WQ0045764_Application (FTSE)_20240927

JK
JoynerKeeny
Planning, Surveying & Engineering
August 26, 2024
Raleigh Regional Office AUG 2
Water Quality Section Z�Z4
3800 Barrett Drive
Raleigh, North Carolina 27609
Reference: Sanitary Sewer Extension
The Villages at Cross Creek
Cross Creek Drive, Weldon Township, Halifax County
Dear Sir or Madam:
Hand Delivery
Please find attached the following permit application documents for the proposed The Villages at Cross Creek
residential subdivision sewer service extension of the Roanoke Rapids Sanitary District. The project is located at
the corner of Cross Creek Drive and NC-125 in Weldon Township, Halifax County, North Carolina.
Please find included the following:
• Completed FTA 10-23 Application and FTSE 10-23 .0 form
• Narrative
• USGS and Aerial Maps
• Drawings Available Upon Request
• Check in the amount of $600.00
If after reviewing you have any questions, or if you require any additional information, please contact me at
your earliest convenience.
Sincerely,
Briana D. Eddy
Civil Engineering Project Manager
Joyner Keeny, PLLC
X Project: 230015A
Copy: Nicholas S. Rightmyer, PE
Post Office Box 7533. 1051 N. Winstead Ave • Rocky Mount + North Carolina • 27804-7533
252- 977-3124 (office) • wwwjoynerkeenycom . 252- 985-6026 (fax)
Page 1 of 1

Flow revised based on 75 GPD/bedroom new session law
Corrected/resubmitted pages 20240923. SW/DWR/RRO
The Villaees at Cross Creek
Narrative
Items to be included in the awlication oackaee:
• Completed FTA 10-23 Application & FTSE 10-23_0 form
• Cover Letter
• Narrative and Maps
• NC Secretary of State business Annual Report
Brief description of requested permitting action:
The extension of the sanitary sewer in the proposed Villages at Cross Creek will serve 82 single-family
homes. The minimum lot size is 9,000 square feet. There will be 3,330 linear feet of 8" PVC. The
connecting existing manhole is located at the intersection of Hatteras Drive and Cross Creek Drive as
shown below.
.rS
System Type;
Number of homes served: 82
E

Additional info submitted 20240923 - revised flow
See email 20240923
DWR AUG 2 6
Division of Water Resources ZQ�
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
WQ0045764
(IG be completed by DWR)
All items must be completed or the application will be returned
1. APPLICANT INFORMATION:
I. Applicant's name: Roanoke Rapids Sanitary District (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: Thomas Wrenn per15ANCACO2TC _0t06fb)t06fb)
Title: CEO
4. Applicant's mailing address: 1000 Jackson Street
City: Roanoke Rapids State: NC Zip: 27870-
5. Applicant's contact information:
Phone number: [phone] Email Address: twrenn@,rrsd.org
11. PROJECT INFORMATION:
1. Project name: The Villages at Cross Creek
2. Application/Project status: ® Proposed (Mew 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: Halifax
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.425" Longitude:-77.65W 4
5. Parcel I (if applicable): 1205886 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Nicholas S. Rightmyer, RE License Number: 036243
Firm: Joyner Keenv PLLC
Mailing address: 1051 N. Winstead Avenue
City: Rocky Mount State: NC Zip: 27804-
Phone number: {252) 977-3i24 Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility.Name: Roanoke River Wastewater Plant Permit Number: NCO024201
Owner Name: Roanoke Rapids Sanitary District
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
I. Permit Number(s): WQ unknown
2. Downstream (Receiving) Sewer information: 8 inch I I Gravity El Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS00027
Owner Name(s): Roanoke Rapids Sanita District
FORM: FTA 10-23 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 ® N/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached?
❑ Yes ❑ No ® N/A
3. If the Applicant is a Home/Property Owners' Association, has an HOA/POA Operational Agreement (FORM: HOA) and
supplementary documentation as required by 15A NCAC 02T.0115(c) been attached?
❑ Yes ❑ No ® N/A
4. Origin of wastewater: (check all that apply):
® Residential (Individually Owned) ❑ Retail (stores, centers, malls) ❑ Car Wash
❑ Residential (Leased) ❑ Retail with food preparation/service ❑ Hotel and/or Motels
❑ School / preschool / day care ❑ Medical / dental / veterinary facilities ❑ Swimming Pool/Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 % Domestic % Commercial % Industrial (See 15A NCAC 02T .0103(20))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(f)? ❑ Yes ®No
➢ If yes, provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow','
No. of Units
Flow
3 bedroom dwelling
225 gal/day
82
18,450 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
18,450 GPD
a See 15A NCAC 02T .0114(b), (d), (e)(1) and (e)(2) for caveats to wastewater design flow rates (i.e. proposed unknown
non-residential development uses; public access facilities located near high public use areas; and residential property
located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined in G.S. 42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 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: 18,450 GPD (per 15A NCAC 02T .0114 and G.S. 143-215.1)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero, please indicate why:
❑ Pump Station/Force Main or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line.
Please provide supplementary information indicating the approximate timeframe for permitting upstream sewers with flow.
❑ Flow has already been allocated in Permit Number: Issuance Date:
❑ Rehabilitation or replacement of existing sewers with no new flow expected
❑ Other (Explain):
FORM: FTA 10-23 Page 2 of 5

