WQ0044622_Application (FTSE)_20230719

July 18, 2023
Mr. Trent Allen
Division of Water Quality
NCDEQ
225 Green Street
Ste 714 Systel Building
Fayetteville, NC 28301
Re: Kingston Village
Fast Track Sewer Application
Dear Trent,
ENGINEERS •
PLANNERS
SURVEYORS
MOORMAN, KIZER & REITZEL, INC.
115 Broadfoot Ave.
P.O. Box 53774
Fayetteville, NC 28305
[phone]
Fax:[phone]
www.mkrinc.com
Enclosed please find the Fast Track Sewer Permit Application, Flow Tracking Form,
Vicinity/Topographic Map and fee for the Kingston Village Subdivision off of Johnson Mill Road
in Hoke County, NC. Kingston Village consists of 75 residential lots.
The wetlands for this Kingston Village have been submitted for permits to the State and Corps of
Engineers. The sewer that crosses the road in the area where there are wetlands will not be
constructed until those permits are obtained.
Please let me know if you have any questions or need any further information.
Respectfully Submitted,
Moorman, Kizer & Reitzel, Inc.
MUM
Lill III
Cynthia M. Smith
Ed'
JUL 19 2023
0EQ
_FAME VILLE r710NAL01FRU

State of North Carolina
IDWR Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources INSTRUCTIONS FOR FORM: FTA 04-16 & 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 and that plans, specifications and supporting documents have been prepared in accordance with, 15A
NCAC 02T, 15A NCAC 02T .0300, Division policies and good engineerinc 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 available upon request by the Division.
Projects that are deemed permitted (do not require a permit from the Division) are explained in 15A NCA 3,—
- % IVC:
Projects not eligible for review via the fast track process (must be submitted for full technical review):
➢ Projects that require an environmental assessment in accordance with 15A NCAC I .0100; JUL 19 2023
➢ Projects that do not meet any part of the minimum design criteria (MDC) document;
➢ Projects that involve a variance from the requirements of 15A NCAC 2T;
➢ Pressure sewer systems utilizing septic tank -effluent pumps (STEPS) or simplex grinder pum�;Q-FAYETTEVILLE REGIONAL OFFICE
➢ 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 of Application and Supporting Documents
® Required unless otherwise noted
B. Cover Letter (Required for All Application Packages):
® List all items included in the application package, as well as a brief description of the requested permitting action.
➢ Be specific as to the system type, number of homes served, flow allocation required, etc.
➢ If necessary for clarity, include attachments to the application form.
C. Application Fee (All New and Major Modification Application Packages):
0 Submit a check or money order in the amount of $480.00 dated within 90 days of application submittal.
➢ Payable to North Carolina Department of Environmental Quality (NCDEQ)
D. Fast Track (Form: FTA 04-16) Application (Required for All Application Packages):
® 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 I.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 North
Carolina licensed Professional En ig neer.
® 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 .0I06(b).
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Pagel of 3

E. Flow Tracking/Acceptance Form (Form: FTSE 04-16) (If Applicable):
E 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):
E Submit an 8.5-inch x 11-inch color copy of a USGS Topographic Map of sufficient scale to identify the entire project
area and closest surface waters.
➢ Location of the project (gravity sewer, pump stations & force main)
A Downstream connection points and permit number (if known) for the receiving sewer
® Include a street level map showing general project area.
G. Existing Permit (All Modification Packages):
❑ Submit the most recently issued existing permit.
❑ Provide a list of any items within the permit the Applicant would like the Division to address during the pen -nit
modification (i.e., permit description, flow allocation, treatment facility, etc.).
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 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):
❑ Home/Property Owners' Associations
❑ Per 15A NCAC 02T .0115(c), submit the properly executed Operational Agreement (FORM: HOA).
❑ Per 15A NCAC 02T .0115(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
❑ Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(b), submit the properly executed Operational Agreement (FORM: DEV).
For more information, visit the Division's collection systems website
INSTRUCTIONS FOR FORM: FTA 04-16 & 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 Regional Office
2090 US Highway 70
Avery, Buncombe, Burke, Caldwell, Cherokee,
Water Quality Section
Swannanoa, North Carolina 28778
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 28301-5094
Montgomery, Moore, Robeson, Richmond,
[phone]
Sampson, Scotland
[phone] Fax
Mooresville Reqional 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 Regional Office
1628 Mail Service Center
Chatham, Durham, Edgecombe, Franklin,
Water Quality Section
Raleigh, North Carolina 27699-1628
Granville, Halifax, Johnston, Lee, Nash,
[phone]
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
Warren, Wilson
Washington Regional Office
943 Washington Square Mall
Beaufort, Bertie, Camden, Chowan, Craven,
Water Quality Section
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, Alleghany, Ashe, Caswell, Davidson,
Water Quality Section
Suite 300
Davie, Forsyth, Guilford, Rockingham, Randolph,
Winston-Salem, North Carolina 27105
Stokes, Surry, Watauga, Wilkes, Yadkin
[phone]
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 3 of 3

