WQ0044799_Application (FTSE)_20231011

NORRIS & TUNSTALL
CONSULTING ENGINEERS P.C.
J. Phillip Norris, P.E.
John S. Tunstall, P.E.
T. Jason Clark, P.E.
Joseph K. Bland, P.E.
Robbie P. Hennelly, E.I.
2602 Iron Gate Drive, Suite 102 • Wilmington, NC 28412 • Phone [phone] • Fax [phone]
1429 Ash Little River Road NW • Ash, NC 28420-1715 • Phone [phone] • Fax [phone]
LETTER OF TRANSMITTAL
To:
NC DEQ / DWR Matthew Nevills
Water Quality Section — PERCS UNIT
512 N. Salisbury St.,
Archdale Bldg. 9th Floor Suite 925
Raleigh, NC 28604
Date: October 9, 2023
Subject• 1605 Southport -Supply
Road Sewer Extension
Job No.
23092
WE ARE SENDING YOU VIA Fed ex
❑ ATTACHED ❑ UNDER SEPARATE COVER
❑ SHOP DRAWINGS ❑ PRINTS ❑ CERTIFICATION
❑ SPECIFICATIONS ❑ DISKS ❑ COPY OF LETTER
❑ILreceiving
FAX TRANSMITTAL: NUMBER OF PAGES
INCLUDING THIS TRANSMITTAL
Call 910-343-9653 if you have any difficulty
this message.
COPIES
DATE
NO.
DESCRIPTION
10-09-23
$600.00 Review Fee — Replacement Check (Norris Check #2809)
Fvr'AS REQUESTED
❑ FOR YOUR USE
❑ FOR REVIEW AND COMMENT
❑ FOR BIDS DUE
REMARKS: Previously sent review fee 480.00 (Norris Check #2803 )
❑ FOR APPROVAL
❑ YOUR PRINTS LOANED TO US
CC: Jeff Satterwhite J. Phillip Norris, P.E. J. Phillip Norris, P.E.
CONFIDENTIAL AND PRIVILEGED: Information contained in this document is privileged and confidential, intended for the sole use of the addressee.
If you are not the addressee or the person responsible for delivering it to the addressee you are hereby notified that any dissemination, distribution or
copying of this document is strictly prohibited. If you have received this document in error, please immediately notify the sender and return to the
address above.

NORRIS & TUNSTALL
CONSULTING ENGINEERS P.C.
2602 Iron Gate Dr. Suite 102
Wilmington, NC 28412
[phone]
[phone] Fax
John S. Tunstall, P.E.
T. Jason Clark, P.E.
Robbie P. Hennelly, E.I.
October 2, 2023
NC DEQ / DWR
Water Quality Section — PERCS UNIT
512 N. Salisbury St.,
Archdale Bldg. 9th Floor Suite 925
Raleigh, NC 28604
1429 Ash -Little River Road
Ash, NC 28420
[phone]
[phone] Fax
J. Phillip Norris, P.E.
Joseph K Bland, P.E.
RECEIVED
OCT 0 4 2023
Re: Alternative Sewer Extension Application (Private) NCDEQ/DWR/NPDES
Project Name: 1605 Southport -Supply Road Sewer Extension
N&T Project No. 23092
Dear Reviewer,
Enclosed please find a check in the amount of $480.00 (Norris Check #2803 ) for the processing
fee and the following copies:
• Two (2) 81/2 x 11 color USGS Topographic Maps
• ASEA —Original and (1) copy
• FTSE — Two (2) Copies
• Two (2) Copies of the Sewer Narrative
• Two (2) Copies of the Calculations
• Two (2) Copies of the Specifications
• Two (2) Set of Plans for the Above Referenced Project
Sincerely,
NORRIS & TUNSTALL
CONSULTING ENGINEERS, P.C.
(a 'OJJ�o �JQ_4-� /"Aicki
J. Phillip Norris, P.E.
J P N/ttw
23092 10-03-23-swr-Itr-peres
cc: Jeff Satterwhite
NCBELS License C-3641

SEWER NARRATIVE
1605 SOUTHPORT — SUPPLY ROAD SEWER EXTENSION
For
Centerline Development
Jeff Satterwhite
P.O. Box 11060, Southport, NC 28461
910-776-0044 / [e-mail]
N CAR
s% GIN OQ�
"••� yILLIP •��
t�rt�l �1/11111\\\Nib'
U OZ ZOL3
October 2023
Prepared by:
NORRIS & TUNSTALL CONSULTING ENGINEERS, P.C.
1429- Ash — Little River Road
Ash, North Carolina 28420
[phone] /[e-mail]
License # C-3641
N&T Project No. 23092
ti

NARRATIVE
SEWER SYSTEM:
This private sewer system is designed to service a general business office with 4
employees.
The system is comprised of 90 LF of 2" sewer forcemain and one Liberty Pump 2448
LGS.
This new system will owned and operated by Centerline Development.

