WQ0044215_Application (FTSE)_20230508

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 06-2I & SUPPORTING DOCUMENTATION
Application Number: V39) V 01fli2) to be completed by DWR)
All items must be completed or the application will be returned
1. APPLICANT INFORMATION:
1. Applicant's name: Town Of Clpyton (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual
❑ Corporation
❑ General Partnership
❑ Federal
❑ State/County
® Municipal
3. Signature authority's name: Joshua Baird per j.� I _1C
f! , 1' .111 o6[I);
Title: Director of Enginnering
4. Applicant's mailing address:
City: Clayton State: NC
Zip: 24528-
5. Applicant's contact information:
Phone number: (919)-553-1554
Email Address: jbairdQtownofclavtonnc.org
11. PROJECT INFORMATION:
❑ Privately -Owned Public Utility
❑ Other
I. Project name: Walk at East Villee - Phase 4
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: WQOO
3. County where project is located: Johnston
4. Approximate Coordinates (Decimal Degrees): Latitude.35.642508" Longitude: -78. 443888"
5. Parcel ID (if applicable): 166807-59-0985 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Timothy P. Nau License Number: 30339
Firm: The Nau Cornuany. PLLC
Mailing address: PO Box 810
City: Rolesville State: NC Zip: -27571
Phone number: (9l9) Q5-3090 Email Address: tnau(@thenauco.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Little Creek WRF Permit Number: 0025453
Owner Name: Town Of Clayton0038598
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s). W 0038698
2. Downstream (Receiving) Sewer Information: 8 inch ® Gravity D Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCSOO l 10
Owner Name(s): Town of Clayton
FORM: FTA 06-21 Page 1 of 5

VI. GENERAL REQUIREMENTS
I. 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 (I ORM. DEV) been attached?
[-]Yes [:]No ON -'A
3. if the Applicant is a Home/Property Owners' Association, has an HOA.POA Operational Agreement {FOR1M,.H and
supplementary documentation as required by 15A NCAC 02T.0115(c) been attached?
❑ Yes [-]No ON. -'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
❑ SchooI / preschool / day care ❑ Medical! dental r veterinary facilities ❑ Swimming Pool/Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming PooVFilter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater : 100 % Domestic % Commercial _ % Industrial (e_15A NC, 0�T .9103(W1
If Industrial, is there a Pretreatment Program in effect? ❑ Yes❑ No
6. Hasa flow reduction been approved under I SA NCAC 02T .0114(t)? ®Yes []No
➢ If 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 ',b
No. of Units
Flow
60 Single Family Homes
250 gal/day
60
15,000 GPD
gal/
GPD
gal/
GPD
gat/
GPD
gal/
GPD
gal/
GPD
Total
15,000 GPD
a See 15A ISCAC 02 4(b ,_(d), le)(T) and (elf2} 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 1 1A NCAC02T_0114] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 15.000 GPD (per 15A NCAC 02T .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 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): _..
FORM: FTA 06-21 Page 2 of 5

