WQ0044786_Application (FTSE)_20231030

State of North Carolina
l k,i Department of Environmental Quality
DWR Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources INSTRUCTIONS FOR FORM: FTA 06-21 & SUPPORTING DOCUMENTATION
This application is for sewer extensions involving gravity sewers, pump stations and force mains, or any combination that has been
certified by a professional engineer and the applicant that the project meets the requirements of 15A NCAC 02T and the Division's
Minimum Design Criteria (C3rawirr- Sewer & Pump Stations. -force Mains} and that plans, specifications and supporting documents
have been prepared in accordance with 15A NCAC 02T, 15A NCAC 02T .03i}0, 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 tSA NCAC 02T_-0305 and the applicable minimum design criteria. These
documents shall be immediately available upon request by the Division.
Projects that are deemed permitted (do not require a permit from the Division) are explained in 15A NCAC 02T.0303.
Projects not eligible for review via the fast track process (must be submitted for full technical review):
➢ Projects that do not meet any part of the minimum design criteria (MDC) documents;
➢ Projects that involve more than one variance from the requirements of 15A NCAC 02T;
➢ Pressure sewer systems utilizing simplex septic tank -effluent pumps (STEPs) or simplex grinder pumps;
➢ Simplex STEP or simplex grinder pumps connecting to pressurized systems (e.g. force mains);
➢ Vacuum sewer systems.
General - When submitting an application, please use the following instructions as a checklist in order to ensure all required items are
submitted. Adherence to these instructions and checking the provided boxes will help produce a quicker review time and reduce the
amount of requested additional information. Failure to submit all required items will necessitate additional processing and review
time, and may result in return of the application. Unless otherwise noted, the Applicant shall submit one original and one copy of
the application and supporting documentation.
A. One Original and One Copy (second copy may be digital) of Application and Supporting Documents
® Required unless otherwise noted. Signatures on original must be "wet ink" or secure digital signatures.
Please do not submit engineering design plans with the application unless specifically requested.
B. Cover Letter/Narrative Description (Required for All Application Packages):
® List all items included in the application package, as well as a brief description of the requested permitting action.
➢ Be specific as to the system type, number of homes served, flow allocation required, etc.
➢ Include the permit number+status of any other required sewer permits (downstream/upstream)
➢ If necessary for clarity, include attachments to the application form.
C. Application Fee (All New and Modification Application Packages):
® Submit a check or money order in the amount of $480.00, dated no more than 90 days prior to application submittal.
➢ Payable to North Carolina Department of Environmental Quality (NCDEQ)
D. Fast Track Application (Required for All Application Packages, Form FTA 05-21):
® Submit the completed and appropriately executed application.
➢ If necessary for clarity or due to space restrictions, attachments to the application may be made.
❑ if the Applicant Type in Item 1.2 is a corporation or company, provide documentation it is registered for business with the
North Carolina Secretary of State.
❑ If the Applicant Type in Item 1.2 is a partnership or d/b;`a, enclose a copy of the certificate filed with the Register of Deeds in
the county of business.
® The Project Name in Item II.1 shall be consistent with the project name on the flow acceptance letters, agreements, etc.
® The Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a Nujih Carolina
licensed Proles%ional Fniyine�r.
® The Applicant's Certification on Page 5 of the application shall be signed in accordance with 15A NCAC 02T .0106(b). Per
15A NCAC 02T .0106(c), an alternate person may be designated as the signing official if a delegation letter is provided from
a person who meets the criteria in 15A NCAC 02T .0106(b).
INSTRUCTIONS FOR FORM: FTA 06-21 & SUPPORTING DOCUMENTATION Pagel of 3

