WQ0043822_Application Attachment_20221011

DWR
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: (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Aberdeen, Town of (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual El Corporation El General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ® Municipal ❑ Other
3. Signature authority's name: per 15A NCAC 02T .0106(b)
Title: Harold Watts, Public Works Director
4. Applicant's mailing address: Post Office Box 785
City: Aberdeen State: NC Zip: 28315
5. Applicant's contact information:
Phone number: [phone] Email Address: [e-mail]
II. PROJECT INFORMATION:
1. Project name: Duck's Landing
2. Application/Project status:
® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ00 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: WQ00
3. County where project is located: Moore
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.1546 N ° Longitude: -79.4036 W °
5. Parcel ID (if applicable): 00051128 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Kevin S. Lindsay License Number: NCO27502
Firm: Crawford Design Company
Mailing address: 230 West Pennsylvania Ave., Suite C
City: Southern Pines State: NC Zip: 28387-
Phone number: [phone] Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Permit Number:
Owner Name: Aberdeen, Town of
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ
2. Downstream (Receiving) Sewer Information: inch
❑ Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s):
FORM: FTA 06-21
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