State of North Carolina
Department of Environmental Quality
_DWR Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number: N00OW4 2Z (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
l . Applicant's name: Hoke County (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ® State/County ❑ Municipal
3. Signature authority's name: James McQueen per 15A NCAC 02T .0106(b�
Title: Utilities Director
4. Applicant's mailing address: PO Box 240
City: Raeford State: NC Zip: 28376-
5. Applicant's contact information:
Phone number: [phone] Email Address: jmcyueemii hokecount�,.or�
II. PROJECT INFORMATION:
1. Project name: Kingston Village
❑ Privately -Owned Public Utility
❑ Other
aECEivEI)
JUL; /_3 M
DE&FAYETTEVILLE REGIONALOFFIC
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: Hoke County
4. Approximate Coordinates (Decimal Degrees): Latitude: 35. 014167 ° Longitude: -79. 15250 °
5. Parcel ID (if applicable): 494560301441 (or Parcel ID to closest downstream sewer)
111. CONSULTANT INFORMATION:
l . Professional Engineer: James M. Kizer, Jr. License Number: 20680
Firm: Moorman. Kizer & Reitzel. Inc.
Mailing address: 1 I Bmadfigot AvenLIC
City: Fayetteville State: NC Zip: 28305-A____
Phone•number: 910) 484-5191 Email Address: ikizerir:irmkrinc.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Hoke County WWTF Permit Number: NCO089176
Owner Name: Hoke County
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ0033891
2. Downstream (Receiving) Sewer Information: 12 inch ® Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s): Hoke County
FORM: FTA 06-21 Page I of 5

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 Operational AsrecnieiiIt t WM:_DI been attached?
❑ Yes ❑ No ® N/A
3. Ifthe Applicant is a Home/Property Owners' Association, has an IIOA'POA Operational Agreement tFt)KM: 110A) and
supplementary documentation as required by 15A NCAC 02T.01 15(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 1 SA NC AC.. 021 .0103t20))
If Industrial, is there a Pretreatment Program in effect? Yes No
6. Has a flow reduction been approved under I51_NCAC 02T .01 14(f)? ® Yes ❑ No
it If ves. 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 °,b
No. of Units
Flow
Residential lots in Kingston Village
210 gal/unit
75
15,750 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gall
GPD
gal/
!
GPD
Total
15,750 GPD
a See 15A NCAC .02T .01 14(b), (d), (e)(!J and lelt_'► 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 .01 14(c), design flow rates for establishments not identified [in table I SA NCAC 021 .0 I_I11] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 15,750 GPD (per 15A NCAC 02T .01 14)
y 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) - tt2 1 .1>30�, & \11K +,(;r•,: if,, ry:
Summarize gravity sewer to be pen-nitted:
Size (inches)
t;
12"
Length (feet)
14
1,150
250
12 _ 516
Material
PVC SDR26
PVC SDR26
Ductile Iron
Ductile Iron 1
Section 11 & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
i Section III contains information related to minimum slopes for gravity sewer(s)
Oversizing :fines to meet minimum slope requirements is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (if Applicable) - tt'-T .03u & lilt) tl'umt> ytati„nsrt nrrc �Iaiu�>;
PROVIDE A SEPARATE COPY OF THIS PAGE FOR FACH_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)
i 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
i
I
If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction prr
MDCI'SF'M Section 2.01C.1.b. ❑ Grinder Pump ❑ Mcchanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 1 \1,\t- 0 1" ,0 3,(15111 o 1 I:
❑ Standby power source or ❑ Standby pump
i= Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(1)(13)_
v Required for all pump stations with an average daily flow greater than oi• equal to 15,000 gallons per day
v 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 Page 3 of 5