` T4 C)9 a State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
15A NCAC 02T .0300 — ALTERNATIVE SEWER EXTENSION APPLICATION
Division of Water Resources INSTRUCTIONS FOR FORM: ASEA 04-16 & SUPPORTING DOCUMENTATION
Plans", specifications and supporting documents shall be prepared in accordance with, ISA NCAC 02T .0100, 15A NCAC 02T
.0300, Division Policies and good en<uineerina practices. Failure to submit all required items will necessitate additional
processing and review time, and may result in return of the application.
For more infonmation, visit the Water Quality Permitting Section's collection systems website
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.
Unless otherwise noted, the Applicant shall submit one original and one copy of the application and supporting documentation.
A. One Qriginal and One Copy of Application and Supporting Documents
FLK"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.
Y Be specific as to the system type, number of homes served, flow allocation required, etc.
➢ 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.
Y Payable to North Carolina Department of Environmental Quality (NCDEQ).
D. Alternative Sewer Extension (Form: ASEA 04-16) Application (Required for All Application Packages):
[L,S�u'bmit the completed and appropriately executed application.
➢ If necessary for clarity or due to space restrictions, attachments to the application may be made.
Cj'If the Applicant Type in Item I.2 is a corporation or company, provide documentation it is registered for business with
�] IfNorth Carolina Secretary of State. f'
e 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.
fhe project name in Item I1.1 shall be consistent with the project name on the plans, specifications, 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
C rolina licensed Professional Engineer.
Ef
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).
E. Section X & XI Attachment (If Applicable):
If the project includes gravity sewer, pump stations with multiple pumps and force mains, include the Section X & XI
attachment(s).
F. Flog racking/Acceptance Form (Form: FTSE 04-16) (If Applicable):
Submit the completed and appropriately executed Flow Tracking/Acceptance for Sewer Extension Permit Form from the
owners of the downstream sewers and treatment facility.
Y The flow acceptance indicated in form FTSE 04-16 must not expire prior to permit issuance and must be dated less than
one year prior to the application date.
Y Submittal of this application and form FTSE 04-16 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 04-16.
INSTRUCTIONS FOR FORM: ASEA 04-16 & SUPPORTING DOCUMENTATION Pagel of 4

G. Engi ering Plans (Required for All Application Packages):
Per 15A NCAC 02T .0305 b l , submit two sets of detailed plan sets that have been signed, sealed and dated by a North
Carolina licensed Professional lEngincer, and shall include at a minimum:
➢ Table of contents with each sheet numbered.
Y A general location map with at least two geographic references and a vicinity map.
➢ Plan and profile views of the sewer extension as well as the proximity of the sewer extension to other utilities and natural
features
➢ Detail drawings of all items pertinent to the sewer extension (including clean -out locations) and pump stations.
➢ The location of all wells (including usage and construction details if available), streams (ephemeral, intermittent, and
perennial), springs, lakes, ponds, and other surface drainage features within 100 feet of the project.
➢ Minimum separations required per 15A NCAC 02T.0305(o, and where separations cannot be maintained, alternative
criteria per 15A NCAC 021'.0305(g).
)-I Minimum cover for sewer extensions required per 15A NCAC 02T.0305(o must also be shown clearly on the plans.
);> Nodes/Zones listed in calculations and computer models must be accurately reflected on the plans.
➢ Plans must include lot numbers, zones, approximate pump and top of wet well elevations, and pump model number and
capacity in a table format.
Plans shall represent a completed design and not be labeled with preliminary phrases (e.g., FOR REVIEW ONLY, NOT
FOR CONSTRUCTION, etc.) that indicate they are anything other than final plans. However, the plans may be labeled
with the phrase: FINAL. DESIGN - NOT RELEASED FOR CONSTRUCTION.
H. Specifications (Required for All Application Packages):
Li-lPer 15A NCAC 02T .0305(b)(3), submit specifications that have been signed, sealed and dated by a North Carolina
licensed Professional Engineer, and shall include at a minimum:
➢ Table of contents with each section/page numbered.
➢ Detailed specifications for pump stations (i.e. packaged grinder pump requirements, valves, controls, etc.)
i= Site Work (i.e., earthwork, clearing, grubbing, excavation, trenching, backfrlling, compacting, fencing, seeding, etc.)
)o Materials (i.e., low pressure mains and laterals, force main, gravity, concrete, method of construction, etc.)
➢ Electrical (i.e., control panels, transfer switches, automatically activated standby power source, etc.)
➢ Means for ensuring quality and integrity of the finished product in accordance with the Minimum Design Criteria,
including leakage and pressure testing for the sewer extension.
❑ Specifications shall represent a completed design and not be labeled with preliminary phrases (e.g., FOR REVIEW
ONLY, NOT FOR CONSTRUCTION, etc.) that indicate they are anything other than final specifications. However, the
specifications may be .labeled with the phrase: FINAL DESIGN - NOT RELEASED FOR CONSTRUCTION.
❑ Specifications for standard equipment may only be omitted for municipalities with approved standard specifications, but
the use of the standard specifications must be noted on each sheet of the plans.
I. Eng!Peering Calculations (All Application Packages):
Per 15A NCAC 02T .0305(b)(2) and 15 A NCAC 02T .0305(N 1), submit engineering calculations that have been signed,
sealed and dated by a North Carolina licensed Professional Engineer, and shall include at a minimum:
➢ Friction/Total Dynamic Head calculations and system curve analysis (with one pump running, two pumps running, etc.)
➢ Pump selection information including pump curves, manufacturer's information, and recommended installation
guidelines.
➢ Pump station cycle times and pump run times.
➢ Minimum velocities in the sewer extension in accordance with the Minimum Design Criteria
➢ Flotation calculations for all units constructed partially or entirely below grade (i.e. pump stations)
❑ If computer models are provided to document system design, the model and corresponding node/zone nomenclature must
clearly and accurately reflect the plans and specifications.
Note that upon completion of the review process and prior to permit issuance, a request for the final plans and
specifications will be requested on digital media (CD, DVD, Jump Drive, etc.) for our records. You will be notified when
this information is requested, as the review may necessitate changes
INSTRUCTIONS FOR FORM: ASEA 04-16 & SUPPORTING DOCUMENTATION Page 2 of 4

