WQ0045420_Application (FTSE)_20240502

Architecture
.
Engineering
.
Environmental
Land Surveying
Companies
TRANSMITTAL
An Employee -Owned Company
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DATE: 5/1/2024 `AYFT7-mfofI s0Cf-!1lhrer �ccrr
ATTENTION: Hughie White / [e-mail] / 910.433.3300
COMPANY: NCDEQ Fayetteville Regional Office
Water Quality Section
ADDRESS: 225 Green Street, Suite 714
Fayetteville, NC 28301-5095
FROM: Carlos Petrovich / [e-mail] / 704.851.7092
3420 Toringdon Way, Suite 210
Charlotte, NC 28277
[phone]
E-MAIL ADDRESS: [e-mail] / [e-mail]
PROJECT: Anson County Middle School
PROJECT NO: 2201272
SUBJECT: FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
WE ARE SENDING YOU:
® Attached ❑ Plans ❑ Prints ❑ Application for Payment
❑ Via: ❑ Specifications ❑ Shop Drawings ❑ Change Order
❑ Under Separate Cover ❑ Copy of Letter ❑ Samples ❑ Other
COPIES
DATE
NO.
DESCRIPTION
1
04-24-2024
1
Cover Leiter
2
04-24-2024
2
Fast Track Application 1 Original & 1 Co
1
04-24-2024
3
Aerial Map
1
04-24-2024
1 4
USGS Ma
1
I 04-25-2024
5
Application Fee Check #117947
THESE ARE TRANSMITTED as checked below:
®
For Approval
❑
No Exceptions
❑
For Your Use
❑
Furnish as Corrected
❑
As Requested
❑
Revise & Resubmit
❑
For Review & Comment
❑
Rejected
❑
For Bids Due:
❑
Resubmit for Record
REMARKS:
c/o Alan Moseley, PE
COPY TO:
❑ Resubmit ❑ For Distribution
❑ Submit ❑ Corrected Prints
❑ Return
❑ Prints Returned After Loan to Us
Signed:

Architecture
Engineering
.
Environmental
Land Surveying
Companies
April 24, 2024
NCDEQ Fayetteville Regional Office
Water Quality Section
225 Green Street Suite 714
Fayetteville, North Carolina 28301
Attn: Hughie White
RE: Anson County Middle School
To Whom It May Concern:
An Employee -Owned Company
K>tVCtVCV
DEQ/DWR
MAY 0 2oa�
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The proposed site will accommodate a county project containing a ±136,514 square foot building that
will be used as a middle school. The facility will have offices, classrooms, a library, cafeteria, and
gymnasium. The county building's sewer will drain to the proposed gravity sewer system on the
property. Portion of the existing sewer main and easement will be relocated to avoid potential conflicts
with the proposed building footprint. This will be achieved by first installing the proposed relocated line.
The proposed sewer line will then be tested and approved before re -directing the wastewater flow. See
attached Exhibit for Reference. The sewer system from the school will tap into a proposed manhole
upstream and an existing manhole downstream connected by 8" PVC pipes. The proposed sewer flow
rate being added to the existing sewer system will be a total of 12,000 GPD.
Sincerely,
Alan Moseley, P.E.
[e-mail]
[phone]
BL Companies
3420 Toringdon Way, Suite 210
Charlotte, NC 28277
Enclosure(s):
1. Fast Track Application
2. Flow Tracking/Acceptance Form
3. Site Maps