E. Flow Tracking/Acceptance Form (Form: FTSE 44-16) (if Applicable):
❑ Submit the completed and executed FTSE form from the owners of the downstream sewers and treatment facility.
➢ Multiple forms maybe required where the downstream sewer owner and wastewater treatment facility are different.
➢ The flow acceptance indicated in form FTSE must not expire prior to permit issuance and must be dated less than one year
prior to the application date.
➢ Submittal of this application and form FTSE indicates that owner has adequate capacity and will not violate G.S. 143-215.67(a).
➢ Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific FTSE.
F. Site Maps (All Application Packages):
® Submit an 8.5-inch x 1 l-inch color copy of a USGS Topographic Map of sufficient scale to identify the entire project area,
including the closest surface waters.
D General location of the project components (gravity sewer, pump stations, & force main)
➢ Downstream connection points and permit number (if known) for the receiving sewer
® IncIude an aerial location map showing general project area (such as street names or latitude/longitude) so that Division staff
can easily locate it in the field.
G. Existing Permit (Application Packages for Modifications to an Existing Permit):
❑ Submit a copy of the most recently issued existing permit.
❑ Include a descriptive and clear narrative identifying the previously permitted items to remain in the permit, items to be
added, and/or Items to be modified (the application form itself should include only include items to be added/modified). The
narrative should also include whether any previously permitted items have been certified.
Q 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)(1), submit documentation of power reliability for pumping stations.
➢ This alternative is only available for average daily flows less than 15,000 gallons per day
➢ It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant and is compatible with
the station. The Division will accept a letter signed by the applicant (see 15A NCAC 02T .0106(b)) or proposed contractor,
stating that "the portable power generation unit or portable, independently -powered pumping units, associated appurtenances
and personnel are available for distribution and operation of this pump station."
➢ If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations'
storage capacities and the rotation schedule of the portable power source or pump, including travel timeframes, shall
be provided in the case of a multiple station power outage. (Required at time of certification)
I. Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per 15A NCAC 02T .0115(a)(1) provide the Certificate of Public Convenience and Necessity from the North Carolina Utilities
Cominission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served by the sewer
extension, or
❑ Provide a letter from the North Carolina Utilities Commission's Water and Sewer Division Public Staff stating an application
for a franchise has been received and that the service area is contiguous to an existing franchised area or that franchise approval
is expected.
J. Operational Agreements (Applications from HOA/POA and Developers for lots to be sold):
❑ Home/Property Owners' Associations
❑ Per 15A NCAC 02T .0115(c), submit the properly executed Operational Agreement (FORM: HOA).
❑ Per 15A NCAC 02T .01 15(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
❑ Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(b), submit the properly executed Operational Agreement (,FORM: DEW
For more information, visit the Division's collection systems xvebsite
INSTRUCTIONS FOR FORM: FTA 05-21 & SUPPORTING DOCUMENTATION Page 2 of 3

THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville$wional Office
2090 US Highway 70
Avery, Buncombe, Burke, Caldwell, Cherokee,
Walter Quality Sea toe
Swannanoa, North Carolina 28778-8211
Clay, Graham, Haywood, Henderson, Jackson,
[phone]
Macon, Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Harnett, Hoke,
Water Quality Section
Fayetteville, North Carolina 28301-5095
Montgomery, Moore, Robeson, Richmond,
[phone]
Sampson, Scotland
[phone] Fax
Mooresville Regional Office
610 E. Center Avenue
Alexander, Cabarrus, Catawba, Cleveland,
Water Quality Section
Mooresville, North Carolina 28115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
Raleigh Realonal Office
3800 Barrett Drive
Chatham, Durham, Edgecombe, Franklin,
Water.Quallty Section
Raleigh, North Carolina 27609
Granville, Halifax, Johnston, Lee, Nash,
[phone]
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
Warren, Wilson
Washington Regional Office
943 Washington Square Mail
Beaufort, Bertie, Camden, Chowan, Craven,
Water.QyAftLSection_
Washington, North Carolina 27889
Currituck, Dare, Gates, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
Wilmington Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
Water Quality Section
Wilmington, North Carolina 28405
Hanover, Onslow, Pender
[phone]
[phone] Fax
Winston-Salem Regional Office
450 W. Hanes Mill Road
Alamance, Aileghany, Ashe, Caswell, Davidson,
Water Quality Section
Suite 300
Davie, Forsyth, Guilford, Rockingham, Randolph,
Winston-Salem, North Carolina 27105
Stokes, Sung, Watauga, Wilkes, Yadkin
[phone]
[phone] Fax
INSTRUCTIONS FOR FORM: FTA 05-21 & SUPPORTING DOCUMENTATION Page 3 of 3