J. Downstream Sewer Evaluations (All Application Packages)
❑ Per 15A NCAC 02'F .0305(b)(2) and 15A NCAC 02T .0304(h)(1), submit engineering calculations that have beenn signed,
sealed and dated by a North Carolina licensed Professional Engineer, for receiving collection systems:
❑ For connection to a gravity sewer, submit:
An evaluation of the gravity sewer based on peak flow from the proposed project and peak flows already tributary to the
existing gravity sewer. Provide calculations and detail how existing peak flows were determined.
❑ For connection to a pump station, submit:
An evaluation of the existing pump station to pump peak flow from the proposed project and peak flows already tributary
to the existing pump station. Provide calculations and detail how existing peak flows were determined.
❑ For connection to a force main/low pressures sewer, submit:
An evaluation of the existing system based on peak flows from the proposed project and peak flows already tributary to
the existing system. In addition, evaluate the ability of each pump station tributary to the existing system to pump against
additional head created by greater flows through the system. Evaluation may include alternative designs such as telemetry
to coordinate pumping between pump stations (provided sufficient storage is available). Also include an evaluation of
the discharge point of the existing force main/pressure sewer.
K. 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 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 showing general project area.
L. 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.).
M. Power Reliability Plan (All Application Packages):
❑ Per 15A NCAC 02T .0305 h 1 D , submit documentation of power reliability for simplex/vacuum units.
❑ 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)
N. Final Environmental Document (If Applicable):
❑ Per 15A NCAC 02T .0105 c 4 , submit one copy of the environmental assessment and one copy of the final
environmental document (i.e., Finding of No Significant Impact or Record of Decision).
❑ Include information on any mitigating factors from the Environmental Assessment that impact the design and/or
construction of the subject sewer.
O. 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.
INSTRUCTIONS FOR FORM: ASEA 04-16 & SUPPORTING DOCUMENTATION Page 3 of 4

State of North Carolina
D Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — ALTERNATIVE SEWER EXTENSION APPLICATION
Division of Water Resources ASEA 04-16 & SUPPORTING DOCUMENTATION
Application Number: (to be completed by t7w►t) N� aIsO a.
I. APPLICANT INFORMATION: 1/v Q 0 0 `U' 1 `� 7 9
1. Applicant's name: Centerline Development, Inc. (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ® Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State ❑ Municipal ❑ County
3. Signature authority's name: Jeffrey B. Satterwhite per 15A NCAC 02T .0106(b)
Title: President
4. Applicant's mailing address: P.O. Box 11060
City: Southport State: NC Zip: 28461
5. Applicant's contact information:
Phone number: C�10) 776-0044 Email Address: jefOgocenterline.com
IL PROJECT INFORMATION:
1. Project name: 1605 Southport -Supply Road Sewer Extension
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: Brunswick (Parcel #1850001004)
4. Approximate Coordinates (Decimal Degrees): Latitude: 33.9910 Longitude:-78.213'
III. CONSULTANT INFORMATION:
1. Professional Engineer: J. Phillip Norris, P.E. License Number: 11966
Firm: Norris & Tunstall Consulting Engineers, P.C.
Mailing address: 1429 Ash -Little River Road NW
City: Ash State: NC Zip: 28420-
Phone number: [phone] Email Address: pnorris(@ntenpineers.com
ntengineers.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: West Brunswictc WWRF Permit Number: W00023693
Owner Name: Brunswick County
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): W 0023693 (West Brunswick WWRF 16" FM)
System Wide Collection System Permit Number(s): WQCS00284
Owner Name(s): Brunwick County
FORM: ASEA 04-16 Pagel of5

