WQ0044486_Application (FTSE)_20230531

State of North Carolina
Application Number (to he compicled 11v DW R
All items nitist be completed or the application will he returned
1. APPLICANT INFORMATION:
Town of Southern Pines
I Applicant's name- ---- (company. n1LJI1iCij),flItY, I 10A, utility, etc.)
II F] General P-artnership
Applicant tvpe� Ej ndividual El corporation
F-1 1, 'cdcral ❑ State/County ML1111cipal
A N C � C 02 1.0 106 1)
In
A. Si011lattffe aUt110I-ItV*S 11,MIC: Reac-nin Parsons per I A . ..... ... . ........
I I Ream_ . . . ...... ....... .. I ............ ...........
Title: -17OW11 MWULel-
4. Applicant's mailing address: 801 SE Service Road.
Cilv Southern Pines State: NC Zip: -18187-
5, Applicant's contact inl'ormatiom
Phone number (9 10) 6921-70711 1,1'mail Address: paisotisi'(-I`SOLItIIC'I'Ilpines.tict
...............
❑ 11rivately-Owned PLINK Utility
❑ Other
IL PROJECT INFORMATION:
1, Pro,ject name: Tara Office Park
Application/Project SUALIS: El Proposed (New Permit) 0 IAlstim-, Pernil't,"ProJect
If a niodification, provide the CXIStlilly f)eI'I11It 111LIniber. WQOO--- alad iSSI-led date:
For modifications, also attach a detailed narrative description as described in Item G of the checklist.
If newv construction, but part- of a master plan. provide the existing permit nuinticr WQOO__,
COUMV �,VIICI-C pl-O'CO10C�.ItCd: M0 01-C CQUIlty
I J I 'S I I I 1.. 1
4, Approxiniate Coordinates (Decimal De(-,rees): Latitude: 15. 175 Lon-ItLide: -79.402
Parcel ID (it -applicable): L.RK000'.-,'8' (or Parcei ID to closest downstream sewer)
Ill. CONSULTANT INFORMATION
1 Filgincer: jeffre", L). 11arczak f,icense Number 0' 1
I`irm: Bar- -czak I'fl"I'lleellilu Services PLLC
1-1--l--l- .............
MaIiInL, address., -1 9 Grantham I louse Wav
City- AJ State: Nc Zip: ?7:�1'
Ph011e IlUfflhel-, [phone] Einail Add ress : barczak cn,-, I lice I-1 nqid�-nla ILconl
IV. WASTEWATER TREATNIENT FACILITY (WWTF) INFORMATION:
- 1, I'ficilitv Name: Niloore CotintN, Permit Nuniber: NC'00'7?�08
Owner Nanic: Moore Countv Water Pollution Control Plant
..........
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit N! LI ITI be I'( S) : WQ00680 2
I I - (Jravit",
1)ownstrearn (Receiving) Sewer Int'viration: 8 Inch M''1111
(Receiving)
3.
I -jhlc)- WQC'S00309 System Wide Collection Systeni Porniit N,,.imt
0\vner Name(s): Town cal' Southern
1 `0 1 1 -" I'A 0 6 - " I Pay=e I iif

State of North Carolina
DWR Department of Environmental Quality
Division of Water Resources
Division of Water Resources FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 96-21 & SUPPORTiNG DOCUMENTATION
Application Number: V\[QQWy!��A?�(O (to be completed by l)WR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: (company, municipality, I-IOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑Privately -Owned Public Utility
❑ Federal ❑ State/County M Municipal ❑ Other
3. Signature authority's name: Reagan Parsons per 15A NCAC 02T 0106(b)
Title: Town Manager
4. Applicant's mailing address: 801 SIB Service Road.
City: Southern Pines State: NC lip: 28387-
5. Applicant's contact information:
Phone number: (9I0) 092-7021 Email Address: parsonsgsouthernpines net
if. PROJECT INFORMATION:
i , Project name: Tiara Office Park
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: Moore County
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.175° Longitude:-79.402°
5. Parcel ID (if applicable): LRK4 00037583 (or Parcel ID to closest downstream sewer)
Ill. CONSULTANT INFORMATION:
JPMORGAN CHASE BANK, NA 1414 i=
BARCZAK ENGINEERING SERVICES PLLC 133 West Franklin Street
139 Grantham House Way Chapel Hill, NC 27516
Apex NC 27523 12-1/750 ;
414-429-4865
Y
. -... f0
m
PAY TO THE o
ORDER OF _ Nr nPnartmPnt of F virnnmPnt__gl nliplit **
--- --- — ---� 480.00
0
—_ Fniff H i inrlrPri Finht v and
F077_ 1
NCDEQL
kidFayetteville Regional Office -
Jeffrey D. Barczak
225 Green Street Suite 714 u
Y
Fayetteville, NC.:28301-50995
10
MEMO NP
Tiara Office Park S
4.
- _

