WQ0044154_Application (FTSE)_20230309

State of North Carolina
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number:Xml�-"CompletedbyDWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Town of Southern Pines (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ® Municipal ❑ Other
3. Signature authority's name: James Michel PE per 15A NCAC 02T .0106(b)
Title: Town En, ineer ( V1
E ED`
4. Applicant's mailing address: 140 Memorial Park Ct. C
City: Southern Pines State: NC Zip: 28387- FEB 2 3 Z023
5. Applicant's contact information:
Phone Dumber: [phone] Email Address: imichel(a)southernpines.net DEQ-FAYETTEV1LLE.R€MNALOFFICE
11. PROJECT INFORMATION:
1. Project name: Ace Hardware Store - Phase 1
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing pen -nit 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: 35.225908° Longitude:-79.404667'
5. Parcel ID (if applicable): 857300963887 / 857300974411 (or Parcel iD to closest downstream sewer)
Ill. CONSULTANT INFOWMATION:
1. Professional Engineer: Carlo Pardo License Number: 051571
Firm: Bowman North Carolina- Ltd.
- - -
15857
RHETSON COMPANIES INC.
60-1809/433
2075 JUNIPER LAKE RD
FIRST NATIONAL BANK
1031
r'dCHECKaABMOK "i
WEST END, NC 27378
10/31 /22
PAY TO THE
ORDER OF NCDEQ
**480.00
Four Hundred Eighty and 00/100*******************************************************************************************
DOLLARS
NC DEQ
225 Green St., Suite 714
, VAii VALft
=
Fayetteville, NC 28301
D App VAtlll
_
MEMO
D VALID VALIC
�lltlVAtl9
NCDDEQ_SP, NC Ace Hardware
AL r i

4006 Barrett Drive, Suite 104
ow Raleigh, North Carolina, 27609
TEL [phone]
Transmittal.
Date February 21, 2023 Job Number: 220064-01-001
Project Name: Ace Hardware
To: NCDEQ-Fayetteville Regional Office
Attn: Water Quality Section
225 Green Street, Suite 714
Fayetteville, NC 28301
We are sending these by
❑ U.S. Mail ® UPS ❑ Hand Delivery
❑ Other
We are sending you
® Attached ❑ Under separate cover via the following iterns:
❑ Shop drawings ® Prints/Plans ❑ Samples ❑ Specifications ❑ Change Orders
❑ Other
(''nni'ov l)nto Nn T)Pvrrintinn
2
Application and Supporting Documents
1
$480 Application Fee
2
Cover Letter
2
Fast Track Application
2
Flow Tracking/Acceptance Form x 2 (TOSP / Moore County)
These are transmitted as checked below:
❑ For your use ❑ Approved as submitted ❑ Resubmit ❑ Copies for approval
❑ As requested ❑ Approved as noted ❑ Submit ❑ Copies for distribution
N For review and comment ❑ Returned for corrections ❑ Return ❑ Corrected prints
Remarks:
Copy to:
Signed:
Ca Rr ffC�EIVED
FEB 2 3 2023
1 L, l \ il�
DEQ-FAYETTEVILLE REOtONAL OFFICE,

State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources INSTRUCTIONS FOR FORM: FTA 06-21 & SUPPORTING DOCUMENTATION
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 15A NCAC 02T and the Division's
Minimum Design Criteria (Gravity Sewer & Pump Stations/Force Mains) and that plans; specifications and supporting documents
have been prepared in accordance with 15A NCAC 02T, 15A NCAC 02T .0300, Division policies, and good engineering practices.
While no upfront engineering design documents are required for submittal, in accordance with 15A NCAC 02T .0305(b), 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 15A NCAC 02T .0305 and the applicable minimum design criteria. These
documents shall be immediately available upon request by the Division.
Projects that are deemed permitted (do not require a permit from the Division) are explained in 15A NCAC 02T.0303.
Projects not eligible for review via the fast track process (must be submitted for full technical review):
➢ Projects that do not meet any part of the minimum design criteria (MDC) documents;
➢ Projects that involve more than one variance from the requirements of 15A NCAC 02T;
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 $480.00, dated no more than 90 days prior to application submittal.
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.
➢ If necessary for clarity or due to space restrictions, attachments to the application may be made.
❑ If the Applicant Type in Item 1.2 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 II.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.
® The Applicant's Certification on Page 5 of the application shall be signed in accordance with 15A NCAC 02T .0106(b). 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 15A NCAC 02T .0106(b).
INSTRUCTIONS FOR FORM: FTA 06-21 & SUPPORTING DOCUMENTATION Page] of 3