IX. SETBACKS & SEPARATIONS - (02B .0200 & 15A NCAC 02T .0305(0):
Does the project comply with all separations/alternatives found in I "A NCAC 02 1- .1)305(tl & (t_))? ®Yes ❑ No
15A NCAC 02T.0305(t) contains minimum separations that shall be provided 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)
i '--Water mains (horizontal)
18 inches
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.
**Waters classified WS (except WS-1 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)
100 feet
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
5 feet
Any building foundation (horizontal)
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 — J
10 feet
Final earth grade (vertical)
36 inches
;- if noncompliance with 02T.0305(fl or (g), see Section X.1 of this application
*I 5A NCAC 02 1.0305m,) 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 Surtace Water Classiticatiuns_web�
2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ N/A
y 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
y Please provide supplementary information identifying the areas of non-conformance.
Y See the Division's draft separation regttirenents 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
y This includes Trout Buffered Streams per 15A NCAt_'_'13.020_'
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 I5A NCAC 02T.0105(c)( )(additional permits/certifications)? ® Yes ❑ No
Per 15A.NCAC 02T.0I05(c)(6J, 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).
FORM: FTA 06-21 Page 4 of 5

X. CERTIFICATIONS:
I. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Pump Stations
�na_I o►r c Ri:►ins (Latest rer ism). and the Gr.rvit\ Sower Minimum Design Criteria (latest ven;ionj as applicable?
® Yes ❑ No
If no, for projects requiring a single variance, complete and submit the Variance/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 projects requiring two or more variances or where the variance is determined by the Division to be a
significant portion of the project, the full technical review is required.
2. Professional Engineer's Certification:
James M. Kizer, Jr., PE^ attest that this application for Kingston Village
(Professional Engineers name from Application Item III I) (Project Name from Application Item 11 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 Desia-n Criteria for Gravity Sewers ( latest version), and the Minimum Design Criteria for the Fast- I rack Permitting.:
of Punk Stations and hwcc 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 143-215.613, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a 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)
North Carolina Professional Engineer's seal, signature, and date:
Z5
W t?£i3-ap
'
�r�c3•
It
3. Applicant's Certification per 15A NCAC 02T .0106(b):
_o
attest that this application for Kingston Villate
(Signature Authority Name from Application Item 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. 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. I also understand that if all required parts of this application package
are not completed and that if all required supporting information and attachments are not included, this application package
will be returned to me as incomplete.
NOTE — In accordance with General Statutes 143,-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package 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.
Signature: w, Zi�. //C.cC�.�CCe�r Date:
FORM: FTA 06-21 Page 6 of 5

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE i 0- i 8 )
Entity Requesting Allocation: Hoke COU111V Public Works
Project Name for which flow is being requested: KinastonUillaae _-
More than one FTSE maybe required fora single project if the owner of the K'WTP 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: Hoke Count WWTF _
b. WWTP Facility Permit #: NC00891176
Al! flows are in MGD
c. WWTP facility's permitted flow
1.5
d. Estimated obligated flow not yet tributary to the WWTP
0.508
e. WWTP facility's actual avg. flow
0.57
f. Total flow for this specific request
0.01575
g. Total actual and obligated flows to the facility
1.103
h. Percent of permitted flow used
71.4% _
I1. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
List pump stations located be' I.-een the project connection point and the WWTP:
(A)
(B)
(C)
Design
Obligated,
Pump
Pwnp
Average
Approx.
Not Yet
Station
Station
Finn Daily Flow**
Current
Tributary
(Name or
Permit
Capacity, * (Firm / p fl,
Avg. Daily
Daily Flow,
Number)
No.
MGD MGD
Flow, MGD
MGD
i2r�iunal run,h SIMIon
wOw)-,f)I-W
3 7; 1 300
0 77
0 -1'i_'
(D)=(B+C)
(E)=(A-D)
Total Current
Flow Plus
Obligated
Available
Flow
Capacity***
1 071
O d;
* 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 Daftly Flow is the firm opacity 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): Hoke County
Downstream Permit Number: _WQCS5003_52_
Page 1 of 6
f=TS!; 10-18

III. Certification Statement:
I .lames McQueen. t Itilities Director 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
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.
Sjpill r Official Signature ! Date
t..rv�� t � L ►1,.-`, ` J `�
Title of 'Si(wing OfflChIl
Page 2 of 6
FTSE 10-18

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NORTH AMERICAN VERTICAL DATUM OF 1988