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been submitted?
❑ 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 submitted?
❑ Yes ❑No ®N/A
3. If the Applicant is a Home/Property Owners' Association, has an Operational Agreement (FORM: HOA) been submitted?
❑ Yes ❑No ®N/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. Is/was an Environmental Assessment required under 15A NCAC 01C? ❑ Yes ❑ No
If yes, submit the appropriate final environmental document (FONSI, ROD, etc.)
6. Nature of wastewater: 100 % Domestic/Commercial0 % Other waste —specify:
0 % Industrial (See 15A NCAC 02T .0103(20))
7. Wastewater generated by project: 100 GPD (per 15A NCAC 02T .0114)
Hasa flow reduction been approved under 15A NCAC 02T .0114(fl? ❑ Yes ❑ No
If yes, provide a copy of approval
8. Summarize wastewater generated by project:
Establishment Type
Daily Design Flow'
No. of Units
Flow
General Business Office
25 gal/employee
4
100 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
100 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 .0I 14(c), design flow rates for establishments not identified below shall be determined using available
flow data, water using fixtures, occupancy or operation patterns, and other measured data.
FORM: ASEA 04-16 Page 2 of 5

VII. PRESSURE SEWER DESIGN CRITERIA — 15A NCAC 02T .0305:
1. Number of simplex pump stations (STEP tanks/effluent pumps, vacuum pits, etc.) provided: 1
2. What is the nearest 100-year flood elevation to the facility? 14.7 feet mean sea level.
Is any of the proposed project located within the 100-year flood plain? ❑ Yes ® No
3. If Yes, are the following items provided per 15A NCAC 02T .0305(e):
Water -tight seals on all station hatches and manholes; and
Control panels vents extend two feet above the 100-year flood plain elevation? ❑ Yes ❑ No ® N/A
If No, what measures are being taken to protect them against flooding?
4. Volume of storage in wet well above pump on elevation: 100 Gallons (include calculations)
5. How power reliability will be provided in accordance with 15A NCAC 02T .0305(h)(D):
® Wet well storage provides 24 hours worth of wastewater storage; or
❑ Wet well storage provides wastewater storage based on power reliability and response times
(See "Policy for Meeting Reliability Requirements")
➢ Provide 3 years of power history date in the area.
➢ Provide response time to replace a failed pump. This would include travel time, time to replace pump, etc.
➢ Wet well storage would be based on whichever is greater.
All other pump stations meet the reliability requirements of 15A NCAC 02T .0305(h)(1): ❑ Yes ❑ No ❑ N/A
6. Summarize simplex pump station design elements:
Design Element
Plan Sheet
Reference
Specification
Reference
Emergency Contact Placard or Sticker
C2
N/A
Screened Wet Well Vent
C2
N/A
Restricted Access Details
C2
N/A
Control Panel
C2
N/A
High Water Alarms (Audible & Visual)
C2
N/A
Valves (Check, Gate, etc)
C2
N/A
Air Relief Valves
N/A
N/A
7. Summarize the pipe length by diameter to be permitted. Lines from a building to the septic or pump tank should be excluded.
(provide attachments if necessary)
Zone
From Node
To Node
Diameter (in)
Length (feet)
# Pumps in Zone
Pump Model
Specified for Zone
2
90
1
Liberty Pump 2448
LGS
8. Air release valve station locations per 15A NCAC 02T .0305(i) (provide attachments if necessary)
Air Release Valve #
Station
Plan Sheet Reference
N/A
N/A
N/A
FORM: ASEA 04-16 Page 3 of 5

VIII. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(t)):
I. Does the project comply with all separations found in 15A NCAC 02T.0305(f) & (s) ® 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
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 II impounded reservoirs used as a source of drinking water
100 feet
**Waters classified WS (except WS-1 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
➢ 15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
➢ If noncompliance with 02T.0305(f) or (g). see Section IX of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ❑ Yes ❑ No ® N/A
➢ See the Division's draft separation requirements for situations where separation cannot be meet
➢ No variance is required if the alternative design criteria specified is utilized in design and construction
➢ As built documents should reference the location of areas effected
3. Does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ❑ Yes ❑ No ® N/A
➢ This would include Trout Buffered Streams per 15A NCAC 26.0202
4. Does the project require coverage/authorization under a 404 Nationwide or ❑ Yes ® No
individual permits or 401 Water Quality Certifications?
➢ Information can be obtained from the 401 &Buffer Permittine Branch
5. 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 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 15A NCAC 02T.0402, "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes 2No
➢ 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: ASEA 04-16 Page 4 of 5

