WQ0042774_Application (FTSE)_20210929

Permit Number WQ0042774
Program Category
Non -discharge
Permit Type
Gravity Sewer Extension, Pump Stations, & Pressure Sewer Extensions
Primary Reviewer
tyler.benson
Coastal SWRule
Permitted Flow
Facilitv
Facility Name
Barclay Place Apartments Phase 2 Private Sewer
Location Address
Owner
Owner Name
Dry Pond Partners LLC
Dates/Events
Central Files: APS _ SWP _
8/26/2021
Permit Tracking Slip
Status
Project Type
In review
New Project
Version
Permit Classification
A
Individual
Permit Contact Affiliation
Major/Minor Region
Minor Wilmington
County
New Hanover
Facility Contact Affiliation
Owner Type
Non -Government
Owner Affiliation
Bruce B. Cameron IV
PO Box3649
Wilmington NC 2840636•
Scheduled
Ong Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
8/20/2021

NOMS & TUNSTALL
® CONSULTING ENGINEERS P.C.
2602 Iron Gate Drive, Suite 102
Wilmington, NC 28412
[phone]
[phone] Fax
John S. TunstAl, P.E.
T. Jason Clark, P.E.
Robbie P. Hennellp, E.I.
August 19, 2021
NC DEQ
Division of Water Resources
Water Quality Regional Operations Section
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, NC 28405
Re: Gravity Sewer Extension Fast -Track Permit Application (Private)
Barclay Place Phase 2
2540 Costmary Lane
New Hanover County
N&T Project No. 20055
Dear Sir or Madam:
1429 Ash -Little River Road
Ash, NC 28420
[phone]
[phone] Fax
J. Phillip Norris, P.E.
Joseph K. Bland, P.E.
Thomas J. Scheetz, F.A.
Enclosed electronically is the application form, Sewer Narrative, Flow Tracking / Acceptance
Form (FTSE 10-18) from the Cape Fear Public Utility Authority, 8 '/2 x 11 color USGS
Topographic Map, site plan (ledger size) and a $480.00 check (to be mailed in) for the processing
fee.
Please review this information for approval and contact us with any questions or comments you
may have. Thank you for your assistance on this project.
Sincerely,
NORRIS & TUNSTALL
CONSULTING ENGINEERS, P.C.
T. Jason lark, P.E.
1
TJC/asn
20055 08-19-21-s-swr-Itr (Private)
Enclosures
Raw
A►W 2
cc: Hill Rogers / Cameron Co. (by E-Mail Only)
NCBELS Licc isc C-3641

NORRIS & TUNSTALL
C0N!1 l{:T1NGixvclty WP,C.---
26M Icon Gam Dtive, Sulu 102
WiWuaron, NC 28412
MG)343-9653
[phone] Fax
John S. TunsmB, P.B.
T. Jason park, P.E.
Robbie P. K4WW llr, E,I.
August 19, 2021
NC DEQ
Division of Water Resources
Water Quality Regional Operations Section
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, NC 28405
Re: Gravity Sewer Extension Fast -Track Permit Application (Private)
Barclay Place Phase 2
2540 Costmaty Lane
New Hanover County
N&T Project No, 20055
Dear Sir or Madam:
1429 Ash-11ide Rive Road
Ash, NC 28420
[phone]
[phone] Fu
J. Map Norris. P.E-
Joseph-K. Bland, P.E.
Thomas ), Scheerz, E.I.
Enclosed electronically is the application form, Sewer Narrative, Flow Tracking / Acceptance
Form (FTSE 10-18) from the nape Fear Public Utility Authority, 8 % x 11 color USES
Topographic Map, site plan (ledger size) and a $480.00 check (to be mailed in) for the processing
fee.
Please review this information for approval and contact us with any questions or comments you
may have. Thank you for your assistance on this project.
Sincerely,
NORRIS & TUNSTALL
CONSULTING ENGINEERS, P,C.
T. Jason lark, P.E.
TJC/asn
20065 08-19-21-s-swr-ft (R4VA)
Enclosures
oc: Hill Rogers / Cameron Co. (by E-Mail Only)
NCBP-U T acenm C-3641