VI1. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8
436
C-900
8
1144
SDR-35 PVC
➢ Section lI & 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 requirements is not allowed and a violation of the MDC
VIII. 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
If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.01C.I.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(1):
❑ 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 0 T _0305(fJ"? ® Yes ❑ No
15A NCAC 02T.0305 contains minimum separations that shall be provided for sewers stems:
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-1 waters of Class I or
Class It 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) ur fg), see Section X.1 of this application
* 15A NCAC 02T.0305 contains alternatives where separations in 02T.0305 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 NQ 5M e Walgr ClaasilGcatians webua
2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ NSA
➢ 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 scparatian 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: Neuse ❑ No
If yes, does the project comply with setbacks found in the river basin rules per 15A N_ C'AC Q,ZB _0200? ® Yes ❑ No
➢ This includes Trout Buffered Streams per 15A NCAC 2 13.0202
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 15.A NCA(' 02T_Q1 Q1Lv1[6) (additional permits/certifications)? ® Yes ❑ No
Per )SA2NCAC 02T_OIQ,k(i-M, 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 UA N(`_AC QZT`& 2, "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.
➢ 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 permittee's individual System -Wide Collection permit.
FORM: FTA 06-21 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NC':,,C.' 02T, the Minimum Dcsign Criteria for Ilse Permitting of Pump.St,-1tions
and Fnrce Mains (latest version), and the Gravity Sewer Minimum Design Criteria (latest version) as applicable?
® Yes ❑ No
If no, for projects requiring a single variance, complete and submit the Variance.'Altemative Design Request application
(VADC 10-14) and supporting documents for review to the Central Office. Avyrovall of the reguest will be issued
concurrently with the. approval of the Permit, and Projects requiring a variance amroval may be subject to longer
review times. For protects requiring two or more variances or where the variance is determined by the Division to be a
significant Portion of the project, the full technical review is required.
2. Professional Engineer's Certification:
1, _ , attest that this application for _
(Professional Engineer's name from Application Item HL I ) (Project Name from Application Item 11.1)
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 Cri[cria fnr Oravity Sewers (latest version, and the Minimum Design t'ritcria [Dr 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 143-215.613, 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. 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 referral to the licensing board. (21 NCAC 56.0701)
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
�N CARD +. 4
o�3"i'a�r.'ti
EAL
li pap ,} /
4/24/2023
1, Joshua Baird Walk at East Village - Phase 4
_ ,attest that this application for ._
(Signature Authority Name from Application Item 13 } (Project Name rom Application Item II.1)
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. 1 will make no claim against the Division
of Water Resources should a condition of this permit be violated. 1 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.f5A and 143-215.613, 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.
Signature: ! Date. Apr 28, 2023
FORM: FTA 06-21 Page 5 of 5

State of North Carolina
DWR
Department of Environmental Quality
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 ISA NCAC 02T and the Division's
Minimum Design Criteria (Gr4yily..5ewer & Pumn Stations/Force Mains) and that plans, specifications and supporting documents
have been prepared in accordance with 15A NCAC 02T. I SA 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 numberlstatus 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 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 I.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 11.1 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 En i� neer.
® The Applicant's Certification on Page 5 of the application shall be signed in accordance with 15A NCAC 02T .0106. hl. 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 1 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. 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 1 I -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.
H. Power Reliability Plan (Required if portable reliability option utilized for Pump Station):
❑ Per 15,E NCAC 112T .0305; h if I }, 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 _0115f a1i 1 I 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 Noah 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 HOAIPOA and Developers for lots to be sold):
❑ Home/Property Owners' Associations
❑ Per 15A NCAC 02T .0115(c), submit the properly executed Operational AMement,(FOR : HOAI.
❑ Per 15A NCAC 02T .01 15(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 013crational Agreement tFORI+I: D13Vt.
For more information, visit the Division's 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 Realonal 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
Fa etteville 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 Reaional 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
Raleiah 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 Reaional 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
Wilminaton Regional QfRce
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
Water Quality Section
Wilmington, North Carolina 28405
Hanover, Onslow, Pander
[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

2023-04-24- FTA-06-21 - Phase 4 Walk of at
East Village
Final Audit Report 2023-04-28
Created: 2023-04-28
By: Shannon Poole ([e-mail])
Status: Signed
Transaction ID: CBJCHBCAABAA7Gt6gHGgd-AbXm1Lv3EJ_CDak7LmTkpi
"2023-04-24- FTA-06-21 - Phase 4 Walk of at East Village" Histo
ry
#'1 Document created by Shannon Poole ([e-mail])
2023-04-28 - 12:44:44 PM GMT
L', Document emailed to Joshua Baird [e-mail]) for signature
2023-04-28 - 12:45:26 PM GMT
o Document e-signed offline by Joshua Baird { [e-mail])
Signature Date: 2023-04-28 - 2:44:47 PM GMT - Time Source: device
As recorded by: eSignManagerForiOSOApp
Offline document signing event synchronized and recorded
2023-04-28 - 2:44:48 PM GMT - Time Source: server
Q Agreement completed.
2023-04-28 - 2:44:48 PM GMT
a Adobe Acrobat Sign

