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HomeMy WebLinkAboutWQ0045156_Application (FTSE)_20240205■ Complete items 1, 2, and 3. ■ Print your name and address on the reverse so that we can return the card to you. ■ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: 6M ENGINEERING, PLLC t:: , a: A. SCOTT MATTHEWS 248 JOEL RD 'ARTHAGE, NC 28327 11111111111111111111111111111111111111111 IN III III III 9590 9402 8052 2349 4590 34 2. Article Number (transfer from service label) 7022 2410 0003 3233 8190 PS Form 3811, July 2020 PSN 7530-02-000-9053 x A-*, , BQReceived by (Printed Name) 0• ,n9Zt,,, Is delivery address different from item 17 w res If YES, enter delivery address below: ❑ No 3. Service Type ❑ Priority Mall Express® i ❑ Adult signature ❑ Registered Maipe ❑ Registered Mail Restricted ❑ Adult Signature Restricted Delivery DelrverY I Codified Mal® Signature Cordnatloni° I ❑ Codified Mail Restricted Delivery Signature Confirmation ❑ Collect on Delivery ❑ Collect on Delivery Restricted Delivery Restricted Delivery ^'nsured Mail I nsured Mail Restricted Delivery wer 450g1 Domestic Return Receipt USPS MC"G # 11111111111111110112 L 9590 9402 8052 2349 4590 34 United States •Sender: Please print your name, address, -a Postal Service CDEQ — DWR - WQROS TTN: KIRSTEN STENINGER RECEI Agg VIL LI?,,NC 28301E 714 FEB 14 074 First -Class Mail Postage & Fees Paid USPS Permit No, G-10 —�:�;�;;•,�:� Itlrrflrq�rllllrlrui,,,nrfarfl�l,rlrrrlr�h1111111Ir,I,y,r„ U.S. Postal Service'" CERTIFIED MAIL® RECEIPT Domestic Mail Only Certified Mail service provides the following benefits: �•Aramlit(this portion of the Certified Mall Labe(i. for an electronic return receipt, see a retail associate for asslsbrm¢.To receive a duplicate • A unique identifier for your mallplece. reNm receipt for an additional fee, present this Electronic uarifcetion Millinery or attempted USPS®-postmarked Certified Mail receipt to the Electron. j • A record of delivery @rcluding the recipient's relate associate. -Restor1ed delivery service, which provides signature) that is retained by the Postal Seneca'" delivery to the addressee specified by name. or - - - - - - - - - - - - --- -- faaspecthed period. to the addressce's authorized agent 1 Important Reminders: -Adult signature service, which requires the I• You may purchase Certified Mail service with signee to he at least 21 years of age (not First -Class Mail', First -Clan Package Service-, available at reeae8. or Priority Mail- service. -Adult signature reshicte! delivery service, whk •Comfed Mail service is notavailable for requires the sign¢ to be at least 21 years of at delivery to the addressee speClfe International mall. • Insurance coverage Is'notavailable for purchase and provides byname, or to the addressee's authorized agar with Certified Mail service. Hannover, the purchase (not available at retalg. of Certified Mail service does nut charge the •Toensure that your Certified Mail receipt is Insurance coverage automatically included with accepted as legal proof of mailing, it should bear certain Priority Mail items. USPS postmark fi you would like a postmark on as For an additional fee, and with a proper endorsement on the mallplece, you may request this Certified Mail receipt, press¢ present your Certified Mail Item at a Post GMCOe for the fallowing services: posfnaddng. It you don't need a postmark an thl -Return receipt service, which provides a record Certified Mail recelpt, detach the barricaded Park of delivery (including the recipient's signature). You cen request a hardobpy return receipt or an of this label, amixlt to the mallplece, apply appraprealepustage, and deposit the mailplace. electronic version. For a hardcopy return receipt. =plate PS Form 3811, Domestic Return Rereipt attach PS Form 3811 to your mailpiece; IMPORTANT: Sara this racelpffar your recordn PSFemr38O0,Apri12015yRere2e)PSN]Sap02-0 K41 - ROY COOPER Governor ELIZABETH S. BISER Secretary RICHARD E. ROGERS, JR. Director Att: A. Scott Matthews, PE, PLS ASM Engineering, PLLC 2248 Joel Road Carthage, NC 28327 NORTH CAROLINA Environmental Quality February 9, 2024 SUBJECT: Fast Track Application Fee Increase Dear Scott Mathews, PE, PLS: The Division of Water Resources received increases in fees, Session Law 2023-134, Section 12.14a for several program areas including National Pollutant Discharge Elimination System (NPDES) permits, Non -Discharge permits, Water Quality Certifications and Public Water Supply. Fees for these programs have not been increased in sixteen years (since 2007). These fees will be used throughout these programs to provide funding to retain and recruit staff who are engaged in these permit programs. The fee increases in G.S.143.215.3D became law on October 3, 2023. As a result of the fee increase, your application fee which was received after October 3, 2023 does not align with