U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id. SAW-2023-01216 County: Hoke County
NOTIFICATION OF JURISDICTIONAL DETERMINATION
Property Owner/Applicant: Gregory Floyd
Floyd Properties & Development, Inc.
Address: Post Office Box 53630
Fayetteville, NC, 28305
Telephone Number: [phone]
E-mail Address: gregfloyd(a,floydprop.com
Size (acres) 37.06
Nearest Waterway Beaver Creek
USGS HUC 03030004
Nearest Town Raeford, NC
River Basin Cape Fear
Coordinates Latitude: 35.01598 Longitude:-79.15433
Location description: This 37.06-acre project is located on Johnson Mill Road in Raeford, Hoke County, NC.
(Parcel ID:494560301441)
Indicate Which of the Following Apply:
A. Preliminary Determination
X There appear to be waters, including wetlands, on the above described property, that may be subiect to Section 404 of the
Clean Water Act (CWA)(33 USC & 1344) and/or Section 10 of the Rivers and Harbors Act (RHA) (33 USC & 403). The
waters, including wetlands, have been delineated, and the delineation has been verified by the Corps to be sufficiently
accurate and reliable. Therefore this preliminary iurisdiction determination may be used in the permit evaluation
process, including determining compensatory mitigation. For purposes of computation of impacts, compensatory
mitigation requirements, and other resource protection measures, a permit decision made on the basis of a preliminary JD
will treat all waters and wetlands that would be affected in any way by the permitted activity on the site as if they are
jurisdictional waters of the U.S. This preliminary determination is not an appealable action under the Regulatory
Program Administrative Appeal Process (Reference 33 CFR Part 331). However, you may request an approved JD,
which is an appealable action, by contacting the Corps district for further instruction.
_ There appear to be waters, including wetlands, on the above described property, that may be subject to Section 404 of the Clean
Water Act (CWA)(33 USC § 1344) and/or Section 10 of the Rivers and Harbors Act (RHA) (33 USC § 403). The
waters, including wetlands, have been delineated, and the delineation has been verified by the Corps to be sufficiently accurate
and reliable. Therefore this preliminary jurisdiction determination may be used in the permit evaluation process, including
determining compensatory mitigation. For purposes of computation of impacts, compensatory mitigation requirements, and other
resource protection measures, a permit decision made on the basis of a preliminary JD will treat all waters and wetlands that
would be affected in any way by the permitted activity on the site as if they are jurisdictional waters of the U.S. This preliminary
determination is not an appealable action under the Regulatory Program Administrative Appeal Process (Reference 33 CFR Part
331). However, you may request an approved JD, which is an appealable action, by contacting the Corps district for further
instruction.
_ There appear to be waters, including wetlands, on the above described property, that may be subject to Section 404 of the Clean
Water Act (CWA)(33 USC § 1344) and/or Section 10 of the Rivers and Harbors Act (RHA) (33 USC § 403). However, since the
waters, including wetlands, have not been properly delineated, this preliminary jurisdiction determination may not be used in the
permit evaluation process. Without a verified wetland delineation, this preliminary determination is merely an effective
presumption of CWA/RHA jurisdiction overall of the waters, including wetlands, at the project area, which is not sufficiently
accurate and reliable to support an enforceable permit decision. We recommend that you have the
waters of the U.S., including wetlands, on your property delineated. As the Corps may not be able to accomplish this wetland
delineation in a timely manner, you may wish to obtain a consultant to conduct a delineation that can be verified by the Corps.
Page 1 of 2