Barczak Engineering Services, PLL C
139 Grantham House Way. ♦ Apex,NC. 4,27523
♦ 414-429-4865
email barczaken 7ineering a1amail com
.January 27th, 2023
Fayetteville Regional Office
Water Quality Section
225 Green Street Suite 714
Fayetteville, NC. 28301-5094
RE: 8" Sanitary Sewer Extension "Tiara Office Park"
Town of Southern Pines, North Carolina
Dear Sir/Madam:
Enclosed please find the Fast -Track Application (FTA 10-14) and Flow Tracking for
Sewer Extension Application (FTSE 10-18) for a proposed sewer extension to service the
above referenced site. The project will consist of extending an 8" gravity sanitary sewer
line to service a 21,600-office building development and 3 residential lots. The site plan
as well as construction drawing are attached. The plans have been reviewed by Jarnes
McMichael, Southern Pines Engineer, and Moore County Public Utilities County
Engineer, Mr. Brian Patnode PE.
Sincerely,
Barczak Engineering Services, LLC
Jeffrey D. Barezak, PE
C E Vti, IV
MAY 31 2023
`Z = j %'�f
DEQ-FAYETT
E V I LCE RE IONAL OFFIrLL

State of North Carolina
DWIR Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources INSTRUCTIONS FOR FORM: FTA 06-21 & SUPPORTING DOCUMENTATION
This application is for sewer extensions involving gravity sewers, pump stations and force mains, or any combination that has been
certified by a professional engineer and the applicant that the project meets the requirements of 15A NCAC 02T and the Division's
Minimum Design Criteria (Gravity 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 N .0 0203
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; MAY J1 1 2`1
➢ Projects that involve more than one variance from the requirements of 15A NCAC 02T; 023
➢ Pressure sewer systems utilizing simplex septic tank -effluent pumps (STEPs) or simplex griiXds�r--ftgiJp�k/ji I �� I rF�C�
➢ Simplex STEP or simplex grinder pumps connecting to pressurized systems (e.g. force mains); �`'�`'���'L�r
➢ 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 0.5-21):
® 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 I.2 is a partnership or d/b/a, enclose a copy of the certificate filed with the Register of Deeds in
the county of business.
® The Project Name in Item 11.1 shall be consistent with the project name on the flow acceptance letters, agreements, etc.
® The Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a North Carolina
licensed Professional 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 027' .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 Paee 1 of 3

E. Flow Tracking/Acceptance Form (Form: FTSE 04-16) (if Applicable):
® Submit the completed and executed FTSE form from the owners of the downstream sewers and treatment facility.
y Multiple forms maybe required where the downstream sewer owner and wastewater treatment facility are different.
➢ The flow acceptance indicated in form FTSF 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).
Y 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 i 1-inch color copy of a USGS Topographic Map of sufficient scale to identify the entire project area,
including the closest surface waters.
Y General location ofthe project components (gravity sewer, pump stations, & force main)
Downstream connection points and permit number (if known) for the receiving sewer
❑ Include an aerial location map showing general project area (such as street names or latitude/longitude) so that Division staff
can easily locate it in the field.
G. Existing Permit (Application Packages for Modifications to an Existing Permit):
❑ Submit a copy of the most recently issued existing permit.
❑ Include a descriptive and clear narrative identifying the previously permitted items to remain in the permit, items to be
added, and/or items to be modified (the application form itself should include only include items to be added/modified). The
narrative should also include whether any previously permitted items have been certified.
❑ The narrative should clearly identify the requested permitting action and accurately describe the sewers to be listed in
the final permit.
H. Power Reliability Plan (Required if portable reliability option utilized for Pump Station):
❑ Per 15A NCAC 02T .0300)(1), submit documentation of power reliability for pumping stations.
Y This alternative is only available for average daily flows less than 15,000 gallons per day
v 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 .01 15(a)(1) provide the Certificate of Public Convenience and Necessity from the North Carolina Utilities
Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served by the sewer
extension, or
❑ Provide a letter from the North Carolina Utilities Commission's Water 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):
❑ 1-iome/Property Owners' Associations
❑ Per 15A NCAC 02T .01 15(c), submit the properly executed Operational Agreement (FORM: HOA).
❑ Per 15A NCAC 02T .01 15(c), submit a copy ofthe Articles of Incorporation, Declarations and By-laws.
❑ Developers of lots to be sold
❑ Per 15A NCAC 02T .01 15(b), submit the properly executed Operational Agreement (FORM: DEV).
For more information, visit the Divisions collection systems websile
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 Reqional Office
Water Quality Section
2090 US Highway 70
Swannanoa, North Carolina 28778-8211
Avery, Buncombe, Burke, Caldwell, Cherokee,
[phone]
Clay, Graham, Haywood, Henderson, Jackson,
[phone] Fax
Macon, Madison, McDowell, Mitchell, Polk,
Rutherford, Swain, Transylvania, Yancey
Fayetteville Regional Office
Water Quality Section
225 Green Street Suite 714
Anson, Biaden, Cumberland, Harnett, Hoke,
Fayetteville, North Carolina 28301-5095
Montgomery, Moore, Robeson, Richmond,
[phone]
Sampson, Scotland
[phone] Fax
Mooresville Regional Office
Water Quality Section
610 E. Center Avenue
Mooresville, North Carolina 28115
Alexander, Cabarrus, Catawba, Cleveland
[phone]
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
Stanly, Union
[phone] Fax
Raleigh Regional Office
Water Quality Section
3800 Barrett Drive
Raleigh, North Carolina 27609
Chatham, Durham, Edgecombe, Franklin,
[phone]
Granville, Halifax, Johnston, Lee, Nash,
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
Warren, Wilson
Washington Regional Office
Water Quality Section
943 Washington Square Mall
Beaufort, Bertie, Camden, Chowan, Craven,
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
Water Quality Section
127 Cardinal Drive Extension
Wilmington, North Carolina 28405
Brunswick, Carteret, Columbus, Duplin, New
Hanover, Onslow, Pender
[phone]
[phone] Fax
Winston-Salem Regional Office
Water Quality Section
450 W. Hanes Mill Road
Alamance, Alleghany, Ashe, Caswell, Davidson,
Suite 300
Winston-Salem, North Carolina 27105
Davie, Forsyth, Guilford, Rockingham, Randolph,
Stokes, Surry, Watauga, Wilkes, Yadkin
[phone]
[phone] Fax
INSTRUCTIONS FOR FORM: FTA 05-21 & SUPPORTING DOCUMENTATION Pape 3 of