the new/increased fee recently established by the General Assembly. Please resubmit the appropriate fee within 15 days. Your application for Henson Street Sanitary Sewer Extension has been placed on hold until your resubmitted fee is received: Your new Fast Track Sewer System Extension Application fee is $600 Please be sure to make the check payable to NC DEQ and write the Fast Track Application Project name on the Memo line to identify which application the check is associated with. Return to the following address: NC Department of Environmental Quality Attention: Kirsten Steininger 225 Green Street Suite 714 Fayetteville NC 28301-5095 If you should have any questions, please contact Sharon Moran at (910) 916-3489 or at Sharon. Moran@deq.nc.gov. Sincerely, Cnasoearsnonrase Kirsten Steininger, Environmental Specialist Water Quality Regional Operations Section Fayetteville Regional Office Division for Water Resources, NCDEQ D_EQ�� \al(arof Dpaiicm anId all Dfdsfu t\\rrRosouccs farce tills R , a 1 0(Hcc 25 G r Stmat I S r 714 I Favett ' lle. Awh Csrolto �8301 - ""''Y'^^ 910,413 3300 �glrinm pFMM1onm,nW OUWyL� DocuSign Envelope ID: B5E01256-AA32-493A-AA43-7A8027A4D48C DWR Division of Water Resources State of North Carolina Department of Environmental Quality Division of Water Resources FAST TRACK SEWER SYSTEM EXTENSION APPLICATION FTA 06-21 & SUPPORTING DOCUMENTATION Application Number: [] 5 (to be completed by DWR) All items must be completed or the application will be returned I. APPLICANT INFORMATION: 1. Applicant's name: Town of Southern Pines (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: James Michel_ PE. MBA per 15A NCAC 02T .0106(b) IJtL&1 VtU Title: Town Engineer, Asst. Public Works Director -010WR 4. Applicant's mailing address: 801 SE Service Rd. FEB 0 5 a0a� City: Southern Pines State: NC Zip: 28387-_ 5. Applicant's contact information: WOROS Phone number: 9( ]0) 692-1983 Email Address: jmichel6osouthennines.net=AYETmin I F RGgIf1NAl OFFICE IL PROJECT INFORMATION: 1. Project name: Henson Street Sanitary Sewer Extension 2. Application/Pmject 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: W000_ 3. County where project is located: Moore 4. Approximate Coordinates (Decimal Degrees): Latitude: 35.161°Longitude:-79.409' 5. Parcel ID (if applicable): _ (or Parcel ID to closest downstream sewer) III. CONSULTANT INFORMATION: 1. Professional Engineer: A. Scott Matthews, PE, PLS License Number: 036809 Firm: ASM Engineering, PLLC Mailing address: 2248 Joel Rd. City: Carthaee State: NC Zip: 28327-_ Phone number: 9( ]0) 701-3070 Email Address: scott(a),asmenaineering.net IV. WASTEWATER 3070 FACILITY (WWTF) INFORMATION: 1. Facility Name: Moore County Water Pollution Control Plant Permit Number: NC-0037508 Owner Name: Moore County V. RECEIVING DOWNSTREAM SEWER INFORMATION: 1. Permit Number(s): WQ_ 2. Downstream (Receiving) Sewer Information: 8 inch ® Gravity ❑ Force Main 3. System Wide Collection System Permit Number(s) (if applicable): WQCS00309 Owner Name(s): Town of Southern Pines FORM: FTA 06-21 Page 1 of 5 DocuSign Envelope ID: B5E01256-AA32-493A-AA43-7A8027A4D48C VI. GENERAL REQUD2EMENTS 1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached? ❑ Yes ❑ No ® N/A 2. If the Applicant is a Developer of lots to be sold, has a 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 PoollClubhouse ❑ Food and drink facilities ❑ Church ❑ Swimming PooVFilter 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(11? ❑ Yes ®No ➢ If yes, provide a cony of flow reduction approval letter with this application 7. Summarize wastewater generated by project: Establishment Type (see 02T.0114(t)) Daily Design Flow a,b No. of Units Flow 1 Lot (4 bedrooms) 120 gal/bedroom 1 480 GPD gal/ GPD gal/ GPD gal/ GPD gal/ GPD gal/ GPD Total 480 GPD a See 15A NCAC 02T .0114(bL (dL (e)(I) 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: 48 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 DocuSign Envelope ID: B5E01256-AA32-493A-AA43-7AS027A4D48C VIL GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers): 1. Summarize gravity sewer to be permitted: Size (inches) Length (feet) Material S 129 PVC ➢ 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 VIH. 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 flow of the pump station: —millions gallons per day (firm capacity) ➢ This should reflect the total GPM for the pump station with the largest pump out of service. 4. Operational point(s) per pump(s): _ gallons per minute (GPM) at _ feet total dynamic head (TDH) 5. Summarize the force main to be permitted (for this Pump Station): Size (inches) Length (feet) Material If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per MDCPSFM Section 2.01C.1.