WQ0045412_Application (FTSE)_20240304

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources INSTRUCTIONS FOR FORM: FTA 06-21 & SUPPORTING DOCUMENTATION
This application is for sewer extensions involving gravity sewers, pump stations and force mains, or any combination that has been
certified by a professional engineer and the applicant that the project meets the requirements of 15A NCAC 02T and the Division's
Minimum Design Criteria (Gravity Sewer & Pump Siations/force Mains) and that plans, specifications and supporting documents
have been prepared in accordance with 15A NCAC 02T, 15A NCAC 02T .0300, Division policies, and zood engineering practices.
While no upfront engineering design documents are required for submittal, in accordance with 15A NCAC 02T .0305(b), design
documents must be prepared prior to submittal of a fast track permit application to the Division. This would include plans, design
calculations, and project specifications referenced in 15A NCAC 02T .0305 and the applicable. minimum design criteria. These
documents shall be immediately available upon request by the Division.
Projects that are deemed permitted (do not require a permit from the Division) are explained in 15A 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 (STBPs) 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 maybe 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):
E 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 attacbments to the application form.
C. Application Fee (All New and Modification Application Packages):
E Submit a check or money order in the amount of $480.00, dated no more than 90 days prior to application submittal.
➢ Payable to North Carolina Department of Environmental Quality (NCDEQ)
D. Fast Track Application (Required for All Application Packages, Form FTA 05-21):
® Submit the completed and appropriately executed application.
➢ If necessary for clarity or due to space restrictions, attachments to the application may be made.
E If the Applicant Type in Item 1.2 is a corporation or company, provide documentation it is registered for business with the
North Qprolina Secretai 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 11.1 shall be consistent with the project name on the flow acceptance letters, agreements, etc.
® The Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a North Carolina
licensed Professional Engineer.
® The Applicant's Certification on Page 5 of the application shall be signed in accordance with 15A NCAC 02T .0 106b . Per
15A NCAC 02T .0106(c), an alternate person may be designated as the signing official if a delegation letter is provided from
a person who meets the criteria in 15A NCAC 02T .0106(b).
INSTRUCTIONS FOR FORM: FTA 06-21 & SUPPORTING DOCUMENTATION Page I of 3

E. Flow Tracking/Acceptance Form (Form: FTSE 04-16) (If Applicable):
® Submit the completed and executed FTSE form from the owners of the downstream sewers and treatment facility.
➢ Multiple forms maybe required where the downstream sewer owner and wastewater treatment facility are different.
➢ The flow acceptance indicated in form FTSE must not expire prior to permit issuance and must be dated less than one year
Prior to the application date.
➢ Submittal of this application and form FTSE indicates that owner has adequate capacity and will not violate G.S. 143-215.67(a).
➢ Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific FTSE.
F. Site Maps (All Application Packages):
® Submit an 8.5-inch x 11-inch color copy of a USGS Topographic Map of sufficient scale to identify the entire project area,
including the closest surface waters.
➢ General location of the project components (gravity sewer, pump stations, & force main)
➢ Downstream connection points and permit number (if known) for the receiving sewer
® Include an aerial location map showing general project area (such as street names or latitude/longitude) so that Division staff
can easily locate it in the field.
G. Existing Permit (Application Packages for Modifications to an Existing Permit):
❑ Submit a copy of the most recently issued existing permit.
❑ Include a descriptive and clear narrative identifying the previously permitted items to remain in the permit, items to be
added, and/or items to be modified (the application form itself should include only include items to be added/modified). The
narrative should also include whether any previously permitted items have been certified.
❑ The narrative should clearly identify the requested permitting action and accurately describe the sewers to be listed in
the final permit.
H. Power Reliability Plan (Required if portable reliability option utilized for Pump Station):
El Per 15A NCAC_02T.0305(h)(I ), 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)
1. Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per 1 SA NCAC 02T .01 15fa)( I) provide the Certificate of Public Convenience and Necessity from the North Carolina Utilities
CommiE.ion 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 .01 15 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 J SA NStAC 02T.0 1_J. Ste, submit the properly executed Qptionai Agreement (FORM: DEV).
For more information, visit the Division's collection systems websile
INSTRUCTIONS FOR FORM: FTA 05-21 & SUPPORTING DOCUMENTATION Page 2 of 3

THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD 13F SENT TO THE APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
AlheyIlls Regional Office
2090 US Highway 70
Avery, Buncombe, Burke, Caldwell, Cherokee,
ftWQualily Section
Swannanoa, North Carolina 28778-8211
Clay, Graham, Haywood, Henderson, Jackson,
[phone]
Macon, Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
EAMottgville Regional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Harnett, Hoke,
Water QW11ily Section
Fayetteville, North Carolina 28301-5095
Montgomery, Moore, Robeson, Richmond,
[phone]
Sampson, Scotland
[phone] Fax
MooLgsAlle Reaional bffIca,
610 E. Center Avenue
Alexander, Cabarrus, Catawba, Cleveland,
Water Quality 800013
Mooresville, North Carolina 28115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
Raleigh Reaional 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
Vggrington Regional Office
943 Washington Square Mall
Beaufort, Berne, Camden, Chowan, Craven,
V"12r 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
WIMEM12n 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-SaIgrn bnlonal Office
450 W. Hanes Mill Road
Alamance, Alleghany, Ashe, Caswell, Davidson,
Wjer Quality Section
Suite 300
Davie, Forsyth, Guilford, Rockingham, Randolph,
Winston-Salem, North Carolina 27105
Stokes, Surry, Watauga, Wilkes, Yadkin
[phone]
[phone] Fax
INSTRUCTIONS FOR FORM: FTA 05-21 & SUPPORTING DOCUMENTATION Page 3 of 3

DWR
Division of Water Resources
Application Number:
State of North Carolina
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 06-21 & SUPPORTING DOCUMENTATION
(W be completed by DWR)
All items mast be completed or the aonlication will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: C&H Investment Group., LLC (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: Halimah Dabo per 15A NCAC 02T.0106(b
Title: Member/Organizer/Chief Executive Officer
4. Applicant's mailing address: 405 Western Boulevard, Suite B
City: Jacksonville State: NC Zip: 28546-
5. Applicant's contact information:
Phone number: 910) 389-9394 Email Address: [e-mail]
II. PROJECT INFORMATION:
1. Project name: Strip Center Building -- C&H Investment Group LLC
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: Onslow
4. Approximate Coordinates (Decimal Degrees): Latitude: 34. 7436' Longitude: -77. 3300'
5. Parcel ID (if applicable): 530609158710 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
I. Professional Engineer: David R. Newsom License Number; NC18148
Finn: Crystal Coast Engineering, PA
Mailing address: 205-3 Ward Road
City: Swansboro State: NC Zip: 28584-
Phone number: [phone] Email Address: david.n(@crysalcoastengineering.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: French Creek. WWTF Permit Number: W00063029
Owner Name: US Marine Corps — Camp Lejeune
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ0032377
2. Downstream (Receiving) Sewer Information: 14 inch ❑ Gravity ® Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s): ONWASA
FORM: FTA 06-21 Page 1 of 5

VI. GENERAL REQUIREMENTS
I. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑ No ®N/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached?
❑ Yes ❑ No ® N/A
3. If the Applicant is a Home/Property Owners' Association, has an HOA/POA Operational Agreement (FORM: HOA) and
supplementary documentation as required by 15A NCAC 02T.01 15(c) been attached?
❑ Yes ❑ No ❑ NIA
4. Origin of wastewater: (check all that apply):
❑ Residential (Individually Owned) ❑ Retail (stores, centers, malls) ❑ Car Wash
❑ Residential (Leased) ❑ Retail with food preparationtservice ❑ 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 I offices I factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 % Domestic % Commercial % Industrial (See 15A NCAC 02T .0103(20))
If industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 02T .01 14(f)? ❑ Yes ® No
➢ If yes, provide a coQ3L9f Clow 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
20 Employees in Total
25 gal/person
20
500 GPD
gall
GPD
gall
GPD
gall
GPD
gall
GPD
gall
GPD
Total
500 GPD
a See 15A NCAC 02T_.01 14(b). (d), (c)(1) and [cQ 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 I SA NCAC 02T.01 14(c), design flow rates for establishments not identified [in table 15A NCAC 02T.01 14] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 500 GPD (per 15A NCAC 02"r .01 14)
➢ Do not include future flows or previously pennitted 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) - 02,r .0305 & MDC(Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
n/a n/a n/a
➢ 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
VIll. 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: Pine Green Val. Fire De
2. Approximate Coordinates (Decimal Degrees): Latitude: 34.7436' Longitude:-77.3300'
3. Total number of pumps at the pump station; .2
3. Design flow of the pump station:.06336 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): 44 gallons per minute (GPM) at 53 feet total dynamic head (TDII)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
1.5 188 PVC
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. i.b. ® Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 1 A A, 0 f 03 5 h 1
❑ Standby power source or ❑ Standby pump
➢ Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(1)(B)_
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
➢ Must be permanent to facility and may not be portable
Or if the pump station has an average daily flow less than 15,000 gallons per day 15A NCACO2T.0305(h)(1)(C):
® Portable power source with manual activation, quick -connection receptacle and telemetry -
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry:
➢ Include documentation that the portable source is owned or contracted by the applicant and is compatible with the station.
➢ If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel timeframes, shall be provided
as part of this permit application in the case of a multiple station power outage.
FORM: FTA 06-21 Page 3 of 5