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross Jr., Secretary
Kerr T. Stevens, Director
July 2, 2001
Mr. Steve Biggs, Town Manager
Town of Clayton
Post Office Box 879
Clayton, North Carolina 27520
JUL o ^ 2001
AVM -WA
� s Gt15 rah.
NCDENR
NORTH CAROLINA DERARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
Subject: Town of Clayton
Flow Reduction Approval
Johnston County
Dear Mr. Biggs:
On January 3, 2001, the Division of Water Quality received your flow reduction request for new
single -fancily dwellings in the Town of Clayton. The letter requests approval of a residential flow value of 250
GPD/residence for any future dwellings that may become tributary to the subject wastewater collection system.
The Division also received additional information on April 3, 2001
The information provided flow records between January 1998 and November 2000 for the WWTP.
The evaluation also included the daily wastewater flows for a 33 day period from February 19 through March
23, 2001 for a select 97 homes in accordance with 15A NCAC 2H .0219(1)(3).
Based upon the information submitted, the Division hereby approves the use of 250 GPD per single-
family residence in all applicable non -discharge permit applications for future sewer line extensions for the
Town of Clayton. This consideration applies to any applicable future projects submitted to the Division as well
as any projects which are currently under review. Regardless of the ad Ousted design-dailydesign-daily wastewater flow rate
at no time shall the wastewater flows exceed the effluent limits defined in the Town's NPDES hermit for the
treatment facilitlr or exceed the capacity Df the sewers downstmnq,of1DXLqw grwer-exlensic n.
If you have any questions or comments regarding this matter, please contact Mr. Kim H. Colson at
[phone] ext. 540.
Sit iy,
/ Kerr T. Stevens
cc: Raleigh Regional Office
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] Fax [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post -consumer paper

NC Dept of Environmental Quality
MAR 14 2023 State of North Carolina
Department of Environmental Quality
Division of Water Resources
VW- Raleigh Regional Office -�
Division of Water Resources Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: Town of Clayton
Project Name for which flow is being requested: Walk At East Village - Phase 4
More than one FTSE may be 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
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Little Creek
b. WWTP Facility Permit 4: NC0025453
All flows are in MGD
c. WWTP facility's permitted flow LCWRF 2.5 + JoCo 1.4 +
Raleigh 1.75 = 5.65 MGD
d. Estimated obligated flow not yet tributary to the WWTP 0.9317
e. WWTP facility's actual avg. flow 3.144
f. Total flow for this specific request 0.015
g. Total actual and obligated flows to the facility 4.031
h. Percent of permitted flow used 71.3%
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, * (Firm / pt), Avg. Daily Daily Flow, Obligated Available
Number) No, MGD MGD Flow, MGD MGD Flow Capacity***
Arbors WQ36203 0.5688 0.2275 0.0269 0.0208 0.0477 0.1798
* 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
(po 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
between the project connection point and the WWTP where the A
Downstream Facility Name (Sewer): Unk
Downstream Permit Number: WQ0038698
Page 1 of 6
Capacity is < 0. \
FTSE 1

III. Certification Statement:
I Joshua Baird certify to the best of my knowledge that the addition of
the volume of wastewater to be permitted in this project has been evaluated along the route to the receiving
wastewater treatment facility and that the flow from this project is not anticipated to cause any capacity
related sanitary sewer overflows or overburden any downstream pump station en route to the receiving
treatment plant under normal circumstances, given the implementation of the planned improvements
identified in the planning assessment where applicable. This analysis has been performed in accordance
with local established policies and procedures using the best available data. This certification applies to
those items listed above in Sections I and II plus all attached planning assessment addendums for which I
am the responsible party. Signature of this form certifies that the receiving collection system or treatment
works has adequate capacity to transport and treat the proposed new wastewater.
3/7/2023
ing Official Signature Date
Engineering Director
Title of Signing Official
Page 2 of 6
FTSE 10-18