SAW-2023-01216
B. Approved Determination
_ There are Navigable Waters of the United States within the above described property subject to the permit requirements of
Section 10 of the Rivers and Harbors Act (RHA) (33 USC § 403) and Section 404 of the Clean Water Act (CWA)(33 USC §
1344). Unless there is a change in law or our published regulations, this determination may be relied upon for a period not to
exceed five years from the date of this notification.
There are waters of the U.S., including wetlands, on the above described property subject to the permit requirements of Section
404 of the Clean Water Act (CWA) (33 USC § 1344). Unless there is a change in law or our published regulations, this
determination may be relied upon for a period not to exceed five years from the date of this notification.
_ We recommend you have the waters of the U.S., including wetlands, on your property delineated. As the Corps may not be
able to accomplish this wetland delineation in a timely manner, you may wish to obtain a consultant to conduct a delineation that
can be verified by the Corps.
_ The waters of the U.S., including wetlands, on your property have been delineated and the delineation has been verified by
the Corps. We strongly suggest you have this delineation surveyed. Upon completion, this survey should be reviewed and
verified by the Corps. Once verified, this survey will provide an accurate depiction of all areas subject to CWA jurisdiction on
your property which, unless there is a change in law or our published regulations, may be relied upon for a period not to exceed
five years from the date of this notification.
_ The waters of the U.S., including wetlands, have been delineated and surveyed and are accurately depicted on the plat signed
by the Corps Regulatory Official identified below on . Unless there is a change in law or our published
regulations, this determination may be relied upon for a period not to exceed five years from the date of this notification.
_ There are no waters of the U.S., to include wetlands, present on the above described property which are subject to the permit
requirements of Section 404 of the Clean Water Act (33 USC 1344). Unless there is a change in law or our published regulations,
this determination may be relied upon for a period not to exceed five years from the date of this notification.
_ The property is located in one of the 20 Coastal Counties subject to regulation under the Coastal Area Management Act (LAMA).
You should contact the Division of Coastal Management in Morehead City, NC, at [phone] to determine their
requirements.
Placement of dredged or fill material within waters of the US, including wetlands, without a Department of the Army permit may
constitute a violation of Section 301 of the Clean Water Act (33 USC § 1311). Placement of dredged or fill material, construction or
placement of structures, or work within navigable waters of the United States without a Department of the Army permit may
constitute a violation of Sections 9 and/or 10 of the Rivers and Harbors Act (33 USC § 401 and/or 403). If you have any questions
regarding this determination and/or the Corps regulatory program, please contact Gary Beecher at [phone] or
Gary.H.Beecher(&usace. army.mil.
C. Basis For Determination: N/A. An Approved JD has not been completed.
D. Remarks: A desk top review was conducted on this application using information obtained from the consultant (S&EC)
and from Corps produced Lidar Maps.
E. Attention USDA Program Participants
The delineation included herein has been conducted to identify the location and extent of the aquatic resource boundaries and/or the
jurisdictional status of aquatic resources for purposes of the Clean Water Act for the particular site identified in this request. This
delineation and/or jurisdictional determination may not be valid for the Wetland Conservation Provisions of the Food Security Act of
1985, as amended. If you or your tenant are USDA program participants, or anticipate participation in USDA programs, you should
discuss the applicability of a certified wetland determination with the local USDA service center, prior to starting work.
F. Appeals Information for Approved Jurisdiction Determinations (as indicated in Section B. above)
If you object to this determination, you may request an administrative appeal under Corps regulations at 33 CFR Part 331. Enclosed
you will find a Notification of Appeal Process (NAP) fact sheet and Request for Appeal (RFA) form. If you request to appeal this
determination you must submit a completed RFA form to the following address:

SAW-2023-01216
US Army Corps of Engineers
South Atlantic Division
Attn: Mr. Philip A. Shannin
Administrative Appeal Review Officer
60 Forsyth Street SW, Floor M9
Atlanta, Georgia 30303-8803
AND
PHILIP.A. SHANN1NgUSACE.ARMY.MIL
In order for an RFA to be accepted by the Corps, the Corps must determine that it is complete, that it meets the criteria for appeal
under 33 CFR part 331.5, and that it has been received by the Division Office within 60 days of the date of the NAP. Should you
decide to submit an RFA form, it must be received at the above address by N/A.
It is not necessary to submit an RFA form to the Division Office if you do not object to the determination in this
correspondence.
Corps Regulatory Official:
Digitally signed by Gary H.
Gary H. Beecher Beecher
Date: 2023.07.26 13:34:27-04'00'
Date of JD: July 26, 2023 Expiration Date: PJD does not expire
The Wilmington District is committed to providing the highest level of support to the public. To help us ensure we
continue to do so, please complete our Customer Satisfaction Survey, located online at
https://re ug latoiy.00ps.usace.army.mil/customer-service-survey.
Copy Furnished via email to:
Consultant:
Bob Zarzecki
Soil and Environmental Consultants, PA
bzarzecki(&sandec.com