IX. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 021, the Minimum Design Criteria for the Permitting of Pump Stations
and Force Mains (latest version), and the Gravity Sewer Minimum Design Criteria (latest version) as applicable?
® Yes ❑ No
If No, complete and submit the Variance/Alternative Design Request application (VADC 10-14) and supporting documents for
review. Approval of the request is required prior to submittal of the Fast Track Application and supportine documents.
2. Professional Engineer's Certification:
John Phillip Norris
attest that this application for
(Professional Engineer's name from Application Item III.1.)
1605 Southport -Supply Road Sewer Extension
(Facility name from Application Item II.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 this application package and its instructions, as
well as all applicable regulations and statutes. Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that I have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation.
North Carolina Professional Engineer's seal, signature, and date:
y�y2 `�NGtNEE 0A J
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I Jeffrey B. Satterwhite _
(Signature Authority's name & title from Application Item I.3.)
1605 Southport -Supply Road Sewer Extension
(Facility name from Application Item II.1.)
0
attest that this application for
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that any discharge of
wastewater from this non -discharge system to surface waters or the land will result in an immediate enforcement action that
may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water
Resources should a condition of this permit be violated. I also understand that if all required parts of this application package
are not completed and that if all required supporting information and attachments are not included, this application package
will be returned to me as incomplete. As the vermittee for the pressure sewer system, I understand I will be required to
own, maintain, and operate all individual pump stations.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fiAnot to,exceed W,000_4$_uwJLas civil ppnaffiq up to $25,000 per violation.
Signature: 0, Date: 9 Z& 'Z--3
FORM: ASEA 04-16 Page 5 of 5

"y'- � SAC,
N7 �- a3o1; a.
MUSGS1 ,(�rc U.S. DEPARTMENT OF THE INTERIOR _ NOOCKWOODS FOLLY QUADRANGLE
U.S. GEDLOGICAL SURVEY ►::US Tapo �GSfWRUTE5EU6KEAUNTY
,wn �M eM U tr.ykal Survey
..unxx.
xv unmmsw� m�v
SGLE 1rt2rt 000 m m
a..w-- C7.W� 0—
•� n LOCKWOODS FOLLY, NC

Entity Requesting Allocation:
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Centerline Development
Project Name for which flow is being requested: 1605 Southport SupplyRd (Private PS)
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 waste►vater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: _
b. WWTP Facility Permit #
WEST BRUNSWICK REGIONAL WWRF
WQ0023693
All flows are in MGD
c. WWTP facility's permitted flow
6.00
d. Estimated obligated flow not yet tributary to the WWTP
1.940
e. WWTP facility's actual avg. flow
4.204
f. Total flow for this specific request
0.00010
g. Total actual and obligated flows to the facility
6.144
h. Percent of permitted flow used
102.4%
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)
Design
Pump
Pump
Average
Approx.
Station
Station
Firm Daily Flow**
Current
(Name or
Permit
Capacity, * (Firm / p fl,
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***
* 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
(pi) 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 WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): West Brunswick Regional WWTF FM
Downstream Permit Number: WQ0023693
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I William L. Pinnix P.E., Dir of Engr 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.
Signing Official Signature
Title of Signing
Date
Page 2 of 6
FTSF. 10-1 R

- -X'- � 51A-e-,
P �- a30-; 1�.
X. 1 ,SGS U.S. DEPART
GEOLOOKK SURVEY RIOR
•: US§-Topo
5[KE 1M1000 � _
LOCKWOODS FOLLY QUADRANGLE
MGRTN —OU-- lRIWSW I. COUNTY
�.s.wNsrrt sEUEs
4
�.«r..«. LOCKWOODS FOLLY. NC

�T4,q,3oq
State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
15A NCAC 02T .0300 — ALTERNATIVE SEWER EXTENSION APPLICATION
Division of Water Resources INSTRUCTIONS FOR FORM: ASEA 04-16 & SUPPORTING DOCUMENTATION
Plan+ specifications and supporting documents shall be prepared in accordance with, 15A NCAC 02T .0100, 15A NCAC 02T
PlaA
.0300, Division Policies and eood engineering Practices. Failure to submit all required items will necessitate additional
processing and review time, and may result in return of the application.
For more information, visit the Water Quality Permitting Section's collection systems website
General — When submitting an application, please use the following instructions as a checklist in order to ensure all required items are
submitted. Adhererwe to these instructions and checking the provided boxes will help produce a quicker review time and reduce the
amount of requested additional information.
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
ELK'Required unless otherwise noted
B. Cover Letter (Required for All Application Packages):
ET'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.
➢ If necessary for clarity, include attachments to the application form.
C. App ' ation 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.
➢ Payable to North Carolina Department of Environmental Quality (NCDEQ).
D. Alterna ' Sewer Extension (Form: ASEA 04-16) Application (Required for All Application Packages):
ubmit the completed and appropriately executed application.
➢If necessary for clarity or due to space restrictions, attachments to the application may be made.
[I>I1f the Applicant Type in Item I.2 is a corporation or company, provide documentation it is registered for business with
e North Carolina Secretary of State.
LJ'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.
LY fhe project name in Item I1.1 shall be consistent with the project name on the plans, specifications, flow acceptance
letters, agreements, etc.
q,iT ie Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a North
olina 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).
E. Section X & X1 Attachment (If Applicable):
❑ If the project includes gravity sewer, pump stations with multiple pumps and force mains, include the Section X & XI
attachment(s).
F. Flo racking/Acceptance Form (Form: FTSE 04-16) (If Applicable):
Submit the completed and appropriately executed Flow Tracking/Acceptance for Sewer Extension Permit Form from the
owners of the downstream sewers and treatment facility.
➢ The flow acceptance indicated in form FTSE 04-16 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 04-16 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 04-16.
INSTRUCTIONS FOR FORM: ASEA 04-16 & SUPPORTING DOCUMENTATION Pagel of 4

