES (TOPOGRAPHIC)
SW/4 FAYETTEVILLE 15' QUADRANGLE
LILLINGTON 20 MI.
2030000 FEET 692 BUNNLEVE 15 MI.
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FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 1
B. PERMIT
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD!
Application Number:
(to be completed by DWQ)
1. Owner:
l a. Public Works Commission of the City of Fayetteville
Full Legal Name (company, municipality, HOA, utility, etc.)
Z 1b. Joseph E. Glass, P.E. - Water Resources Engineering Manager
0 Signing Official Name and Title (Please review 15A NCAC 2H .0206(b) for authorized signing officials!)
I' lc. The legal entity who will own this system is: 1---
< ❑ Individual 0 Federal Z Municipali ❑ State/County ElPrivate Partnership 0 Corporation 0 Other (specify):
fY 1 d. 955 Old Wilmington Road 1 e. Fayetteville
0 Street Address City
LL
Z 1f. North Carolina 1g. 28301
Z State Zip Code
Q lh. [phone] 1 i. [phone] 1j. joe.glass©faypwc.com
H Telephone Facsimile E-mail
U2. Project (Facility) Information:
"'l 2a. Country Club North Addition 2b. Cumberland
aBrief Project Name (permit will refer to this name) County Where Project is Located
< 3. Contact Person:
Q 3a. Thomas S. Speight, Jr., P.E. Design Engineer © Larry King & Associates, R.L.S., P.A.
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. [phone] 3c. tomspeight©engineer-survey.com
Phone Number E-mail
1. Project is ❑ New Z Modification (of an existing permit)
If Modification, Permit No.: Country Club North - Section 3
(1976) - not available
2. Owner is Z Public (skip to Item 8(3)) ❑ Private (go to Item 2(a))
2a. If private, applicant will be: 2b. If sold, facilities owned by a (must choose one)
❑ Retaining Ownership (i.e. store, church, single office, etc.)
❑ Leasing units (lots, townhomes, etc. - skip to Item B(3))
0 Selling units (lots, townhomes, etc. - go to Item B(2b))
E Public Utility (Instruction III)
E Homeowner Assoc./Developer (Instruction IV)
O 3. Public Works Commission
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
4a. Cross Creek Waste Treatment Facility 4b. NC0023957
0 Name of WWTF WWTF Permit No.
0 5a. PWC 5b. 12" 5c. Country Club Lake (Line "C") - (1971) - not available
Z Owner of Downstream Sewer Receiving Sewer Size Permit Number of Downstream Sewer
6. The origin of this wastewater is (check all that apply):
® Residential Subdivision E Car Wash
❑ Apartments/Condominiums ❑ Institution
❑ Mobile Home Park ❑ Hospital
❑ School ❑ Church
❑ Restaurant ❑ Nursing Home
❑ Office ❑ Other (specify):
7. Volume of wastewater to be permitted in this project: gallons per day
100 % Domestic/Commercial
Industrial
% Other (specify):
8. If the permitted flow is zero, indicate why:
0 Interceptor Line - Flow will be permitted is subsequent permits that connect to this line
❑ Flow has already been allocated in Permit No.
0 Rehabilitation or replacement of existing sewer with no new flow expected