WQ0045304_Application (FTSE)_20240416

STRONGROCK STRONGROCK ENGINEERING GROUP, PLLC
P.O. Box 99552
9552
Raleigh, NC 27624
E N G I N E E R I N G G R G u P ` ���D, f� !\� Company License # P-2166
\VAS (.� U V RECEIVED/NCDENR/DWR
TRANSMITTAL FORM
TO: NCDEQ Division of Water Resources —Wilmington Regional Office Water Quality Section APR 16 2024
943 Washington Square Mall Water Quality
Washington, NC 27889 Regional Ope•ations Section
Washington Regional Office
SUBJECT: La Grange Perry 2 Fast Track Sewer #WQ0045259
DATE: April 15, 2024
SENT BY: Sara Rogan
We are sending you the following items:
COPIES ITEM DESCRIPTION
1 Application Fast Track Sewer form signed by Town of LaGrange ORIG I NAL
1 Flow tracking Flow tracking form filled out by Town of La Grange ORIGINAL
These are transmitted as checked below:
_ For Information _ Approved as Noted — Revise and Resubmit
_ As Requested Not Approved — Revise and Resubmit
X For Review and Comments _ For Record and File
_ For Revision _ Submittal
For Approval For Recording
Approved For Signature, then return to:
REMARKS:
Originally signed application and FTSE for La Grange Perry 2 Fast Track Sewer, initial package was received by
3/13/24, review is Sarah Toppen

STRONGR4CK
E N G I N E E R I N G G R O U P
TRANSMITTAL FORM
STRONGROCK ENGINEERING GROUP, PLLC
P.O. Box 99552
Raleigh, NC 27624
Company License # P-2166
TO: NCDEQ Division of Water Resources —Wilmington Regional Office Water Quality Section
943 Washington Square Mall
Washington, NC 27889
SUBJECT: La Grange Perry 2 Fast Track Sewer Initial Submittal
DATE: Martha,', 2024
SENT BY: Sara Rogan
We are sending you the following items:
COPIES
1
Check I $600 check N1144
DESCRIPTION
2 _ 1 Application I Fast Track Sewer form signed by Town of La Grange
2 Flowtracking I Flow tracking form filled out by Town of La Grange
Site Map USGS topo map with site highlighted
1 Narrative
2 Operational Agreement
Engineering narrative
RECEIVED/NCDENR/DWR
MAR 2 5 2024
Water Quality
Regional Operations Section
Washington Regional Office
Operation agreement execute by developer — Ellis Developments NC, LLC
These are transmitted as checked below:
For Information _ Approved as Noted — Revise and Resubmit
As Requested _ Not Approved — Revise and Resubmit
X For Review and Comments _ For Record and File
_ For Revision _ Submittal
For Approval _ For Recording
Approved _ For Signature, then return to:
REMARKS:
1�j rrQ(
c� 3�-z'

STRONGROCK
C ., I '! - C I I .. P i. ..
03/12/2024
North Carolina Department of Environmental Quality
Division Of Water Resources
RE: La Grange Tract 2 — Fast Tract Sewer Submittal
Dear NCDEQ: Division of Water Resources,
STRONGROCK ENGINEERING GROUP, PLLC
8362 Six Forks Rd. Suite 104
RECENED/NCDEN R/DWRRaleigh, NC 27615
Company License # P-2166
MAR 2 5 2024
Water Quality
Regional Operations Section
Washington Regional Office
This application is being submitted for review for a proposed 89-lot residential subdivision
consisting of single family dwellings. This project is located in La Gange, North Carolina within
Lenior County off of Lake Pine Drive near the intersection of South Charles Street. This
subdivision is to be served via 8-inch diameter PVC gravity sanitary sewer systems, connecting
to existing gravity sewer at the entrances of the proposed residential subdivision. The demand
for this subdivision is calculated to be 20,025 GPD using 75 gallons per bedroom per lot.
Please let me know if you have any further questions.
Take care,
Christopher Stone
Engineering Team Lead
Strong Rock Engineering Group, PLLC