PLANNING ASSESSMENT ADDENDUM (PAA)
Submit a planning assessment addendum for each pump station listed in Section II where Available Capacity is <
0.
Pump Station (Name or Number):
Given that:
a. The proportion and amount of Obligated, Not Yet Tributary Daily Flow (C) accounts for
% and MGD of the Available Capacity (E) in Pump Station
; and that
b. The rate of activation of this obligated, not yet tributary capacity is currently approximately
MGD per year; and that
c. A funded Capital Project that will provide the required planned capacity, namely
is in design or under construction with
planned completion in ; and/or
d. The following applies:
Therefore:
Given reasonably expected conditions and planning information, there is sufficient justification to allow
this flow to be permitted, without a significant likelihood of over -allocating capacity in the system
infrastructure.
I understand that this does not relieve the collection system owner from complying with G.S. 143-
215.67(a) which prohibits the introduction of any waste in excess of the capacity of the waste disposal
system.
Signing Official Signature
Page 3 of 6
Date
FTSE 10-18

NC Dept of Environmental Quality
DWR
Division of Water Resources
MAR 14 2023
State of North Carolina
Department of Environmental Quality
Raleigh Regional Office Division of Water Resources
15A NCAC 02T .0300— FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
INSTRUCTIONS FOR FORM: FTA 04-16 & 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 NCACQ2T and the Division's
Minimum Design Criteria a;7d 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 available upon request by the Division.
Projects that are deemed permitted (do not require a permit from the Division) are explained in I SA NCAC 02T.0303.
Projects not eligible for review via the fast track process (must be submitted for full technical review):
➢ Projects that require an environmental assessment in accordance with 15A NCAC I C .0100;
➢ Projects that do not meet any part of the minimum design criteria (MDC) document;
➢ Projects that involve a variance from the requirements of 15A NCAC 2T;
y Pressure sewer systems utilizing septic tank effluent pumps (STEPs) or simplex grinder pumps;
➢ 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 of Application and Supporting Documents
® Required unless otherwise noted
B. Cover Letter (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.
i If necessary for clarity, include attachments to the application form.
C. Application Fee (All New and Major Modification Application Packages):
® Submit a check or money order in the amount of $480.00 dated within 90 days of application submittal.
L Payable to North Carolina Department of Environmental Quality (NCDEQ)
D. Fast Track (Form: FTA 04-16) Application (Required for All Application Packages):
® 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/bia, enclose a copy of the certificate filed with the Register of
Deeds in the county of business.
® The Project Name in Item 11.1 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 04-16 & SUPPORTING DOCUMENTATION Page 1 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.
i 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 1 l-inch color copy of a USGS Topographic Map of sufficient scale to identify the entire project
area and closest surface waters.
Location of the project (gravity sewer, pump stations & force main)
Downstream connection points and permit number (if known) for the receiving sewer
® Include a street level map (aerial) showing general project area so that Division staff can easily locate it in the field.
G. Existing Permit (All Modification Packages):
❑ Submit the most recently issued existing permit.
❑ Provide a list of any items within the permit the Applicant would like the Division to address during the permit
modification (i.e., permit description, flow allocation, treatment facility, etc.).
H. Power Reliability Plan (Required if portable reliability option utilized for Pump Station);
❑ Per 15A NCAC 02T .0305(h)(�, submit documentation of power reliability for pumping stations.
i 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)
1. Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per 15A NCAC 02T .01 15(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 acid 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 HOAIPOA and Developers for lots to be sold):
❑ HomelPropegy Owners' Associations
❑ Per 15A NCAC 02T .0115(c), submit the properly executed Operational Agreement (FORM: HOA?.
❑ Per 15A NCAC 02T .0 i 15(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
p Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(b), submit the properly executed Operational Agreement (FORM: DEV).
For more information, visit the Division's collection systems websile
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 2 of 3