ADAMS & HODGE
ENGINEERING, PC
September 19, 2023
NC DWQ
3800 Barrett Dr.
Raleigh, NC 27609
Subject: Public Sewer Construction Plans
Candlewood Townes
Johnston County
To whom it may concern,
Please find attached a $480.00 check for the application fee and a copy of the following:
1. Fast Track Application (Form FTA 06-21)
2. Flow Tracking/Acceptance for Sewer Extension (Form FTSE 10-18)
3. USGS Map
4. Vicinity Map
5. Flow Reduction Letter
Proiect Narrative:
This application is for an extension of the gravity sewer system of Johnston County to serve Candlewood
Townes. This extension includes 9381f of new 8" gravity sewer and will connect to an existing Johnston
County gravity sewer system permit number WQ 14516. The proposed connection will also reroute the
existing flow of this permitted line to eliminate—1-2461f of older sewer pipe. The sewer system will serve
30 single family duplex homes in this subdivision. The attached flow reduction letter specifies 250
gal lons/daylresidence.
If you have any questions or comments, please give me a call at 919-298-2001 or email
amanda"a.adamsandhodge.com
Sincerely,
Amanda Grimm, PE
ADAMS & HODGE ENGINEERING, PC • 314 E Main Street Clayton, NC 27520 • Office: 919-243 1332 • Firm # C-4187

State of North Carolina
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources O &o ]1-1 VIA 06-21 & SUPPORTING DOCUMENTATION
application Number: "C011V 7 g, , (to be completed by DWtt)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Town of Clayton (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State/County ® Municipal
3. Signature authority's name: Jonathan Jacobs. PE per 15A NCAC 02T .0106fb1
Title: Assistant Engineering Director
4. Applicant's mailing address: PO Box 879
City: Clayton State. NC Zip. 27520-
5. Applicant's contact information:
Phone number: [phone] Email Address: [e-mail]
11. PROJECT INFORMATION:
❑ Privately -Owned Public Utility
❑ Other
1. Project name: Candlewood Townes
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
3. County where project is located: Johnston
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.653091.: Longitude: -78 469013
5. Parcel ID (if applicable): (or Parcel 1D to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Eva Kin s License Number: 039159
Firm: Adams & Hodge Engineering, PC
Mailing address: 314 E. Main Street
City: Clayton State: NC Zip: 27520-
Phone number: (9� 238-1205 Email Address: eva0adamsandhod ee com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
I. Facility Name: Little Creek WRF Permit Number: NCO025453
Owner Name: Town of Clayton
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ14516
2. Downstream (Receiving) Sewer Information: 8 inch ® Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS00110
Owner Name(s): Town of Clayton
FORM: FTA 06-21 Page l of 5

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑ No ® N:-A
2. If the Applicant is a Developer of lots to be sold, has a Qvveloper's Uoeratjo.nal Agreement (FORM. DEV) been attached?
[:]Yes [:]No ® N/A
3. If the Applicant is a Home/Property Owners' Association, has an I10A/POA Operational Agreement (FORM: H0A) and
supplementary documentation as required by 15A NCAC 02T.0115(c) been attached?
[:]Yes ❑ No ® N?A
4. Origin of wastewater: (check all that apply):
® Residential (Individually Owned) ❑ Retail (stores, centers, malls) ❑ Car Wash
❑ Residential (Leased) ❑ Retail with food preparation/service ❑ Hotel and/or Motels
❑ School / preschool / day care ❑ Medical / dentaI / veterinary facilities ❑ Swimming Pool/Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 % Domestic % Commercial % Industrial (See 15A NCAC 02T .0103(20))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes[] No
6. Has a flow reduction been approved under 15A N C A U 02T .01 14(f)? ® Yes ❑ No
➢ If yes, provide a cony of flow reduction a roval letter with this auplication j
IIP
7. Summarize wastewater generated by project:A ((�
Establishment Type (see 02T.0114(f))
Daily Design Flow
No. of Units
Flow
Duplexes
250 gal/day
30
7,500 GPD
gall
GPD
gall
GPD
gall
GPD
gal/
GPD
gal/
GPD
Total
7,500 GPD
a See l5A NCAC 02T .0114(b). (d), (e)(1) and. Ie)(2) for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use areas;
and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in G.S. 42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.01141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
$. Wastewater generated by project: 7,500 GPD (per 15A NCAC 02T .0114)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero, please Indicate why:
❑ Pump Station/Force Main or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line.
Please provide supplementary information indicating the approximate timeframe for permitting upstream sewers with flow.
❑ Flow has already been allocated in Permit Number: Issuance Date:
❑ Rehabilitation or replacement of existing sewers with no new flow expected
❑ Other (Explain):
FORM: FTA 06-21 Page 2 of 5