® The Applicant's Certification on Page 5 of the application shall be signed in accordance with IS A NCAC 021 .01061 b 1. 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 I5A NCAC 02T .0106(b).
V45CFNEDINCOENTV"--_
g -k 5 2�24 State of North Carolina
DWR Department of Environmental Quality
Water r [ section Division of Water Resources
Regional OPe nat 0"
W p. 4t4l'�ii UCK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources INSTRUCTIONS FOR FORM: FTA 10-23 & 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. 15.A NCAC 02T.030t6 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 IS.A NCAC 02T .0305 and the applicable minimum design criteria. These
documents shall be immediately available upon request by the Division.
Projects that are deemed permitted (do not require a permit from the Division) are explained in 15A NCAC 02T.0303.
Projects not eligible for review via the fast track process (must be submitted for full technical review):
> Projects that do not meet any part of the minimum design criteria (MDC) documents;
> Projects that involve more than one variance from the requirements of 15A NCAC 02T;
> Pressure sewer systems utilizing simplex septic tank -effluent pumps (STEPs) or simplex grinder pumps;
> Simplex STEP or simplex grinder pumps connecting to pressurized systems (e.g, force mains);
> Vacuum sewer systems.
General — When submitting an application, please use the following instructions as a checklist in order to ensure all required items are
submitted. Adherence to these instructions and checking the provided boxes will help produce a quicker review time and reduce the
amount of requested additional information. Failure to submit all required items will necessitate additional processing and review
time, and may result in return of the application. Unless otherwise noted, the Applicant shall submit one original and one copy of
the application and supporting documentation.
A. One Original and One Copy (second copy may be digital) of Application and Supporting Documents
® Required unless otherwise noted. Signatures on original must be "wet ink" or secure digital signatures.
Please do not submit engineering design plans with the application unless specifically requested.
B. Cover Letter/Narrative Description (Required for All Application Packages):
® List all items included in the application package, as well as a brief description of the requested permitting action.
> Be specific as to the system type, number of homes served, flow allocation required etc.
> Include the permit number/status of any other required sewer permits (downstream/upstream)
> If necessary for clarity, include attachments to the application form.
> If the project is funded by American Rescue Plan Act (ARPA) funds, please include the ARPA project number in the cover
letter and in parentheses under Project Name (Section 11.1. of the application).
C. Application Fee (All New and Modification Application Packages):
® Submit a check or money order in the amount of $600.00, 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 10-23):
® Submit the completed and appropriately executed application.
> If necessary for clarity or due to space restrictions. attachments to the application may be made.
® If the Applicant Type in Item 1.2 is a corporation or company, provide documentation it is registered for business with the
North Carolina Secretary of State.
❑ If the Applicant Type in Item 1.2 is a partnership or d/b/a, enclose a copy of the certificate filed with the Register of Deeds in
the county of business.
® The Project Name in Item ILI 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.
INSTRUCTIONS FOR FORM: FTA 10-23 & SUPPORTING DOCUMENTATION Page I of 3

THE COMPLETED APPLICATION PACKAGE IIVCLDING 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 28778-8211
Clay, Graham, Haywood, Henderson, Jackson,
[phone]
Macon, Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Harnett, Hoke,
Water Quality Section
Fayetteville, North Carolina 28301-5095
Montgomery, Moore, Robeson, Richmond,
[phone]
Sampson, Scotland
[phone] Fax
Mooresville Regional Office
610 E. Center Avenue
Alexander, Cabarrus, Catawba, Cleveland,
Water Quality Section
Mooresville, North Carolina 28115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
Raleigh Regional Office
3800 Barrett Drive
Chatham, Durham, Edgecombe, Franklin,
Water Quality Section
Raleigh, North Carolina 27609
Granville, Halifax, Johnston, Lee, Nash,
[phone]
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
Warren, Wilson
Washington Regional Office
943 Washington Square 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, Pander
[phone]
[phone] Fax
Winston-Salem Regional Office
450 W. Hanes Mill Road
Suite 300
Alamance, Allegheny, Ashe, Caswell, Davidson,
Davie, Forsyth, Guilford, Rockingham, Randolph,
Water Quality Section
Winston-Salem, North Carolina 27105
Stokes, Surry, Watauga, Wilkes, Yadkin
[phone]
[phone] Fax
INSTRUCTIONS FOR FORM: FTA 10-23 & SUPPORTING DOCUMENTATION Page 3 of