G. En ' ' g Plans (Required for All Application Packages):
Ek"Per 15A NCAC 02T .0305 b 1 , submit two sets of detailed plan sets that have been signed, sealed and dated by a North
Carolina licensed Professional Engineer, and shall include at a minimum:
➢ Table of contents with each sheet numbered.
➢ A general location map with at least two geographic references and a vicinity map.
➢ Plan and profile views of the sewer extension as well as the proximity of the sewer extension to other utilities and natural
features
➢ Detail drawings of all items pertinent to the sewer extension (including clean -out locations) and pump stations.
➢ The location of all wells (including usage and construction details if available), streams (ephemeral, intermittent, and
perennial), springs, lakes, ponds, and other surface drainage features within 100 feet of the project.
➢ Minimum separations required per 15A NCAC 02T.0305(f), and where separations cannot be maintained, alternative
criteria per 15A NCAC 02T.0305(g).
➢ Minimum cover for sewer extensions required per 15A NCAC 02T.0305(f) must also be shown clearly on the plans.
➢ Nodes/Zones listed in calculations and computer models must be accurately reflected on the plans.
➢ Plans must include lot numbers, zones, approximate pump and top of wet well elevations, and pump model number and
capacity in a table format.
❑ Plans shall represent a completed design and not be labeled with preliminary phrases (e.g., FOR REVIEW ONLY, NOT
FOR CONSTRUCTION, etc.) that indicate they are anything other than final plans. However, the plans may be labeled
with the phrase: FINAL. DESIGN - NOT RELEASED FOR CONSTRUCTION.
H. Specifications (Required for All Application Packages):
61-fer 15A NCAC 02T .0305(b)(3), submit specifications that have been signed, sealed and dated by a North Carolina
licensed Professional Engineer, and shall include at a minimum:
➢ Table of contents with each section/page numbered.
➢ Detailed specifications for pump stations (i.e. packaged grinder pump requirements, valves, controls, etc.)
➢ Site Work (i.e., earthwork, clearing, grubbing, excavation, trenching, backfilling, compacting, fencing, seeding, etc.)
➢ Materials (i.e., low pressure mains and laterals, force main, gravity, concrete, method of construction, etc.)
➢ Electrical (i.e., control panels, transfer switches, automatically activated standby power source, etc.)
➢ Means for ensuring quality and integrity of the finished product in accordance with the Minimum Design Criteria,
including leakage and pressure testing for the sewer extension.
❑ Specifications shall represent a completed design and not be labeled with preliminary phrases (e.g., FOR REVIEW
ONLY, NOT FOR CONSTRUCTION, etc.) that indicate they are anything other than final specifications. However, the
specifications may be labeled with the phrase: FINAL DESIGN - NOT RELEASED FOR CONSTRUCTION.
❑ Specifications for standard equipment may only be omitted for municipalities with approved standard specifications, but
the use of the standard specifications must be noted on each sheet of the plans.
I. En ering Calculations (All Application Packages):
Per 15A NCAC 02T .0305(b)(2) and 15A NCAC 02T .03056)(1), submit engineering calculations that have been signed,
sealed and dated by a North Carolina licensed Professional Engineer, and shall include at a minimum:
➢ Friction/Total Dynamic Head calculations and system curve analysis (with one pump running, two pumps running, etc.)
➢ Pump selection information including pump curves, manufacturer's information, and recommended installation
guidelines.
➢ Pump station cycle times and pump run times.
➢ Minimum velocities in the sewer extension in accordance with the Minimum Design Criteria
➢ Flotation calculations for all units constructed partially or entirely below grade (i.e. pump stations)
❑ If computer models are provided to document system design, the model and corresponding node/zone nomenclature must
clearly and accurately reflect the plans and specifications.
Note that upon completion of the review process and prior to permit issuance, a request for the final plans and
specifications will be requested on digital media (CD, DVD, Jump Drive, etc.) for our records. You will be notified when
this information is requested, as the review may necessitate changes
INSTRUCTIONS FOR FORM: ASEA 04-16 & SUPPORTING DOCUMENTATION Page 2 of 4