ViI. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 938 PVC
> Section II & [Hof the MDC for Permitting of Gravity Sewers contains information related to design criteria
> Section III contains information related to minimum slopes for gravity sewer(s)
> Oversizing lines to meet minimum slope requirements is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable)— 02T .0305 & MD (Pump tati n rce Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: -
3. Total number of pumps at the pump station:
3. Design flow of the pump station: millions gallons per day (firm capacity)
> This should reflect the total GPM for the pump station with the largest pump out of service.
4. Operational point(s) per pump(s): gallons per minute (GPM) at feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.01 C.l.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NCAC 02T _0305(h)f I :
❑ Standby power source or ❑ Standby pump
> Must have automatic activation and telemetry . 15A NCAC 02T.0305(h)(1)(B):.
> Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
> Must be permanent to facility and may not be portable
Or if the pump station has an average daily flow less than 15,000 gallons per day 15A NCACO2T.0305(h)(l)(C):
❑ Portable power source with manual activation, quick -connection receptacle and telemetry -
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry:
> Include documentation that the portable source is owned or contracted by the applicant and is compatible with the station.
> If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel timeframes, shall be provided
as part of this permit application in the case of a multiple station power outage.
FORM: FTA 06-2 l Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T.0305(f)):
I. Does the project comply with all separations/alternatives found in 15A NCAC 02T.0305(f) & (e)? ® Yes [--]No
ISA NCAC 02T.0305(f) contains minimum separations that shall be Drovided for sewer systems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
'Water mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
'Water mains (horizontal)
10 feet
Reclaimed water lines (vertical - reclaimed over sewer)
18 inches
Reclaimed water lines (horizontal - reclaimed over sewer)
2 feet
"Any private or public water supply source, including any wells, WS-1 waters of Class I or
Class II impounded reservoirs used as a source of drinking water, and associated wetlands.
100 feet
**Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal
high water (or tide elevation) and wetlands associated with these waters (see item TX.2)
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches, as well as wetlands associated with these waters or classified as WL.
10 feet
Any building foundation (horizontal)
5 feet
Any basement (horizontal)
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
➢ If noncompliance with 02T.0305(f) or (a). see Section X. I of this application
* 15A NCAC 02T.0305(a) contains alternatives where separations in 02T.0305(f) cannot be achieved. Please check "yes"
above if these alternatives are used and provide narrative information to explain.
**Stream classifications can be identified using the Division's NC Surface Water Classifications webpaae
2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ NIA
➢ If no, please refer to 15A NCAC 18C.0906(f) for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? ® Yes ❑ No ❑ N/A
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ See the Division's draft separation requirements for situations where separation cannot be met.
➢ No variance is required if the alternative design criteria specified is utilized in design and construction.
4. Is the project located in a river basin subject to any State buffer rules? ® Yes Basin name: Neuse ❑ No
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ® Yes ❑ No
➢ This includes Trout Buffered Streams per 15A NCAC 2B.0202
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ❑ Yes ® No
or 401 Water Quality Certifications?
➢ Please provide the permit number/permitting status in the cover letter if coverage/authorization is required.
6. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T.0105(c)(6), directly related environmental permits or certification applications must be being prepared,
have been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion
and sedimentation control plans, stormwater management plans, etc.).
7. Does this project include any sewer collection lines that are deemed "high -priority?" ❑ Yes ® No
Per 15A NCAC 02T.0402, "high -priority sewer" means any aerial sewer, sewer contacting surface waters,
siphon, or sewers positioned parallel to streambanks that are subject to erosion that undermines or deteriorates the sewer.
Siphons and sewers suspended through interference/conflict boxes require a variance approval.
➢ 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 permiiee or its representative at least once every six -months and
inspections documented per 15A NCAC 02T.0403(a)(5) or the permittee's individual System -Wide Collection permit.
FORM: FTA 06-21 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A 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 versions as applicable?
® Yes ❑ No
If no, for projects requiring a single variance, complete and submit the Variance/Altemative Design Request application
(VADC 10-14) and supporting documents for review to the Central Office. Approval of the request will be issued
concurrently_ with the auuroval of the permit, and arolects requiring a variance approval may be„subiect to longer
review times. For uroiects requiring two or more variances or where the variance is determined by the Division to be a
significant portion of the proiect, the full technical review is required.
2. Professional Engineer's Certification:
I, _Eva King, PE , attest that this application for Candlewood Townes
(Professional Engineer's name from Apptication Item Ill. I`.) (Project Name from Application Item IT. 1)
has been reviewed by me and is accurate, complete and consistent with the Information supplied in the plans,
specifications, engineering calculations, and all other supporting documentation to the best of my knowledge. I further
attest that to the best of my knowledge the proposed design has been prepared in accordance with the applicable regulations,
Minimum Design -Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track Permitting
of Pump Stations and Force Mains (latest version). Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that I have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, 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. Misrepresentation of the application
information, including failure to disclose any design non-compliance with the applicable Rules and design criteria, may subject
the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NCAC 56.0701)
`ttt�1t11rrr��
North Carolina Professional Engineer's seal, signature, and date:
039159
I/A 4C4Nfi?,,�'�.
1118tltit0%
3. Applicant's Certification per 15A NCAC 02T A106(b): 91IV2023
1, _Jonathan K Jacobs, PE, CFM , attest that this application for Candlewood Townes
(Signature Authority Name from Application Item 1.3.) (Project Name from Application Item 11.1)
attest that this application has been reviewed by me and is accurate and complete to the best of my knowledge.
I understand that if all required parts of this application are not completed and that if all required supporting documentation
and attachments are not included, this application package is subject to being returned as incomplete. I understand that any
discharge of wastewater from this non -discharge system to surface waters or the land will result in an immediate enforcement
action that may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division
of Water Resources should a condition of this permit be violated. 1 also understand that if all required parts of this application
package are not completed and that if all required supporting information and attachments are not included, this application
package will be returned to me as incomplete.
NOTE In accordance with General Statutes 143-215.6A 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 exce#d $10,000as well as civil penalties up to $25,000 per violation.
Signature:
Date: ! !N
FORM: FTA 06-21 V J Page 5 of 5