SAW-2023-01216
NOTIFICATION OF ADMINISTRATIVE APPEAL OPTIONS AND PROCESS AND
REQUEST FOR APPEAL
Applicant: Gregory Floyd
File Number: SAW-2023-01216
Date: July 26, 2023
Floyd Properties & Development, Inc.
Attached is:
See Section below
INITIAL PROFFERED PERMIT Standard Permit or Letter ofpermission)
A
PROFFERED PERMIT Standard Permit or Letter ofpermission)
B
PERMIT DENIAL WITHOUT PREJUDICE
C
PERMIT DENIAL WITH PREJUDICE
D
APPROVED JURISDICTIONAL DETERMINATION
E
X
I PRELIMINARY JURISDICTIONAL DETERMINATION
F
SECTION I
The following identifies your rights and options regarding an administrative appeal of the above decision.
Additional information may be found at https://www.usace.army.miI/Missions/Civil-Works/Requlatory-Program-
and-Permits/a eals/ or Corps regulations at 33 CFR Part 331.
A: INITIAL PROFFERED PERMIT: You may accept or object to the permit
• ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the district
engineer for final authorization. If you received a Letter of Permission (LOP), you may accept the LOP and
your work is authorized. Your signature on the Standard Permit or acceptance of the LOP means that you
accept the permit in its entirety, and waive all rights to appeal the permit, including its terms and
conditions, and approved jurisdictional determinations associated with the permit.
• OBJECT: If you object to the permit (Standard or LOP) because of certain terms and conditions therein,
you may request that the permit be modified accordingly. You must complete Section II of this form and
return the form to the district engineer. Upon receipt of your letter, the district engineer will evaluate your
objections and may: (a) modify the permit to address all of your concerns, (b) modify the permit to address
some of your objections, or (c) not modify the permit having determined that the permit should be issued
as previously written. After evaluating your objections, the district engineer will send you a proffered
permit for your reconsideration, as indicated in Section B below.
B: PROFFERED PERMIT: You may accept or appeal the permit
• ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the district
engineer for final authorization. If you received a Letter of Permission (LOP), you may accept the LOP and
your work is authorized. Your signature on the Standard Permit or acceptance of the LOP means that you
accept the permit in its entirety, and waive all rights to appeal the permit, including its terms and
conditions, and approved jurisdictional determinations associated with the permit.
• APPEAL: If you choose to decline the proffered permit (Standard or LOP) because of certain terms and
conditions therein, you may appeal the declined permit under the Corps of Engineers Administrative
Appeal Process by completing Section II of this form and sending the form to the division engineer. This
form must be received by the division engineer within 60 days of the date of this notice.
C. PERMIT DENIAL WITHOUT PREJUDICE: Not appealable
You received a permit denial without prejudice because a required Federal, state, and/or local authorization
and/or certification has been denied for activities which also require a Department of the Army permit before
final action has been taken on the Army permit application. The permit denial without prejudice is not
appealable. There is no prejudice to the right of the applicant to reinstate processing of the Army permit
application if subsequent approval is received from the appropriate Federal, state, and/or local agency on a
previously denied authorization and/or certification.
D: PERMIT DENIAL WITH PREJUDICE: You may appeal the permit denial
You may appeal the denial of a permit under the Corps of Engineers Administrative Appeal Process by
completing Section II of this form and sending the form to the division engineer. This form must be received
by the division engineer within 60 days of the date of this notice.

SAW-2023-01216
E: APPROVED JURISDICTIONAL DETERMINATION: You may accept or appeal the approved JD or provide
new information for reconsideration
• ACCEPT: You do not need to notify the Corps to accept an approved JD. Failure to notify the Corps
within 60 days of the date of this notice means that you accept the approved JD in its entirety and waive all
rights to appeal the approved JD.
• APPEAL: If you disagree with the approved JD, you may appeal the approved JD under the Corps of
Engineers Administrative Appeal Process by completing Section II of this form and sending the form to the
division engineer. This form must be received by the division engineer within 60 days of the date of this
notice.
• RECONSIDERATION: You may request that the district engineer reconsider the approved JD by
submitting new information or data to the district engineer within 60 days of the date of this notice. The
district will determine whether the information submitted qualifies as new information or data that justifies
reconsideration of the approved JD. A reconsideration request does not initiate the appeal process. You
may submit a request for appeal to the division engineer to preserve your appeal rights while the district is
determining whether the submitted information qualifies for a reconsideration.
F: PRELIMINARY JURISDICTIONAL DETERMINATION: Not appealable
You do not need to respond to the Corps regarding the preliminary JD. The Preliminary JD is not appealable.
If you wish, you may request an approved JD (which may be appealed), by contacting the Corps district for
further instruction. Also, you may provide new information for further consideration by the Corps to reevaluate
the JD.
POINT OF CONTACT FOR QUESTIONS OR INFORMATION:
If you have questions regarding this decision you
If you have questions regarding the appeal process, or
may contact:
to submit your request for appeal, you may contact:
District Engineer,
Philip Shannin
Wilmington Regulatory Division,
Regulatory Appeals Review Officer
Attn: Gary Beecher
South Atlantic Division
69 Darlington Avenue
60 Forsyth St SW, Floor M9
Wilmington, North Carolina 28403
Atlanta, Georgia 30303-8803
Philip.A.Shan nin2(aD-usace.arm
404-562-5136
SECTION II — REQUEST FOR APPEAL or OBJECTIONS TO AN INITIAL PROFFERED PERMIT