Division of Water Resources
& O 3 O � State of North Carolina
Department of Environmental Quality
Division of Water Resources
Application Number:
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 10-23 & SUPPORTING DOCUMENTATION
(to be completed by DWR)
All items must be completed or the application will be returned
1. APPLICANT INFORMATION:
I. Applicant's name: TOWN OF LA GRANGE (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: SHAWN CONDON per 15A NC\C 02T .0106(b)
Title: TOWN MANAGER
4. Applicant's mailing address: 203 S. CENTER ST
City: LA GRANGE State: NC Zip: 28551-
5. Applicant's contact information:
Phone number: [phone] Email Address: smcondonAlaurangenc.com
11. PROJECT INFORMATION:
1. Project name: LA GRANGER PERRY TRACT 2
2. ApplicationTroject status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: W000_ and issued date: ,
❑ ARPA funded
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: LENOIR /
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.297571' Longitude:-77.794338°v
5. Parcel ID (if applicable): 355616948861 (or Parcel ID to closest downstream sewer)
111. CONSULTANT INFORMATION: /
I. Professional Engineer: JOSH LAMBERT License Number: 036225V
Firm: STRONG ROCK ENGINEERING GROUP
Mailing address: 305 CHURCH AT NORTH HILLS ST. STE. 1110
City: RALEIGH State: NC Zip: 27609
Phone number. 9(� 200-1932 Email Address: INFORMATIONna STRONGROCKGROURCOM
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Town of La Grange Permit Number: NCO021644
Owner Name: Town of La Grange
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. PermitNumber(s): WQ_
2. Downstream (Receiving) Sewer Information: 8 inch ❑ Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS 00148
Owner Name(s): Town of La Grange
FORM: FTA 10-23 Page I of 5

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility. has a Certificate of Public Convenience and Necessity been attached?
❑ Yes []No ®N/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement ( FORM: DEV I 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 .01 14(T. ❑ Yes ®No
i 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 Subdivision u- ti
75 gal/bed/day
89
20025 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
20025 GPD
t/
a See 15A \CAC 021 .0114(b). (d). (e)( I ) and (e)(2) for caveats to wastewater design flow rates (i.e. 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 I5A NCAC 02T.0114 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 20025 GPD (per 15A NCAC 02T .0114 and G.S. 143-215.1)
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 10-23 Page 2 of 5

VIL GRAVITY SEWER DESIGN CRITERIA (If Applicable)-02T.0305&i1DC(Gravity Sewers):
I. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8" 5111 ft C900 PVC
Section 11 & 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
I. 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 (firth 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. Lb. ❑ 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 10-23 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B.0200 & 15A NCAC 02T.0305(f)):
1. Does the project comply with all separations/altematives found in 15A NCAC 02T.0305(f) & NV ® Yes ❑ No
15A NCAC 02T.0305 contains minimum separations that shall be provided for sewers stems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
'Water mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
=Water mains (horizontal)
10 feet
Reclaimed water lines (vertical - reclaimed over sewer)
18 inches
Reclaimed water lines (horizontal - reclaimed over sewer)
2 feet
"Any private or public water supply source, including any wells, WS-1 waters of Class 1 or
Class 11 impounded reservoirs used as a source of drinking water, and associated wetlands.
100 feet
"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)
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches, as well as wetlands associated with these waters or classified as WL.
10 feet
Any building foundation (horizontal)
5 feet
Any basement (horizontal)
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
> If noncompliance with 02T.0305(f) or (2). see Section X.l of this application
`15A NCAC 02T.0305(e) contains alternatives where separations in 02"1.0305(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 weboage
2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ N/A
S 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.
> Seethe Division's draft separation reuuirements 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 I SA NCAC 02B .0200? ❑ Yes ❑ No
> This includes Trout Buffered Streams per 15A NCAC 2B.0202
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ❑ Yes ® No
or 401 Water Quality Certifications?
> Please provide the permit number/permitting status in the cover letter if coverage/authorization is required.
6. Does project comply with 15A NCAC 02T.0 I 05(c)(6) (additional permits/certifications)? ® Yes ❑ No
Per I5A NCAC 02T.0105(c)(6), directly related environmental permits or certification applications must be being prepared,
have been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion
and sedimentation control plans, stormwater management plans, etc.).
7. Does this project include any sewer collection lines that are deemed "high -priority?" ❑ Yes ® No
Per 15A NCAC 02T.0402, "high -priority sewer' means any aerial sewer, sewer contacting surface waters,
siphon, or sewers positioned parallel to streambanks that are subject to erosion that undermines or deteriorates the sewer.
Siphons and sewers suspended through interference/conflict boxes require a variance approval.
> If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the 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 10-23 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Pump Stations
and Force Mains (latest version), and the Gravity Sewer Minimum Design Criteria (latest 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
concurrently with the approval of the permit, and projects requiring a variance approval may be subject to longer
review times. For proiccts requiring two or more variances or where the variance is determined by the Division to be a
significant portion of the proiect, the full technical review is required.
2. Professional Engineers Certification:
1 Josh Lambert , attest that this application for La Grange Perry Tract 2
(Professional Engineer's 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 Design Criteria for Gravity Sewers (latest t ersion), and the %linimum Design Criteria for the First- 1-rack Permitting
of Pump Stations and Force plains (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 1 have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation. Misrepresentation of the application
information, including failure to disclose any design non-compliance with the applicable Rules and design criteria, may subject
the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NCAC 56.0701)
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
1, .SAAvirk `onWon attest that this application for `a G'�a�5e Pryy 6,J 2
(Signature Auihorin Name from Application Item 13) IPrnicn \amc I' Am�n Item 11.1)
attest that this application has been reviewed by me and is accurate and complete to the best of my knowledge.
I understand that if all required parts of this application are not completed and that if all required supporting documentation
and attachments are not included, this application package is subject to being returned as incomplete. I understand that any
discharge of wastewater from this non -discharge system to surface waters or the land will result in an immediate enforcement
action that may include civil penalties, injunctive relief, and/or criminal prosecution. 1 will make no claim against the Division
of Water Resources should a condition of this permit be violated. 1 also understand that if all required parts of this application
package are not completed and that if all required supporting information and attachments are not included, this application
package will be returned to me as incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.661 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 S 10,000 as well as civil penalties up to $25,000 per violation.
Signature:
Date: 3 2/ 20 y
I Or
FORM: FTA 10-23 Page 5 of 5