Division of Water Rf-sources
Entity Requesting Allocation:
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-1 S)
Town of Clayton
Project Name for which flow is being requested: Candlewood Townes
Afore than one FTSE may be required far a single project if the owner of the WWTP is not responsible for all pun+p
stations along the route of the proposed wastewater flow.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name:
Little Creek
b. WWTP Facility Permit #: NCO025453
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
- - , �S
V.Qq[v
a .24S
(3.O o5
see er"ht r-
to j�4% 25
p Gc-
11. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
List pump stations located between the project connection point and the WWTP:
(A)
(B)
(C) (D)=(B+C) (E)=(A-D)
Design
Obligated,
Pump
Pump
Average
Approx.
Not Yet Total Current
Station
Station
Firm Daily Flow**
Current
Tributary Flow Plus
(Name or
Permit
Capacity, * (Firm I po,
Avg. Daily
Daily Flow, Obligated Available
Number)
No.
MGD MGD
Flow, MGD
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
(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): G-Ht InVed- k.101:7
Downstream Permit Number: /4r 3
Page 1 of 6
FTSE l 0- l 4

III. Certification Statement:
I Jonathan Jacobs, PE certify to the best of my knowledge that the addition of
the volume of wastewater to be permitted in this project has been evaluated along the route to the receiving
wastewater treatment facility and that the flow from this project is not anticipated to cause any capacity
related sanitary sewer overflows or overburden any downstream pump station en route to the receiving
treatment plant under normal circumstances, given the implementation of the planned improvements
identified in the planning assessment where applicable. This analysis has been performed in accordance
with local established policies and procedures using the best available data. This certification applies to
those items listed above in Sections I and II plus all attached planning assessment addendums for which I
am the responsible Arty. Signature of this form certifies that the receiving collection system or treatment
works has adegx4t pacity to )ransport and treat the proposed new wastewater.
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Page 2 of 6
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Dataset, National Land Cover Database. National Structures Dataset, and
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State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross Jr., Secretary
Kerr T. Stevens, Director
Mr. Steve Biggs, Town Manager
Town of Clayton
Post Office Box 879
Clayton, North Carolina 27520
Dear Mr. Biggs:
—"'-Iv `-Iv JUL V LOW
AIT - -2 'L" GU4
NCDENR
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f
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT ANo NATURAL RESOURCES
July 2, 2001
Subject: Town of Clayton
Flow Reduction Approval
Johnston County
On January 3, 2001, the Division of Water Quality received your flow reduction request for new
single-family dwellings in the Town of Clayton. The letter requests approval of a residential flow value of 250
GPDlresidence for any future dwellings that may become tributary to the subject wastewater collection system.
The Division also received additional information on April 3, 2001
The information provided flow records between January 1998 and November 2000 for the WWTP.
The evaluation also included the daily wastewater flows for a 33 day period from February 19 through March
23, 2001 for a select 97 homes in accordance with 15A NCAC 2H .0219(l)(3).
Based upon the information submitted, the Division hereby approves the use of 250 GPD per single-
family residence in all applicable non -discharge permit applications for future sewer line extensions for the
Town of Clayton. This consideration applies to any applicable future projects submitted to the Division as well
as any projects which are currently under review. Regardless of the adjusted design daily wastewater flow rate,
at no time shall.the.wastewater flows exceed the effluent limits defined in the Town's NPDES permit for the
treatment. facility or exceed the capacity of the sewers downstream of my new sewer extension.
If you have any questions or comments regarding this matter, please contact Mr. Kim H. Colson at
[phone] ext. 540.
iie,
Kerr T. Stevens
cc: Raleigh Regional Office
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] Fax [phone]
An Equal Opportunity Affirmative Action Employer 50% recycledA 0% post -consumer paper