VI1. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 3,330 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
Vill. PUMP STATION DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Pump StationsfForce Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: nla
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.I.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
G. Power reliability in accordance with 15A NCAC-{ZT_.0305t1i)(11:
❑ Standby power source or ❑ Standby pump
➢ Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(I)(B)�
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
➢ Must be permanent to facility and may not be portable
Or if the pump station has an average daily flow less than 15,000 gallons per day 15A NCACO2T.0305(h)(1)(C):
❑ Portable power source with manual activation, quick -connection receptacle and telemetry -
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry:
➢ Include documentation that the portable source is owned or contracted by the applicant and is compatible with the station.
➢ If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel timeframes, shall be provided
as part of this permit application in the case of a multiple station power outage.
FORM: FTA 10-23 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations/alternatives found in 15A NCAC 02T .03054f) & ? ® 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
'Water mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
'Water mains (horizontal)
10 feet
Reclaimed water lines (vertical - reclaimed over sewer)
18 inches
Reclaimed water lines (horizontal - reclaimed over sewer)
2 feet
"Any private or public water supply source, including any wells, WS-1 waters of Class I or
Class II impounded reservoirs used as a source of drinking water, and associated wetlands.
100 feet
**Waters classified WS (except WS-1 or WS-V), B, SA, ORW, HQW, or SB from normal
high water (or tide elevation) and wetlands associated with these waters (see item IX.2)
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches, as well as wetlands associated with these waters or classified as WL.
10 feet
Any building foundation (horizontal)
5 feet
Any basement (horizontal)
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
➢ If noncompliance with 021<. 3 5[I?.of W. see Section X.l of this application
* I, A Cg�+w 02T.0305 g] 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.
O'Stream classifications can be identified using the Division's NC.Surface Water Classifications webpag.e
2. Does this project comply with the minimum separation requirements for water mains? ® Yes [—]No ❑ Nr'A
i If no, please refer to 15A NCAC 18C.0906(f) for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? ® Yes ❑ No ❑ N.-'A
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ See the Division's drag separation Mgtiin�qmts 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: Roanoke ® No
If yes, does the project comply with setbacks found in the river basin rules per I SA NCA 2B _0200? ❑ Yes ❑ No
➢ This includes Trout Buffered Streams per 15A NC A.0 213 0202
5. Does the project require coverage?authorization under a 404 Nationwide. -individual permits ❑ Yes ® No
or 401 Water Quality Certifications?
➢ Please provide the permit number.`permitting status in the cover letter if coverage -authorization is required.
6. Does project comply with 15A N('A(' p')1'.0105i 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 NC'AC' 02T_0402, "high -priority sewer" means any aerial sewer, sewer contacting surface waters,
siphon, or sewers positioned parallel to streambanks that are subject to erosion that undermines or deteriorates the sewer.
Siphons and sewers suspended through interference/conflict boxes require a variance approval.
➢ If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at least once every six -months and
inspections documented per 15A NCAC 02T.0403(a)(5) or the permittee's individual System -Wide Collection permit.
FORM: FTA 10-23 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criterii$ for the Permittine of Puma Stations
Main latest versioril and the Gravity Sewer Mini�DCsien Criteria flatqsl 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. Aporoval of the request will be issued
concurrently with the aporoyal of the permit, and projects requiriniz a variance approval may, be subject to longer
review times. For projects reguirine two or more variances or where the variance is determined by the Division to be a
sit'nifiicant portion of the project, the full technical review is required.
2. Professional Engineer's Certification:
I, 41 Ci18(4 3 , 01tL+,VO-,f r , attest that this application for _V i I tq e_ 5 Q T CCDSJ G Me �c
(Professional Engineer's name f Applrcatiorn Item 111 I.) (Project Ne from Application Item 11.1)
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans,
specifications, engineering calculations, and all other supporting documentation to the best of my knowledge. 1 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!aravity ewers (latest version), and the Minimum Design Crkeria for the Fast -Track Permitting
of Pump Stationss roc gN EQMains {latest version]. Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and sea] signifies that 1 have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE In accordance with General Statutes 143-215.6A and 143-215.613, 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
North Carolina Professional Engineer's seal, signature, and date: �A.•• �- �E$$/� �j'4g
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3. 'sS' Applicant's Certification per 15A NCAC 02T .0106(b):
I, / /' 6^44(�. attest that this application for
(Signature Authority Name from Application Item 13.) Proj Name from Application Item II 1)
attest that this application has been reviewed by me and is accurate and complete to the best of my knowledge.
I understand that if all required parts of this application are not completed and that if all required supporting documentation
and attachments are not included, this application package is subject to being returned as incomplete. I understand that any
discharge of wastewater from this non -discharge system to surface waters or the land will result in an immediate enforcement
action that may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division
of Water Resources should a condition of this permit be violated. I also understand that if all required parts of this application
package are not completed and that if all required supporting information and attachments are not included, this application
package will be returned to me as incomplete.
NOTE - In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10, 0 as well as civil penalties up to $25,000 per violation.
Signature: Date: 09r3. 2,o7,1
FORM: FTA 10-23 Page 5 of 5

Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-23)
Entity Requesting Allocation: Villages at Cross Creek
Project Name for which flow is being requested: Villages at Cross Creek
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.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Roanoke River Wastewater Treatment Plant
b. WWTP Facility Permit #: NCO024201
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
8.34
0.15
3.0
0.02
3.17
38.01
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 / p fl,
Avg. Daily
Number)
No.
MGD MGD
Flow, MGD
(C)
(D)=(B+C) (E)=(A-D)
Obligated,
Not Yet
Total Current
Tributary
Flow Plus
Daily Flow,
Obligated Available
MGD
Flow Capacity***
* The Firm Capacity (design flow) of any pump station is defined as the maximum pumped flow that can be
achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor (pt) not
less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located between the
project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer):
Downstream Permit Number:
Page 1 of 6
FTSE 10-23

III. Certification Statement:
1 Thomas C. Wrenn _ certify to the best of my knowledge that the addition of
the volume of wastewater to be permitted in this project has been evaluated along the route to the receiving
wastewater treatment facility and that the flow from this project is not anticipated to cause any capacity
related sanitary sewer overflows or overburden any downstream pump station en route to the receiving
treatment plant under normal circumstances, given the implementation of the planned improvements
identified in the planning assessment where applicable. This analysis has been performed in accordance
with local established policies and procedures using the best available data. This certification applies to
those items listed above in Sections I and II plus all attached planning assessment addendums for which I
am the responsible party. Signature of this form certifies that the receiving collection system or treatment
works has adequate capacity to transport and treat the proposed new wastewater.
Signing fficial Signature to
LEO
Title of Signing Official
Page 2 of 6
FTSE 10-23

Flow allocation required: 29,520 GPD
No other required sewer permits downstream or upstream are required at this time.

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4Rp DOWNSTREAM J
L CONNECTION POINT ` OCR
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0
125
- DICKENS FARM RDS
rso
USGS QUADRANGLE AND SEWERPIPE ROUTES
1 " = 1000'