E. Flow Tracking/Acceptance Form (Form: FTSE 04-16) (If 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 one year
prior to the application date.
➢ Submittal of this application and form FTSE indicates that owner has adequate capacity and will not violate G.S. 143-215.67(a).
➢ Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific FTSE.
F. Site Maps (All 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
narrative 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.
N. Power Reliability Plan (Required if portable reliability option utilized for Pump Station):
❑ Per 15A NCAC 02T .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
➢ 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 .0115(a)(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 North Carolina Utilities Commission's Water and Sewer Division Public 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.
J. Operational Agreements (Applications from HOA/POA and Developers for lots to be sold):
❑ Home/Property Owners' Associations
❑ Per 15A NCAC 02T .0115(c), submit the properly executed Operational Agreement (FORM: HOA).
❑ 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 15A NCAC 02T .01 15(b), submit the properly executed Operational Agreement (FORM: DEV).
For name infonnation, visit the Divisions collection systems ivebsite
INSTRUCTIONS FOR FORM: FTA 05-21 & SUPPORTING DOCUMENTATION Page 2 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
Avery, Buncombe, Burke, Caldwell, Cherokee,
Water Quality Section
Swannanoa, North Carolina 28778-8211
Clay, Graham, Haywood, Henderson, Jackson,
[phone]
Macon, Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Harnett, Hoke,
Water Quality Section
Fayetteville, North Carolina 28301-5095
Montgomery, Moore, Robeson, Richmond,
[phone]
Sampson, Scotland
[phone] Fax
Mooresville Regional Office
610 E. Center Avenue
Alexander, Cabarrus, Catawba, Cleveland,
Water Quality Section
Mooresville, North Carolina 28115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
Raleigh Regional Office
3800 Barrett Drive
Chatham, Durham, Edgecombe, Franklin,
Water Quality Section
Raleigh, North Carolina 27609
Granville, Halifax, Johnston, Lee, Nash,
[phone]
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
Warren, Wilson
Washington Regional Office
943 Washington Square Mall
Beaufort, Bertie, Camden, Chowan, Craven,
Water Quality Section
Washington, North Carolina 27889
Currituck, Dare, Gates, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
Wilmington Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
Water Quality Section
Wilmington, North Carolina 28405
Hanover, Onslow, Pender
[phone]
[phone] Fax
Winston-Salem Regional Office
450 W. Hanes Mill Road
Alamance, Alleghany, Ashe, Caswell, Davidson,
Water Quality Section
Suite 300
Davie, Forsyth, Guilford, Rockingham, Randolph,
Winston-Salem, North Carolina 27105
Stokes, Surry, Watauga, Wilkes, Yadkin
[phone]
[phone] Fax
INSTRUCTIONS FOR FORM: FTA 05-21 & SUPPORTING DOCUMENTATION Page 3 of 3

Fast Track Sewer System Extension Applicatiol�
(FTA 06-2 1) Cover Leifer
January 30, 2023
Ace Hardware
Airport Road
Southern Pines,
Moore County
Store - Phase 1
NC
Prepared for:
Southern Pines Ace Land Company, LLC
215 Capital Drive
Carthage, NC 28327
[phone]
[e-mail]
Prepared by:
Bowman North Carolina, Ltd.
4006 Barrett Drive, Suite 104
Raleigh, NC 27609
[phone]
Firm#F-1445
FEB 2 3 2023