Wilson, Susan A
From: Jonathan Jacobs <[e-mail]>
Sent: Tuesday, October 24, 2023 1:40 PM
To: Wilson, Susan A; [e-mail]; [e-mail]
Subject: [External] RE: Fast Track permit application Candlewood Townes WQ0044786
Attachments: Town of Clayton Resolution.pdf; ToC SOP Delegation of Authority (003).pdf
Follow Up Flag: Follow up
Flag Status: Flagged
CAUTION: External email. Do not click links or open attachments unless verified. Report suspicious emails with the Report Message
button located on your Outlook menu bar on the Home tab.
Susan — Please see signatory delegation attached. I have been signing executed permits for over 18 months, so it's
interesting you're the first one to notice!
I have responded to the others below.
Thank you!
Jonathan K. Jacobs, PE, CFM
Interim Planning Director
Assistant Engineering Director
111 E. Second St.
Clayton, NC 27520
0: 919-553-5002 x6537
D: 919-553-1554
ClaytonNC.org
00MG00
Please note that email sent to and from this address is subject to the North Carolina Public Records Lan) and may be disclosed to third parties.
1

From: Wilson, Susan A <[e-mail]>
Sent: Tuesday, October 24, 2023 9:54 AM
To: [e-mail]; [e-mail]
Cc: Jonathan Jacobs <[e-mail]>
Subject: Fast Track permit application Candlewood Townes WQ0044786
Be Advised: This email originated from outside of the Town of Clayton's network. Do not click links or open attachments unless
you recognize the sender and know the content is safe.
Hi Amanda and/or Eva-
1) I'm sorry — I cannot find information indicating Jonathan Jacobs is delegated signature authority for these permit
applications. Could you provide that? It could be here and I am just not locating it. I know Joshua Baird is in our
database as having signature authority.
2) Just want to make sure we're thinking of the flow per residence in the same way. Will there be 30 total
individual units (15 duplexes * 2), so that each unit has separate water and sewer tie-in? So each residence is
counted at 250 gpd/residence? Yes; each duplex will have it's own lot which will require it's own water and
sewer toe -in. Each residence will count using the reduced flow of 250 GPD.
3) 1 need some clarification on the flow tracking sheet. I'm confused on the actual permitted flow for Clayton (I
realize they have tiers for expansion and flow is being shunted around) — but where did the 5.65 MGD figure on
the flow tracking sheet come from? I see — looking back at other applications for Clayton, they're more
completely spelled out re. amounts of flow going to different places. Probably best to do it that way in case
someone reviews the application and then wonders why the permitted flow doesn't match the NPDES permit.
Or if you or Jonathan would like to send a response back to this email, I'll include it in the record and you won't
have to submit a modified FTSE. Little Creek WRF 2.5MGD , Johnston County 1.4MGD, and Raleigh 1.75 MGD
(5.65 total).
4) Is Little Creek called Sam's Branch WRF now? Or is that with a future tier? I thought I had seen a permit
modification indicating the name change. Little Creek is the current WRF that will serve this parcel. Sam's Branch
is being constructed currently and Little Creek will be decommissioned once it comes online. I do know we are
working to correct the permitting, because I believe Little Creek was incorrectly named Sam's Branch.
Thanks much. Hope to get this one out fairly soon, once you return the requested information. And thank you all for the
great maps!
Susan Wilson
Environmental Engineer (Part Time, Temporary)
Water Quality Regional Operations — Raleigh Regional Office
NC Department of Environmental Quality
Office: 91 9-791-4240
D,E Q5
Emaiicr.%,&pa-eaws toarrd frarn Pfiis address rs:tn4ectta NoNwh
Cwurna Fluhh'c Reoards Law wdma} to drfakased W thirdpartes

Email correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties by an authorized
state official.