State of North Carolina
DWR Department of Environmental Quality
Division of Water Resources
Division of Water Resources FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number: WQOOyyiAS(y (to be completed by DWR)
All items must be completed or the application will be returned
1. APPLICANT INFORMATION:
1. Applicant's name: (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ® Municipal ❑ Other-
,
3. Signature authority's name: Rea an Parsons per 15A NCAC 02T .0I 06(h
Title: Town Manager C- EN E D
RE """ 1
4. Applicant's mailing address: 801 SE Service Road. 3
1 3
City: Southern Pines State: NC Zip: 28387- �Y�
5. Applicant's contact information: DE&FAYETTEVILLE REOV-(rr�C�_
Phone number: [phone] Email Address: arsons cr,southernpines net
I1. PROJECT INFORMATION:
1. Project name: Tiara Office Park
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: Moore County
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.175"Longitude:-79.402'
5. Parcel ID (if applicable): LRK# 00037583 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
l . Professional Engineer: Jeffrey D. Barczak License Number: 035213
Firm: Barczak Engineering Services PLLC
Mailing address: 139 Grantham Mouse Way
City: Apex State: NC Zip: 27523 -
Phone number: [phone] Email Address: barezakengineeringaa gtnail corn
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
l . Facility Name: Moore County Permit Number: NCO037508
Owner Name; Moore County Water Pollution Control Plant
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ0068023
2. Downstream (Receiving) Sewer Information: 8 inch M Gravity 11 Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS00309
Owner Name(s): Town of Southern Pines
FORM: FTA 06-21 D_3(." 1 F c

V1. GENERAL REQUIREMENTS
I , if the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑ No ® N/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM DEV) been attached?
❑ Yes ❑ No ® N/A
3. If the Applicant is a Home/Property Owners' Association, has an HOA/POA Operational Agreement (FORM: 110A� and
supplementary documentation as required by 15A NCAC 02T.0I 15(c) been attached?
❑ Yes [:]No 0 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 / dental / veterinary facilities ❑ Swimming Pool/Clubhouse
❑ Food and drink facilities ❑ Church
® Businesses /offices /factories ❑Swimming Pool/Filter Backwash
❑ 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. Hasa flow reduction been approved under 15A NCAC 02T .01 14(f)? ❑ Yes [:]No
➢ If yes, provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow "''
No. of Units
Flow
Residential assume 4 bedrooms
480 gal/lot
3
1440 GPD
Infiltration
1 gal/acres
4.52
5 GPD
Office space (70 employees)
25 gal/employee
70
1750 GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
3195 GPD
a See 15A NCAC 02T .01 14b 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).
Per 15A NCAC 02T .01 14(c), design flow rates for establishments not identified [in table 15A NCAC 02T.01141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 3093 GPD (per 15A NCAC 02T .01 14)
➢ 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: _ ISSllance Date:
❑ Rehabilitation or replacement of existing sewers with no new flow expected
❑ Other (Explain):
FORM: FTA 06-21 patlP of s