1X. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations/alternatives found in i 5A NCAC 02T ,0305 & ? ®Yes ❑ No
15A NCAC 02T.0305 contains minimum se arations that sha11 be rovided for sewers stems:
* Separation Required
Setback Parameter
18 inches
Storm sewers and other utilities not listed below (vertical) 1 g inches
2Water mains (vertical - water over sewer preferred, including in benched trenches) 10 feet
2Water mains (horizontal)
18 inches
Reclaimed water lines {vertical -reclaimed over sewer}
2 feet
Reclaimed water lines (horizontal - reclaimed over sewer)
*"Any private or public water supply source, including any wells, WS-I waters of Class I or
drinking water, and associated wetlands.
100 feet
Class II impounded reservoirs used as a source of
SA, ORW, 1IQW, or SB from normal
**Waters classified WS (except WS-1 or WS-V), B,
with these waters (see item IX.2)
50 feet
high water (or tide elevation) and wetlands associated
water lowering and surface drainage
**Any other stream, lake, impoundment, or ground
with these waters or classified as WL,
10 feet
ditches, as well as wetlands associated
5 feet
Any building foundation (horizontal)
10 feet
Any basement (horizontal)
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
5 feet
Drainage systems and interceptor drains
10 feet
Any swimming pools
36 inches
Final earth grade (vertical)
➢ If noncompliance with 02T.0345(fl or , see Section X.I of this application
* 15A N C 2 . 0 contains alternatives where separations in 02T.0305 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 (' rf W, er Classifications web a e
2. Does this project comply with the minimum separation requirements for water mains? ®yes ❑ No ❑ NIA
➢ If no, please refer to 15A NCAC 1SC.0906(f) for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
® Yes []No ❑NIA
3. Does the project comply with separation requirements for wetlands?
ofnon-conformance.
➢ Please provide supplementary information identifying the
➢ See the Division's draft se aratian renuir n s 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 l5A NCAC 02B .0200? []yes ❑ No
➢ This includes Trout Buffered Streams per 15A NCAC 21i.0202
❑ Yes ❑ No
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits
or 401 Water Quality Certifications?
➢ Please provide the permit numberlpelimitting status in the cover letter if coverage/authorization is required.
SA C 02T,0105 c 6) (additional permiitslcertifrcations)? ®Yes []No
6. Does project comply with 1
Per 1 A NCA 0 "I A 104 c 6 ,directly related environmental permits or certification applications must be being prepared,
have been applied for, or have bes#oobtained. er anagement plans, contingent on issuance of dependent permits (erosion
and sedimentation control plans,
7. Does this project include any sewer collection lines that are deemed "high -priority?" []yes ®No
Per 0 " 4 2, "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 permitte or its eindividual System -Wide m-W'd Collection permit.
at least once every six -months and
inspections documented per ISA NCAC 02T.0403(a)(5 ) or the perm ttee's
Page 4 of 5
FORM: FTA 06-21

