WQ0044803_Application (FTSE)_20231009

wo 00 C-1 q90 3
Hood Richardson, PA Cs76
110 West Second street
Washington, N. C. 27889
252-975-3472
October 9, 2023
NC Department of Environmental {duality
Division of Water Resources
943 Washington Square Mall
Washington, N. C. 27889
RE: Application for Gravity Sewer Extension
City of Washington Treatment Plant
Laurcour Farms, Inc.
North Market Street Square
Gentlemen:
RRCEMMCDENWWR
OCT - 9 ?0213
Water Quality
Regional Operatlons Section
Washington Regional Ofhce
l_
This is an application for additional capacity to ad 8 residential lots to the City of Washington's
Sewage Treatment System (NC00 20648.There will be 480 feet of new gravity sewage
collection pipe. The increase in flow will be 2,880 gallons per day.
Included in this package are the following.
1. Check in the amount of $480.00
2. Two copies of the following -
Plans with cross section of proposed sewer line
Location map
Photo of area
8.5 by 11 inch sheet with part of Old Ford Quadrangle
Check sheet for Fast Track Application
Form FTA 06-21
Down stream Flow Tracking for Sewer Extension forms
Calculations
Sincerely yours,
Hood L. Richardson, PE

O6��gv3
State of North Carolina
r - vvvlll Department of Environmental Quality
_ Division of Water Resources
tom_ t._ RECEIVED/NCDENRIDWR
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 06-21 & SUPPORTING DOCUMENTATION
LULJ
Application Number: (to be completed by DwR)
Wdwf uuallry
All ite R QMR or the application will be returned
I. APPLICANT INFORMTION:
D� Gv�s�f+�T�
1. Applicant's name: company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State/County *unicipal
3. Signature authority's name: o_per 15ANCACO2T.0106(b)
Title: 1 I' y /t/1 fl H/i yprt
4_ A��ppH� is address:
WrSlyJw h%
city: State: zip: 7 9
❑ Privately -Owned Public Utility fif Ile
❑ Other
-!{ v
5. Applicants �S ormaFif— q 3%% / inldU �i4rZ� Sn ���!� ���� ✓
Phone number. (_� _- Y( mail Address: r `
11. PROJECT INFORMATION:
1. Project name:.
80 1<T# M,� n-rc�r Sri fi -f
2. Application/Project status: [Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number. WQ00 and issued date:
For modifications, also attach a detailed narrative description as described in Item G of the checklist.
If new construction, but part of a master plan, provide the existing permit number WQ00 .L 0 6
3. County where project is located: � �d 3S, 62-77 /� -�'� ©3
4. Approximate Coord' (Decimal 9�): Latitude: Longitude: - f
5. Parcel ID (if ap�Sle)r Y �(or-Parcg to closest downstream sewer)
III. CON -'Al ]IN�FOR1ViATION• /
1. ProXssional Engine s ZSU License Number. lit 1/ g
Firm: _&i/ tz d� .SOH/
�MaflinLy address: I /U S r S. Q LO ST'
city: 7� ate:C zip:
x-�- q� 7 �7 Email Address:
�� r I GA 4R S 0 �,'g `P'�` R D 6J All,
Phone nufuber. (� _ m dres
IV. WASTEWATER TREA CIE FACILITY g� INFORMATION•
CT , —A Z,4-j WLAv
1. Facility Nam Permit Number. �� 2ffs`t`
Owner Name: C i f V ry j= WA
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Nimmber(s): WQ
2. Downstream (Receiving) Sewer Information: 00 inch XGravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS.
Owner Name(s): C r q 0`F (104S /- ('V ft�—
FORM: FTA 06-21 Pagel of 5 r

