WQ0043192_Application (FTSE)_20220225

Coulter { Jewell Thames,.
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December 6, 2021
NCDWR
Fayetteville Regional Office
225 Green Street
Suite 714
Fayetteville, N.C. 28301
Re: Arrowpoint Subdivision
Fast Track Sewer Application
Dear Sirs:
Enclosed are the Application and associated documents for the above referenced Project located in Robeson
County, North Carolina. The proposed subdivision is 12 lots that will be served by public water and sewer. The
total acreage to be disturbed will be 4.97 acres. As this is an on-line submittal, we will contact you to arrange
for the payment of the required Application Fee of $480.
Please review the enclosed information and if acceptable, please issue the approved permit for the Project at
your earliest possible convenience.
incerely,
Chuck Hill P.
Project Engineer
cc: Mr. Dave McGirt, Lumbee Tribe of North Carolina
ENGINEERING • LAND SURVEYING • LANDSCAPE ARCHTECTURE

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources INSTRUCTIONS FOR FORM: FTA06-21 & SUPPORTING DOCUMENTATION
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
This application is for sewer extensions involving gravity sewers, pump stations and force mains, or any combination that has been
certified by a professional engineer and the applicant that the project meets the requirements of 1 5A NCAC 02T and the Division's
Minimum Design Criteria (CGrat its, Sewer & Pump StationstFoice Mains) and that plans, specifications and supporting documents
have been prepared in accordance with ISA NCAC 02T, ISA. NCAC 02T .0300, Division policies, and good engineering
practices.
While no upfront engineering design documents are required for submittal, in accordance with I5A NCAC 02T .0305(6), design
documents must be prepared prior to submittal of a fast track permit application to the Division. This would include plans, design
calculations, and project specifications referenced in ISA NCAC 021 0305 and the applicable minimum design criteria. These
documents shall beimmediately available upon request by the Division.
Projects that are deemed permitted (do not require a permit from the Division) are explained in 15A'NCAC 02fp.0303.
Projects not eligible for review via the fast track process (must be submitted for full technical review):
A Projects that do not meet any part of the minimum design criteria (MDC) documents;
A Projectsthat involve more than one variance from the requirements of I5A NCAC 02T;
A Pressure sewer systems utilizing simplex septic tank -effluent pumps (STEPs) or simplex grinder pumps;
> Simplex STEP or simplex grinder pumps connecting to pressurized systems (e.g. force mains);
➢ Vacuum sewer systems.
General — When submitting an 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. Failure to submit all required items will necessitate additional processing and review
time, and may result in return of the application. Unless otherwise noted, the Applicant shall submit one original and one copy of
the application and supporting documentation.
A. One Original and One Copy (second copy may be digital) of Application and Supporting Documents
❑ Required unless otherwise noted. Signatures on original must be "wet ink" or secure digital signatures.
Please do not submit engineering design plans with the application unless specifically requested.
B. Cover Letter/Narrative Description (Required for All Application Packages):
❑ List all items included in the application package, as well as a brief description of the requested permitting action.
• Be specific as to the system type, number of homes served, flow allocation required, etc.
• Include the permit number/status of any other required sewer permits (downstream/upstream)
❑ If necessary for clarity, include attachments to the application form.
C. Application Fee (All New and Modification Application Packages):
❑ Submit a check or money order in the amount of S480.00, dated no more than 90 days prior to application submittal.
A Payable to North Carolina Department of Environmental Quality (NCDEQ)
D. Fast Track Application (Required for All Application Packages, Form FTA 05-21):
❑ Submit the completed and appropriately executed application.
D if necessary for clarity or due to space restrictions, attachments to the application may be made.
❑ If the Applicant Type in Item I.2 is a corporation or company, provide documentation it is registered for business with the
North Carolina Secretary of State:
❑ if the Applicant Type in Item 1.2 is a partnership or d/b/a, enclose a copy of the certificate filed with the Register of Deeds in
the county of business.
❑ The Project Name in Item IL 1 shall be consistent with the project name on the flow acceptance letters, agreements, etc.
❑ The Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a North Carolina
licensed Professional Engineer.
INSTRUCTIONS FOR FORM: FTA 06-21 & SUPPORTING DOCUMENTATION Page I of 3