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 021, the
Minimum Desi n Criteria for the Permiuihcabl 7of um Stations
and Force Mains latest version and the Gravity Sewer Minimum Dest�n Criteria latest version as app
® Yes ❑ No
ign Request
If no, for projects requiring a single nts forc reviewlletanon
he Central Offiice.t the nA rAroval of tlternative hen a nest will abelissued
(VADC 10-14) and supporting
concurrent)erm
with the a rove] of the it and ro'ects re uirin a variance a rove] ma be subject to ion er
review times. For protects re uiring two or more variances or where the variance is determined by the Division to be a
si nificant Portion of the ro'ect the full technical review is re uired.
2
Professional Engineer's Certification:
1, David K. Newsom , attest that this application for Strip Center Buildinr C&H Investimet Grow
(Professional Engineer's name from Application Item 111.1.)
(Project Name from Application item I")
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans,
on
specifications, engineering calculations,e nd all other proposed design has been preparedtintaccordance with the applicable the best of my ge. I further
egulat regulations,
attest that to the best of my knowledgep
Min'rnu Desi n Cri ri for C3tvi Sewers (!test versioi11, and the Minimum Desi n Criteria for the Fast -Track Permitting
rofession
of P 1 Stations an Farce M inSe etas tvealsunderlmy ggnatureh other pand seal signifies that ls may havedeveloped
wed ttis mcertain ta er ai anons of td
submittal package, inclusion of
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
anor, which m
statement, ay
representation, or certification in any application package shall be ,000 per guilty of tion Misrepresentation eof the application
include a fine not to exceed $10,000, as well as civil penalties up to $25,
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 56.070
........... ............1. ........................ ,
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I, Halimah Dabo, attest that this application for Stri Center Buildin — C&H Invesr act Name Application Item [l. L )
(Signature Authority Name from Application item 13 J
s accurate and complete to the best of my knowledge.
attest that this application has arts of this iewed by me and application are not icompleted and that f all required supporting documentation
I understand that if all re qui p
and attachments arc not from chided, non -discharge systemication ago surfae is ce waterct to s atr he land will result in an immediate g returned as incomplete. I enforcement
discharge of wastewater
action that may include civil penalties,o duof uncove ris er eli ef, beaviolat di I alsominal punder tend that if a rosecution. I will mla required parts of this applic tion
of Water Resources should a
are not completed and that if all required supporting information and attachments are not included, this app
package lication
package will be returned to me as incomplete.
-215.6A and 143T 215,68, any Person who knowingly makes any false
NOTE — In accordance with General Statutes 143
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.
Date:
Signature!
Page 5 of 5
FORM: FTA 06-21

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-23)
Entity Requesting Allocation: C & H Investment Group, LLC
Project Name for which flow is being requested: Strip Center Bldg - C & H Invest Group
More than one FTSE may be requiredfor a single project if the owner of the WWTP is not responsible for all punip
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:
b. WWTP Facility Permit #:
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
i Total flow for this specific request .0005
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) (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, * (Finn / p f), Avg. Daily Daily Flow, Obligated Available
Number) No. MGD MGD Flow, MGD MGD Flow Capacity***
Piney WQ32377 5.76 2.3 .3636 .2513 .6148 1.6852
U� eeli-�
* The Firm Capacity (design flow) of any pump station is defined as the maximum pumped flow that can be
achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor (pf) not
less than 2.5, per Section 2,02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located between the
project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): ONWASA
Downstream Permit Number: W90035256
Page 1 of 6
FTSE 10-23

III. Certification Statement:
I David M. Mohr, PE, C.O.O. 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.
icial Signature
D co 6=)CVf��
Title of Signing Official
492 /!sue
Page 2 of 6
FTSE 10-23

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: ONWASA
Project Name for which flow is being requested: Strip Center Bldg - C&H Invest. Group
More than one FTSE may be required for a single project ifthe owner of the WWTP is not responsible for all pump
stations along the route of the proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant,
a. WWTP Facility Name: French Creek WWTP
b. WWTP Facility Permit #: W 0063029
All flows are in MGD
c. WWTP facility's permitted flow 15 MGD
d. Estimated obligated flow not yet tributary to the WWTP 0 MGD
e. WWTP facility's actual avg. flow 4.400 MGD
f Total flow for this specific request 0.000500 MGD
g. Total actual and obligated flows to the facility 4.401 MGD
h, Percent of permitted flow used 29.3%
1I. 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)fit+C) (E)-(A-D)
Design
Obligated,
Pump
Average Daily
Approx.
Not Yet
Total Current
Station
Firm Flow"
Current Avg.
Tributary
Flow Plus
(Name or
Capacity, • (Firm I pf),
Daily Flow,
Daily Flow,
Obligated Available
Number)
MGD MGD
MGD
MGD
Flow Capacity***
+ The Firm Capacity ofany pump station is defined as the maximum pumped flow that
can be achieved with the largest pump taken out of service,
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking
factor (pf) not less than 2.5.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is 5 0.
Downstream Facility Name (Sewer):
Downstream Permit Number:
Page 1 of 6
FTSE 04-16

111. Certification Statement;
I Talia Prendergast _ certify to the best of my knowledge that the addition of
the volume of wastewater to be permitted in this project has been evaluated along the route to the
receiving wastewater treatment facility and that the flow from this project is not anticipated to
cause any capacity related sanitary sewer overflows or overburden any downstream pump station
en route to the receiving treatment plant under normal circumstances, given the implementation of
the planned improvements identified in the planning assessment where applicable. This analysis
has been performed in accordance with local established policies and procedures using the best
available data. This certification applies to those items listed above in Sections I and II plus all
attached planning assessment addendums for which I am the responsible party. Signature of this
form indicates acceptance of this wastewater flow.
Signing Official
Date
Page 2 of 6
FTS E 04-16