VIi. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
I. Summarize gravity sewer to be permitted:
::Size (inches) Length (feet) Material
8 1163 PVC SDR 35
➢ 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)
➢ Oversizing lines to meet minimum slope requirements is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (if Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: ° Longitude: - °
3. Total number of pumps at the pump station:
3. Design now 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)(1):
❑ Standby power source or ❑ Standby pump
➢ Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(1)(B)_
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
➢ Must be permanent to facility and may not be portable
Or if the pump station has an average daily flow less than 15,000 gallons per day 15A NCACO2T.0305(h)(1)(C):
❑ Portable power source with manual activation, quick -connection receptacle and telemetry -
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry:
➢ Include documentation that the portable source is owned or contracted by the applicant and is compatible with the station.
➢ If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel timeframes, shall be provided
as part of this permit application in the case of a multiple station power outage.
FORM: FTA 06-21 Pane I of S

iX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations/alternatives found in 15A NCAC 02T .0305(f) & (g)? Yes ❑] No
15A NCAC 02T.0345 contains minimum se arations that shall be rovid d f
e or sewers
Setback Parameter*
stems.
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-I 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 IX.2)
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches, as well as wetlands associated with these waters or classified as WL.
10 feet
Any building foundation (horizontal)
5 feet
Any basement (horizontal)
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
%. ir�-- -- ''— "I
36 inches
1! i10fiCO IP!in ue witn VL 1 .0305(" or (0. see Section X.1 of this application
*I5A NCAC 02T.0305(g) 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 weboaize
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 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: ®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
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.0 I 05(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 M No
Per ISA 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 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 Pane 4 of 5

X. CERTIFICATIONS:
Does the submitted system comply with i.5 N(I;N(. 0 1�. the l\,llnimulr� I�t�i�ir t'ritc�r, I Ior the P0r111lit in,_ (.)I' 11tin1l) Stations
�' w1lti 1 1'. ' i ','t;t `;;l,'I1 !. and the �_il i vIt I N/1i111l11111t1 [)t";Wn () Itei Gl I I4i1( st ver ;rt n as applicable''
®Yes ❑No
If no, for projects requiring a single variance, complete and submit the Varjance,Alternative 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 approval of the permit, and projects requiring a variance approval may be subject to longer
review times. For protects requiring two or more %ariances or inhere the variance is determined by the Division to be a
sr nificant portion of the project, the full technical review is required
2. Professional Engineer's Certification:
1, Jeffrey D. Barczak . attest that this application for l iara Office Park
Pmlcssional i nglneer's name from Applic-ation Item Ili I i (Proiect Namc from Appllcauoll Item 11 I)
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 hest of my knowledge the proposed design has been prepared in accordance with the applicable regulations,
N11innuunl Design C IALffla liar C,ra%Its c r,,ion . and the !i linlrtltrnl Ott - !li_CI ItE;rr 11or file l ,t;t-1 !;1clo I'crnlittlr �
od ;':r 11 a �)tatruns and I orce Maim 1;111:a., } c; i1 . 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 It to be consistent with the proposed design.
NOTE in accordance with General Statutes 1 a3-215.6A and 143-215.613, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of 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 Fngineer to referral to the licensing board. (21 NCAC 56.0701)
North Carolina Professional Engineer's seal, signature, and date: ��\\��CAR��///
Q 213
..
, ,� 1
VG I N�G�t-`\��
1111110
3. Applicant's Certification per 15A NCAC 02T .0I06(b): I Z?1Z'l
7
o'wtl �...n�,Aeer. attest that this application for i4r'� C`�����
(Sixnature Aulhurit} Name from AppllcatiorrKem 13 (Project Name from Application Item II 1)
attest that this application has been reviewed by me and is accurate and complete to the best of my knowledge.
understand that if all required parts of this application are not completed and that if all required supporting documentation
and attachments arc 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, in.junct►ve relief: and. or criminal prosecution. I will make no claim against the Division
of Water Resources should a condition of this permit be violated. i also understand that if all required parts of this application
package are not completed and that if all required supporting Information and attachments are not included, this application
package will be returned to me as incomplete.
NOTE In accordance with General Statutes i ­_' 1 ` .t, j, and ! ! ' ! any person %%ho knowingly makes any false
statement, representation. or certification in any application package shall be guilty of a Class 2 misdemeanor. which may
include a tine not to exceed $10,000 as well as civil penalties up to $25.000 per violation
Signature. Date: S A(0 AOd,3
FORM FTA 06-21 Page 5 of'5

�(�� U.S. DEPARTMENT OF THE INTERIOR re.xpa«Mrwr SOUTHERN PINES QUADRANGLE
�f SGS U.S. GEOLOGICAL SURVEY ♦i
r.rrn.p lar..rn.Mr„p nme! ►�/ US Topo NORTH CAIN• A100RE COUNTY
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SOUTHERN PINES, NC
7019 EER