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 limeframes, 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 DocuSign Envelope ID: B5E01256-AA32-493A-AA43-7A8027A4D48C IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(t)): I. Does the project comply with all separations/alternatives found in 15A NCAC 02T .0305(f) & (a)? ® Yes ❑ No 15A NCAC 02T.0305(fl contains minimum separations that shall be orovided for sewer systems: Setback Parameter* Separation Required Storm sewers and other utilities not listed below (vertical) 18 inches 2Water mains (vertical - water over sewer preferred, including in benched trenches) 18 inches 2Water 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 It impounded reservoirs used as a source of drinking water, and associated wetlands. 100 feet **Waters classified WS (except WS-I or WS-l), 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) 36 inches ➢ If noncompliance with 02T.0305(fl or (g), see Section X.1 of this application * 15A NCAC 02T.0305(a) contains alternatives where separations in 02T.0305 (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 webpage 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 nonconformance. ➢ Seethe 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 .02007 ❑ Yes ❑ No ➢ This includes Trout Buffered Streams per 15A NCAC 213.0202 5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ❑ Yes ® No or 401 Water Quality Certifications? ➢ Please provide the permit number/permitting status in the cover letter if coverage/authorization is required. 6. Does project comply with 15A NCAC 02T.0105(c)(61 (additional permits/certifications)? ® Yes ❑ No Per 15A NCAC 02T.0105(c)(6), directly related environmental permits or certification applications must be being prepared, have been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion and sedimentation control plans, stormwater management plans, etc.). 7. Does this project include any sewer collection lines that are deemed "high -priority?" ❑ Yes ® No Per 15A NCAC 02T.0402. "high -priority sewer" means any aerial sewer, sewer contacting surface waters, siphon, or sewers positioned parallel to streambanks that are subject to erosion that undermines or deteriorates the sewer. Siphons and sewers suspended through interference/contlict 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 permttiee or its representative at least once every six -months and inspections documented per 15A NCAC 02T.0403(a)(5) or the permittee's individual System -Wide Collection permit. FORM: FTA 06-21 Page 4 of 5 DocuSign Envelope ID: B5E07256-AA32-493A-AA43-7A8027A4D48C X. CERTIFICATIONS: 1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Pump Stations and Force Mains (latest version), and the Gravity Sewer Minimum Design Criteria (latest version) as applicable? ® Yes ❑ No If no, for projects requiring a single variance, complete and submit the Variance/Altemative Design Request application (VADC 10-14) and supporting documents for review to the Central Office. Approval of the request will be issued 2. Professional Engineer's Certification: 1, A. Scott Matthews, PE. PLS attest that this application for Henson Street Sanitary Sewer Extension (Professional Engineer's name from Application Item I11.1.) (Project Name from Application from R 1) has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans, specifications, engineering calculations, and all other supporting documentation to the best of my knowledge. I further attest that to the best of my knowledge the proposed design has been prepared in accordance with the applicable regulations, Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains (latest version). Although other professionals may have developed certain portions of this submittal package, inclusion of these materials under my signature and seal signifies that I have reviewed this material and have judged it to be consistent with the proposed design. NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation. Misrepresentation of the application information, including failure to disclose any design noncompliance 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: ,OWN CAR0111,,,, j 4� SEAL. �9 t i= 36809 ra� EZEM764124[il... sgnm ey: i ';, -� •. FArGINEF't' ki G TT M11-12-23 e................ .'-""_....._........... :..............._........