SAW-2023-01216
REASONS FOR APPEAL OR OBJECTIONS: (Describe your reasons for appealing the decision or your
objections to an initial proffered permit in clear concise statements. Use additional pages as necessary. You
may attach additional information to this form to clarify where your reasons or objections are addressed in the
administrative record.)
ADDITIONAL INFORMATION: The appeal is limited to a review of the administrative record, the Corps
memorandum for the record of the appeal conference or meeting, and any supplemental information that the
review officer has determined is needed to clarify the administrative record. Neither the appellant nor the
Corps may add new information or analyses to the record. However, you may provide additional information
to clarify the location of information that is already in the administrative record.
RIGHT OF ENTRY: Your signature below grants the right of entry to Corps of Engineers personnel, and any
government consultants, to conduct investigations of the project site during the course of the appeal process.
You will be provided a 15-day notice of any site investigation and will have the opportunity to participate in all
site investigations.
Date:
Signature of appellant or agent.
Email address of appellant and/or agent:
Telephone number:

Appendix 2 - PRELIMINARY JURISDICTIONAL DETERMINATION (PJD) FORM
BACKGROUND INFORMATION
A. REPORT COMPLETION DATE FOR PJD: 06/12/2023 Corps completion date July 26, 2023
B. NAME AND ADDRESS OF PERSON REQUESTING PJD: Joshua Harvey - 8412 Falls of Neuse Road, Raleigh NC 27615
C. DISTRICT OFFICE, FILE NAME, AND NUMBER: Wilmington, Kingston Village, SAW-2023-01216
D. PROJECT LOCATION(S) AND BACKGROUND INFORMATION:
(USE THE TABLE BELOW TO DOCUMENT MULTIPLE AQUATIC RESOURCES AND/OR
AQUATIC RESOURCES AT DIFFERENT SITES)
State: NC County/parish/borough: Hoke County City: Raeford
Center coordinates of site (lat/long in degree decimal format):
Lat.: 35.015570 Long.:-79.155103
Universal Transverse Mercator: NAD 83
Name of nearest waterbody: Black Branch
E. REVIEW PERFORMED FOR SITE EVALUATION (CHECK ALL THAT APPLY):
x❑ Office (Desk) Determination. Date: July 26, 2023
❑ Field Determination. Date(s):
TABLE OF AQUATIC RESOURCES IN REVIEW AREA WHICH "MAY BE" SUBJECT TO REGULATORY
JURISDICTION.
Site
number
Latitude
(decimal
degrees)
Longitude
(decimal
degrees)
Estimated amount
of aquatic resource
in review area
(acreage and linear
feet, if applicable)
Type of aquatic
resource (i.e., wetland
vs. non -wetland
waters)
Geographic authority
to which the aquatic
resource "may be"
subject (i.e., Section
404 or Section 10/404)
W1
35.015570
-79.155103
1.28 Acres
Wetland
Section 404