❑ The Applicant's Certification on Page 5 of the application shall be signed in accordance with l5A NCAC 02"T,OI OUm). 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 I5A NCAC 02T .0106(b).
INSTRUCTIONS FOR FORM: FTA 05-21 & SUPPORTING DOCUMENTATION Page 2 of 3

E. Flow Tracking/Acceptance Form (Form: FTSE 04-16) Of Applicable):
❑ Submit the completed and executed FTSE form from the owners of the downstream sewers and treatment facility.
> Multiple forms maybe required where the downstream sewer owner and wastewater treatment facility are different.
> The flow acceptance indicated in form FTSE must not expire prior to permit issuance and must be dated less than oneyear
prior to the application date.
D Submittal of this application and form FTSE indicates that owner has adequate capacity and will not violate (i S 143-
215.67(a).
> Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific FTSE.
F. Site Maps (AU 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,
including the closest surface waters.
➢ General location of the project components (gravity sewer, pump stations, & force main)
> Downstream connection points and permit number (if known) for the receiving sewer
❑ Include an aerial location map showing general project area (such as street names or latitude/longitude) so that Division staff
can easily locate it in the field.
G. Existing Permit (Application Packages for Modifications to an Existing Permit):
❑ Submit a copy of the most recently issued existing permit.
❑ include a descriptive and clear narrative identifying the previously permitted items to remain in the permit, items to
be added, and/or items to be modified (the application form itself should include only include items to be added/modified).
The namative should also include whether any previously permitted items have been certified.
❑ The narrative should clearly identify the requested permitting action and accurately describe the sewers to be listed in
the final permit.
H. Power Reliability Plan (Required if portable reliability option utilized for Pump Station):
❑ Per I SA NCAC 021'.0305(h)(1), submit documentation of power reliability for pumping stations.
> This alternative is only available for average daily flows less than 15,000 gallons per day
D It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant and is compatible
with the station. The Division will accept a letter signed by the applicant (see 15A NCAC 02T .0106(b)) or proposed
contractor, stating that "the portable power generation unit or portable, independently -powered pumping units, associated
appurtenances and personnel are available for distribution and operation of this pump station."
➢ 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. (Required at time of certification)
I. Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per 15A NCAC 02T .0I IS(iti(�1 provide 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 a letter from the Norrth Carolina Utilities Commission's Water and Sewer Division Pubic 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.
d. Operational Agreements (Applications from HOA/POA and Developers for lots to be sold):
❑ Home/Property Owners' Associations
❑ Per 15.4. NCAC 02T .0115(c), submit the properly executed Operattonal Aeteetnent tFORMs FIOA).
❑ 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 I 5A NCAC 02T .0 I 15(b). submit the properly executed Opelat:Mu! Agreement. (FORM DEV1.
For more information, visit the Division's collection systems weebat g
INSTRUCTIONS FOR FORM: FTA 05-21 & SUPPORTING DOCUMENTATION Page 3 of 3

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
2090 US Highway 70
Swannanoa, North Carolina 28778-8211
(828) 2964500
[phone] Fax
Avery, Buncombe, Burke, Caldwell, Cherokee,
Clay, Graham, Haywood, Henderson, Jackson,
Macon, Madison, McDowell, Mitchell, Polk,
Rutherford, Swain, Transylvania, Yancey
Water Quality Section
Fayetteville Reglanat Office
225 Green Street Suite 714
Fayetteville, North Carolina 28301-5095
[phone]
[phone] Fax
Anson, Bladen, Cumberland, Hamett, Hoke,
Montgomery, Moore, Robeson, Richmond,
Sampson, Scotland
Water Quality Section
Mooresville Regional Office
610 E. Center Avenue
Mooresville, North Carolina 28115
[phone]
[phone] Fax
Alexander, Cabanus, Catawba, Cleveland,
Gaston, lredell, Lincoln, Meddenburg, Rowan,
Stanly, Union
Water Quality Section
Raieigh Regional Office
3800 Barrett Drive
Raleigh, North Carolina 27609
(919) 7914200
[phone] Fax
Chatham, Durham, Edgecombe, Franklin,
Granville, Halifax, Johnston,; Lee, Nash,
Northampton, Orange, Person, Vance, Wake,
Warren, Wilson
Water Quality Section
Wasltfirgton Rep onaI Office
943 Washington Square Mall
Washington,North Carolina 27889
[phone]
[phone] Fax
Beaufort, Berge, Camden, Chowan, Craven,
Currituck, Dare, Gates, Greene, Hertford, Hyde,
Jones, Lenoir, Martin, Pamlico, Pasquotank,
Perquimans, Pitt, Tyrrell, Washington, Wayne
Water Quality Section
Wiimington Regnat Office
127 Cardinal Drive Extension
Wilmington, North Carolina 28405
[phone]
(910).350-2004 Fax
Brunswick, Carteret, Columbus, Duplin, New
Hanover, Onslow, Pander
Water Quality Section
W nston-Salem Regional Cifice
450 W. Hanes Mill Road
Suite 300
Winston-Salem, North Carolina 27105
[phone]
[phone] Fax
Alamance, Alleghany, Ashe, Caswell, Davidson,
Davie, Forsyth, Guilford, Rockingham, Randolph,
Stokes, Surry, Watauga, Wilkes, Yadkin
Water f3ualitySection
INSTRUCTIONS FOR FORM: FTA 05-21 & SUPPORTING DOCUMENTATION Page 4 of 3

Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number: TA1(}yiCA+T 1l1 (to becompleted byowe)
AU items must be completed or the application will be returned
1. APPLICANT INFORMATION:
1. Applicant's name: Town of Pembroke (company, municipality, HOA, utility, etc.)
2. Applicant type: 0 Individual 0 Corporation ❑ General Partnership 0 Privately -Owned Public Utility
0 Federal 0 State/County El Municipal 0 Other
3. Signature authority's name: Tyler W Thomas per I5A NCAC 02T 0 106(b)
Title:Town Manager
4. Applicant's mailing address: PO Box 866
City: Pembroke State: NC Zip: 28372-
5. Applicant's contact information:
Phone number: [phone] Email Address: [e-mail]
1II, PROJECT INFORMATION:
1. Project name: Arrowpoint Subdivision
2. Application/Project status: ❑ Proposed (New Permit) 0 Existing Pennit/Project
If a modification, provide the existing permit number: WOOD and issued date: __
For modifications, also attach a detailed narrative description as described in Item G of the checklist.
If new construction, but part of a master plan, provide the existing permit number: W000_
3. County where project is located: Robeson
4. Approximate Coordinates (Decimal Degrees): Latitude: 34.664691° Longitude: -79.162804°
5. Parcel ID (if applicable): 0334 80 (or Parcel ID to closest downstream sewer)
IIL CONSULTANT INFORMATION:
1. Professional Engineer. Charles Hill P.E. License Number. NCPE 23461
Finn: CJT P.A.
Mailing address: 111 West Main Street
City: Durham State: NC Zip: 27701-_
Phone number. [phone] Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Town of Pembroke WWTP Permit Number: Ate 00t)
Owner Name: Town of Pembroke
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. PermitNumber(s): WQ CSa, /IV
2. Downstream (Receiving) Sewer Information: e inch )0 Gravity 0 Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS
OwnerName(s): Town of Pembroke
FORM: FTA 06-21
7 io 3
Page 1 of 5

