WQ0044561_Application (FTSE)_20230626

State of North Carolina DWR JUL 7 2023 Department of Environmental Quality
Division of Water Resources
Division of Water Resources Raleigh Regional Offi�T TRACK SEWER SYSTEM EXTENSION APPLICATIONFTA 06-21 & SUPPORTING DOCUMENTATION
Application Number: M,?4? W'f,fS"7/ (lo he cmnplcl�-d hy DWR)
All items must be completed or the application will be returned
I.APPLICANT INFORMATION:
I.Applicant's name: Glenwood Homes. LLC (company, municipality, HOA, utility, etc.)
2.Applicant type: 0 Individual 12]Corporation D General Partnership
0 Federal O State/County O Municipal
D Privately-Owned Public Utility
D Other
3.Signature authority's name: Mitchell T Murphy per 15A NCAC 02T .0106(h)
Title: Managing Member
4.Applicant's mailing address: PO 90427
City: Raleigh State: NC Zip: 27675-__
5.Applicant's contact infonnation:
Phone number: [phone] Email Address: [e-mail]
II.PROJKCT INFORMATION:
I.Project name: Camel Street TO\vnhomes -Units 1-6
2.Application/Project status: C8] Proposed (New Permit)D Existing Pcnnit/Pr�jcct
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: Johnston
4.Approximate Coordinates (Decimal Degrees): Latitude: 35.35460'Longitude: -78.45315°
5.Parcel ID (if applicable): 05E99012C (or Parcel ID to closest downstream sewer)
Ill. CONSULTANT INFORMATION:
I.Professional Engineer: Andrew Hodge. PE
Finn: Adams & Hodge Engineering, PC
Mailing address: 3 I 4 I:ast Main Street
City: Clayton State: NC Zip: 27520-__
License Number: 21094
Phone number: [phone] Email Address: [e-mail]
IV.WASTEWATER TREATMENT FACILITY (WWTF) INFOR MATION:
l.Facility Name: Little Creek WWTP Permit Number: 0025433
Owner N amc: Town of Clayton
V.RECEIVING DOWNSTREAM SEWER INFORMATION:
I.Pennit Number(s): WQ0042722
2.Downstream (Receiving) Sewer lnfonnation: B. inch lxl Gravity LJ Force Main
3.System Wide Collection System Pennit Numbcr(s)(ifapplicablc): WQCS00! 10
Owner Namc(s): Town of Clayton
FORM: FTA 06-21 Page l of 5