The Nau Company
Consulting Civil Engineers
NC Dept of Environmental Quality
NC Department of Environmental Quality
Division of Water Resources MAR 14 � P3
Raleigh Regional Office
RE: Walk at East Village — Phase 4 Raleigh Regional Office
To whom it may concern:
Attached are the required documents for the permitting of the gravity sanitary sewer line
required for the Walk at East Village Phase 4 project located in Clayton, NC. Below is a summary
of the system to be permitted:
System Name: Walk at East Village — Phase 4
Homes served: 60
Flow allocation required: 15,000 GPD
Pipe data: 436 LF of 8" C-900 gravity sanitary sewer
1,144 LF of 8" SDR-35 PVC gravity sanitary sewer
If you have any questions or concerns, please let me know.
Sincerely,
The Nau Company, FLLC
PO Box 810 / Rolesville, North Carolina 27571 / [phone]

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ACCENT
CORPORATI GRAPI-4ICS
LETTER OF TRANSMITTAL
8121 Brownleigh Drive Raleigh, NC 27617
919/782-3332 800/280-0755 919/783-0702 Fax
To: NCDEQ Raleigh Regional Office Date: 3/13/2023
Water Quality SectionNC Dept of Environmendpl�" Raleigh Regional Office
3800 Barrett Drive Job Name: Walk at East Village Phase 4
Raleigh, NC 27609 Job #: 20230313-047
MAR 14 2023 Per: Jon Eakins
Entered By: Zach
Raleigh Regional Office
WE ARE SENDING YOU THE FOLLOWING ITEM(S):
Qty Unit Description
3 Set (s) b&w 8.5x11 bound
2 color line 8.5x11 bound
Misc. Notes:
Received By: Date:
-,3.-;;St.
Delivered By:
Time:
If you have any questions about this order please call and ask for the Production Manager

WO
�d

NC Dept of Environmental Quality
DWR
Division of Water Resources
MAR 14 2023
' MT . JI ,T,fir: �
State of North Carolina
Department of Environmental Quality
Division of Water Resources
STEM EXTENSION APPLICATION
SUPPORTING DOCUMENTATION
Application Number:i C� t0`(' 4 7-1 S (to be completed by DWR)
All items must be completed or the application wW be returned
1. APPLICANT INFORMATION:
1. Applicant's name: Town of Clayton (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ® State/County ❑ Municipal
3. Signature authority's name: Jonathan Jacobs per 15A NCAC 02T .0106(b)
Title: Assistant Engineering Director
4. Applicant's mailing address: PO Box 879
City: Cla on State: NC Zip: 27528-
5. Applicant's contact information:
Phone number: [phone] Email Address: inacobsRtownofclaytonnc.org
II. PROJECT INFORMATION:
qPP
;--,,r
❑ Privately -Owned Public Utility
❑ Other
1. Project name: Walk at East Village - Phase 4
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ00 and issued date:
If new construction but part of a master plan, provide the existing permit number: WQ00
3. County where project is located: Johnston
4, Approximate Coordinates (Decimal Degrees): Latitude: 35.642508' Longitude:-78.443888"
5. Parcel iD (if applicable): 166807-59-0985
(or Parcel LD to closest downstream sewer)
III. CONSULTANT INFORMATION:
I. Professional Engineer: Brian O'Kane License Number: 037468
Firm: The Nau Company, PLLC
Mailing address: PO Box 810
City: Rolesville State: NC Zip: 27571-
Phone number: [phone] Email Address: bokaneathenauco.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
I. Facility Name: Little Creek WRF Permit Number: 00-02084
Owner Name: TowG of Clayton
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ 00 38698 Downstream (Receiving) Sewer Size: 8 inch
System stem Wide Collection System Permit Number(s) {if applicable): WQCSOOI 10
Owner Name(s): Town of Clayton
FORM. FTA 04-16
Pagel of 5