Architecture
Engineering
Environmental
. Land Surveying
Companies
May 6, 2024
NCDEQ Fayetteville Regional Office
Water Quality Section
225 Green Street, Suite 714
Fayetteville, NC 28301
Attn: Sharon Moran
RE: Anson County Middle School — Fast Track Sewer Application
Ms. Moran:
An Employee -Owned Company
Per our phone conversation last week, the following items should be added to the application:
IX. Setbacks and Separations:
1. Does the project comply with all separations/alternatives found in 15A NCAC 02T .0305(f) &
(g) should have been checked "Yes".
5. Does the project require coverage/authorization under a 404 Nationwide/Individual Permits
or 401 Water Quality Certifications should have been checked "Yes". I've included a copy
of the 404 Permit.
6. Does the project comply with 15A NCAC 02T00105(c)(6) (additional permits/certifications)
should have been checked "Yes". I've included a copy of the Certificate of Coverage.
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 should have been checked "Yes".
Sorry for the mistakes and let me know if you need any additional information.
Sincerely,
/,-� --A
Alan Moseley, P.E.
[e-mail]
[phone]
BL Companies
3420 Toringdon Way, Suite 210
Charlotte, NC 28277
Enclosures:
U.S. Army Corps Nation Wide Permit 2019-02279
NCDEQ Certificate of Coverage ANSON-2023-002
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State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
405ivision of Water Resources FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
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 Stations/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 good engineering ractices.
While no upfront engineering design documents are required for submittal, in accordance with l5A 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. i U?tl V Qij
Projects that are deemed permitted (do not require a permit from the Division) are explained in 15A NCACIS l..J R
Projects not eligible for review via the fast track process (must be submitted for full technical review): ���Y Q i, d. 3
➢ 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 pumpWOROS
➢ Simplex STEP or simplex grinder pumps connecting to pressurized systems (e.g. force ➢ Vacuum sewer systems. rnp' T=tln t C t3CENAMAI n=lrr:
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):
IR 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.
C. Application Fee (All New and Modification Application Packages):
® Submit a check or money order in the amount of S480.00, dated no more than 40 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):
R 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 I.2 is a partnership or d/b/a, enclose a copy of the certificate filed with the Register of Deeds in
the county of business.
® The Project Name in Item II.1 shall be consistent with the project name on the flow acceptance letters, agreements, etc.
® The Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a North Carolina
licensed Professional Engineer.
® The Applicant's Certification on Page 5 of the application shall be signed in accordance with 15A NCAC 02T .0106(b). Per
15A NCAC 02T .0106(c), an alternate person may be designated as the signing official if a delegation letter is provided from
a person who meets the criteria in 15A NCAC 02T .0106(b).
INSTRUCTIONS FOR FORM: FTA 06-21 & SUPPORTING DOCUMENTATION Pagel of 3

E. Flow Tracking/Acceptance Form (Form: FTSE 04-16) (If Applicable):
CQ 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 Iess 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):
p Submit a copy of the most recently issued existing permit.
Q 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.
Q 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):
Q Per 15A NCAC 02T ,0305(h)(1), submit documentation of power reliability for pumping stations.
➢ This alternative is only available for average daily flows less than 15,000 gallons per day
➢ It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant and is compatible with
the station. The Division will accept a letter signed by the applicant (see 15A NCAC 02T .0106(b)) or proposed contractor,

stating that "the portable power generation unit or portable, independently -powered pumping units, associated appurtenances
and personnel are available for distribution and operation of this pump station."
➢ If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations'
storage capacities and the rotation schedule of the portable power source or pump, including travel timeframes, shall
be provided in the case of a multiple station power outage. (Required at time of certification)
I. Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per 15A NCAC 02T .0115(a)(1) provide the Certificate of Public Convenience and Necessity from the North Carolina Utilities
Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served by the sewer
extension, or
❑ Provide a letter from the North Carolina Utilities Commission's Water and Sewer Division Public Staff stating an application
for a franchise has been received and that the service area is contiguous to an existing franchised area or that franchise approval
is expected.
J. Operational Agreements (Applications from HOA/POA and Developers for lots to be sold):
❑ Home/Property Owners' Associations
❑ Per 15A NCAC 02T .0115(c), submit the properly executed Operational Agreement (FORM: HOA).
❑ Per 15A NCAC 02T .0115(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
[] Developers of lots to be sold
❑ Per 15A NCAC 02T .01150), submit the properly executed Operational Agreement (FORM: DM.
For more information, visit the Division's collection systems +vehsite
INSTRUCTIONS FOR FORM: FTA 05-21 & SUPPORTING DOCUMENTATION Page 2 of 3

THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional Office
2090 US Highway 70
Avery, Buncombe, Burke, Caldwell, Cherokee,
Water Quality Section
Swannanoa, North Carolina 28778-8211
Clay, Graham, Haywood, Henderson, Jackson,
(828) 2964500
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, Iredeil, 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 Mail
Beaufort, Bertie, Camden, Chowan, Craven,
Water Quality Section
Washington, North Carolina 27889
Currituck, Dare, Gates, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
Wilmington Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
Water Quality Section
Wilmington, North Carolina 28405
Hanover, Onslow, Pender
[phone]
[phone] Fax
Winston-Salem Regional Office
450 W. Hanes Mill Road
Alamance, Alleghany, Ashe, Caswell, Davidson,
Water Quality Section
Suite 300
Davie, Forsyth, Guilford, Rockingham, Randolph,
Winston-Salem, North Carolina 27105
Stokes, Surry, Watauga, Wilkes, Yadkin
[phone]
[phone] Fax
INSTRUCTIONS FOR FORM: FTA 05-21 & SUPPORTING DOCUMENTATION Page 3 of 3

r State of North Carolina
DWR
Department of Environmental Quality
Yam.,
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number: WQ0045420 (to be completed by DWR)
All items must be com leted or the aoolication will be returned
I. APPLICANT INFORMATION:
I . Applicant's name: Anson CoqM Utilities Department (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ® State/County ❑ Municipal ❑ ur-i VGL.r
3. Signature authority's name: Mike Sessions per 15A NCAC 02T .0106 b DEQIDWR
Title: Utilities Director
4. Applicant's mailing address: 575 U.S. Hwv 52 South
City: Wadesboro State: NC Zip: 28170- c) 3tim
5. Applicant's contact information:
WQROS r1)
^AYETTFInj i I<DerinM4P OFFjCF
Phone number: [phone] Email Address: [e-mail]
H. PROJECT INFORMATION:
1. Project name: Anson County Middle School
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: Anson
4. Approximate Coordinates (Decimal Degrees): Latitude: 34.9750° Longitude:-80.1016'
5. Parcel ID (if applicable): 646402860058 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Alan Moseley License Number: 28400
Firm: Bh Companies
Mailing address: 3420 Toringdon Way, Suite 210
City: Charlotte State: NC Zip: 28277-
Phone number: 704 851-7093 Email Address: amoseltyOlblcomoanies.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
A^Sam
1. Facility Name:$l1,j�k Wksk< Permit Number: JDA aC),A �{o9
uQtef 7�cq��.ti� Qua„►}
Owner Name:Cou+tiJ A h S.V-,
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ
2. Downstream (Receiving) Sewer Information: 8 inch ® Gravity 0 Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS OQO (pip
Owner Name(s): C u A� y So yl
FORM: FTA 06-21 Page 1 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 ® NIA
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (NORM: DEV) been attached?
❑ Yes ❑ No ® NIA
3. If the Applicant is a Homo/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 ® NIA
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 0 % Commercial 0 % Industrial (See 15A NCAC 02T .0103(205)
If Industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(fl? ❑ Yes ® No
➢ Imes, provide a cony of flow reduction approval letter with this aoplication
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow '"b
Na. of Units
Flow
School with cafeteria, gym and showers
15 gal/student
800
12,000 GPD
gal/
GPD
gall
GPD
gall
GPD
gal/
GPD
gal/
GPD
Total
12,000 GPD
a See 15A NCAC 02T .0114 W. e 1 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. 42A4).
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: 12,000 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

VH. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
S 870 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
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Puma 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. Lb. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NCAC 02T .0305 ffl(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