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
0 Yes 0 No $1 N/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Aereement (FORM: DEVI been attached?
❑Yes ❑No ®N/A
3. If the Applicant is a Home/Property Owners' Association, has an HOA/POA Operational Agreement (FOR HOA I and
supplementary documentation as required by 15A NCAC 02T.0115(c) been attached?
❑ Yes ❑ No N/A
4. Origin of wastewater. (check all that apply):
El Residential (Individually Owned) 0 Retail (stores, centers, malls)
❑ Residential (Leased) 0 Retail with food preparation/service
❑ School / preschool / day care 0 Medical. / dental / veterinary facilities
❑ Food and drink facilities 0 Church
❑ Businesses / offices / factories 0 Nursing Home
❑ Car Wash
Hotel and/or Motels
❑Swimming Pool/Clubhouse
❑ Swimming Pool/Filter Backwash
❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 % Domestic % Commercial % Industrial (See ISA NCAC'02T .0 iO3(20))
If Industrial, is there a Pretreatment Program in effect? 0 Yes ❑ No
6, Has a flow reduction been approved under I SA NCAC 02T .0I 1411)9 0 Yes lEi No
If ves. provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(0)
Daily Design Flow ab
No. of Units
Flow
Residential Dwelling Units (3-bedrooms)
120 gal/day/bedroom
12
4320 GPD
gall
GPD
gall
GPD
gal/
GPD
gal/
GPD
gal
GPD
Total
4320 GPD
a See ISA NCAC 02T .0.1 i4(b) (d). (e)(1) and (e)(2) for caveats to wastewater design flow rates (Le., 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 ISA NCAC 021'.O 11A4] shall
be determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 4320 GPD (per I 5A NCAC 02F .0114)
> Do not include future flows or previously permitted allocations
If permitted flow is zero, please indicate why:
❑ Pump Station/Force Main or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line.
Please provide supplementary information indicating the approximate timefratne for permitting upstream sewers with flow.
❑ Flow has already been allocated in Permit Number: Issuance Date:
❑ Rehabilitation or replacement of existing sewers with no new flow expected
❑ Other (Explain):
FORM: FTA 06-21
Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) -02TA305& MDC(CravlirSewers):
1. Summarize gravity sewer to be permitted:
> Section II & Ill of the MDC for Permitting of Gravity Sewers contains information rela ed to design criteria
➢ Section III contains information related to minimum slopes for gravity sewers)
➢ Oversizing linesto meet minimum slope requirements is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA Of Applicable) —02T.0305 & MDC (PunraStations/Force Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinates (Decline( Degrees) Latitude: . Longitude: -
3.
3.
Total number of pumps at the pump station:
Design flow of the pump station: millions gallons per day (firm capacity)
> This should reflect the total GPM for the pump station with the largest pump out of service.
4. Operational point(s) per pump(s): gallons per minute (GPM) at _ feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
If any portion of the force main is less than 4-inches in diameter, please identify the me hod of solids reduction per
MDCPSFM Section 2.0IC.1.b. ❑ Grinder Pump 0 Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with I SA NCAC 021' .0 05(1h)(I ):
/ ❑ Standby power source or ❑ Standby pump
> Must have automatic activation and telemetry - I5A NCAC 02T.0305(h)(1)(B)_
• 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 and may not be portable
Or if the pump station has an average daily flow less than 15,000 gallons per day 15A NCACO2T.0305(1XI)(C):
0 P• ortable power source with manual activation, quick -connection receptacle and telemetry -
or
❑ P• ortable pumping unit with plugged emergency pump connection and telemetry:
➢ Include documentation that the portable source is owned or contracted by the applicant and is compatible with the
station.
FORM: FTA 06-21
Page 3 of 5