J. Downstream Sewer Evaluations (All Application Packages)
❑ Per 15A NCAC 02T .0305(b)(2) and 15A NCAC 02T .0304(h)(1), submit engineering calculations that have been signed,
sealed and dated by a North Carolina licensed Professional Engineer, for receiving collection systems:
❑ For connection to a gravity sewer, submit:
An evaluation of the gravity sewer based on peak flow from the proposed project and peak flows already tributary to the
existing gravity sewer. Provide calculations and detail how existing peak flows were determined.
❑ For connection to a pump station, submit:
An evaluation of the existing pump station to pump peak flow from the proposed project and peak flows already tributary
to the existing pump station. Provide calculations and detail how existing peak flows were determined.
❑ For connection to a force main/low pressures sewer, submit:
An evaluation of the existing system based on peak flows from the proposed project and peak flows already tributary to
the existing system. In addition, evaluate the ability of each pump station tributary to the existing system to pump against
additional head created by greater flows through the system. Evaluation may include alternative designs such as telemetry
to coordinate pumping between pump stations (provided sufficient storage is available). Also include an evaluation of
the discharge point of the existing force main/pressure sewer.
K. 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 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 showing general project area.
L. 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.).
M. Power Reliability Plan (All Application Packages):
❑ Per 15A NCAC 02T ,0305(h)(1)(D), submit documentation of power reliability for simplex/vacuum units.
❑ 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)
N. Final Environmental Document (If Applicable):
❑ Per 15A NCAC 02T .0105 c 4 , submit one copy of the environmental assessment and one copy of the final
environmental document (i.e., Finding of No Significant Impact or Record of Decision).
❑ Include information on any mitigating factors from the Environmental Assessment that impact the design and/or
construction of the subject sewer.
O. 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.
INSTRUCTIONS FOR FORM: ASEA 04-16 & SUPPORTING DOCUMENTATION Page 3 of 4

DWR "0,
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — ALTERNATIVE SEWER EXTENSION APPLICATION
ASEA 04-16 & SUPPORTING DOCUMENTATION
Application Number:
I. APPLICANT INFORMATION:
(to be completed by DWR) 1 19* 011sO�
1. Applicant's name: Centerline Development, Inc. (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ® Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State ❑ Municipal ❑ County
3. Signature authority's name: Jeffrey B. Satterwhite per 15A NCAC 02T .0106(b)
Title: President
4. Applicant's mailing address: P.O. Box 11060
City: Southport State: NC Zip: 28461-
5. Applicant's contact information:
Phone number: [phone] Email Address: jef(a,cocenterline.com
IT. PROJECT INFORMATION:
1. Project name: 1605 Southport -Supply Road Sewer Extension
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: Brunswick (Parcel 91850001004)
4. Approximate Coordinates (Decimal Degrees): Latitude: 33.9910 Longitude:-78.213'
III. CONSULTANT INFORMATION:
1. Professional Engineer: J. Phillip Norris, P.E. License Number: 11966
Firm: Norris & Tunstall Consulting Engineers, P.C.
Mailing address: 1429 Ash -Little River Road NW
City: Ash State: NC Zip: 28420-
Phone number: C910) 287-5900 Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: West Brunswick WWRF Permit Number: W00023693
Owner Name: Brunswick County
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): W00023693 (West Brunswick WWRF 16" FM)
System Wide Collection System Permit Number(s): WQCS00284
Owner Name(s): Brunwick County
FORM: ASEA 04-16 Pagel of 5

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been submitted?
[:]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 submitted?
❑ Yes [-]No ®N/A
3. If the Applicant is a Home/Property Owners' Association, has an Operational Agreement (FORM: HOA) been submitted?
❑ Yes ❑No ®N/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. Is/was an Environmental Assessment required under 15A NCAC 01C? ❑ Yes ❑ No
If yes, submit the appropriate final environmental document (FONSI, ROD, etc.)
6. Nature of wastewater: 100 % Domestic/Commercial0 % Other waste —specify:
0 % Industrial (See 15A NCAC 02T .0103(20))
7. Wastewater generated by project: 100 GPD (per 15A NCAC 02T .0114)
Has a flow reduction been approved under 15A NCAC 02T .0114(fl? ❑ Yes ❑ No
If yes, provide a copy of approval
8. Summarize wastewater generated by project:
Establishment Type
Daily Design Flow s
No. of Units
Flow
General Business Office
25 gal/employee
4
100 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
100 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 .0I 14(c), design flow rates for establishments not identified below shall be determined using available
flow data, water using fixtures, occupancy or operation patterns, and other measured data.
FORM: ASEA 04-16 Page 2 of 5