OVERVIEW
APPLICATION FEE
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION (FORM: FTA 06-21)
FLOW TRACKING FOR SEWER EXTENSION APPLICATION (FORM: FTSE 10-18)
SITE MAPS
OVEEVIEV/
The Town of Southern Pines is requesting o Sanitary Sewer permit for the Ace
Hardware Store - Fhese 1 project on Airput Road in Vcore County. The system will be
a Crovity Sewer system comprised of 42- LF of 8- SDR-35 PVC. The system will have
a daily design flow of 5,819 GPD at ]GO gal/1 DDO sf.
FE-0 202

State of North Carolina
Department of Environmental Quality
Division of Water Resources
DWR
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number: completed by DWR)
All items must be completed or the application will be returned
1. APPLICANT INFORMATION:
1. Applicant's name: Town of Southern Pines (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ® Municipal ❑ Other
3. Signature authority's name: James Michel, PE per 15A NCAC 02T .0106f b>
Title: Town En ig neer ����v�®
4. Applicant's mailing address: 140 Memorial Park Ct.
City: Southern Pines State: NC Zip: 28387- FEB 2 3 2023
I
5. Applicant's contact information:
Phone number: [phone] Email Address: jmichel(a)southernpines.net DEQ-FAYETTEVILLE REM1 MOFFICE
H. PROJECT INFORMATION:
1. Project name: Ace Hardware Store - Phase 1
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Preject
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: 35.225908' Longitude:-79.404667'
5. Parcel ID (if applicable): 857300963887 / 857300974411 (or Parcel ID to closest downstream sewer)
111. CONSULTANT INFORMATION:
l . Professional Engineer: Carlo Pardo License Number: 051571
Firm: Bowman North Carolina, Ltd.
Mailing address: 4006 Barrett Drive, Suite 104
City: Raleigh State: NC Zip: 27609-
Phone number: [phone] Email Address: cl2ardo0$owman.com
IV. WASTEWATER TREATMENT FACILITY (WNVTF) INFORMATION:
1. Facility Name: Moore County Water Pollution Control Plant Permit Number: NCO037508
Owner Name: Moore County
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 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?
❑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 HOA/POA Operational Agreement (FORM: HOA) 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):
❑ Residential (Individually 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: % Domestic 100 % Commercial % Industrial (See 15A NCAC 02T .0103(201)
If Industrial, is there a Pretreatment Program in effect? El Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(fl? ❑ Yes ® No
➢ Ifs yes, provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow
No. of Units
Flow
Stores and shopping ceiiters without food
service
100 gal/1000 sq ft
58,182 sf
5,819 GPD
gall
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
5,819 GPD
a See 15A NCAC 02T .0114(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.01141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 5,819 GPD (per 15A NCAC 02T .0114)
9 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 timeframe 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):
RECEIVED
FEB 2 3 2020
FORM: FTA 06-21
OFCC-FAYETTEVILLE RE&ONAL OFFICE
Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
R 42 SDR-35 PVC
Section II & III of the MDC for Pennitting 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 requirements is not allowed and a violation of the AMC
VIH. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/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 (Decimal Degrees): Latitude: Longitude: -
3. Total number of pumps at the pump station:
3. 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
FEB 2 3 2023
DELI-FAYETTEVILLE RMONAL OFFICE
If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.01 CA .b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NCAC 02T .0305011 :
❑ Standby power source or ❑ Standby pump
➢ Must have automatic activation and telemetry - 15A 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(h)(1)(C):
❑ Portable power source with manual activation, quick -connection receptacle and telemetry -
or
❑ Portable 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.
➢ 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 06-21 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T.0305(f)):
1. Does the project comply with all separations/alternatives found in 15A NCAC 02T.0305(f) & (g)? ® Yes [—]No
15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
'Water mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
'Water 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-I 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, HQW, 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 noncompliance with 02T.0305(f) or (g), see Section X.1 of this application
* 15A NCAC 02T.0305(a) contains alternatives where separations in 02T.0305(f) 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 webpag_e
2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ N/A
➢ if no, please refer to 15A NCAC 18C.0906(f) 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? [:]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: ®No
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ❑ Yes ❑ No
This includes Trout Buffered Streams per 15A NCAC 213.0202
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ❑ Yes ® No
or 401 Water Quality Certifications?
➢ Please provide the permit number/permitting status in the cover letter if coverage/authorization is required.
6. Does project comply with 15A 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, stormwater management plans, etc.).
7. Does this project include any sewer collection lines that are deemed "high -priority?" ❑ Yes ® No
Per 15A 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. RECEIVED
➢ 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-mokfiBin2 3 2023
inspections documented per 15A NCAC 02T.0403(a)(5) or the permittee's individual System -Wide Collection permit.
FORM: FTA 06-21 DEQ-FA,YETTEVILLE�itONAL OFFICE

