WQ0043690_Application (FTSE)_20220831

Roof, Sandee
From: Roof, Sandee
Sent: Wednesday, August 3, 2022 11:23 AM
To: [e-mail]
Cc: Richardson, Cheryl
Subject: Harnett Regional Water - Fast Track SS Ext App for Serenity Phases 1, 2 & 6
Good morning,
The Fast Track Sewer System Extension Application for Harnett Regional Water —Serenity Phases 1, 2 & 6, received on
August 2, 2022, will need to go to our Fayetteville Regional Office at the following address:
Fayetteville Regional Office
Attn: Danielle Simpson, DWR-WQROS
225 Green Street, Suite 714
Fayetteville, NC 28301
If you have any additional questions, please let us know.
Best,
Sandee Roof
Office Manager
Division of Environmental Assistance and Customer Service
North Carolina Department of Environmental Quality (DEQ)
[phone] Direct
[phone] Front desk
[e-mail]
DEQ Raleigh Regional Office
3800 Barrett Drive
Raleigh, NC 27609
D S
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•
NC 1)
of Environmental Quality.
DocuSign Envelope ID: 2E41263F-B464-4E92-B3F3-00E7ED069220
Division of Water Resources
Raleigh Rep'
15A NCAC 02T .0300 — FAS1t n.ZeifiSEWER SYSTEM EXTENSION APPLICATION
ETA 04-16 & SUPPORTING DOCUMENTATION
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Application NumberVICII4Makyte be completed by DWR)
All items must be completed or the application will be returned
L APPLICANT INFORMATION:
1. Applicant's name: Harnett Regional Water (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County 1/ Municipal ❑ Other
3. Signature authority's name: Steve Ward per 15A NCAC 02T .0106(b)
Title: Director
4. Applicant's mailing address: PO Box 1119
City: Lillington State: NC Zip: 27546-_
5. Applicant's contact information:
Phone number: [phone] Email Address: sward t®.harnett.org/scwnmings c(6harnett.org
IL PROJECT INFORMATION:
1. Project name: Serenity Phases 1, 2 & 6
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: W000N/A and issued date: N/A
If new construction but part of a master plan, provide the existing permit number: W0000
3. County where project is located: Harnett
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.546841° Longitude: -78.835183°
5. Parcel ID (if applicable): 0655-23-9685, 0655-13-8762, 0655-03-4488 0645-95-9146 0645-82-8633 0645-72-7454
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Zachary L. Fuller. PE
Firm: WithersRavenel, Inc.
Mailing address: 115 MacKenan Drive
City: Cary State: NC Zip: 27511-
Phone number: [phone] Email Address: [e-mail]
License Number: 033776
IV. WASTEWATER TREATMENT FACILITY (W WTF) INFORMATION:
1. Facility Name: North Harnett Regional Wastewater Treatment Plant Permit Number: NC0021636
Owner Name: Harnett Regional Water
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than W WTF):
1. Permit Number(s): WQxxxxx Downstream (Receiving) Sewer Size: 18 inch
System Wide Collection System Permit Number(s) (if mineable): i icable): WQCS000166
Owner Name(s): Harnett Regional Water
FORM: FTA 04-16 Page 1 of 5

DocuSign Envelope ID: 2E41263F-B464-4E92-B3F3-COE7ED069220
Vl. 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 Develoner's Operational Agreement (FORM: DEV) been attached?
❑ Yes ❑No ®N/A
3. If the Applicant is a Home/Pr perty Owners' Association has an Operational Agreement (FORM: HOA). been attached?
❑ Yes ❑No ®N/A
4. Origin of wastewater: (check all that apply):
® Residential Owned
❑ Residential Leased
❑ School / preschool / day care
❑ Food and drink facilities
❑ Businesses / offices / factories
0 Retail (stores, centers, malls)
0 Retail with food preparation/service
❑ Medical / dental / veterinary facilities
❑ Church
❑ 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 0 % Commercial
0 %Industrial (See 15ANCAC 02T.0103(201)
�Is there a Pretreatment Program in effect? 0 Yes ® No
6. Has a flow reduction been approved under 15A NCAC 02T .0114(0? ❑ Yes ® No
D. If ves, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(1))
Daily Design Flow .,o-
No. of Units
Flow
3 Bedroom Residence
360 gal/day
200
72,000 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gall
GPD
gal/
GPD
Total
72,000 GPD
a See 15A NCAC 02T .01 14(b) (d) (e)( I) and (e)(2) for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facili ies 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.01 141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 72.000 GPD (per 15A NCAC 02T .0114)
> 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 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