_........... F 3. Applicant's Certification per 15A NCAC 02T .0106(b): I, James Michel, PE. MBA attest that this application for Henson Street Sanitary Sewer Extension (Signature Authority Name from Application Item 1.3.) (Project Name from Application Item IL 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 $25,000 per violation. n Slang by: ,'watts M.iclu,l, Signature: 672191 A4RA 412... Date: 1/19/2024 FORM: FTA 06-21 Page 5 of 5 State of North Carolina Department of Environmental Quality Division of Water Resources Di,%ki, q[ of k ;a+<-( t,,,,, m v. Flow Tracking for Sewer Extension Applications (FTSE 10-18) Entity Requesting Allocation: Town of Southern Pines Project Name for which flow is being requested: Henson Street Sanitary Sewer Extension Afore than one FTSE maybe required for a single project if the owner of the WIl'TP is not responsible for all pump stations along the route of theproposed wastewaterflow. I"' J=L&lUi-1 t I. Complete this section only if you are the owner of the wastewater treatment plaQI!Q/bWR a. WWTP Facility Name: Moore County Water Pollution Control Plant ��$aoo"t-`� b. WWTP Facility Permit #: NC O037508 All flows are it0 908 c. WWTP facility's permitted flow 10.0008ayI.r.m„,. __— d. Estimated obligated flow not yet tributary to the WWTP 1.09030 AI OFFICE e. WWTP facility's actual avg. flow 4.92200 f. Total flow for this specific request 0.00048 g. Total actual and obligated flows to the facility 6.01278 h. Percent of permitted flow used 60.1278 I1. 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) (0) (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. MOD MOD Flow, MOD MOD Flow Capacity*** * The Firm Capacity (design Dow) 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 FTSE 10-18 III. Certification Statement: I Randy 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 Il 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. t`— Title of Signing Official / 12t/ Z3 Date Page 2 of 6 FTSE 10-18 State of North Carolina Department of Environmental Quality DWR Division of Water Resources Division of water Resources Flow Tracking for Sewer Extension Applications (FTSE 10-23) Entity Requesting Allocation: Town of Southern Pines Project Name for which flow is being requested: Henson Street Sanitary Sewer Extension More than one FTSF, maybe required for a single project if the owner of the WWTP is not responsible far 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: WQCS-00309 b. WWTP Facility Permit M NCG590018 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 0.00048 g. Total actual and obligated flows to the facility h. Percent of permitted flow used 11. Complete this section for each pump station you are responsible for along the route of this proposed wastewater flow. List pump stations located between the project connection point and the WWTP: (A) (B) (C) (D)=(B+C) (F)=(A-D) Design Obligated, Pump Pump Average Approx. Not Yet Total Current Station Station Finn 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*** * The Firm Capacity (design flow) of any pump station is defined as the maximum pumped flow that can be achieved with the largest pump taken out of service. ** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor (pi) not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria. *** A Planning Assessment Addendum shall be attached for each pump station located between the project connection point and the W WTP where the Available Capacity is < 0. Downstream Facility Name (Sewer): Moore County Public Utilities Downstream Permit Number: WQCS00034 Page 1 of 8 FTSE 10-23 III. Certification Statement: I J arks M i C kr- certify to the best of my knowledge that the addition of the volume of wastewater to be permitted in this project has been evaluated along the route to the receiving wastewater treatment facility and that the flow from this project is not anticipated to cause any capacity related sanitary sewer overflows or overburden any downstream pump station en route to the receiving treatment plant under normal circumstances, given the implementation of the planned improvements identified in the planning assessment where applicable. This analysis has been performed in accordance with local established policies and procedures using the best available data. This certification applies to those items listed above in Sections I and II plus all attached planning assessment addendums for which I am the responsible party. Signature of this form certifies that the receiving collection system or treatment works has adequate capacity to transport and treat the proposed new wastewater. Of Title of Signing Date Page 2 of 8 FTSE 10-23 ASM P" "c1 : HENSON ST. SANITARY SEWER EXTENSION 1: 23018 1:12000 10-29-23 VSGS MAP 1 d 1 ASM ENGINEERING, PLLC ASM Engineering, PLLC 2248 Joe/ Rd. Carthage, NC 28327 Phone: (910) 701-3070 scottC asmengina&ring.net License # P 2502 Project Narrative Due to the property being within the limits required by the LIDO of the Town of Southern, public sanitary sewer shall be extended to the property. The construction of the project will consist of sanitary sewer improvements. The total requested flow for the project is 480 GPD. 129 Linear feet of 8" PVC pipe and three manholes will be installed per the plans by ASM Engineering, PLLC. Once construction is completed, all sanitary sewer lines will be owned by Town of Southern Pines and all waste water will flow to Moore County Water Pollution Control Plant; WWTF # NC 0037508. KkL,Kivtu DF-0.10 NR FEB 0 5 aoa� WORDS r'AYETTEvIIlF RFrinNAI OFFICE