> 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 as part of this permit application in the case of a multiple station power outage_
FORM: FTA 05-2
Page 4 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .030501):
1. Does the project comply with all separations/alternatives found in I SA NCAC 02T .0305(11 4109
15A NCAC 02T.0305(f) contains minimum s orations th t h lI b 'd d f
EYes ❑No
ep a s a a provr a or sewer symoms:
Setback Parameter* Separation Required
Storm sewers and other utilities not listed below (vertical) 18 inches
2Water mains (vertical - water over sewer preferred, including in benched trenches) 18 inches
2Water mains (horizontal) 10 feet
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 I or
Class II impounded reservoirs used as a source of drinking water, and associated wetlands. 100 feet
**Waters classified WS (except WS-I or WS-V), B, SA, ORW, HOW, or SB from normal
high water (or tide elevation) and wetlands associated with these waters (see item IX.2) 50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches, as well as wetlands associated with these waters or classified as WL. 10 feet
Any building foundation (horizontal) 5 feet
Any basement (horizontal) 10 feet
Top slope of embankment or cuts of 2 feet or more vertical height 10 feet
Drainage systems and interceptor drains 5 feet
Any swimming pools 10 feet
Final earth grade (vertical) 36 inches
➢ If
noncomplrance wrth 021.0305{ f} or Ig . see Seenon X.1 of this application
*I5A NCAC 02T.0305.(g) contains alternatives where separations in 02T.0305(1) cannot be achieved. Please check "yes"
above if these alternatives are used and provide narrative information to explain.
**Stream classifications can be identified using the Division's NC Surface Water Classifications weboase
2. Does this project comply with the minimum separation requirements for water mains? E Yes ❑ No ❑ N/A
> If no, please refer to 15A NCAC 18C.0906(t) for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? El Yes ❑ No ❑ N/A
➢ Please provide supplementary information identifying the areas of non-conformance.
> See the Division's draft separation requirements for situations where separation cannot be met.
No variance is required if the alternative design criteria specified is utilized in design and construction.
4. Is the project located in a river basin subject to any State buffer rules? ® Yes Basin name: Lumber
If yes, does the project comply with setbacks found in the river basin rules per I5A NCAC 02 B .0200?
> This includes Trout Buffered Streams per 15A NCAC 213.0202
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits
or 401 Water Quality Certifications?
> Please provide the permit rwmber/pemvtting status in the cover letter if coverage/authorization is requ
❑ No
®Yes ❑No
❑ Yes 1 No
led.
6. Does project comply with I5A NCAC 02T.0105(c)(6) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T.0105(c)(6), directly related environmental permits or certification applications must be 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, stormwatermanagement plans, etc.).
7. Does this project include any sewer collection lines that are deemed "high -priority?" ❑ Yes Eg No
Per i 5A NCAC 02T:0402, "high -priority sewer" means any aerial sewer, sewer contacting surface waters,
siphon, or sewers positioned parallel to streambanks that are subject to erosion that undermines or deteriorates the sewer.
Siphons and sewers suspended through interference/conflict boxes require a variance approval.
➢ Ifyes, include an attachment with details for each line, including type (aerial tine, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at least once every six -months and
inspections documented per 15A NCAC 02T.0403(aX5) or the permittee's individual System -Wide Collection permit.
FORM: FTA 06-21
Page 5 of 5
noncomplrance wrth 021.0305{ f} or Ig . see Seenon X.1 of this application
*I5A NCAC 02T.0305.(g) contains alternatives where separations in 02T.0305(1) cannot be achieved. Please check "yes"
above if these alternatives are used and provide narrative information to explain.
**Stream classifications can be identified using the Division's NC Surface Water Classifications weboase
2. Does this project comply with the minimum separation requirements for water mains? E Yes ❑ No ❑ N/A
> If no, please refer to 15A NCAC 18C.0906(t) for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? El Yes ❑ No ❑ N/A
➢ Please provide supplementary information identifying the areas of non-conformance.
> See the Division's draft separation requirements for situations where separation cannot be met.
No variance is required if the alternative design criteria specified is utilized in design and construction.
4. Is the project located in a river basin subject to any State buffer rules? ® Yes Basin name: Lumber
If yes, does the project comply with setbacks found in the river basin rules per I5A NCAC 02 B .0200?
> This includes Trout Buffered Streams per 15A NCAC 213.0202
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits
or 401 Water Quality Certifications?
> Please provide the permit rwmber/pemvtting status in the cover letter if coverage/authorization is requ
❑ No
®Yes ❑No
❑ Yes 1 No
led.
6. Does project comply with I5A NCAC 02T.0105(c)(6) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T.0105(c)(6), directly related environmental permits or certification applications must be 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, stormwatermanagement plans, etc.).
7. Does this project include any sewer collection lines that are deemed "high -priority?" ❑ Yes Eg No
Per i 5A NCAC 02T:0402, "high -priority sewer" means any aerial sewer, sewer contacting surface waters,
siphon, or sewers positioned parallel to streambanks that are subject to erosion that undermines or deteriorates the sewer.
Siphons and sewers suspended through interference/conflict boxes require a variance approval.
➢ Ifyes, include an attachment with details for each line, including type (aerial tine, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at least once every six -months and
inspections documented per 15A NCAC 02T.0403(aX5) or the permittee's individual System -Wide Collection permit.
FORM: FTA 06-21
Page 5 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02'T; the Minimum Design Criteria for the Pelmh(in, oi'Pbnip Stati
and Force Mains Latest eersioi ). and the Gravity Sewer Minimum Des Cher (latest version) as applicable?
�1
Yes 0 No
If no, for projects requiring a single variance, complete and submit the Variance/Alternative Design Request application
(VADC 10-14) and supporting documents for review to the Central Office. Approval of the request will be issued
concurrently with the approval of thepermit, and projects requiring a variance approval may be subject to longer
review tunes. For projectsrequiring two or more variances or where the variance is determined by the Division to be
a significant portion of the proiect, the full technical review is required.
2. Professional Engineer's Certification:
1, , attest that this application for
(Professional Engineer's name front Application Item W.I.) (Project Name from Application Item 11 p
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans,
specifications, engineering 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,
Minimum Design Criteria rot Gravity Sewers (latest version) and the Mminaum Dest'n Criteria for the fast -Track
Pctanittine or Pump Stations and Force Mains (latest version). Although other professionals may have developed certain
portions of this submittal package, inclusion of these materials under my signature and seal signifies that 1 have reviewed this
material and have judged it to be 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 shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $1.0,000,_as well as civil penalties up to $25,000 per violation. Misrepresentation of the
application information, including, failure to disclose any design non-compliance with the applicable Rules and design
criteria, may subject the North Carolina -licensed Professional Engineer to ref ual to the licepsin(boatd.,(21 NCAC 56.0701)
-
Syr z"Cr r'i::��:
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(6):
1, _Town of Pembroke
Arrowpoint Subdivision
(Signature Authority Name from Application Item 13.)
, attest that this application for
(Project Name from Application Item n.l)
attest that this application has been reviewed by me and is accurate and complete to the best of my knowledge.
I understand that if all required parts of this application are not completed and that if all required supporting documentation
and attachments are not included, this application package is subject to being returned as incomplete. I understand that any
discharge of wastewater from this non -discharge system to surface waters or the land will result in an immediate enforcement
action that may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the
Division of Water Resources should a condition of this permit be violated. I also understand that if all required parts of this
application package are not completed and that if all required supporting information and attachments are not included, this
application package will be returned to me as incomplete.
NOTE — In accordance with General Statutes I43-215.6A and ! 43-215 6ri, any person who knowingly makes any false
statement, representation, or certification in any application package 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.
FORM: ETA 06-21
Page 6 of 5