OnceSign Envelope ID: 2E41263F-B464.4E92-83E3-00E7ED069220
VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
See
attached
form
> Section 11 & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
> Section III contains information related to minimum slopes for gravity sewer(s)
> Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
II PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Frtmn Stations/Force Mains):;.
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Ptt p station number or name:
2. Appn ate Coordinates (Decimal Degrees): Latitude: ° Longitude: - °�/
3. Design flo the pump station: _ millions gallons per day (firm capacity)
4. Operational pout of the pump(s): gallons per minute at feet total dynamichead (TDH)
5. Summarize the force to be permitted (for this Pump Station):
=11
Length (feet) EMI
WAN
6. Power reliability in accordance with 15A NCAC 02
❑ Standby power source or pump with auto . is activation an ti't lemetry - 15A NCAC 02T .0305(hx1)(B);
> Required for all pump stations with qn a erage daily flow greater en or equal to 15,000 gallons per day
> Must be permanent to facility
Or if the pump station has an ave
e daily flow less than 15,000 gallons per da
❑ Portable power source $ manual activation, quick -connection receptacle and tekrrnetry - 15A NCAC 02T
.0305(h)(1)(C)
or �,,
❑ Portable p ping unit with plugged emergency pump connection and telemetry - 15A NCAC) 00305(h)(1)(C):
> It sha e demonstrated to the Division that the portable source is owned or contracted by the applicalrt (draft agreement)
an s compatible with the station.
➢ the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump sta ' ns' storage
capacities and the rotation schedule of the portable power source or pump, including travel timeframes, shall be ovided
in the case of a multiple station power outage.
N.
FORM: FTA 04-16
Page 3 of 5