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(1)):
1. Does the project comply with all separations/alternatives found in 15A NCAC_02T .0305(fl & (g)? ❑ Yes ❑ No
15A NCAC 02T.0305(fl contains minimum separations that shall be provided for sewer systems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
2Water 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 I 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-Y), B, SA, ORW, HQW, or SB from normal
high water (or tide elevation) and wetlands associated with these waters (see item 1X.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 (g), see Section XI of this application
*15A NCAC 02T.0305(a) contains alternatives where separations in 02T.0305(fl 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 wcbpaae
2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ NIA
➢ If no, please refer to 15A NCAC 18C.0906(f) for documentation requirements and submit a separate document,
signed/scaled 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.
➢ See the 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 .0200? ❑ Yes ❑ No
➢ This includes Trout Buffered Streams per 15A NCAC 211.0202
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)(6} (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/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 06-21 Page 4 of 5

X.
CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting, of Pub Stations
and Force Mains (latest version), and the Gravi Sewer Minimum Design Criteria latest version as applicable?
❑ Yes ❑ No
If no, for projects requiring a single variance, complete and submit the Variance/Alternative Design Request application
(VADC 10-14) and supporting documents for review to the Central Office. Approval of the request will be issued
concurrently with the apuroval of the permit. and Rr9jects reguiring a variance approval may be subject to longer
review times. For projects reauirina two or more variances or where the variance is determined by the Division to be a
significant portion of the oroiect, the full technical review is required.,
2. Professional Engineer's Certification:
1, Alan Moseley, P.E. , attest that this application for Anson County Middle School
(Professional Engineer's name from Application Item III,1.) (Project Name from Application Item H. t)
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 Pcrmitting
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 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):
,,tiHrrarrrr���
CARp'
�p4' ��Essra��V
4/1/2024
I, attest that this application for Anson CouW Middle School
(Signature Authority Name from Application Item I.3.) (Project Name from Application Item U.I)
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 attaclunents are not included, this application
package will be returned to me as incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: AU( Date: O�
FORM: FTA 06-21 Page 5 of 5

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of WMer Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: Anson County Utilities Department
Project Name for which flow is being requested: Anson County Middle School
More than one FTSE may be required for a single project if the owner of the WWTP is not responsible for all pump
stations along the route of the proposed wastewater flow.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Anson County Regional WWTP
b. WWTP Facility Permit #: NCO041408
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
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
All flows are in MGD
3.5
.4
1.54
.012
195
55.7
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)
Design
Pump
Pump
Average
Approx.
Station
Station
Firm
Daily Flow**
Current
(Name or
Permit
Capacity, *
(Firm / pt),
Avg. Daily
Number)
No.
MGD
MGD
Flow, MGD
Gould
3.24
1.296
.740
52 North
(C)
(D)=(B+C)
(E)=(A-D)
Obligated,
Not Yet
Total Current
Tributary
Flow Plus
Daily Flow,
Obligated
Available
MGD
Flow
Capacity***
.4
1.14
.156
3.24 1.296 .770 .4 1.17 .126
* 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. r<t:UJ=IVMU
*** A Planning Assessment Addendum shall be attached for each pump station locvrz�l�R
between the project connection point and the WWTP where the Available Capacity is
Downstream Facility Name (Sewer): Anson County WWTP
Downstream Permit Number: NC0041408 — WQROS
�AYFrr1111I c e)rri `r
MAY 02 'Ao-4
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I Gary Garrison 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 stati.on_.en.raute 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 Df ciEd Signature Date
Title of
Page 2 of 6
FTSE 10-18

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Certificate of Coverage
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES
GENERAL PERMIT NO. NCG010000
NC Reference No. NCG01-2024-1126
Certificate of Coverage No. NCC241126
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards and regulations
promulgated and adopted by the North Carolina Environmental Management Commission, and the Federal Water
Pollution Control Act, as amended,
Anson County Board of Education
is hereby authorized to discharge stormwater associated with CONSTRUCTION ACTIVITIES to surface waters of North
Carolina from a site located at:
New Middle School
Anson High School Road
Wadesboro
Anson County
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in N.C. General Permit
No. NCG010000.
This Certificate of Coverage is affiliated with E&SC Plan Project No. ANSON-2023-002
This Certificate of Coverage shall become effective 4/24/2024.
This Certificate of Coverage shall remain in effect until rescinded or expired.
This Certificate of Coverage will expire on the anniversary of its effective date unless it is renewed by payment of the
annual administration and compliance fee.
William E. Vinson, Jr., PE, CPESC, CPM, Interim Director
Division of Energy, Mineral, and Land Resources
By the Authority of the Environmental Management Commission