Signature:
Date: 1f-Z1 -Lot/
FORM: FTA 06-21
Page 7 of 5

IUSGS Quad Map - Pembroke Quad/

CJT P.A.
ENGINEERING LAND SURVEYING LANDSCAPE ARCHITECTURE
LETTER OF TRANSMITTAL
Date: 2/11/2022
To: DWR - Fayetteville Regional Office
R CVI-
E . .
FEB 1 1 2022
DEQ-FAYETTEVILLE REGIONAL OFFICE-
Attn: Trent Allen Subject: Arrowpoint Subdivision
Fayetteville Regional Supervisor
WE TRANSMIT TO YOU HEREWITH:
# Copies Sheet No. Date Description
1 na 25-Jan Flow Tracking/Acceptance Form
1 na 12/23/2021 Application Fee
Remarks:
Copies To:
From: Chuck Hill P.E.
Daniel A. Jewell, ASLA, RLA, President Main Office: 111 West Main Street, Durham, NC 27701
Jeremy S. Anderson, RLA, Vice President Phone: [phone] Fax: [phone]
Preston B. Royster, PE, V.P./Treasurer Email: design(hcitpa.com
Jeffrey P. Williams, PLS, V.P./Corp. Sec
Branch Office: P.O. Box 30, 212 S. Lamar St., Roxboro, NC 27573
Phone: [phone] Fax: [phone]
Email: jay.lenningsacltpa.com

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: Town of Pembroke
Project Name for which flow is being requested: Arrowpoint Acres Subdivision
More than one FTSE may be required for a single project if the owner of the WWTP is not responsible for alI 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: Town of Pembroke
b. WWTP Facility Permit #: NC0027103
All flows are in MGD
c. WWTP facility's permitted flow 1.33
d. Estimated obligated flow not yet tributary to the WWTP .04357
e. WWTP facility's actual avg. flow .87
f Total flow for this specific request .00432
g. Total actual and obligated flows to the facility .913
h. Percent of permitted flow used 68.7
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,
Pump Pump Average Approx. Not Yet Total Current
Station Station Firm Daily Flow** Current Tributary Flow Plus
(Name or Permit Capacity, * (Finn / pt), Avg. Daily Daily Flow, Obligated Available
Number) No. MGD MGD Flow, MGD MGD Flow Capacity***
Foxglove 0.565 0.226 0.054 0.04357 .0975 .1285
Lumbee
0.576 0.23 0.046 0.04357 .0895 .1405
* The Firm Capacity (design 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
(p1) not less than 2.5, per Section 2.02(A)(4)(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): Town of Pembroke
Downstream Permit Number: NC0027103 (WTP)/00114 (Collections)
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I Tyler W. Thomas 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 tj nsport and treat the proposed new wastewater.
Signing Official Signatu
Town Manager
Title of Signing Official
Date
Page 2 of 6
FTSE 10-18