Resolution #2020-40
Whereas, the Clayton Town Manager is authorized to enter into contracts and
authorized to execute contracts and agreements that do not specifically require
authorization and execution by the Mayor and/or Town Council; and
Whereas, the Clayton Town Council further grants authority to the Deputy Town
Manager(s) to execute contracts and agreements not specifically required to be
executed by the Mayor and/or Town Council; and
Whereas, the Clayton Town Council authorizes the Town Manager to establish
policies regarding further designees and authority for the execution of contracts and
other agreements.
Duly adopted this the 19th day of October, 2020 while in regular session.
Jody McLeod
Mayor
ATTEST:
4- 4n%fft —
Kimberly A. Moffett, CMC, NCCMC
Town Clerk

Resolution #2020-44
RESOLUTION AUTHORIZING REPRESENTATIVES) OF THE MUNICIPALITY BE
DESIGNATED AS DEPUTY FINANCE OFFICERS
Whereas, NCGS 159-25 defines both the Finance Officer and Mayor as being authorized to
sign checks on behalf of the town should no other designation be made; and
Whereas, on September 8, 2020, Resolution #2020-32 was adopted appointing certain
representatives of the Town of Clayton the authorization to sign and/or countersign checks
on behalf of the Town of Clayton; and
Whereas, it is the request of the Town Council to modify and replace Resolution #2020-32
by authorizing the following representatives authority to sign and/or countersign checks
on behalf of the Town of Clayton.
Name Title
JD Solomon
Richard Cappola
Robert W. McKie, Jr
Kimberly A. Moffett
Interim Town Manager
Deputy Town Manager
Finance Director
Town Clerk
This Resolution will be effective immediately and remain until such time it is modified.
Duly adopted this the 16tn day of November, 2020 while in regular session.
Jody McLeod
Mayor
ATTEST: 00g111111ilINCt
ORPORATE'p
Kimberly A. Moffett, CMC, NCCMC APRIL 1869
Town Clerk

" •
TOWN OF CLAYTON POLICY
Department: Finance
Effective: August 15, 2022
For e
Supersedes: New
Policy Title: Manager's Delegation of Authority for Contract Negotiation,
Prepared By:
Award, Approval and Execution
Shaun Mizell
Version 1
Procurement, Contracts & MWBE
Manager
Approved By: Town Council ❑ or Town Manager ❑ Date: Select Approval Date
I. Purpose
To designate positions (and their designated backup) to make, award, approve, execute, and amend agreements or
instruments on behalf of the Town. Town Staff other than those recognized in the Council Resolution and those
given delegation in this Policy have authority to execute any agreement (quote, contract etc.) on behalf of the Town.
II. Background
The Town Council by "Resolution #2020-40 authorizing representatives of the Town to Execute Contracts and
Agreements and set policies and procedures.
■ Authorized the Town Manager to enter into contracts and authorized to execute contracts and
agreements that do not specifically require authorization and execution by the Mayor and/or Town
Council.
■ Further grants authority to the Deputy Town Manager(s) to execute contracts and agreements not
specifically required to be executed by the Mayor and/or Town Council.
■ Authorized the Town Manager to establish policies regarding further designees and authority for the
execution of contracts and other agreements.
This Policy implements the delegation authority of the Town Manager.
III. Delegation Policy
Delegation to Finance Management:
The Finance Director, Assistant Finance Director and the Procurement, Contracts and MWBE Manager
are authorized to (i) award, approve, amend, and execute materials and apparatus contracts and change
orders or amendments thereto, and to reject bids, and re -advertise to receive bids on behalf of the Town,
where the reasonably expected expenditure under the contract is less than $90,000; and (ii) informal range
construction and repair contracts and service contracts, where the reasonably expected expenditure under
the contract is less than $10,000.
TOWN OF CLAYTON POLICY: Manager's Delegation of Authority for Contract Negotiation, Award, Approval and
Execution Page 1 of 3