North Carolina Secretary of State Search Results
https://www.sosnc.gov/on line_services/search/Business_Registrati...
• File an Annual Report/Amend an Annual Report • Upload a PDF Filing • Order a Document Online
Add Entity to My Email Notification List • View Filings • Print a Pre -Populated Annual Report form • Print
an Amended a Annual Report form
Limited Liability Company
Legal Name
Dry Pond Partners, LLC
Information
Sosld: 1387928
Status: Current -Active O
Date Formed: 7/1/2014
Citizenship: Domestic
Annual Report Due Date: April 15th
CurrentAnnuaL Report Status:
Registered Agent: Sullivan, Scott Christopher
Addresses
Principal Office
1201 Glen Meade Road
Wilmington, NC 28401
Mailing
P.O. Box 3649
Wilmington, NC 28406
Company Officials
Reg Office
1201 Glen Meade Road
Wilmington, NC 28401
Reg Mailing
P.O. Box 3649
Wilmington, NC 28406
All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20.
Managing Member Member Member
Bruce B Cameron , IV Jane C Sullivan Trust 4/3/13 Rachel Cameron Trust 4/3/13
P.O. Box 3649 P.O. Box 3649 P.O. Box 3649
Wilmington NC 28406 Wilmington NC 28406 Wilmington NC 28406
I of 1 8/26/2021, 4:44 PM

State of North Carolina
Department of Environmental Quality
Division of Water Resources
ISA NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: �t(1%1y (to beeamplrtcdbyDWR)
All Items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicufs name: Dry Pond Partners,C (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ® Corporation ❑ General Partnership
❑ Federal ❑ State/County El Municipal
3. Signature. authority's nitm0: Bruce B. Catneron. IV per I SA NCAC tYi'f...0106(bl
Title: Mannino Member
C Applicant's mailing address: P.O. &,x 3649
City: WilmingLo State: N9 Zip: 2R406
5. Applicant's contact information:
Phone number. (20 B2-2U¢ Email Address hilt(glTaite�orico com
IL PROJECT INFORMATION:
❑ Privately -Owned Public Utility
❑ Other
1. Project rmtne: Bared Piaee Phase 2
2. ApplicatiordProjcet status: ® Proposed (Now Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: Wg00_ and issued date:
If new construction but part of a master plan, provide the existing permit number: W000_
3. County where project is located: New Hanover
4, Approximate Coordinates (Decimal Degrees); Latitude: 34,19430 Longitude: -17 9665^
5, Parcel ID (if applicable): R061 i7-011-016.0Mi
(or Parcel ID to closest downstream sewer)
Ill. CONSULTANT INFORMATION:
Professional Engineer: T. Jgton Clark P.E. License Number: QUgk2 N
Pion: Norris & Tunrtall Consulting Engineers, P C
Mailing address:1602 Iron Oats Ddya, Suite l
City: Wilmington State: Nam[' Zip: 29412
Phone number: (20 L43-= Email Address: jclazk6q )tettgineers can & anerriq@ r %iftp �+n
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
I. Facility Name: Wl(wn Ma[I;IT (Soothside W WTP] Permit Number: NC.00 397
Owner Name: Cape Fear Public Utility Authoriry
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Numbcr(s): WQ_ Receiving Sewer. Size: $"
System Wide Collection System Permit Number(s) (if applicable): WQCS_
Owner Name(s): Sane Fear Public Utility Authority
FORM: FTA 04.16 n?OP t ,.re

V1. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑No ®N/A
2. If the Applicant is a Developer of lots to be sold, has a boyelcmer's Oocrational Agreement (FORM: DEV) been attached?
❑ Yes ❑No ONIA
3. If the Applicant is a }dgtp,otllropoyOwnets' Association: has an Operational Agreement (FORM: HOA) been attached?
❑ Yes ❑No ®NfA
4. Origin of wastewater. (check all that apply):
❑ Residential Owned Retail (stores, canters, malls) ❑ Car Wash
® Residential Leased Retail with food preparation/service ❑ Hotel and/or Motels
❑ School / preschool ( day care ❑ Medical / dental I veterinary facilities Swimming Pool !Clubhouse
❑ Foal and drink facilities ❑ Church H Swimming Pool/Filter Backwash
❑ Businesses / officesi factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: lQQah Domestielcommercial _%Commercial
_I % Industrial (Sal 5�tCAC 02T .0Ib3(207)
`--->` is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under iSANg"=.ftl 14M? [—]Yes []No
Y if vea. provide a copy of flow reduction atnttent later
7. S»mma size wastewater generated by panjm:
Establishment Type (sea . I 14&
Daily Design Flow wu
No. of Units
Flow
I -Bedroom units
240gaWnit
16
3,840GPD
2-Bedroom Units
360 gaWnit
16
5,760 GAD
2-Bedroom Townhomes
360 gaWoit
8
2,880 GPD
gay
GPD
gay
GPD
gay
GPD
Total 1
12,480 GPD
a See I SA Jy" AC 02T AI l4b), (a (eN ll and (e)t21 for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use areas;
and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in 0,s: 42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.01141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data
8. Wastewater generated by project: 12A80 GPD (per 1 SA NCAC 027 01 Id)
D Do not include future flows or ptoviously permitted allocations
If permitted flow is zero, indicate why:
❑ Pump Station or Gravity Sewer where now will be permitter) in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit Number:
❑ Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain): _
FORM: FTA 04-16 Page 2 of 5