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking/Acceptance for Sewer Exte n .
E
Entity Requesting Allocation: Town of Southern Pines
MAY %3 1 2023
Project Name for which flow is being requested: Tiara Office Park L T�' ' EJI
Mo►-e than one FTSE may be required for a single project if the owner of the WWTP is not responsible for all pump
stations along the route of the proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Moore County Water Pollution Control Plant _
b. WWTP Facility Permit #: NC 0037508
All flows are in MGD
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 0.00309
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
II. Complete this section for each pump station you are responsible for along the route of this
proposed wastewater flow.
List pump stations located between the project connection point and the WWTP:
(A)
(B)
(C)
(D)=(B+C) (E)=(A-D)
Design
Obligated,
Pump
Average Daily
Approx.
Not Yet
Total Current
Station
Firm Flow"
Current Avg.
Tributary
Flow Plus
(Name or
Capacity, '" (Firm / po,
Daily Flow,
Daily Flow,
Obligated Available
Number)
MGD MGD
MGD
MGD
Flow Capacity***
* The Firm Capacity 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.
*** 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): Moore County Public Utilities
Downstream Permit Number: WQCS00034
Page 1 of 6

III. Certification Statement:
I James Michel, P.E. 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 indicates acceptance of this wastewater flow.
igning Official Signature
..S
Date
3
Page 2 of 6
I -If .Sf

1. INII IN
ass essment addend c a (h 'is ted h I Sccho-n, fl. A ,la H,�,c Car^)a(city *s <
Jam m planISQ:
Givell that:
of ObNgatcd, Not 'Yet Da.,.!y (C) Foi-
% a ri M,,GID ,)Ft,hc; Avadabic Capac-ily �D i-.-i Pu.,-ni.-) S-iation
N
cylil, ooligmed, not ye', t-ibu,,,,'ary C'a"'Dacity is ccuri-enfl,,,,y approxinn�ateiy
per ycac; and,
provide the requked, pia-nncd ca-Pacity, nanne"y
s in ow uinder con's-Irruction m/il"In
CA,. llh,�c Fc),iiOw-,,-ng
Merebm.,
Givien reasonably -expcctccryplyming WArmalion, there it; WEAK ;- Lo 1 ,,eustiFlcatian, -,,' , a'R,,,j,/
this flow to loco peymitted, without Ea, of over-Aloc-ati-rig capac-ty ir., t'he systc-rn
1 understaind', tha,'Ll -,,,,,,,niS does not YCHCVC hie C1311cocticmi system cuw-,u,,C-r tronr, wit'n, -14-3-
21 5.67(a) which mWITAs the hamdurwim-, 'n"F �-cv -n fif flip f-PlIwAv nNAP ImQMP Xer"'Od",
Dwe

MOW Traci"
A, s'sess-n,�ie ;@t A,
Me namo
of the N;"'T\,/`V0O
that will reem've
Lip c E A A
V 1. P_ 14:
i_3 . S c -na rile nzmer
Or N­�e
cilhy's OCril"We'C B, NPDES mr NJon.Discharge pernj±
�Mud IVA
'This 4-ntciudes allocated to othm,
prc�-)`Octs not yet contributing f! 0 NA/ to the sysl.em. Flows diocated throqoi ReAca,"
or other contacts not yet contAbuting IF,"OW W the cOdection system arc aiso, ii-icluded. For PLOTWs
that it piemelili a qw0gram, include PONA's allocated to industrial users who nnay not be usjng ai,�, of
"i ',r alloca6on. Please Contact you."'. P.cct,�,"catmcnt Coordinator fbL,- on, industria"!
U, e,,
'o ymui- V,/ W `,,F P.
A"'S 5., 2CM Si".'Ould have revievm-d Fd!,!ocadons smade oiler the last two years -anc.".
reconcded their how records, to he ',,-)CsT o-l"flneir abilly, so it is Klom how much f1ow '.�hms `beei,� oMigated-
is not yet been made trikiv,,ary to fl-ho VVVVTP, in acccadance svhh local polUes pr()ccc:JL-,aJoyc L,-es ejij-� Y the
)d
c 'V WVVTP
r d'sspeCHIre UWG5mh'Ek eq,,ues'tcd
g. Total aclual and,' rub�i.igF
+
C)
For exanye:
iC'
_a Now NEVC), I`Ai'l D� rc,,-)oAcd to the Rcg',mna'�i' OCtIce It'nal- is !,115
G, D o 0 's n c) 11 0 t 1,�:' al , r y � T 11 c a 11 n u a, a, '."/ c ag e 2! o vi 2 0, �'; 7 i s 2 . 7 PA G. 1 -L, e -r 0, i s
55
The first Form FT,`SE a to r .la nu a ry 15, 2008 nn a, y i.avce nu,�qn beFs �,-.i.ke tin'i's:
17 101 G D
0.015 N4 G ED
.5 3
'file next Mm USE" a -),rC,".-)osC-c.'1 expans�,on 9(12
2.73 NA 03 Oo
-i 02
g.
5, 5. ',,2, %
Each svbseq,rcn,,L'. ibo u,-pcilaied