U.S. ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Action Id. SAW-2019-02279 County: Anson U.S.G.S. Quad: NC-Wadesboro
GENERAL PERMIT (REGIONAL AND NATIONWIDE) VERIFICATION
Permittee: Anson County Board of Education
Attn: Howard McClean
Address: 320 Camden Road
Wadesboro, NC 28170
Size (acres) --67.5 Nearest Town Wadesboro
Nearest Waterway Culpepper Creek River Basin Upper Pee Dee
USGS HUC 03040104 Coordinates 34.9750,-80.1030
Location description: The proiect area is located south of US Highway 74 and west of Anson High School Road, in Wadesboro,
Anson County, North Carolina.
Description of projects area and activity: This verification authorizes the permanent discharge of dredged or rill material into
0.08 acre of riparian non-riverine wetlands necessary for the construction of access and infrastructure for Anson Middle
School.
Applicable Law(s): ® Section 404 (Clean Water Act, 33 USC 1344)
❑ Section 10 (Rivers and Harbors Act, 33 USC 403)
Authorization: Nationwide Permit 39. Commercial and Institutional Developments
SEE ATTACHED NWP GENERAL, REGIONAL, AND/OR SPECIAL CONDITIONS
Your work is authorized by the above referenced permit provided it is accomplished in strict accordance with the attached
Conditions, your application signed and dated 11/29/2022, additional information submitted via email on 11130 and 12/9/2022,
and the enclosed plans "New Middle School -Anson County Schools" Sheets C.20, C2.1, C2.2, C2.3, and 2. Any violation of the
attached conditions or deviation from your submitted plans may subject the permittee to a stop work order, a restoration order,
a Class I administrative penalty, and/or appropriate legal action.
This verification will remain valid until the expiration date identified below unless the nationwide and/or regional general permit
authorization is modified, suspended or revoked. If, prior to the expiration date identified below, the nationwide and/or regional general
permit authorization is reissued and/or modified, this verification will remain valid until the expiration date identified below, provided
it complies with all requirements of the modified nationwide permit. If the nationwide and/or regional general permit authorization
expires or is suspended, revoked, or is modified, such that the activity would no longer comply with the terms and conditions of the
nationwide permit, activities which have commenced (i.e., are under construction) or are under contract to commence in reliance upon
the nationwide and/or regional general permit, will remain authorized provided the activity is completed within twelve months of the
date of the nationwide and/or regional general permit's expiration, modification or revocation, unless discretionary authority has been
exercised on a case -by -case basis to modify, suspend or revoke the authorization.
Activities subject to Section 404 (as indicated above) may also require an individual Section 401 Water Quality Certification. You
should contact the NC Division of Water Resources (telephone [phone]) to determine Section 401 requirements.
For activities occurring within the twenty coastal counties subject to regulation under the Coastal Area Management Act (LAMA), prior
to beginning work you must contact the N.C. Division of Coastal Management.
This Department of the Army verification does not relieve the permittee of the responsibility to obtain any other required Federal, State
or local approvals/permits. If there are any questions regarding this verification, any of the conditions of the Permit, or the Corps of
Engineers regulatory program, please contact David E. Bailey at [phone] or David.E.Bailey2(&usace.army.mil.
Corps Regulatory Official
�—� Date: 2022.12.2816:46:05
-05'00'
Expiration Date of Verification: 3/15/2026
Date: 12/28/2022