N 4 6�
V 11. GRAVITY SEWER DESIGN CRITERIA (1f Applicable) - 022.41i4 & IBC (Gr4v4y-8awenI:
1. Summarize gravity sewer to be perrniftod: n{j� 4 L q1
V
Size (inches) Length (feet) Material
8" 297 PVC
D Section 11 & Ill of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section Ill oontams information related to minimum slopes for gravity sewer(g)
➢ Oversizing hues to meet minimum slope requirement is not allowed and a violation of the MDC
Vill. PUMP STATION DESIGN CRPPERIA (If Applicable) 421AW &MDC [Puma Statimss/Borce Mains:
66IW11A tvrr; Mill tar . a +
1. Pump Ration number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude:
3. Design flow of the pump station; _ millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): _ gallons per minute at _ feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
6. Powerreliabilityinaccordance with lSANCAC ,02T.0305fh5O):
❑ Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(hx 1 XB);
D Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
� Must be permanent to facility
Or if the pump station has an average daily flow less than 15,000 gallons per day:
❑ Portable power source with manual activation, quick -connection receptacle and telemetry - 15A NCAC 02T
.0305(h)(1)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry - 15A NCAC 02T .0305(h)(l)(C):
It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant (draft agreement)
and is compatible with the station.
y If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel timeframes, shall be provided
in the case of a multiple station power outage.
FORM: FTA 04-16 Page 3 of 5

I?(. SETBACKS &SEPARATIONS—(02B.0200& ISANCAC 02T.0303(()):
I. Does the project comply with all separations found in 15A NCAC 021' .03UM & (a)
➢ 15A NCAC 02T.0305(0 contains minimum separations that shall be nrovided far sewer woems•
Setback Parameter+
Separation Re utred
Storm sewema and other utilities not listed below 1
24 inches
Water mains vertical -water over sewerincluding beached trenches
19 inches
Water mains oriental
10 fed
Reclaimed water lines vertical - reclaimed over sewer
18 inches
[reclaimed water lines(horizontal - reclaimed over sewer
2 feet
"*Any private or public water supply source, including any wells, WS-1 waters of Class ( or
Class U fir larded reservoirs used as a source of drinking water
100 feet
*"Waters classified WS (except WS-1 or WS-V). B, SA, ORW, HQW, or SB from normal
high water or tide el vation and wetlands sae rum IX.2
50 feet
"Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches
10 feet
Any bulklina foundation
5 feet
Any bastrnent
to feet
TOP slope of embankment or tuns of 2 feet or more vertical height
10 fed
Dtitioues emaand interceptor drains —
5 feat
Any swimming Is
10 fed
Pinar omth vertical
36 inches
➢ ISA i i Ati 02T_03t)3(g) contains alternatives where separations in 02T�(f) cannot be achieved.
➢ ""$anatn c 931a iifcations can be identified using the Division's ire Water Cl ui estirins; webns e
➢ If noncompliance with 2T 030 (fi or (g see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50feet of separation) ® Yes 0 No
➢ Sea the Division's draft separation requirements for situations where separation cannot be meet
➢ No variance is requited if the alternative design criteria specified is utilized in design and construction
➢ As built documents should reference the location of areas effected
3. Does the project comply with all setbacks found in the river basin rules per 15A NCAC 02B .0200? ® Yes ❑ No
➢ This would include Trout Buffered Streams per 1,5ANCAC 2B.0202
4. Does the project comply with an individual 404 Permit or any 401 Certifications? ® Yes ❑ No
➢ Wetland -related permits shall be requested, obtained, and adhered to for projects that impact wetlands or surface waters
➢ Information can be obtained from the 401 & Buffer Penninlnq( BMich
5. Does project comply with 15A NCAC 02T 0105(cN6) (additional pemmiwcertifications)? ® Yes ❑ No
Per ISA NCAC 02T.0105MM, directly related environmental permits or certification applications are being prepared, have
been applied for, or have been obtained, issuance of this permit Is contingent on issuance of dependent permits (erosion and
sedimentation control plans, stormwater management plans, etc.).
6. Does this project include any sewer collection lines that are deemed "high -priority?"
Per 156 NCAC 02T.0402- "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, cr sewer
positioned parallel to Weambanks that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes ® No
➢ If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority tines shall he inspected by the permittee or Its representative at least once every six -months and inspections
documented per 15A NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit
FORM: FTA 04-16 Page 4 of 5