C mpp"-Ox-"n'al-e clies:""(';i-� a,%
e
Y . I �' N
-3 S, a-i mi
:'J S i✓C")
C
-c"
o' 11
v �-0) C", C: `L-I� El S''
C - 'i eS 3 o ocse�-V-ce nei�' 1�"hc
-
A -,v ag-
LY fO'�- p c a n -� g -11 c 10) 1 1 C S3, L
C'�m !s < 'm 'ssessn
I Ly
C a, VE, LdD' 10 ca'-" c
a S' lom 'D 0 M�11slaC"'i'M '13ltfl"e
Lz'l'c� SYSICM a s T'U 'cj o c a c i y
"A
yi
011 .1
11 pa"'ed,
D
�cy x.
Cl
A, v a� c;
S
Da, y
Acv a a
NA: G'I'-
f \1A -3, D
ovv
C, 1,) 'a C.D
0. 25 2
C. 3, 3 2
iR 731 s
7
0.
1

L 'pIanrkg assessment isted Al Section it where cap'---ci`iy s <
A Anshig assessmewt 5c,- Ka-v"' 'D'cte'k 'P"S (See exEmple daw above) may be PerMlc
'S
that needed o.'- �-SZUKOPS in
if tot System decides to acco"""'t' �'-'asec on -�i p.pnning assessment addendum, it A respondfle to manage the
Pow Whiout capachy ar�d must tako all steps necossaqy �,o -p i etc 111-ic
'ect cumendy in design or canshudion, or a planned project hi-i
"yci a pIll adopled '-)y ti-ie system. Fhe S31AII Sx.ot]S'ci "veig"", fl'-Ec
cc r ,ten 1"I'C".- a-ny �'-."Xpanjon, flow sliversion or V111tration and
VACIV el In,'. -p"a-'JcctS that are the foundation of a Planned solution to capa'-"Ly nt -,`rac-'kig a-nd
conyhEnce,
Gown 200
a. Tho Ploysioll and, rn�ot ye t":'bu",ary acco'mnts F)r 24 IX) a,-,nd 0.080 1VA,GD',, ot"tho
Kaw Qrcel�,d tn�af n -Fhs ob, gaile d') "'n ", t y 01, t ri 1h u -it'ary 0 ap a C Hy i s e U rre n! y ap P i-o- x rn a to I y Q . Q I'V" G
I ("Fao""Va'�io � o -
por yeaq and AM
c A "'-;�'a" i-J*,�, provide the requPed,
is in design on under
WE-
-'o
appks:
file mas-'eir Al and &I Vear canW now and nindigg,'J"O." 0, '-2-
--Th;�qc! is lKanned to add 1). 100 IVIC31
a'-.'y �October 2015. Incksion of this ProppGad czphal Project fats a, conditiori
of this Flc-'vv/ Cor ExI-,cnsior; Permit A, pkm:ion flh'is Pro*
d o a i ar ;V,/s o
�. � I a rn'
nnen,�c , -�ead ofthe activat'i n m"'okAgatecL not US Urits
that oxcead the f0m s",adon caDaNties idcontilled H above.
VcM-, ' -1 �a li, "- I ' -"S SAQ'us'-i'-is 15o';,'/"' bj -baic,hc'e ea, o alovv 'h1
c "')0- Mhout a. significad 11kokhood of over-atiles. cating capacky in the system WhashuKro.
c.
"S

State of North Carolina
Department of Environmental Quality
Division of Water Resources
._ Flm�� Tracking for Sewer lT-"I
��
Entity Requesting Allocation: Town of Southern Pines MAY -3 1 2023
Project Name for which flow is being requested: Tiara Office Park NNAOr����
More than one FTSE may be required for a single project if the owner of the WWTP is not responsible for al! pump
stations along the route of the proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Moore County Water Pollution Control Plant
b. WWTP Facility Permit #: NC 0037508
All flows are in MGD
c. WWTP facility's permitted flow 10.0000
d. Estimated obligated flow not yet tributary to the WWTP 0.82383
e. WWTP facility's actual avg. flow 4.86000
f. Total flow for this specific request 0.00319
g. Total actual and obligated flows to the facility 5.68702
h. Percent of permitted flow used 56.8702
II. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
List pump stations located between the project connection point and the WWTP:
(A) (B) (C) (D)=(B+C) (E)=(A-D)
Design Obligated,
Pump Pump Average Approx. Not Yet Total Current
Station Station Firm Daily Flow** Current Tributary Flow Plus
(Name or Permit Capacity, * (Firm / pf), Avg. Daily Daily Flow, Obligated Available
Number) No. MGD MGD Flow, MGD MGD Flow Capacity***
SP#4 - 5 2 1.0484 0.2028 1.2512 0.7488
* 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): Moore County Public Utilities
Downstream Permit Number: WQCS00034
Page 1 of 6
I n 1 0

III. Certification Statement:
I Randy G. Gould, 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 lI 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.
-2 3
SiigninK'Offi .Si
Title of'Signing Of,f cial
Date
Page 2 of 6