VL GENERAL REQi11REWNTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑ No XN/A
2. If the Applicant is a Developer of lots to be sold, has a Develo 's Operational Agreement (FORM: DE been attached?
❑ Yes ❑ No N/A
3. If the Applicant is a Home/Property Owners' Association, has an HOA/POA Operational Agreement (FORM: HOA) and
supplementary documentation as required by 15A NCAC 02T.0115(c) been attached?
❑ Yes ❑ No A N/A
4, of wastewater: (check all that apply):
IV'
(Individually Owned) ❑ Retail (stores, centers, malls) ❑ Car wash
❑ Residential (Leased) ❑ Retail with food preparation/service ❑ Hotel and/or Motels
❑ School / preschool / day care ❑ Medical / dental / veterinary facilities ❑ Swimming Pool/Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: 00 % Domestic D % Commercial 0 % Industrial (See 15A NCAC 02T .0103(20)
If Industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(f)? . ❑ Yes tNo
➢ If yes, provide a copy of flow reduction approval letter with this ayplicdtion
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow ''b
No. of Units
Flow
3 6 o gal/ c-L A
2 Y�OGPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
Z GPD
a See 15A NCAC 02T .0114(b), (d), (e)(1) and (e)(2) for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use
areas; and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals
as defined in G.S. 42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T,01141 shall
be determined using avail a}�le�Q� data, water using fixtures, occupancy or operation patterns, and other measured data
Wastewater generated by project: _jf 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 ere flow will be permitted in subsequent permits that connect to this lime.
Please provide supplementary info in ' g the approximate timeframe for permitting upstream sewers with flow.
❑ Flow has already been allo in t um Issuance Date:
❑ Rehabilitation or replacement of existing sewers with no new flow expected
❑ Other (Explain):
FORM: FTA 06-21 Page 2 of 5

r
V]Q. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size ('inches) Length (feet) Material
d L
➢ Section II & 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)
➢ Oversbdng lines to meet minimum slope requirements is not allowed and a violation of the MDC
VIIL 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 PROTECT
1. Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): e: Longitude: - °
3. Total number of pumps at the pump station:
3. Design flow of the pump station: milli 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.l.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)(l)(B),.
➢ Required for all pump stations with an average 7ck-connection
ow eater than or equal to 15,000 gallons per day
➢ Mast be permanent to facility and may n le
Or if the pump station has an average daily flo 1,00 gallons per day 15A NCACO2T.0305(h)(1)(C):
❑ Portable power source with manual activ on, 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.
FORM: FTA 06-21 Page 3 of 5

➢ 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 4 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(t)):
1. Does the project comply with all separations/alternatives found in 15A NCAC 02T .0305(fl & (g)?
15A NCAC 02T_0305(fl contains minimum senarations that shall he nrovided for sewer avcternc-
1Yes ❑ No
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
ZWater mains (horizontal)
10 feet
Reclaimed water limes (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 11 impounded mservoirs used as a source of drinldng 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 DC2)
50 feet
"Any other stream, lake, impoundment, orground 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 swiarming pools
10 feet
Final earth grade (vertical)
36 inches
➢ If noncompliance with 02T.0305(fl or (g), see Section X.1 of this application
*15A NCAC 02T.0305(a) contains alternatives where separations in 02T.0305(fl cannot be achieved. Please check "yes"
above if these alternatives are used and provide narrative information to explain.
**Stream classifications can be identified using the Division's NC Surface Water Classifications webpgge
2. Does this project comply with the minimum separation requirements for water mains? Yes ❑ No ❑ N/A
➢ If no, please refer to 15A NCAC 18C.0906(f) for documentation requirements and submi Xaeparate- 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. X
➢ See the Division's draft separation requirements for situations where separation cannot be met
➢ No variance is required if the alternative design criteria specified is utilized in design and construction
7--,4. � pew+ /i LC)
4. Is the project located in a river basin subject to any State buffer rules? Yes Basin name: ElNo
If yes, does the project comply with setbacks found in the river basin per 15A NCAC 0213 .0200? Yes ❑ No
➢ This includes Trout Buffered Streams per 15A NCAC 2B.0202
5. Does the project require coverage/authorization under a 404 Nationwide/mdividual permits ❑ Yes IC1 No
or 401 Water Quality Certifications? j
➢ Please provide the permit numberipermitting status in the cover letter if coveragetauthorization is required.
6. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? Yes- ❑ No
Per 15A NCAC 02T.0105(c)(6), directly related environmental permits or certification applications must be mg 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 KNo
Per 15A NCAC 02T.0402, "high -priority sewer" means any aerial sewer, sewer contacting surface waters,
siphon, or sewers positioned parallel to slreambanks that are subject to erosion that undermines or deteriorates the sewer.
Siphons and sewers suspended through interferencetconilict 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 5 of 5

M CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T. the Minimum Design Criteria for the _PomiMng of PJrrtn StaNnnc
and Force Mains (latest version) and the Gravity Sewer Minimum Design Criteria(latestversion) as applicable?
Yes ❑ No
If no, for projects requiring a single varian complete and submit the Variance/Ahernative Design Request application
(VADC 10-14) and supporting documents for review to the Central Office. Amroval of the request will be issued
concurrently with the approval of the peirmft, aad prokets MgMp Z a varianCe approval may be sublect to longer
review tortes. For Proi" requiring two or more variances or where the variance is determined by the Division to be
a significant portlon of the proiect, the #bll teehnied review is required.
2. ProfessionallEngineer's
�C�ertificatiion�: J `' /�
V vdd Lc f/'� 1 �T/ �S�' 7 attest that this application for "d /t f (4- M6���� f � A-e a,—
(Professional Engineer's name ftm Application Item 111.1.) (Project Name from Application Item IL 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 thdt to the best of my knowledge the proposed design has been prepared in accordance with the applicable regulations,
Mmunum Design Criteria for Qmy4y Sewers (later version) and the Minitnwn Desi%m Criteria for the Fast -Track
Permitting of Pump Stations and Force Mains (lateat 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 143-215.6B, any person who knowingly makes any false
statement, representation, or c eridcation in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fore not to exceed $10,000, as well as civil penalties up to, $25,000 per violation. NTisrepresentation of the
application information, including failure to disclose any design non-compliance with the applicable Rules and design
criteria, may subject the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NCAC 56.0701)
North Carolina Professional Engineer's seal, signature, and date:
Applicant's Ceatification per 15ANCAC 02T .0106(b):
I, . 1 attest that this application for ��b f-* **'(,(,�
(Sf$nata Authority Name from Application Item L3.) (ProjeaNamo flvm Applicattort Item.IL1)
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 ports 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, mjtmctive relief, and/or criminal prosecution. I will make no claim against the
Division of Water Resources should a condition ofthis 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 sha]i be guilty of a Class 2 misdemeanor, whirls may
include a fine not to exceed $10,000 as well as civil penalties up to $25,060 per violation.
Signature: Date:
FORM: FTA 06-21 Page 6 of 5

RECEIVED/NCDENR/DWR
State of North Carolina
0 C T - 9 2023 Department of Environmental Quality
Division of Water Resources
Water QualityFAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Dlvislon of Water Resources FORM: FTA 06r21 & SUPPORTING DOCUMENTATION
i W ngton egio
This application is for sewer extensions involving gravity sewers, pump stations and force mains, or any combination that has been
certified by a professional engineer and the applicant that the project meets the requirements of 15A NCAC 02T and the Division's
Minimum Design Criteria (Gravily Sewer & Pump Stations/Force Mains) and that plans, specifications and supporting documents
have been prepared in accordance with 15A NCAC 02T, 15A NCAC 02T .0300, Division policies, and good engineering
Practices.
While no upfront engineering design documents are required for submittal, in accordance with 15A NCAC 02T .0305(b), design
documents must be prepared prior to submittal of a fast track permit application to the Division. This would include plans, design
calculations, and project specifications referenced in 15A NCAC 02T .0305 and the applicable minimum design criteria. These
documents shall be immediately available upon request by the Division.
Projects that are deemed permitted (do not require a permit from the Division) are explained in 15A NCAC 02T,0303.
Projects not eligible for review via the fast track process (must be submitted for fall 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
01
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. kv =tter/Narrative Description (Required for All Application Packages):
ll items included in the application package, as well as a brief description of the requested permitting action.
➢ Be specific as to the system type, number of homes served, flow allocation required, etc.
➢ Include the permit number/status of any other required sewer permits (downstream/upstream)
➢ If necessary for clarity, include attachments to the application form.
C. Application Fee (All New and Modification Application Packages):
Submit a check or money order in the amount of $480.00, dated no more than 90 days prior to application submittal-
➢ Payable to North Carolina Department of Environmental Quality (NCDEQ)
D. aA 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.
11. If the Applicant Type in Item L2 is a corporation or company, provide documentation it is registered for business with the
j North Carolina Secretary of State.
J4 PJ If the Applicant Type in Item L2 is a partnership or d/b/a, enclose a copy of the certificate filed with the Register of Deeds in
CT
e county of business..
he Project Name in Item 11.1 shall be consistent with the project name on the flow acceptance letters, agreements, etc.
he Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a North Carolina
licensed Professional Engineer.
INSTRUCTIONS FOR FORM: FTA 06-21 & SUPPORTING DOCUMENTATION Page 1 of 3