X CERTIFICATIONS-.
I . Dorn the submitted system comply with ISA NCAC 02T, the
ant! Force Maims (latestyeraiant and the Sitnvity Sewer Minh
❑ yes
If No, complete and submit the Vatiance/Altemative Design Re
review. Auwraval Of the. resrKst6reautrail nrrrw fe... n.,,. re,
2. Profeasig" Englineer's
_ attest that this application for
111.1.j
has been reviewed by me and is accwsta, complete and consistent with the information supplied in the plans, specifications,
engineering 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 (latest version), and the Minimum Design Criteria for the Fast -Track Permittiag
Of Pump Stations and Force Mains (hog version). Although other professionals may have developed certain portions of this
submittal package, inclusion or these materials under my signature and seat signilles that I have reviewed this material and
have judged it to bo consistent with the proposed design,
NOTE — in accordance with General Statutes 143.215.6A and 143-215.68, any person who knowingly makes any false
statement, representation, or certification in any application package shaft be guilty of a Class 2 misdemeanor, which may
include a fine riot to exceed S 1o,000, as well as civil penalties rip to $25.000 per violation.
North Carolina Professional Eaglneer s soh signature, and date: AR
r ,
3, Applicant Certification per t 5A NCAC 02T 0106(b):
that this application for
has beat reviewed by me and is accurate and complete to the bog of my knowledge. 1 understand dot if all required parm of
this applkatiwn are not completed and that if a0 required supporting document4doo and attachments am not included, this
application package ssubjecl to being returned as incomplete. I understand that any discharge of wastewater from this non -
discharge system to surface waters or the land will remit in an immediate enforcement anion that may include civil portaities,
igptnetive relief, and/or criminal prosecution. l will snake no claim against the Division of Wear Resources should a condition
Of this permit be violated. I also understand that if all required pans of this application package are not completed and that if
all required supporting infoanatioo and attachments are not includod, this application package will be returned to me as
Incomplete.
NOTE — In accordance with General Statutes 43I LIJ6A and 143.215:6[3. any person who knowingly makes any false
statement, representation, or certification in any application packa94 shall be guilty of a Class 2 misdemeanor, which may
include a fine nos to exceed S 10,000 as well as civil penalties up to S25,000 per violation.
Signamro: O--6 4 r,�,G=�: Date: „r t ] ?� ?-
FORM: FIA 04.16 Page 5 of 5

r <<
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: Dry Pond Partners, LLC � I
Project Name for which flow is being requested: Barclay Place Phase 2 (NNI
More than one FTSE ntay be required for a single project if ike owner of the H'N'TP is not responsible for afl panrp
stations Along the route of the proposed wastewaterJlow.
Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name:
b. WWTP Facility Permit
rill flows are in MGD
C.
WWTP facility's permitted flow
12.000
d.
Estimated obligated flow not yet tributary to the WWTP'
2.949
e.
WWTP facility's actual avg. flow
9.044
f.
Total flow for this specific request
0.020760
g.
Total actual and obligated flows to the facility
1 OV3
h.
Percent of permitted flow used
91.0
H. Complete this section for each pinup 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)-(S+C)
(E)-(A-D)
Design
Obligated,
Pump
Pump
Average
Approx.
Not Yet
Total Current
Station
Station
Finn
Daily Flow**
Current
Tributary
Flow Plus
(Name or
Permit
Capacity,
(Firm /pf),
Avg. Daily
Daily plow,
Obligated
Available
Number)
No.
MGD
MGD
Flow, MOD
MGD
Flow
Capacity***
34
N/A
14.976
5.760
4.016
0.208
4.224
1.536
The Firm Capacity (desip flow) 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, per Section 2.02(Ax4)(c) of the Minimum Design Criteria
*** 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 < 0.
Downstream Facility Name (Sewer): Cape Fear Public Utility Authority
downstream Permit Number:
Page 1 of 6
FTSE: 10-18