Submit a plannhig assesmew "o-r cac.-i "".-n Secdon it whe.-c- Avao-iLib!c ,s <
S". " 11 (to
Goven that:
alsount of OkAgated, Not 'Yet TASK!' MAY F"k-)VI, (Q) accm-mcs :For
X/r and ofthe ikilaiiak)ie ca-1pacity !I-,, "'Pump Sta"."'on
I and thm',
c m,tc c; ,igated, not yet is c",--ri-crody appi-ox, imnateiy
�, yc
CF-phs! Prqjew thal WH pwAde the
is in desip, -iide-r vviilh
c c, and/m-
fC,.,,c)WKg appiks:
ana ci ent j ustificad Oil to allow
this flow 1c; 1301 T)CTIll itied, Cl caqp,-,S.c,Ly irl i,1he system
inflastructure.
! understaynd, do'c's vh,,-� syslom owmier
21 5.67(a) ywhibAs '),"i, F.-.,-,y "vvasto in mcess ca-
-,�43-
S 7 Q rjj
Dale

TaISMOCIAMS Oar We, 7:001ag Alm-. and Phanoug
Step the naw mcleive
A linter A- or Iyon-DISCAS!, mawbor Ar A-.'e "Ahe
'F-m -n ovvne,,,-'s NPDEES or Non -Discharge permit.
I"V,., D: ; . .i
yet h1butary tc, )kAG'13: This VAudes 11ow5 allocated to other
Consmucum projects yel: Mom, to the cokchon syswnt F,',C,,ws aflo'c-,ated through hwedocal
or Wher contacts not yet ConAbuing I ow tc) 11.nc collechon system arts Aso OMAN. For POTIN's
that implenmn"i, a -p.retreahment iirx:.�ude FG,-,-)vvs a,,�ocalcd to industriad -users who -may not be using all of
--e'r �',`Case contact you'i, Coordinator ifldILqStI-i,-I! -Fio' iributary
,o "vo"u", 'V,"/,\)V "F11.
�4
AF, s J ua, �-,y 15, 2 0 0 8 t h e P 0 TMA o u/ s A h a-"v e v -; 0 ""'ve vv a "i "', o c a t , c) s nr, ad e o v ,, r t c; 1 as 1 t vv o years an d
recon61ed their noxy ecords, to the best A their abMily, so i"L is Nown how iwufc'r� R'Iovv lhas been Wigated and
is not yet been made Mulary `; GC WW'IFP, I accordance vvhh iocal policies and procedures ('niployeal by th�,e,
-'') e-r'reviaus 12 month average.
ii'cj'r tjl,xS requcs-�-MCM Entm, ,A-,e req,,�esicdi 1"?ow
�J J I
'' (,� x, a p iI.
vvS to the SCHI/ IV, ID �c;. + e +
"'"mFtSzn,-!ay !) a a ow.) gko",�!0"ice eres.5
IM"I, D', of Eovv Mat is ObAgated, 'rju,� YOL b�,narye 'Frcs annual aNemp , ow 2000,7 -is 2.7 N4,;'GD. There is a
aRew knuaq, i 5, 2008 "i-iis:
17 C3,I),
3115 Me_...
TA next Am n-,,�Y /C� a propc'sc,"'
.1
in 2.73 PA G
EEO suhscquont T?E,',". sai�-e

gn average
sTalmn name or numbar ana p 'rimp WhoF-�pproxmnate desi
MY pow J) appyoxhilate Curren? average (13). and the oldigated, not yet tributary flov,, flhro,-Igh tfic
moncted by
z 0 toy 1 c a z e r c na s a, t h e a V b 10 c a p a 0 hy (EY A. - Dy. 1 n. c d c t "i c p i-o -po s c
Vp Mis nFolow VAT 01ACY OhAgmd Ows that havo 'c;-L"t, arc i !tip yc�
FBI capacky is the cn chieflh tefi'abe avedi wihe iagpunlp ou�oservce as perchc
Desigr.,. Averag,,,-; ;,S fool capaci""YC pun-.rq) station divided by a pwakingi�actor(pE� ofii,,)-Y,: 7Icss
2.5,
if the avaHable capacity "or sta,-,"*,on, is �S "", pfrepare a plaming assessment rorthmt pump station,
Athe system has to capachy that slil-i"',uld' 'he considered in the pe.,nnitithnig process.
Obligated,
Design
Apprcm
IT ,, c), !. Y c ,4,
Totod, current
F ban
Average
Currc�i-�,t Avg.
Tributary
Flow Plus
DF,.-,,!y Flow
Daily Flow,
Daily FIC,
CO g a t e d,
A v F., al-j I c
jame or
1 \4 D
M G ED
i ow
C p a, ci ty *
;,"S,
1252
A080
A 3 3 2
4012
W&I Row(-y PS"
A 7 58,'
1472
(1135
Q607
A 15 i
g
FURF 10-12