1 ,
IXThe 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 maybe 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 05-21 & SUPPORTING DOCUMENTATION Page 2 of 3

E. Flow Tracking/Acceptance Form (Form: FTSE 04-16) (If Applicable):
Submit the completed and executed FTSE form from the owners of the downstream sewers and treatment facility.
Multiple forms maybe required where the downstream sewer owner and wastewater treatment facility are different
➢ The flow acceptance indicated in form FTSE must not expire prior to permit issuance and must be dated less than one year
prior to the application date.
➢ Submittal of this application and form FTSE indicates that owner has adequate capacity and will not violate G.S. 143-
215. a .
➢ Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific FTSE.
F. S4te Maps (All Application Packages):
ASubmit an 8.5-inch x 11-inch color copy of a USGS Topographic Map of sufficient scale to identify the entire project area,
including the closest surface waters.
➢ General location of the project components (gravity sewer, pump stations, & force main)
➢ Downstream connection points and permit number (if known) for the receiving sewer
Include an aerial location map showing general project area (such as street names or latitude/longitude) so that Division staff
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 15A NCAC 02T .0305(h)(l ), submit documentation of power reliability for pumping stations.
➢ This alternative is only available for average daily flows less than 15,000 gallons per day
p It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant and is compatible
(/ply 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 to 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 .01 W&1) provide the Certificate of Public Convenience and Necessity from the North Carolina
�Jk
Utilities Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served by the
sewer extension, or
❑ Provide a letter from the North Carolina Utilities Commission's Water and Sewer Division Public Staff stating an application
for a franchise has been received and that the service area is contiguous to an existing franchised area or that franchise
approval is expected.
J. Operational Agreements (Applications from HOA/POA and Developers for lots to be sold):
C� Flome/Properly Owners' Associations
%+I�` ❑ Per 15A NCAC 02T .0115(c), submit the properly executed Operational Agreement (FORM: HOA).
I ❑ Per 15A NCAC 02T .0115(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
❑ Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(b), submit the properly executed Operational Agreement (FORM: DEV).
For more information, visa the Division's collection systems webs to
INSTRUCTIONS FOR FORM: FTA 05-21 & SUPPORTING DOCUMENTATION Page 3 of 3

THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND
MATERIAI S; SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Reoional Office
2090 US Highway 70
Avery, Buncombe, Burke, Caldwell, Cherokee,
Water Quality Section
Swannanoa, North Carolina 28778-8211
Clay, Graham, Haywood, Herxierson, Jackson,
[phone]
Macon, Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Harnett, Hoke,
Water Quality Section
Fayetteville, North Carorina 28301-5095
Montgomery, Moore, Robeson, Richmond,
(910) 433-S3W
Sampson, Scotland
(91.0) 486-0707 Fax
Mooresville Regional Office
610 E. Center Avenue
Alexander, Cabamis, Catawba, Cleveland,
Water Quality Section
Mooresville, North Carolina 28115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
Raleigh Resllonal Office
3800 Barrett Drive
Chatham, Durham, Edgecombe, Franklin,
Water Quality Section
Raleigh, North Carolina 27609
Granville, Harrfax, Johnston, Lee, Nash,
(919)-791-4200
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
Warren, Wilson
Washinaton Regional Office
943 Washington Square Mall
Beaufort, Bertie, Camden, Chowan, Craven,
Water Quality Section
Washington, North Carolina 27889
Cunituck, Dare, Gates, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
Wiiminaton Regional Office
127 Cardinal. Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
Water Quality Section
Wilmington, North Carolina 28405
Hanover, Onslow, Pender
[phone]
[phone] Fax
Winston-Salem Reaional 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
(336) 776-98W
[phone] Fax
INSTRUCTIONS FOR FORM: FTA 05-21 & SUPPORTING DOCUMENTATION Page 4 of 3