Gor',gle MapS Lake Pine Estates (La Grange Perry Tract 2)
Imagery ©2024 Airbus, Maxar Technologies, U.S. Geological Survey, USDA/FPAC/GEO, Map data ©2024 500 ft

itECEWED/NCDENFVDWR
APR 16 2024 State of North Carolina
DWRDepartment of Environmental Quality
Water ation y Division of Water Resources
Fegiorrel Opc�ations Sectior�
Washington Flamonai 'c
Division of Water Resources Flow 'making for Sewer Extension Applications
(FTSE 10-23)
Entity Requesting Allocation: Ellis Development NC LLC
Project Name for which flow is being requested: Ellis -LaGrange -Perry
More than one FTSE maybe required for a single project if the owner of the WWTP is not responsible for all pump
stations along the route of the proposed wastewaterJlow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: LaGrange Wastewater Treatment Plant
b. WWTP Facility Permit #: NCO021644
AU lows are in MGD
c. WWTP facility's permitted flow 0.7S
d. Estimated obligated flow not yet tributary to the WWTP 0.00
e. WWTP facility's actual avg. flow 0.46
f. Total flow for this specific request 0.02
g. Total actual and obligated flows to the facility 0.48
h. Percent of permitted flow used 64%
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 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***
Lake Pines 0.2592 0.10368 0.0576 0 0.0576 0.04608
--;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 (pt) 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):
Downstream Permit Number:
La Grange WWTP
NCO021644
Page 1 of 6
FTSE 10-23

III. Certification Statement:
I Shawn Condon 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.
Signing Official Signature
Twn M4A f.Jrr
Title of Signing Official
Page 2 of 6
FTSE 10-23

Average Yearly Flow for:
Jan.2023
Feb.2023
Mar.2023
Apr.2023
May2023
Jun2023
Ju12023
Aug2023
Sept2023
Oct2023
Nov2023
Dec2023
Town of La Grange, NCO021644
Permitted Flow:
0.2469677
0.3767857
0.2765807
0.3785
0.3035807
0.2703667
0.3698387
0.2723548
0.3371667
0.2730968
0.2438333
0.3461613
0.307936092 Avg. Flow
2023 % of Permitted Flow:
0.75
0.410581456
(< 80%/ 90% 0K)