VI, GENERAL REQUIREMENTS
L If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes [:]No MI/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 Sl/A
3. If the Applicant is a Home/Property Owners' Association, has an Operational Agreement (FORM: FIOA) been attached?
❑ Yes []No Bi/A
4. Origin of wastewater: (check all that apply):
® Residential Owned ❑ Retail (stores, centers, malls) ❑ Car Wash
❑ Residential Leased ❑ Retail with food preparation/service ❑ Hotel and/or Motels
❑ School / preschool / day care ❑ Medical / dental / veterinary facilities ❑ Swimming Pool /Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 % Domestic/Commercial % Commercial
% Industrial (See 15A NCAC 02T.0103(201)
NIs there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCACO2T .0114(f)? ®Yes []No
7 If yes, Provide_a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 021,01140
Daily Design Flow a,n
No. of Units
Flow
60 Single Family Homes
250 gal/day
60
15,000 GPD
gall
GPD
gall
GPD
gall
GPD
gall
GPD
gall
GPD
Total
15,000 GPD
a See 15A NCAC 021 .01 l4lbL (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 .0l 14(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 measureddata.
8. Wastewater generated by project: 15,000 GPD (per 15A NCAC 02T .0114)
D 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 PermitNumber:
❑ Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain):
FORM: PTA 04-16 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
8
436
C-900 PVC
8
1,144
SDR-35 PVC
i Section 11 & Ili of the MDC for Permitting of Gravity Sewers contains information related to design criteria
Section Ill contains information related to minimum slopes for gravity sewer(s)
Y Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: -
3. Design flow of the pump station: millions gallons per day (Firm capacity)
4. Operational point(s) of the pump(s): eallons per minute at feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
6. Power reliability in accordance with 15A NCAC _02T.0305(h)(I):
❑ Standby power source or pump with 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
D Must be permanent to facility
Or if the pump station has an average daily Flow less than 15,000 gallons per day:
❑ Portable power source with manual activation, quick -connection receptacle and telemetry - 15A NCAC 02T
.0305(h)(1)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry - 15A NCAC 02T .0305(h)(1)(C):
Y It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant (draft agrecment)
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
in the case of a multiple station power outage.
FORM: FTA 04-16 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations found in 15A NCAC 02T .0305 &
�- 15A NCAC 02T.0305(f) contains minimum senarations that shall he nrovided for sewer systems-
® Yes ❑ No
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 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 1I impounded reservoirs used as a source of drinking water
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 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
Y I SA NCAC 02T.0305(Q} contains alternatives where separations in 02T.0305tf) cannot be achieved.
D *'"Stream classifications can be identified using the Division's NC Surface Water Classifications webpaae
r If noncompliance with 02T.0305(o or (¢). see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feetof separation) ® Yes ❑ No ❑ MA
Y 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
Y As built documents should reference the location of areas effected
3. Does the project comply with setbacks found in the river basin rules per I SA NCAC 02B.0200? X
Yes ❑ No ❑ N?A
This would include Trout Buffered Streams per 15A NCAC 2B,r0202
4. Does the project require coverage/authorization under a 404 Nationwide or Yes No
individual permits or 401 Water Quality Certifications?
7 Information can be obtained from the 401 & Buffer Permitting Br4pch
5. Does project comply with 15A NCAC 02T.0105(c)(6] (additional permits/certifications)? XYes ❑ No
Per 15A NCAC 02T_0105(c)f6), directly related environmental permits or certification applications are being prepared, have
been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion and
sedimentation control plans, stormwater management plans, etc.).
6. Does this project include any sewer collection lines that are deemed "high -priority?"
Per l5A NCAC 02T.04021 "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 ❑ MA
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

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permittingof f Pump Stations
and Farce Mains (latest version), and the Gravity Sewer Minimum Design Criteria (latest version) asapplicable?
® Yes ❑ No
If No, complete and submit the Variance/Altemative Design Request application (VADC 10-14) and supporting documents for
review. Approval of the request is required prior to submittal of the Fast Track Anplicatiou and supportin¢ documents.,
2. Professional Engineer's Certification:
I� Brian T. O'Kane attest that this application for
(Professional Engineer's name from Application Item 11I.1.)
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 143-215.613, 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.
nfirry�fr•
North Carolina Professional Engineer's seal, signature, and date:
Certification per 1
(Signature
02T .0106(b):
ty's name & title from
that this application for
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 143-215.6B, 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 excAed $10,000 as well as civil penalties up to $25,000 per violation.
Date: 90lozw
FORM: FTA 04-16 Page 5 of 5