SAW-2019-02279
SPECIAL CONDITIONS
1. Please note that future impacts and/or phases pertaining to the Anson County Board of Education
Middle School project, and related activities associated with Corps Action ID: SAW-2019-02279,
may be considered part of a single and complete project; these impacts may be considered
cumulative with impacts permitted during earlier phases with respect to compensatory mitigation
and Nationwide Permit thresholds. Current permanent loss of waters of the US associated with
this single and complete project include 0.08 acre of wetlands/waters of the US.
6 - 'Date: 2022.12.28
Corps Regulatory Official: 1 6:45:47-05'00' Date: 12/28/2022
Expiration Date of Verification: 3/15/2026
The Wilmington District is committed to providing the highest level of support to the public. To help us ensure we continue to do so,
please complete the Customer Satisfaction Survey located at https://re ug latory.ops.usace.gM.mil/customer-service-survey.
Copy furnished electronically:
Megan Bollero, Carolina Wetland Services, Inc., megan(c-r�,cws-inc.net
Chad Turlington, NCDEQ-DWR, chad.turlin ongncdenr.gov

2022 BL COMPANIES, INC. THESE DRAWINGS SHALL NOT BE UTILIZED BY ANY PERSON, FIRM OR CORPORATION WITHOUT THE SPECIFIC WRITTEN PERMISSION OF BL COMPANIES. XREF (s): ; XC220127201 ; XC220127202 ; XZ220127201 ; BD220127201 : XC220127203; BD220127202

Action ID Number: SAW-2019-02279 County: Anson
Permittee: Anson County Board of Education (Attn: Howard McClean)
Project Name: Anson County Board of Education / Anson Middle School
Date Verification Issued: 12/28/2022
Project Manager: David E. Bailey
Upon completion of the activity authorized by this permit and any mitigation required by the permit,
sign this certification and return it to the following address:
US ARMY CORPS OF ENGINEERS
WILMINGTON DISTRICT
Attn: David E. Bailey
Raleigh Regulatory Office
U.S Army Corps of Engineers
3331 Heritage Trade Drive, Suite 105
Wake Forest, North Carolina 27587
or
[e-mail]
Please note that your permitted activity is subject to a compliance inspection by a U. S. Army Corps of
Engineers representative. Failure to comply with any terms or conditions of this authorization may
result in the Corps suspending, modifying or revoking the authorization and/or issuing a Class I
administrative penalty, or initiating other appropriate legal action.
I hereby certify that the work authorized by the above referenced permit has been completed in
accordance with the terms and condition of the said permit, and required mitigation was completed in
accordance with the permit conditions.
Signature of Permittee
Date