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State of North Carolina
AUG Z 6 2P24 Department of Environmental Quality
DW.R Division of Water Resources
Pla�l FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Dhrlslon of Water Resources INSTRUCTIONS FOR FORM: FTA 10-23 & SUPPORTING DOCUMENTATION
This application is for sewer extensions involving gravity sewers, pump stations and force mains, or any combination that has been
certified by a professional engineer and the applicant that the project meets the requirements of 15,E NCAC 02T and the Division's
Minimum Design Criteria (Gravity Sewer & Putt Statiunsifor�pg 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 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 J 5A N.i=AC
_QJLJO,105 and the applicable minimum design criteria. These
documents shall be immediately available upon request by the Division.
Projects that are deemed permitted (do not require a permit from the Division) are explained in 15A NCAC 02T.0303.
Projects not eligible for review via the fast track process (must be submitted for full technical review):
➢ Projects that do not meet any part of the minimum design criteria (MDC) documents;
➢ Projects that involve more than one variance from the requirements of 15A NCAC 02T;
➢ Pressure sewer systems utilizing simplex septic tank -effluent pumps (STEPs) or simplex grinder pumps;
➢ Simplex STEP or simplex grinder pumps connecting to pressurized systems (e.g. force mains);
➢ Vacuum sewer systems.
General - When submitting an application, please use the following instructions as a checklist in order to ensure all required items are
submitted. Adherence to these instructions and checking the provided boxes will help produce a quicker review time and reduce the
amount of requested additional information. Failure to submit all required items will necessitate additional processing and review
time, and may result in return of the application. Unless otherwise noted, the Applicant shall submit one original and one copy of
the application and supporting documentation.
A. One Original and One Copy (second copy 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):
® 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 numbedstatus of any other required sewer permits (downstreamlupstream)
➢ 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 $600.00, dated no more than 90 days prior to application submittal.
➢ Payable to North Carolina Department of Environmental Quality (NCDEQ)
D. Fast Track Application (Required for All Application Packages, Form FTA 10-23):
® Submit the completed and appropriately executed application.
If necessary for clarity or due to space restrictions, attachments to the application may be made.
® If the Applicant Type in Item 1.2 is a corporation or company, provide documentation it is registered for business with the
North Carolina Secretary: of State.
❑ If the Applicant Type in Item 1.2 is a partnership or d/bia, enclose a copy of the certificate filed with the Register of Deeds in
the county of business.
❑ The Project Name in Item [1.1 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 C'aroHna
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 10-23 & SUPPORTING DOCI ME TATION Page I of 3

E. Flow Tracking/Acceptance Form (Form: FTSE 10-23) (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.143-215.67f al.
➢ 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 I 1-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):
❑ Per I SA NCAC 02T .0;05i h)r 1 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 15A NCAC. 02T .01 15iIK1 j provide the Certificate of Public Convenience and Necessity from the North Carolina L!ti lities
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 Ivtili$es Commission's Water and S'ewer 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/Pronen Owners' Associations
❑ Per 15A NCAC 02T .01(5W, submit the properly executed Oocrational Agreem t f FORM: HOAi.
❑ Per 15A NCAC 02T .0115(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
❑ Develo ers of lots to be sold
❑ Per I5A NCAC 02T .01 l51 b), submit the properly executed O»erational Agreement (FORM:_2EK
/'or more information, visit the Division's collection systems urebsile
INSTRUCTIONS FOR FORM: FTA 10-23 & 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,
[phone]
Macon, Madison, McDowell, Mitchell, Palk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Hamett, Hoke,
Water Quality Section
Fayetteville, North Carolina 28301-5095
Montgomery, Moore, Robeson, Richmond,
[phone]
Sampson, Scotland
[phone] Fax
Mooresville Regional Office
610 E. Center Avenue
Alexander, Cabarrus, Catawba, Cleveland,
Water Quality Section
Mooresville, North Carolina 28115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
Raleigh Regional Office
3800 Barrett Drive
Chatham, Durham, Edgecombe, Franklin,
Water Quality Section
Raleigh, North Carolina 27609
Granville, Halifax, Johnston, Lee, Nash,
[phone]
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
Warren, Wilson
Washington Regional_ Office
943 Washington Square Mall
Beaufort, Bertie, Camden, Chowan, Craven,
Water Quality Section
Washington, North Carolina 27889
Currituck, Dare, Gates, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
Wilmington Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
Water Quality Section
Wilmington, North Carolina 28405
Hanover, Onslow, Fender
[phone]
[phone] Fax
Winston-Salem Reaional 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 10-23 & SUPPORTING DOCUMENTATION Page 3 of