Delegation to Engineering Department Head and Assistant Engineering Director.
Encroachment Agreements, Right of Entry Agreements, and Jurisdictional Determination Requests:
a) NCDOT and public utility provider, such as Duke Energy, encroachments onto town property for
construction and/or repair projects.
b) Other encroachment agreements substantially in a form approved by council permitting
encroachment over, through, under, or across town property or the right of way of any public street
or alley in accordance with Town of Clayton ordinances, standard specifications and details, and
policies.
c) Encroachment agreements over the lands of others.
d) The Engineering Department Head is authorized to approve right of entry agreements permitting
others to temporarily enter onto Town lands for construction -related or other purposes and
permitting the Town to enter onto the lands of others for construction -related or other purposes.
e) US Army Corps of Engineers jurisdictional determination requests.
Estoppel certificates regarding Stormwater Control Structure and Access Easement Agreements:
a) Estoppel certificates regarding Stormwater Control Structure and Access Easement Agreements
substantially in a form approved by Council.
Permits, Applications, and other Forms:
a) Permits, applications, and other forms required by state or federal entities in connection with
Town activities or participation in regional organizations or other groups.
Delegation to the Cultural Arts Director:
Artist/Performer Agreements:
a) Agreements with Artist/Performers to perform at Town Events or at The Clayton Center.
Requirements: Each person to whom authority is delegated in this policy shall be responsible for assuring
that all applicable laws and regulations, including bidding laws, and all Town policies and standard
procedures are complied with, and shall assure that the Finance Department has provided' pre -audit
authorization' for any Town expenditure prior to contract execution by the Town.
Non -Exclusive: This delegation of authority is non-exclusive. Any contract or other instrument that may be
approved and executed at the departmental level may be referred to the Town Manager or Deputy Town
Managers for award, approval, or execution. When a contract or other instrument is referred to the Town
Manager or Deputy Town Managers for approval, award or execution, the Department shall assure that
the requirements of this policy and all statutory requirements related to the contract or instrument have
been met.
Town Manager and Deputy Town Managers approve all other agreements to include:
Real Property Acquisition:
a) Contracts, including options and purchase agreements, to acquire real property and interests in
real property for the Town
b) Authority to execute all instruments reasonably necessary for closing the transaction after overall
authority to purchase property is obtained.
TOWN OF CLAYTON POLICY: Manager's Delegation of Authority for Contract Negotiation, Award, Approval and
Execution Page 2 of 3

Grant applications and acceptance:
a) Approve grant applications and acceptance for Federal Grants and State Pass Through Grants.
Service Contracts for services provided to the Town:
a) Service contracts include architectural, engineering, surveying professional service and alternative
construction method contracts; other professional and technical service and consulting contracts;
building, grounds, and equipment maintenance contracts; utility contracts, such as contracts for
electric service, including the installation, maintenance, and repair of street lights, the replacement
of streetlights with dual -use facilities, the provision of interim utility services in annexations, and for
electricity.
b) Master agreements for professional/other services on an as needed basis, and task orders to any
master agreement.
c) This delegation includes authority to approve and execute amendments to service and professional
service agreements.
Construction Contracts:
a) Construction agreements and change orders that do not specifically require authorization or
execution by the Mayor and/ or Town Council.
Concession, license, sponsorship, and similar contracts:
a) All contracts that will bring revenue for the town.
Employment and employment related agreements:
a) The Town Manager may approve and execute employment and employment related agreements,
in accordance with town ordinances, except for employment agreements involving the Town
Manager and Town Clerk.
Appeal and Settlement Authority:
Provided there is a sufficient budgeted appropriation, and with the concurrence of the town's attorney:
a) The Town Manager may approve and execute Instruments to settle condemnation actions for any
amount that is reasonably consistent with an appraisal.
b) The Town Manager may settle construction contract claims.
Leases:
In accordance with G.S 160A-272, the Town Manager or Deputy Town Managers can execute a lease for
real or personal property to a private entity or individual with a term of under one year.
In accordance with G.S 160A-274 - the Town Manager or Deputy Town Manager can execute an agreement to
lease property with other governmental units as long as terms and conditions are deemed wise.
TOWN OF CLAYTON POLICY: Manager's Delegation of Authority for Contract Negotiation, Award, Approval and
Execution Page 3 of 3