X. CERTIFICATIONS,
IONS,
Does the submitted systelra comply ',ritll 15A NCAC 02T, [lie Nfifor the 11c►I}u1h ol, PL11111) `�i;ltinlls
and Force_Mailis t l{hest version), and the Gravity Sewer h,1ininnun Design Cntcij,i latest version as applicable'?
yes Nn
if Do for pirojects rvquJriug a siglc 1'arlfniCc, C©rlipleat: PJait sut)r1211 (lie Design 1ZCquc.q upI)11Cillon
i.`JAD � if}-1 )and supporting docutnclits for rcvito the Ce-ntral t)ffice. Aja�a�.i1 of the rettue;t will I)c issued
cr)ncllrrcntl with tine =rlt lr(r;ll t►i' tl►c txcl�ntil. a►Itf trrtrjects left►Ii► lra ti r�,trtt.II}flrrl�al 111,1v he subject to 1► n-cr
rc)-icw time~. For proiccts re(11.61 in+,+ tN+n or r1I)I-e Whe l-e (lie N .ari•ancc is determined by the DiN isitan ttT lac a
NJ nificant portion of the twoject, the full technical review is required.
2. Professioiml E:ngineen`'s C'ertificatioll:
I. Carlo Pardo attest that this application I -or Ace Hardware Store — Pliase 1
(Professional Engineer's name front Application hem 111-1.) (Pt ojcci Name, from Application ltctn 11.1)�— —
has been revicived by -tic and is accurate, complete and consistent with the infor-mation supplied in the plans,
slwcifications, engineering calculations, and all other supporting documentation to the nest of m�, �►o�ylcdke 1 further
attest thnt to the best of my knowledge tine proposcd design has beepp prepared in accordance with die- applicable regulations,
Mininium Design Criteria for Gravity Sewers (latest version). and the Minimum Design Criterja for the Fast -Track Pern- tting
of Pump Stations and Force Mains latest version), Altlaongh outer professionals 11a2y have developed certain portions of iUs
submittal package, inclusion of these materials under my sip'nattire and seal signifies Clint I Have reviewed tl>is material and
have judged it to be consistent Nvith the proposed design.
NQTF -- It) accordance with General Statutes 143-215.6A and 143-215.6B. Dli) l ersoil who knowingly snakes any false
statement, rep esentatioiL or certification: in any application package sliall be guilty of a Class 2 luisdcmeanor, which rilay
include a fine. not, to exceed $10,000, as well as civil penalties up to S25,000 per violation. Misreprescnlation of the application
information, including failurt to disclose any design non-compliance with the applicable Rules and design criteria, may subject
the: North Carolina -licensed PTolbssional Engineer to iefemil to the licensing board. (21 NCAC 56,0701)
Ili fill
North C'a.rolina Professional Engineers seal, signature, and (late: ���1hyy� �, C ACC RC)�
'Q l
_ SEAL
OC* 1 `�71
Applicant':, f crtiheaticitl per 1Sf� NCAC 02T.0 IEi6(tr),
E" e -Fc7W'i �t ('
�_ attest that this application for Ace Hardware Sion — Phase l_
(Signalurc Authorily Nam,, fmrri Applic;rtion It:gym 1.3.) (Project Narne flOM Application teem Il.)) --
attest that this application has been reviewed by are and is accurate and complete to the Kest of my hnowledge.
I understand tNit if all required parts of this al)plicatiorl tare not cotnplcled and Oint if all required supporting doctlmerllatlon
and attachments am not include& this application package is subject to being returned as incomplele. 1 understand that any
discharge of wastewater from this non -discharge nester to surface waters or the land mill result Ira an irnmcdiate, enforcement
Belton tlrit may include civil p;.n;iltics, injunctive relief, aiidlor criminal prosecution- I will ninkc no claim against the Division
of Water Resources should a condition of this permit be yiolatcd. I also understand tli at i_f° A requM,-d parts of this applictation
package arc not Completed and tluif if all required supporting infonnakon and attachments Carr. not included, this application
package will be returned to me as inconiplcte.
NOTE In accordance with Gener;ii Statutes 143-215.6A and 143-215.613, any person who knowingly makes any false
s(atement, representation, or certification ill any application package shall be gu lly of a Class 2 lnisdenlealaor. which ma
include ra finG. riot to exceed FIO,O00 as Gv,cll tas civi )cruilties up to $25,000 per violation.
`7
1g11 atEtTC: / .,
-------- --- ----
Dtate:
FORM. FTA 06-21
P,ig,,C 5 of' 5