SAW-2019-02279
A. Determination of Jurisdiction:
1. ® There are waters, including wetlands on the above -described project area that may be subject to Section 404 of the
Clean Water Act (CWA) (33 USC § 1344) and/or Section 10 of the Rivers and Harbors Act (RHA) (33 USC § 403). This
preliminary determination is not an appealable action under the Regulatory Program Administrative Appeal Process
(Reference 33 CFR Part 331). However, you may request an approved JD, which is an appealable action, by contacting
the Corps district for further instruction. Please note, if work is authorized by either a general or nationwide permit, and
you wish to request an appeal of an approved JD, the appeal must be received by the Corps and the appeal process
concluded prior to the commencement of any work in waters of the United States and prior to any work that could alter
the hydrology of waters of the United States.
2. ❑ There are Navigable Waters of the United States within the above -described project area subject to the permit requirements of
Section 10 of the Rivers and Harbors Act (RHA) (33 USC § 403) and Section 404 of the Clean Water Act (CWA) (33 USC §
1344). This determination may be relied upon for a period not to exceed five years from the date of this notification, provided
there is no change in law or our published regulations or new information that warrants revision of this determination.
3. ❑ There are waters, including wetlands within the above -described project area that are subject to the permit requirements of
Section 404 of the Clean Water Act (CWA) (33 USC § 1344). This determination may be relied upon for a period not to exceed
five years from the date of this notification, provided there is no change in law or our published regulations or new information
that warrants revision of this determination.
4. A jurisdiction determination was not completed with this request. Therefore, this is not an appealable action. However, you may
request an approved JD, which is an appealable action, by contacting the Corps for further instruction.
5. ❑ The jurisdictional areas within the above -described project area have been identified under a previous action. Please reference
jurisdictional determination issued _. Action ID: _.
B. Basis For Determination: See the Preliminary Jurisdictional Determination form dated 12/28/2022.
C. Remarks: Note that a PJD for the majority of the site was issued on 3/3/2020. This PJD includes the original review area
as well as an additional —10.75 acres of review area along the south and southeast of the original review area.
D. Attention USDA Program Participants
This delineation/determination has been conducted to identify the limits of Corps' Clean Water Act jurisdiction for the particular site
identified in this request. The delineation/determination may not be valid for the wetland conservation provisions of the Food Security
Act of 1985. If you or your tenant are USDA Program participants, or anticipate participation in USDA programs, you should request
a certified wetland determination from the local office of the Natural Resources Conservation Service, prior to starting work.
E. Appeals Information for Approved Jurisdiction Determinations (as indicated in A2 and A3 above).
If you object to this determination, you may request an administrative appeal under Corps regulations at 33 CFR Part 331. Enclosed
you will find a Notification of Appeal Process (NAP) fact sheet and Request for Appeal (RFA) form. If you request to appeal this
determination you must submit a completed RFA form to the following address:
US Army Corps of Engineers
South Atlantic Division
Attn: Philip Shannin, Appeal Review Officer
60 Forsyth Street SW, Room 10M15
Atlanta, Georgia 30303-8801
Phone: [phone]
AND
PHILIP.A. SHANNIN(a)USACE.ARMY.MIL
In order for an RFA to be accepted by the Corps, the Corps must determine that it is complete, that it meets the criteria for appeal
under 33 CFR part 331.5, and that it has been received by the Division Office within 60 days of the date of the NAP. Should you
decide to submit an RFA form, it must be received at the above address by Not applicable.
It is not necessary to submit an RFA form to the Division Office if you do not object to the determination in this
correspondence. Date: 2022.12.28 16:45:27
Corps Regulatory Official:
�67-�'T -05-00-
David E. Bailey
Date of JD: 12/28/2022 Expiration Date of JD: Not applicable

NOTIFICATION OF ADMINISTRATIVE APPEAL OPTIONS AND PROCESS AND
REQUEST FOR APPEAL
Applicant: Anson County Board of Education (Attn: Howard McCleanj File Number: SAW-2019-02279 I Date: 12/28/2022
Attached is:
See Section below
❑
INITIAL PROFFERED PERMIT (Standard Permit or Letter of permission)
A
PROFFERED PERMIT (Standard Permit or Letter of permission)
B
PERMIT DENIAL
C
❑
APPROVED JURISDICTIONAL DETERMINATION
D
❑X
PRELIMINARY JURISDICTIONAL DETERMINATION
E
SECTION I - The following identifies your rights and options regarding an administrative appeal of the above decision.
Additional information may be found at or http://www.usace.g.M.mil/Missions/CivilWorks/Re ugulatoryProgramandPennits.aspx
or the Corps regulations at 33 CFR Part 331.
A: INITIAL PROFFERED PERMIT: You may accept or object to the permit.
• ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the district engineer for final
authorization. If you received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your
signature on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all
rights to appeal the permit, including its terms and conditions, and approved jurisdictional determinations associated with the
permit.
• OBJECT: If you object to the permit (Standard or LOP) because of certain terms and conditions therein, you may request
that the permit be modified accordingly. You must complete Section II of this form and return the form to the district
engineer. Your objections must be received by the district engineer within 60 days of the date of this notice, or you will
forfeit your right to appeal the permit in the future. Upon receipt of your letter, the district engineer will evaluate your
objections and may: (a) modify the permit to address all of your concerns, (b) modify the permit to address some of your
objections, or (c) not modify the permit having determined that the permit should be issued as previously written. After
evaluating your objections, the district engineer will send you a proffered permit for your reconsideration, as indicated in
Section B below.
B: PROFFERED PERMIT: You may accept or appeal the permit
• ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the district engineer for final
authorization. If you received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your
signature on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all
rights to appeal the permit, including its terms and conditions, and approved jurisdictional determinations associated with the
permit.
• APPEAL: If you choose to decline the proffered permit (Standard or LOP) because of certain terms and conditions therein,
you may appeal the declined permit under the Corps of Engineers Administrative Appeal Process by completing Section II of
this form and sending the form to the division engineer. This form must be received by the division engineer within 60 days
of the date of this notice.
C: PERMIT DENIAL: You may appeal the denial of a permit under the Corps of Engineers Administrative Appeal Process by
completing Section II of this form and sending the form to the division engineer. This form must be received by the division
engineer within 60 days of the date of this notice.
D: APPROVED JURISDICTIONAL DETERMINATION: You may accept or appeal the approved JD or provide new
information.
• ACCEPT: You do not need to notify the Corps to accept an approved JD. Failure to notify the Corps within 60 days of the
date of this notice, means that you accept the approved JD in its entirety, and waive all rights to appeal the approved JD.
• APPEAL: If you disagree with the approved JD, you may appeal the approved JD under the Corps of Engineers
Administrative Appeal Process by completing Section II of this form and sending the form to the district engineer. This form
must be received by the division engineer within 60 days of the date of this notice.