State of North Carolina
ocT _ 9 nZ3
Department of Environmental Quality
Division of Water Resources
Aivision of water Resources Flow Tracking for Sewer Extension Applications
'Neer
opecao'mce (FTSE 10-18)
wasTiin�
Entity Requesting Allocation: Laucour Farms, Inc.
Project Name for which flow is being requested: North Market Street Square
More than one TTSE 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 low.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Washington WWTP
b. WWTP Facility Permit #: NC0020648
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
All flows are in MGD
3.65
0.3627
2.2627
0.0028 8-
2.6254
71.93
H. 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 Approx.
Average Current Obligated, Total
Pump Daily Avg. Not Yet Current
Pump Station Station Firm Flow** Daily Tributary Flow Plus
(Name or Permit Capacity, * (Firm / p f), Flow, Daily Flow, Obligated
Available
Number) No. MGD MGD MGD MGD Flow
Capacity***
5th&Respess WQ0021322 5.184 2.074 1.469 0.2885 1.7575
0.9825
Penn&Haven N/A 0.864 0.3456 0.2376 0.0744 0.3120
0.0336
Northwood 4838 0.576 0.2304 0.0936 0.004 0.0976
0.1328
RiverBirch WQ0017840 0.4536 0.1814 0.0529 0 ` 0.0529
0.1285
* The Firm Capacity (design flow) of any pump station is defined as the maximum pumped flow
that can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking
factor
(pf) not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): City of Washington Sewer Coll. System
Downstream Permit Number: WQCS00087
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I Jonathan Russell 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_treA the proposed new wastewater.
Signing
Title of Signing Offccia
Date
Page 2 of 6
FTSE 10-18

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Average Yearly Flow for:
Jan.2022
Feb.2022
Mar.2022
Apr.2022
May2022
Jun2022
J u 12022
Aug2022
Sept2022
Oct2022
Nov2022
Dec2022
City of Washington, NCO020648
Permitted Flow:
2.2654516
2.1468571
2.0328221
2.037688
2.1033871
1.9363667
2.1392903
2.0940645
2.0874
2.1281613
2.0887
2.1600645
2.101687767 Avg. Flow
2022 % of Permitted Flow:
3.65
0.575804868
(< 80% / 90% OK)

Beaufort County,NC
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Inc, METI/NASA, USGS, EPA, NPS, US Census Bureau, USDA
DISCLAIMER: Content is not intended to constitute a legal record. The County and Website Host disclaim all liability for information on this map. User agrees that the County and its Assigns shall be held harmless from all actions arising out of the use of C

Property Summary
Data last updated on: 811212023 Ownership current as of: 8/10/2023 Tax Year: 2023
REID 40104 PIN # 5688-49-8102 Print Property Info
Location Address Property Description
0 SR 1422 RD 2.68 ACRES RALPH H HODGES
Property Owner Owner's Mailing Address
LAURCOUR FARMS INC 512 LENNINGTON LN
WASHINGTON NC 27889
Q Parcel ® Buildings Q Misc Improvements Land i Deeds Notes $
Administrative Data
Plat Book & Page
Old Map#
Market Area
Township
Planning Jurisdiction
City
Fire District
Spec District
Land Class
History REID 1
History REID 2
Acreage
Permit Date
Permit #
Transfer Information
Property Value
Deed Date
06/14/1999
Total Appraised Land
NONE
Deed Book
001140
Total Appraised Buildir
SQRE
Deed Page
00072
Total Appraised Misc I,
Value
Washington Township
Revenue Stamps
400.00
BEAUFORT
Package Sale Date
Package Sale Price
NORTHSIDE FIRE
Land Sale Date
Other Exemptions
RES 02
Land Sale Price
Exemption Desc
SINGLE FAMILY RES
Improvement Summary
Use Value Deferred
Historic Value Deferrer
2.65
Total Buildings
0
Total Deferred Value
Total Units
0
Total Living Area
0
Total Taxable Value
Total Gross Leasable Area
0

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Beaufort County,NC
8/12/2023, 4:23:02 PM
LocalCounties
Override 2
Centerlines
1:18,056
0 0.13 0.25 0.5
0 0.2 0.4 0.8
Esri Community Maps Contributors, State of North Carolina DOT, E
Garmin, SafeGraph, GeoTechnologies, Inc, METI/NASA, USGS, EPI
Census Bureau, USDA
DISCLAIMER: Content is not intended to constitute a legal record. The County and Website Host disclaim all liability for information on this map. User agrees that the County and its Assigns shall be held harmless from all actions arising out of the use of (