Ill. Certification Statement;
I Jeff Thebe= c CFPUA Eng. Mar 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 certifies that the receiving collection system or treatment
works has adequate capacity to transport and treat the proposed new wastewater.
Jeff
of
Official
Signature:
Email! [e-mail]
U129/21121
Page 2 of 6
FTSG 1 U-18

SEWER NARRATIVE (PUBLIC & PRIVATE)
BARCLAY PLACE PHASE 2
Iso 660rt) 4wt'
Wilmington, North Carolina
For
Dry Pond Partners, LLC
P.O. Box 3649
Wilmington, NC 28406
[phone]
March 2021
Prepared by:
NORRIS & TUNSTALL CONSULTING ENGINEERS, P.C.
2602 Iron Gate Drive, Suite 102
Wilmington, North Carolina 28412
[phone]
[phone] (Fax)
License # C-W41
N&T Project #20055

NARRATIVE (PUBLIC & PRIVATE)
SEWER SYSTEM:
The public and private gravity system is designed to service the Barclay Place Phase 2
project, a new townhome and multi -family development located at 2540 Costmary Lane
in Wilmington, NC.
PUBLIC:
A total of 329 LF of 8-inch sewer line will be needed to complete the system. Note that
we are removing 364 LF of 8" gravity sewer and installing 329 LF of new 8" gravity
sewer. The new gravity sewer will connect into a newly constructed manhole on the
existing gravity sewer.
The wastewater generated that outfalls to this public portion will be 17,280 GPD.
1 Bedroom Units
2 Bedroom Units
2 Bedroom Townhomes
PRIVATE:
240 Gal/Unit x 24 Units = 5,760 GPD
360 Gal/Unit x 24 Units = 8,640 GPD
360 Gal/Unit x 8 Units = 2,880 GPD
Total: 17,280 GPD
A total of 297 LF of 8-inch sewer line will be needed to complete the system. The new
private gravity sewer will connect into a new public manhole that is to be constructed on
the existing gravity sewer.
The wastewater generated that outfalls to this private portion will be 12,480 GPD.
1 Bedroom Units 240 Gal/Unit x 16 Units = 3,840 GPD
2 Bedroom Units 360 Gal/Unit x 16 Units = 5,760 GPD
2 Bedroom Townhomes 360 Gal/Unit x 8 Units = 2,880 GPD
Total: 12,480 GPD
The private portion of the gravity sewer extension includes an Interference Manhole.
This is required due to the existing elevation in both the gravity sewer and storm
drainage. A detail of the Interference Manhole is provided and has been submitted to
Christyn Fertenbaugh, P.E. of the NC DEQ Municipal Permitting Unit for her approval.
Per communication with Christyn, this project can still proceed with the State Sewer
Fast -Track permitting option with the inclusion of the Interference Manhole.
Both the public and private systems will be served by the Cape Fear Public Utility
Authority.

N i t 11 0r
VI. GENERAL REQUIREMENTS V
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑No ®N/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached?
❑ Yes []No ®N/A
3. If the Applicant is a Home/Property Owners' Association, has an Operational Agreement (FORM: HOA) been attached?
❑ Yes []No EN/A
4. Origin of wastewater: (check all that apply):
❑ Residential Owned ❑ Retail (stores, centers, malls) ❑ Car Wash
® Residential Leased ❑ Retail with food preparation/service ❑ Hotel and/or Motels
❑ School / preschool / day care ❑ Medical / dental / veterinary facilities ❑ Swimming Pool /Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 % Domestic/Commercial % Commercial
_ % Industrial (See 15A NCAC 021-.0103(20))
"Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .01 14(f)? ❑ Yes ❑ No
➢ If yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f1)
Daily Design Flow"b
No. of Units
Flow
1-Bedroom Units
240 gal/Unit
16
3,840 GPD
2-Bedroom Units
240 gal/Unit
16
3,840 GPD
2-Bedroom Townhomes
240 gal/Unit
8
1,920 GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
9,600 GPD
a See 15A NCAC 021' .01 14(b), (d), (e)(1) and (e)(2) for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use areas;
and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in G.S. 42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.0114] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 9,600 GPD (per 15A NCAC 02T .01 14)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
❑ Pump Station or Gravity Sewer where flow will be permitted in subsequent pen -nits that connect to this line
❑ Flow has already been allocated in Permit Number:
❑ Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain):
FORM: FTA 04-16 Page 2 of 5