1) The Corps of Engineers believes that there may be jurisdictional aquatic resources in
the review area, and the requestor of this PJD is hereby advised of his or her option
to request and obtain an approved JD (AJD) for that review area based on an
informed decision after having discussed the various types of JDs and their
characteristics and circumstances when they may be appropriate.
2) In any circumstance where a permit applicant obtains an individual permit, or a
Nationwide General Permit (NWP) or other general permit verification requiring "pre -
construction notification" (PCN), or requests verification for a non -reporting NWP or
other general permit, and the permit applicant has not requested an AJD for the
activity, the permit applicant is hereby made aware that: (1) the permit applicant has
elected to seek a permit authorization based on a PJD, which does not make an
official determination of jurisdictional aquatic resources; (2) the applicant has the
option to request an AJD before accepting the terms and conditions of the permit
authorization, and that basing a permit authorization on an AJD could possibly result
in less compensatory mitigation being required or different special conditions; (3) the
applicant has the right to request an individual permit rather than accepting the terms
and conditions of the NWP or other general permit authorization; (4) the applicant can
accept a permit authorization and thereby agree to comply with all the terms and
conditions of that permit, including whatever mitigation requirements the Corps has
determined to be necessary; (5) undertaking any activity in reliance upon the subject
permit authorization without requesting an AJD constitutes the applicant's acceptance
of the use of the PJD; (6) accepting a permit authorization (e.g., signing a proffered
individual permit) or undertaking any activity in reliance on any form of Corps permit
authorization based on a PJD constitutes agreement that all aquatic resources in the
review area affected in any way by that activity will be treated as jurisdictional, and
waives any challenge to such jurisdiction in any administrative or judicial compliance
or enforcement action, or in any administrative appeal or in any Federal court; and (7)
whether the applicant elects to use either an AJD or a PJD, the JD will be processed
as soon as practicable. Further, an AJD, a proffered individual permit (and all terms
and conditions contained therein), or individual permit denial can be administratively
appealed pursuant to 33 C.F.R. Part 331. If, during an administrative appeal, it
becomes appropriate to make an official determination whether geographic
jurisdiction exists over aquatic resources in the review area, or to provide an official
delineation of jurisdictional aquatic resources in the review area, the Corps will
provide an AJD to accomplish that result, as soon as is practicable. This PJD finds
that there "may be"waters of the U.S. and/or that there "may be" navigable waters of
the U.S. on the subject review area, and identifies all aquatic features in the review
area that could be affected by the proposed activity, based on the following
information:

SUPPORTING DATA. Data reviewed for PJD (check all that apply)
Checked items should be included in subject file. Appropriately reference sources
below where indicated for all checked items:
❑ Maps, plans, plots or plat submitted by or on behalf of the PJD requestor:
Map:
■❑ Data sheets prepared/submitted by or on behalf of the PJD requestor.
❑x Office concurs with data sheets/delineation report.
❑ Office does not concur with data sheets/delineation report. Rationale:
❑ Data sheets prepared by the Corps:
❑ Corps navigable waters' study:
❑ U.S. Geological Survey Hydrologic Atlas:
❑ USGS NHD data.
❑ USGS 8 and 12 digit HUC maps.
On U.S. Geological Survey map(s). Cite scale & quad name: 1 "=1500' & 2019 NC Nicholson Quad
■❑ Natural Resources Conservation Service Soil Survey. Citation: Hoke County Soil Survey Sheet 09
❑ National wetlands inventory map(s). Cite name:
❑ State/local wetland inventory map(s):
❑ FEMA/FIRM maps:
❑ 100-year Floodplain Elevation is: .(National Geodetic Vertical Datum of 1929)
❑ Photographs: ❑ Aerial (Name & Date):
or ❑ Other (Name & Date):
❑ Previous determination (s). File no. and date of response letter:
■❑ Other information (please specify): Wetland delineation survey from 2013
Corps produced Lidar Map
IMPORTANT NOTE: The information recorded on this form has not necessarily
been verified by the Coras and should not be relied uaon for later iurisdictional
determinations.
Digitally signed by Gary H.
Gary H. Beecher Beecher
Date: 2023.07.26 13:33:55-04'00'
Signature and date of
Regulatory staff member
completing PJD
Signature and date of
person requesting PJD
(REQUIRED, unless obtaining
the signature is impracticable)'
' Districts may establish timeframes for requestor to return signed PJD forms. If the requestor does not respond
within the established time frame, the district may presume concurrence and no additional follow up is
necessary prior to finalizing an action.

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Scale: 1 " = 1500' Hoke County, NC New_ ASource: 2019 NC Nicholson Soil & Environmental Consultants, PA
Date: 8412 Falls oC N,,,, Road, S,i1a 1K R,I,igh. NC 27615 • P(919) 846-5900 • F(919) 846-946
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Project No. Scale: Hoke County, NC
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Project Mgr.: 06/08/2023
Sg Prepared by: JH