PIOUSUR Ass
P)"annhm assessnent i�6';- each Pimp Stat"o-n "'.'Ste'd" ''n Sec don H"" vv.'ric-rc avaiJa�b.1le ca.};rachy is < 0.
A PS (Soo exam"p"'�'C d's"­aa niiary c)e
E A A hoc d A a-,': nee �n'�s' 0. red U CV on S i 11 a in H gavec"', r: Pam`" a c -0
sys"'C-i-.cH decides to accept die How hased on if planning; assessnent addendun, A is responsilbae to
)v'! w y u0LVF c a, P ac i I y -,-e i _ate d s a n i ta ry o v a r 0 cm, S ""'n C" ""j S -, ta 'i' C a'Al i s -Le s n" 0 c C s s a ry -to C o nn -p ! e in I h C P rQ j c C I r C 0 r C)
e C).F i']"ov" lo P.rcv"_'i-'t sa-n' i'm i-Y sexer ove""I'!,ows.
The planning assessmen',
p','-C�"Iecl cmendy in desQg)n cA' const'r'uci.lion, or a p�lanned prqject in
TO SI/StOM ShOUId ffeftf�� y We-.,'gl-., ':-e
the future not jwc"".", a %Omum! plan adoptce" ';,-)Y i'PC SYStOM, Ca d,
cWhity success ""�-"rqjjeci -1,0"'. any expansion, flow managmsent, d'vei"-Sion or aild".
tt:-at arc ',the h3undaAcm oF a plamled soNtion to capachy tracking mcceptanoce
Given
'and"! �'�mrun t of obligated, not yet tMut�,;,ry accounts IF63- 24 % 0.080 MI,'G-,,',--)
)
K2v,, Creek-, -�It'hat
on Thle m','-Le of activai�"cm, ob'Hgafed, not yet •'mh)-utary capachy is currently approximately (1()! rvjCjjD
per year, and
c. A ICO-r�',dedl w..,"t, provide the requked, mien-nedt capacity, jjay,0-aejy
is in design or unde'r conslr'uction witli p1mined,
completion in and/or
appHes:
'�/Carr ca'�'plta! pi',Yn nta"m rcconnnended scope and i`uridhio for a capitad pro;cc -ntitjeo
Statjoij uio I: `q `th rumdi' c, 2014"oc0. 101c. Th-Pts pIa �i ccadd 0MG D
October 2015. Wc!usI'*0n of this j I)p(-) _ps 11 �" , ' -, " "1 .1 L' L' 11,
ed COPAVI
_-Sa
of "''-iErsiPerA.,p"icto. Clevaes dh'moject's �pr; "by for
x-teion "ninis r
ano construction Im ",-)c a,�head ofthe achvahm of obilgaled,' -�ric;ly �tt-,,'�b�utar
-) Ilk, Sd as S.
that exc-ed c"'I'3acf% 14-M Oled I Section 11 above.
if
Given reasonabb, cxpeciccii cond�'k':Pon's 'a'-ind"Were is to f"'Ov"
to he perm"'L-Lc(d' a siggAdmit likelihood"�, capacity in the System Washuchm
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VI. GENERAL REQUIREMENTS
L If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑ No ® N/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached?
❑ Yes ❑ No ® 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 ® 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 / dental / veterinary facilities ❑ Swimming Pool/Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
® Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 % Domestic % Commercial % 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(fl? ❑ Yes ❑ No
➢ If yes, provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow a,b
No. of Units
Flow
Residential assume 4 bedrooms
480 gal/lot
3
1440 GPD
Office Space (70 employees)
25 gal/employee
1750 GPD
GPD
gal/
GPD
gal/
GPD
Total
3190 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 available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 3093 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

State of North Carolina
DW Department of Environmental Quality
Division of Water Resources
mim- V V R
Dlvfsfon of Water Resources Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: Town of Southern Pines
Project Name for which flow is being requested: Tiara Office Park
More than one FTSE may be requiredfor a single project if the owner of the WWTP is not responsible for all pnunp
stations along the route of the proposed wasteivater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Moore County Water Pollution Control Plant
b. WWTP Facility Permit #: NC 0037508
All flows are in MGD
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 0.00319
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
II. Complete this section for each pump station you are responsible for along the route of this
proposed wastewater flow.
List pump stations located between the project connection point and the WWTP:
(A) (B) (C) (D)=(B+C) (E)=(A-D)
Design Obligated,
Pump Average Daily Approx. Not Yet Total Current
Station Firm Flow** Current Avg. Tributary Flow Plus
(Name or Capacity, * (Firm / pf), Daily Flow, Daily Flow, Obligated Available
Number) MGD MGD MGD MGD Flow Capacity***
* The Firm Capacity 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.
*** 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): Moore County Public Utilities
Downstream Permit Number: WQCS00034
Page 1 of 6
FTS E 04-16

III. Certification Statement:
I James Michel, P.E. 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 indicates acceptance of this wastewater flow.
Official Signature
61-� 3
Page 2 of 6
E~TS E 04-16