DocuSign Envelope ID: 2E41263F-B464-4E92-B3F3-00E7ED069220
IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(0):
1. Does the project comply with all separations found in 15A NCAC 02T .0305(0 & (&)
NCAC 02T 0305(f) tales minimum se arations that shall be provided for sewer systems:
El Yes ❑ No
➢ 15A con p
Setback Parameter* Separation Required
Storm sewers and other utilities not listed below (vertical) 24 inches
Water mains (vertical -water over sewer including in benched trenches) 18 inches
Water mains (horizontal) 10 fret
Reclaimed water lines (vertical - reclaimed over sewer) 18 inches
Reclaimed water lines (horizontal - reclaimed over sewer) 2 feet
**My private or public water supply source, including any wells, WS-I waters of Class I or
Class II impounded reservoirs used as a source of drinking water 100 feet
**Waters classified WS (except WS-1 or WS-V), B, SA, ORW, HOW, or SB from normal
high water (or tide elevation) and wetlands (see item IX.2) 50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches 10 feet
Any building foundation 5 feet
Any basement 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
➢ 15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
➢ If noncompliance with 02T.0305(f) or (a) see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ® Yes 0 No 0 N/A
➢ See the Division's draft separation requirements for situations where separation cannot be meet
➢ No variance is required 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 setbacks found in the river basin rules per 15A NCAC 02I3 .0200? ® Yes 0 No ❑ N/A
➢ This would include Trout Buffered Streams per 15A NCAC 28.0202
4. Does the project require coverage/authorization under a 404 Nationwide or
individual permits or 401 Water Quality Certifications?
➢ Information can be obtained from the 401 & Buffer Permittinu Branch
ZYes ❑No
5. Does project comply with I5A NCAC 02T.0105(2)(6) (additional permits/certifications)? ® Yes 0 No
Per 15A NCAC 02T.0105(c)(6), 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, stonnwater management plans, etc.).
6. Does this project include any sewer collection lines that are deemed "high -priority?"
Per 15A NCAC 02T.0402, "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer.
® Yes ❑ No ❑ N/A
➢ If yes, include an attachment with details for each line, including type (aerial line, 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(a)(5) or the permitee's individual System -Wide Collection permit.
FORM: FTA 04-16 Page 4 of 5
➢ 15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
➢ If noncompliance with 02T.0305(f) or (a) see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ® Yes 0 No 0 N/A
➢ See the Division's draft separation requirements for situations where separation cannot be meet
➢ No variance is required 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 setbacks found in the river basin rules per 15A NCAC 02I3 .0200? ® Yes 0 No ❑ N/A
➢ This would include Trout Buffered Streams per 15A NCAC 28.0202
4. Does the project require coverage/authorization under a 404 Nationwide or
individual permits or 401 Water Quality Certifications?
➢ Information can be obtained from the 401 & Buffer Permittinu Branch
ZYes ❑No
5. Does project comply with I5A NCAC 02T.0105(2)(6) (additional permits/certifications)? ® Yes 0 No
Per 15A NCAC 02T.0105(c)(6), 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, stonnwater management plans, etc.).
6. Does this project include any sewer collection lines that are deemed "high -priority?"
Per 15A NCAC 02T.0402, "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer.
® Yes ❑ No ❑ N/A
➢ If yes, include an attachment with details for each line, including type (aerial line, 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(a)(5) or the permitee's individual System -Wide Collection permit.
FORM: FTA 04-16 Page 4 of 5

DocuSign Envelope ID: 2E41263F-B464-4E92.03F3-00E7ED069220
X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Pump Stations
and Force Mains (latest version). and the Gravity Sewer Minimum Design Criteria (latest versionl as applicable?
® Yes ❑ No
If No, complete and submit the Variance/Alternative Design Request application (VADC 10-14) and supporting documents for
review. Approval of the request is required prior to submittal of the Fast Track Application and sunnortina documents.
2. Professional Engineer's Certification:
1, Zachary L. Fuller, PE attest that this application for
(Professional Engineer's name from Application Item III1.)
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, Gravity Sewer
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track Permitting
of 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 I 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 143-215.6B, 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.
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North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I, St P l / e LA h 1/ d t J (xe Ci-e r - attest that this application for
(Signature Authority's name & title from Application Item I.3.)
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 143-215.6A and 143-215.613, any person who knowingly makes any false
statement, representation, or certification irytany application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000 as w civil penalties up to $25,000 per violation.
Signature:
Date: / e—
FORM: FTA 04-16 Page 5 of 5