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 Southern Pines
Project Name for which flow is being requested: Ace Hardware Store - Phase I
More than one I TSE may be required for a single pruject if the owner of the IVWTP 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:
b. WWTP Facility Permit #:
All flows are in MGD
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
f. Total. flow for this specific request 0.005819
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
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
Avera,,e Approx. Obligated, Total
Pump Pump Daily Current Not Yet Current
Station Station Firm Flow** Avg, Daily Tributary Flow Plus
(Name or Permit Capacity, * (Firm / pf), Flow, Daily Flow, Obligated Available
Number) No. MGD MGD MGD MGD Flow Capacity***
Warrior WQ0008578M 1.33 0.53 0.1668 .145 0.3118 0.218
* 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
(pf) 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 "IWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): Moore County Public Utilities
Downstream Permit Number: WQCS00034 FE01
Page. I of 6

III. Certification Statement;
I James Michel. PE 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 pw-ty. Signature of this form certifies that the receiving collection system or treatment
works has adequate capacity to transport and treat the proposed new wastewater.
ing Official Signature
Title of Signing Of
w e T`
cial
-� /a ( /ao-23
Dal
Page 2 of 6

Entity Requesting Allocation:
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Town of Southern Pines
Project Name for which flow is being requested: Ace Hardware Store - Phase 1
More than one FTSE niay he required for a single project if the owner of the WWTP is not responsible for all pump
stations along the route of the proposed wastewater flow.
1.. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Moore County Water Pollution Control Plant
b. WWTP Facility Permit #: NC 0037508
c. WWTP facility's pennitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
All flows are in .AfGD
10.0000
0.83002
4.86000
0.00582
5.69584
56.9584
11, 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)
Design
Pump
Pump
Average
Approx.
Station
Station
Firni Daily Flow`*
Current
(Naive or
Pennit
Capacity. * (Firm 1 pf).
Avg. Daily
Number)
No.
MGD MGD
Flow, MGD
(C)
(D)=(B+C) (E)=(A-D)
Obligated,
Not Yet
Total Current
Tributary
Flow Plus
Daily Flow,
Obligated Available
MGD
Flow Capacity'
K 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 Floiv is the firm capacity of the pump station divided by a peaking factor
(pf) 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 WNVTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): Moore County Public Utilities
Downstream Permit Number: WQCS00034
,"-f 3 2 Ct
_ •1
Page 1 of 6
1 �1F i 0__ I S-

III. Certification Statement:
I Randy G. Gould, PE 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 adecnate capacity to transport and treat the proposed new wastewater.
;gning OfcialSignatue ��� Marc
i
i C (2 (-C"
Title of Signing Official
FEB 2 3 2020
Page 2 of b DEQ-FAYETTEVILLE REGIONAL OFFICE
USE 10-18

m
9
m
N
CJ
-n

RECEIVED
FEB 2 3 2020
DE.Q-FAYETTF_VILLE RE&ONAL OFFICE