WQ0045417_Revised_App_20240520

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 10-23 & SUPPORTING DOCUMENTATION
(to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Carolina Water Service, Inc. of North Carolina (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: Travis Dupree per 15A NCAC 02T .0106(b)
Title: VP, Project Management & En ing eering
4. Applicant's mailing address: 5821 Fairview Road, Suite 401
City: Charlotte State: NC Zip: 28209-
5. Applicant's contact information:
Phone number: [phone] Email Address: travis.dupree -,corix.com
II. PROJECT INFORMATION:
1. Project name: Sugar Mountain Lift Station Improvements
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project ❑ ARPA funded
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: Avery
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.119269' Longitude:-81.834964'
5. Parcel ID (if applicable): (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Corbin Jenkins License Number: 053457
Firm: Goodwyn Mills Cawood, LLC
Mailing address: 4601 Park Road, Suite 520
City: Charlotte State: NC Zip: 28209-
Phone number: [phone] Email Address: corbin.jenkinsAamcnetwork.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Sugar Mounatin WWTP Permit Number: NCO022900
Owner Name: Carolina Water Service, Inc. of North Carolina
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): WQCS00174
Owner Name(s): Carolina Water Service, Inc. of North Carolina
FORM: FTA 10-23 Page 1 of 5