E: PRELIMINARY JURISDICTIONAL DETERMINATION: You do not need to respond to the Corps regarding the
preliminary JD. The Preliminary JD is not appealable. If you wish, you may request an approved JD (which may be appealed),
by contacting the Corps district for further instruction. Also you may provide new information for further consideration by the
Corps to reevaluate the JD.
SECTION II - REQUEST FOR APPEAL or OBJECTIONS TO AN INITIAL PROFFERED PERMIT
REASONS FOR APPEAL OR OBJECTIONS: (Describe your reasons for appealing the decision or your objections to an initial
proffered permit in clear concise statements. You may attach additional information to this form to clarify where your reasons or
objections are addressed in the administrative record.)
ADDITIONAL INFORMATION: The appeal is limited to a review of the administrative record, the Corps memorandum for the
record of the appeal conference or meeting, and any supplemental information that the review officer has determined is needed to
clarify the administrative record. Neither the appellant nor the Corps may add new information or analyses to the record.
However, you may provide additional information to clarify the location of information that is already in the administrative
record.
POINT OF CONTACT FOR QUESTIONS OR INFORMATION:
If you have questions regarding this decision and/or the
If you only have questions regarding the appeal process you may
appeal process you may contact:
also contact:
District Engineer, Wilmington Regulatory Division
MR. PHILIP A. SHANNIN
Attn: David E. Bailey
ADMINISTRATIVE APPEAL REVIEW OFFICER
Raleigh Regulatory Office
CESAD-PDS-O
U.S Army Corps of Engineers
60 FORSYTH STREET SOUTHWEST, FLOOR M9
3331 Heritage Trade Drive, Suite 105
ATLANTA, GEORGIA 30303-8803
Wake Forest, North Carolina 27587
PHONE: [phone]; FAX [phone]
EMAIL: PHILIP.A.SHANNIN(&USACE.ARMY.MIL
RIGHT OF ENTRY: Your signature below grants the right of entry to Corps of Engineers personnel, and any government
consultants, to conduct investigations of the project site during the course of the appeal process. You will be provided a 15-day
notice of any site investigation, and will have the opportuni to participate in all site investi ations.
Date:
Telephone number:
Signature of appellant or agent.
For appeals on Initial Proffered Permits send this form to:
District Engineer, Wilmington Regulatory Division, Attn: David E. Bailey, 69 Darlington Avenue, Wilmington, North Carolina
28403
For Permit denials, Proffered Permits and Approved Jurisdictional Determinations send this form to:
Division Engineer, Commander, U.S. Army Engineer Division, South Atlantic, Attn: Mr. Philip Shannin, Administrative
Appeal Officer, CESAD-PDO, 60 Forsyth Street, Room 1OM15, Atlanta, Georgia 30303-8801
Phone: [phone]