t: 919.469.3340 f: 919.467.6008
TO: NCDEQ - Raleigh Regional Office
3800 Barrett Drive
;/ WithersRave
Our P� �tof8nvironmental
eopleVOW
ur Success.
AU 02 2022
115 MacKenan Drive
Cary, NC 27511 Raleigh RegionalOfieo
Raleigh, NC 27609
®Attached
WE ARE SENDING
YOU THE OShop Drawings
FOLLOWING
ITEMS: ❑Copy of Letter
Ster of Transmittal
DATE
ATTENTION{
RE
08/01/2022
Ivana Barham
PRO1.'NOi:
02180718.00
Serenity
Phases - 1D, 1E, 2C, 2D, 2E, 2F, 2G, 6A, 6B, 6C,
6D, 6E, 6F, & 6G
❑ Under Separate Cover Via
❑Prints ❑Plans ❑Samples OSpecifications
❑ Change Order ❑Disk ❑Other
COPIES
P DESCRIPTION,
1
Plan Set (one full size, one half-size)
1
Cover Letter/Narrative Description
1
Fast Track Application (FTA)
1
Flow Tracking/Acceptance Form (FTSE)
1
Sewer Quantities
1
USGS Site Map (8.5x11)
1
Vicinity Map (8.5x11)
1
Application Fee ($480, Greenfield Serenity Devco, LLC Check #1005)
1
Thumb Drive with All Submittal Items
THESE ARE TRANSMITTED as checked below:
®For approval OApproved as submitted
❑ For your use OApproved as noted
OAs requested ❑Returned for corrections
❑Resubmit copies for approval
❑Submit copies for distribution
❑Return corrected prints
❑ For review and comment ❑Other
❑FOR BIDS DUE ❑PRINTS RETURNED AFTER LOAN TO US
REMARKS:
COPY TO: SIGNED: Zack Fuller, PE
QA/QC:
If enclosures are not as noted, kindly notify us at once.

1/ WithersRavenet
Our People. Your Success.
NC Dept of Environmental Quality
air
August 1, 2022 Raleigh 9cgional Office
Fayetteville Regional Office —Water Quality Section
225 Green Street Suite 714
Fayetteville, North Carolina 28301-5094
RE: Serenity Phases —1 D, 1E, 2C, 2D, 2E, 2F, 2G, 6A, 6B, 6C, 6D, 6E, 6F, & 6G
Fast -Track Sewer System Extension Application
WR Project No. 02190647.0
To whom it may concern:
On behalf of Harnett Regional Water and Greenfield Communities, please find attached documentation in
support of a Fast -Track Application (FTA 04-16) for the above referenced project. As noted in the application,
this project will consist of 19,179 LF of gravity sewer that will tie to the previously permitted pump station
through a new sewer outfall running along Hector Creek. All wastewater generated in the above referenced
phases will be treated at the North Harnett Regional Wastewater Treatment Plant MWTF Permit No. NC-
0021636).
The proposed project meets all NCDENR-DWR minimum design criteria for sanitary sewer
extensions. The design flow rate for these phases is calculated at 72,000 (360 gallons per day per
dwelling for a 4-bedroom residence x 200 residences) in accordance with NCAC 2T Rules for
wastewater flow rates. The proposed sanitary sewer lines are more than adequate to convey the
design flow rates for these Serenity Phases and future expansion.
Included with this submittal are one original and one copy of the items listed below:
• Application Form (FTA 04-16)
• Application Fee — Check in the Amount of $480.00
• Flow Tracking/Acceptance Form (FTSE 04-16)
• Site Map (USGS Quad — Hillsborough)
• Street Level Map (Aerial)
Please advise if you require additional information or have any questions concerning our submittal.
Sincerely
WithersRaveflet
Zack Fuller, PE
cc: Ben Taylor — Greenfield Communities
115 MacKenan Drive I Cary, NC 27511
t: 919.469.3340I f: 919.467.6008 www.withersravenel.com I License No. C-0832
Cary I Greensboro I Pittsboro I Raleigh I Wilmington

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b American Datum of 1903(NA003i
d Geodetic System of 19841WG504). Projection and
D•meter gridUniversal Transverno Mercator, Zane 175
map Is not a legal document. Boundaries maybe
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Is U.S. Census Bureau, 2016
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A metadau file associated with this product s draft version 0.6.1E

Serenity Sewer Quantities
Phases 1D, 1E, 2C, 2D, 2E, 2F, 2G, 6A, 6B, 6C, 6D, 6E, 6F, 6G & Outfall
Size (inches)
Length (feet)
Material
8-inch
10,989
SDR-35 PVC
8-inch
188
DIP
8-inch
3,641
C-900 PVC
10-inch
124
C-900 PVC
12-inch
2,500
C-900 PVC
12-inch
1,520
SDR-35 PVC
14-inch
217
DIP

Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: Hat ne /Zpac on&
Project Name for which flow is being requested: SereMty Ph. 1D, 1E, 2C-2G, 6A-6G,
More than one FTSE may be required for a single project ff 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
Angier Actual + Obligated Flow
h. Percent of permitted flow used
All flows are in MGD
7.5 MGD
2.60 MGD
1.20 MGD
1.008 MGD
2.608 MGD
0.744 MUD
0.237 MGD
0.980 MGD
0.647 MGD
5.080 MGD
1.224 MGD
0.642 MGD
2.568 MGD
0.646 MGD
0.072 MGD
7.260 MGD
1.968 MGD
0.879 MGD
3.620 MGD
1.293 MGD
103.47%*
*A PER to expand the NHRWTTP treatment capacity has been completed and design of the
expansion is currently underway.
Page 1 of 4
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,
Pump Average Daily Approx. Not Yet Total Current
Station Firm Flow** Current Avg. Tributary Flow Plus
(Name or Capacity, * (Firm / pt), Daily Flow, Daily Flow, Obligated Available
Number) MGD MGD MGD MGD Flow Capacity***
SerenityTIC 1.440 0.576 0 0.132 0.132 0.453
SLS 120 14.4 5.76 2.819 2.496 5.315 0.445
* The Finn 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 < 0.
Downstream Facility Name (Sewer): North Harnett Regional WWTP
Downstream Permit Number: NC0021636
III. Certification Statement:
Si -eve t )a, v d 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 addend ., s for which I am the responsible party. Signature of this
form indicates acceptance of this 1 a ater flow.
Signing Official Signature Date
Page 2 of 4
FTSE 06-13

NC Dept of Environmental Quality
DocuSign Envelope ID: 2E41263F-B464-IE92-B3F3-00E7ED069220
Division of Water Resources
Raleigh Re 'rmat
15A NCAC 02T .0300 — FAST WLQ EWER SYSTEM EXTENSION APPLICATION
FTA 04-16 & SUPPORTING DOCUMENTATION
4022 State of North Carolina
Department of Environmental Quality
Division of Water Resources
Application Number completed by DWR)
MI items must be completed`ortheela(ppplliiicaltiifo'n will be returned
L APPLICANT INFORMATION:
1. Applicant's name: Harnett Regional Water (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual 0 Corporation ❑ General Partnership 0 Privately -Owned Public Utility
❑ Federal 0 State/County 0 Municipal 0 Other
3. Signature authority's name: Steve Ward per I5A NCAC 02T .0106(bI RECEIVED
Title: Director RECEIVED
4. Applicant's mailing address: PO Box 1119 10 :OS
City: Lillington State: NC Zip: 27546- AUG 0 4 2022
5. Applicant's contact information:
Phone number: [phone] Email Address: sward@.hamett.org(scumminasaharnett.orglEa-FgvErrEvatEReeroHgtOFFICE
IL PROJECT INFORMATION:
1. Project name: Serenity Phases 1, 2 & 6
2. Application/Project status: ® Proposed (New Permit) 0 Existing Permit/Project
If a modification, provide the existing permit number: W000N/A and issued date: N/A
If new construction but part of a master plan, provide the existing permit number: W0000
3. County where project is located: Harnett
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.546841° Longitude: -78.835183°
5. Parcel ID (if applicable): 0655-23-9685.0655-13-8762 0655-03-4488 0645-95-9146 0645-82-8633.0645,-72-7454
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Zachary L. Fuller. PE License Number: 033776
Firm: WithersRavenel. Inc.
Mailing address: 115 MacKenan Drive
City: Cary State: NC Zip: 27511-
Phone number: [phone] Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1 Facility Name: North Harnett Regional Wastewater Treatment Plant Permit Number: NC0021636
GREENFIELD SERENITY DEVCO LLC
8601 SIX FORKS ROAD, STE 270
RALEIGH, NC 27615
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