VII. PRESSURE SEWER DESIGN CRITERIA —15A NCAC 02T .0305:
1. Number of simplex pump stations (STEP tanks/effluent pumps, vacuum pits, etc.) provided: 1
2. What is the nearest 100-year flood elevation to the facility? 14.7 feet mean sea level.
Is any of the proposed project located within the 100-year flood plain? ❑ Yes ® No
3. If Yes, are the following items provided per 15A NCAC 02T .0305(e):
Water -tight seals on all station hatches and manholes; and
Control panels vents extend two feet above the 100-year flood plain elevation? ❑ Yes ❑ No ® N/A
If No, what measures are being taken to protect them against flooding?
4. Volume of storage in wet well above pump on elevation: 100 Gallons (include calculations)
5. How power reliability will be provided in accordance with 15A NCAC 02T .0305(h)(D):
® Wet well storage provides 24 hours worth of wastewater storage; or
❑ Wet well storage provides wastewater storage based on power reliability and response times
(See "Policy for Meeting Reliability Requirements")
➢ Provide 3 years of power history date in the area.
➢ Provide response time to replace a failed pump. This would include travel time, time to replace pump, etc.
➢ Wet well storage would be based on whichever is greater.
All other pump stations meet the reliability requirements of 15A NCAC 02T .0305(h)(1): ❑ Yes ❑ No ❑ N/A
6. Summarize simplex pump station design elements:
Design Element
Plan Sheet
Reference
Specification
Reference
Emergency Contact Placard or Sticker
C2
N/A
Screened Wet Well Vent
C2
N/A
Restricted Access Details
C2
N/A
Control Panel
C2
N/A
High Water Alarms (Audible & Visual)
C2
N/A
Valves (Check, Gate, etc)
C2
N/A
Air Relief Valves
N/A
N/A
7. Summarize the pipe length by diameter to be permitted. Lines from a building to the septic or pump tank should be excluded.
(provide attachments if necessary)
Zone
From Node
To Node
Diameter (in)
Length (feet)
# Pumps in Zone
Pump Model
Specified for Zone
2
90
1
Liberty Pump 2448
LGS
8. Air release valve station locations per 15A NCAC 02T .0305(i) (provide attachments if necessary)
Air Release Valve #
Station
Plan Sheet Reference
N/A
N/A
N/A
FORM: ASEA 04-16 Page 3 of 5

VIII. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T.0305(f)):
1. Does the project comply with all separations found in 15A NCAC 02T.0305(f) & (g) ® Yes ❑ No
➢ 15A NCAC 02T.0305(fl contains minimum separations that shall be provided for sewer systems:
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 II 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
➢ 15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
➢ If noncompliance with 02T.0305(f) or (g), see Section IX of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ❑ Yes ❑ No ®N/A
➢ See the Division's draft separation requirements for situations where separation cannot be meet
➢ No variance is required if the alternative design criteria specified is utilized in design and construction
➢ As built documents should reference the location of areas effected
3. Does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ❑ Yes ❑ No ® N/A
➢ This would include Trout Buffered Streams per 15A NCAC 213.0202
4. Does the project require coverage/authorization under a 404 Nationwide or ❑ Yes ® No
individual permits or 401 Water Quality Certifications?
➢ Information can be obtained from the 401 & Buffer Permitting Branch
5. 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 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 15A NCAC 02T.0402, "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes KNo
➢ 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: ASEA 04-16 Page 4 of 5

IX. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Pump Stations
and Force Mains (latest version), and the Gravity Sewer Minimum Design Criteria (latest version) as applicable?
® Yes ❑ No
If No, complete and submit the Variance/Alternative Design Request application (VADC 10-14) and supporting documents for
review. Approval of the request is required prior to submittal of the Fast Track Application and supporting documents.
2. Professional Engineer's Certification:
I, John Phillip Norris attest that this application for
(Professional Engineer's name from Application Item III.1.)
1605 Southport -Supply Road Sewer Extension
(Facility name from Application Item H.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 this application package and its instructions, as
well as all applicable regulations and statutes. Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that I have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation.
North Carolina Professional Engineer's seal, signature, and date:CAR
U
O.
GI Nf��
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I, Jeffrey B. Satterwhite _attest that this application for
(Signature Authority's name & title from Application Item 1.3.)
1605 Southport -Supply Road Sewer Extension
(Facility name from Application Item 11.1.)
has been reviewed by me and is accurate and complete to the best of my knowledge. 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. As the permittee for the pressure sewer system I understand I will be required to
own maintain and operate all individual pump stations.
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 fiAnot to,exceed SK,000g&wzlLas civil penalties up to $25,000 per violation.
Signature:
Date: 9 — zG -aa
FORM: ASEA 04-16 Page 5 of 5