Wilson, Susan A
From: Nick Rightmyer <[e-mail]>
Sent: Monday, September 23, 2024 3:07 PM
To: Wilson, Susan A
Cc: Thomas Wrenn; Briana Eddy; BLACKMON, JUSTIN
Subject: [External] FW: Fast Track Sewer Application The Villages at Cross Creek WQ0045764
Attachments: FTSE 10-23.pdf, 2-230015A_ Villages_FTA 10-23.pdf
Follow Up Flag: Follow up
Flag Status: Flagged
CAUTION: External email. Do not click links or open attachments unless verified. Report suspicious emails with the Report Message
button located on your Outlook menu bar on the Home tab.
Susan,
Find attached the two revised sheets for The Villages at Cross Creek with flowrates updated as requested.
Thankyou,
Nicholas S. Rightmyer, PE
Engineering Division Manager
'70)r.
.nrn
Engineering and Surveying
1051 N. Winstead Avenue, Rocky Mount, NC 27804
P.O. Box 7533, Rocky Mount, NC 27804-7533
Office: [phone] / Cell: (252)-532-2364 / Fax: [phone]
Surveying
230 Donaldson Street, Suite 500 A
Fayetteville, NC 28301
nrig htmyer(cDioynerkeeny.com / www.noynerkeeny.com
This message constitutes a confidential communication. If you have received this communication in error, do not read it. It is not
intended for transmission to, or receipt by, any unauthorized persons. Please delete it from your system without copying it, and
notify the sender by reply email or by calling 252-977-3124, so that our address record can be corrected. Thank you.
From: Thomas Wrenn <[e-mail]>
Sent: Monday, September 23, 2024 2:44 PM
To: Nick Rightmyer <[e-mail]>
Cc: Briana Eddy <[e-mail]>; Justin Blackmon <[e-mail]>
Subject: RE: Fast Track Sewer Application The Villages at Cross Creek WQ0045764

No need to re-sign. Good to go on our end.
Thanks!
Thomas
Thomas C. Wrenn
Chief Executive Officer
Roanoke Rapids Sanitary District
1000 Jackson Street
Post Office Box 308
Roanoke Rapids, NC 27870
252-537-9137 Ext. 221
252-537-3064 Fax
252-308-2942 Cell
twrenn(a)rrsd.org
www.rrsd.or
From: Nick Rightmyer <[e-mail]>
Sent: Monday, September 23, 2024 2:39 PM
To: Thomas Wrenn <[e-mail]>
Cc: Briana Eddy <[e-mail]>; Justin Blackmon <[e-mail]>
Subject: RE: Fast Track Sewer Application The Villages at Cross Creek WQ0045764
Thomas,
have attached the two sheets which incorporate the revisions mentioned below.
Are you comfortable with us sending just these sheets back to the State, or would you rather re-sign the
documents?
Thanks,
Nicholas S. Rightmyer, PE
Engineering Division Manager
JJoynerKeen"'
K Y
Funning, Surveying & tnq�neering
Engineering and Surveying
1051 N. Winstead Avenue, Rocky Mount, NC 27804
P.O. Box 7533, Rocky Mount, NC 27804-7533
Office: [phone] / Cell: (252)-532-2364 / Fax: [phone]
Surveying
230 Donaldson Street, Suite 500 A

Fayetteville, NC 28301
nrightmyer(d-)ioynerkeeny.com / www.iovnerkeeny.com
k KI
This message constitutes a confidential communication. If you have received this communication in error, do not read it. It is not
intended for transmission to, or receipt by, any unauthorized persons. Please delete it from your system without copying it, and
notify the sender by reply email or by calling 252-977-3124, so that our address record can be corrected. Thank you.
From: Wilson, Susan A <[e-mail]>
Sent: Monday, September 23, 2024 9:59 AM
To: Nick Rightmyer <[e-mail]>
Cc: [e-mail]
Subject: Fast Track Sewer Application The Villages at Cross Creek WQ0045764
Hi Nicholas -
Thanks so much for a mostly thorough and complete application. It is much appreciated!
Just a couple of comments/corrections -
Based on Session Law 2023 -137, you may use the minimum design flow criteria of 75 GPD/bedroom
(instead of the 120 GPD/bedroom). If you would modify the application to correct that (Part V.7 and
subsequently V.8)
The FTSE form will need to be modified to correct the project flow and subsequent calculations.
If it's ok with Mr. Wrenn -you folks may correct just those pages and not have to get the application re -signed.
Please provide the above information within 30 days. If additional information/corrected application is not
received within 30 days, your application will be returned, and you will need to resubmit along with the fee (ref. 15A
NCAC 02T.0107(e)(2)].
Thanks much.
Respectfully,
Susan Wilson
Environmental Engineer (Part Time, Temporary)
Water Quality Regional Operations - Raleigh Regional Office
NC Department of Environmental Quality
Office: 919-791-4240
Email correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties by an authorized
state official.