Narrative
Strip Center Building -- C&H Investment Group, LLC
C&H Investment Group, LLC proposes to develop a 1.00 acre tract located between Piney
Green Road and Rocky Run Road in the White Oak Township. The tract spans the
distance between NCSR 1460 (Piney Green Road) and NCSR 1411 (Old 30 Road) . The
proposed development includes a 6,000 sf building with associated parking, sidewalks &
dumpster pad.
The site is currently vacant. Site topography is generally flat to gently sloping (0 - 2%). The
site generally drains towards the north to Piney Green Road and onto the adjacent property
The project site is located in the White Oak River basin and drains to an Unnamed Tributary
of Little Northeast Creek (C;NSW). The proposed development activities are high density
(percent impervious > 24 %); therefore, stormwater treatment facilities are required. The
attached Stormwater Plan includes a Constructed Stormwater Wetland (designed to meet
current SCM Design Manual specifications. Stormwater runoff from the site will be diverted
(via swales and inlet structures) into a system of pipes discharging into the forebay of the
Constructed Wetland.
The site contains primarily Stallings loamy fine sand at 0 — 2% grades. Proposed ESC
devices include silt fence around the project perimeter, construction entrances, inlet
projection and sediment storage in the proposed wetland excavation (dewatered by
skimmer device). All collected sediment will be removed upon completion of construction
and prior to placing the constructed wetland into final service.
Water and sewer service to be provided by ONWASA. Sewer Service will require
installation of a Wastewater Pumping Station and 1.5 "forcemain (service) connecting to an
existing 14" forcemain along Piney Green Road..

1VA CA
2 o E $�
Design Calculations
Pump Station
serving
Strip Center Building — C&H Investment Group, LLU
located in
Jacksonville (White Oak Township), North Carolina
Prepared By:
Crystal Coast Engineering, P.A.
David K. Newsom, PE
205-3 Ward Road
Swansboro, NC 28584
Business License #: C-2553
1. Project Description
The project consists of construction of a new pumping station to serve a proposed strip center at 2038 Piney
Green Road. The proposed pump station is to connect to the existing 14" ONWASA forcemain along
Piney Green Road.
2. Flow Project Design
In accordance with NCAC 2T .0114., project shall be designed to accommodate a minimum daily flow rate
of 25 gallons per day per employee. Design flow is computed as follows;
20 employees in total @ 25 gpd/employee
However, for pump selection, use fixture count per Arch Drawing
125 gpd/fixture @ 21 fixtures
3. Compute Minimum Pumping Rate
Peak Factor = 6
Average Daily Flow =
Peak Factor =
Min. Pump Rate =
2,625 gpd
x 5
13,125 gpd
Or 9.1 gpm (say 10 gpm)
Proposed 1.5" service piping will require 13 gpm for 2 fps velocity.
500 gpd
2,625 gpd

4. Pipe Effective Lengths
Effective piping lengths are computed as follows:
1 25" Pump Station Piping
Actual Length = 8
No.
Fitting a LID L
Total
1
gate valve 35 3.6
3.6
1
check valve 135 14.1
14.1
1
90 bend 20 2.1
221
Fitting/Valve Length =
19.8
Total Effective Length =
27.8'
1.50" Forcemain Pipe
Actual Length =
188
No.
Fitting T e LID L
Total
0
90 degree bend 20 2.5
0.0
4
45 degree bend 10 1.3
5�0
Fitting/Valve Length
0.0
Total Effective Length = 193
5. Choose Pump & Compute Operating Conditions
Head losses for each pipe section are computed at various flow rates using Hazen -Williams equation (see
attached EPANET Model),
Most suitable pump appears to be Liberty LSG200
Operating Condition (All Pumps Running) 43 gpm @ 55' TDH
Operating Condition (Single Poplar Pump) 43 gpm @ 55' TDH
Operating Condition (New Pump Alone Running) 44 gpm @ 53' TDH
See attached Hydraulic Models for detailed analysis:
6. compute Pump Cycle Times at ADF
Volume per foot of pump chamber = 52.8 gallons
a. Fill Time at ADF
Fill/Pump Volume = 52.8 gallons
Fill Time = fill volume /ADF
52.8 gallons/ 2,625 gpd
0,02 day (0.48 hours)
3

b, Pump Time at ADF
Pump Time = pump volume / (pump rate — ADF)
52.8 (44 gpm —1.8 gpm)
1.25 min
c. Cycle Time at ADF
Cycle Time = Fill time + Pump Time
— 30.1 min (0.50 hours)
O.K.
6, Emergency Storage
See drawings.
7. Flotation
See drawings.
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