WQ0024909_Application (FTSE)_20050215

I AS1 I �tA('K AI'I'! fCA"TION for(:RANI'I'Y SEWERS, PUMP S FA7IONS, AND FORCE MAINS PACE 3
I1SE THE TAB KEY TO MOVE FROM FIELD TO FIELDS Application Number: 1
(to be rornpteted by DWO, k)Q() O� l t V
Owner.
is CITY OF SANFORD ��
Fiji: Legal Name(company, municipality, t!OA, utility, etc)
Z 1b. VIC CZAR, PE CITY ENGINEER _
0 Signing Official Name and Title (Please review 15A NCAC 2H 0206(b)for authorized signing officials!)
Q 1c. The legal entity who will own this system is-
❑ Individual ❑ Federal® Municipality C State/County❑ Private Partnership❑ Corporation ❑ Other(specify)
1d. P.O. BOX 3729 le SANFORD
0 Street Address City
LL
Z 'f. NC 1 g. 27331 _
Z State Zip Code
O 1 h. [phone] 1 i. [phone] 1 J _ _
~ Telephone Facsimile E-mail
Q
(� 2. Project(Facility) Information:
`J ?-a. NOTTINGHAM SUBDIVISION PHASE II 2b. LEE
[L Brief Project Name (permit will refer to this name) County Where Project is Located
Q 3 Conract Person.
Q 3a. KEN W. BRIGHT, PE
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. [phone] 3c. [e-mail]
Phone Number E-mail
1. Project is® New ❑ Modification(of an existing permit) If Modification, Permit No.:
2. Owner is ® Public(skip to Item B(3)) ❑ Private(go to Item 2(a))
2a. If private, applicant will be: 2b. If sold,facilities owned br a (must choose one)
❑ Retaining Ownership(i.e.store, church, single office, etc)or ❑ Public Utility(Instruction III)
❑ Leasing units(lots,townhomes, etc. -skip to Item 6(3)) ❑ Homeowner Assoc./Developer(Instruction IV)
❑ Selling units(lots,townhomes, etc.-go to Item H(2b))
Z 3. CITY OF SANFORD
Owner of Wastewater Treatment Facility(WWTF)Treating Wastewater From This Project
4a. City of Sanford Big Buffalo Wastewater Treatment Plant 4b. 0024147
Name of WWTF WWTF Permit No.
Ix
O 5a. City of Sanford 5b. 8" 5c
ILL
Z Owner of Downstream Sewer Receiving Sewer Size Permit Number of Downstream Sewer(if known)
Z
6. The origin of this wastewater is(check all that apply)-
® Residential Subdivision ❑ Car Wash
WElApartments/Condominiums ❑ Institution 100%Domestic/Commercial
a ❑ Mobile Home Park ❑ Hospital
❑ School ❑ Church % Industrial
m ❑ Restaurant ❑ Nursing Home /o o
❑Office ❑ Other(specify) Other(specify):
7. Volume of wastewater to be permitted in this project 19,080 gallons per day
8. If the permitted flow is zero, indicate why:
❑ Interceptor Line-Flow will be permitted is subsequent permits that connect to this line
❑ Flow has already been allocated in Permit No.
❑ Rehabilitation or replacement of existing sewer with no new flow expected
f 1 A fly fl;

FAST`TRACK APPLICATION for GRAVITY SEWERS, I'll M1'STATIONS, AND FORCE: MAINS PAGE 4
9 Provide the wastewater flow calculations used is determining the permuted flow in accordance with 15A NCAC 2H
0219(I) for Item 13(7) or the design flow for line or pump station sizing if zero flow in the space below. Values other than
that in 15A NCAC 2H .0219(I)(1-2) must be approved prior to submittal of this application. Submit a separate request to
the Di%,•sion of Water Quality, Non-Discharge Permitting Unit, 1617 Marl Servicc Center, Raleigh, NC 27699-115:7 in
accordance with 15A NCAC 2H 0219(1)(3).
53 lots x 3 BR/lot x 120 gal/BR = 19,080 GPD
'.0 Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size(inches) Length (feet) Gravity or Force Main
(pull down menu)
8" 4,100 Gravity
Gravity
(] Gravity
W
0 Gravity
Z Gravity
F
Z Gravity
0
CU Gravity
Z ENTER TOTAL LINE LENGTH IN MILES 08
0
Q11. Summary of Pump Stations to be Permitted(attach additional sheets as necessary)
Power Reliability Option
Location ID Design Flow Operational Point (dual line feed, permanent generator WATS,
7 (as sh-)wn on plans) (MGD) GPM @ TDH portable generator w/telemetry, wet well storage)
LL
Z
H
W
a' 12. Does the sewer system comply with the Minimum Design Criteria for the Fast Track Permitting of Pump Stations and Force
m Mains(latest version),the Gravity Sewer Minimum Design Criteria(latest version)and 15A NCAC 2H .0200 as applicable?
® Yes ❑ No If no, please reference the pertinent minimum design criteria or regulation and indicate why a
variance is requested
SUBMIT TWO COPIES OF PLANS, SPECIFICATIONS OR CALCULATIONS PERTINENT TO THE VARIANCE WITH YOUR APPLICATION
13. Have the following permits/certifications been submitted for approval?
Wetland/Stream Crossings- General Permit or 401 Certification? ❑Yes ❑ No ® NIA
Sedimentation and Erosion Control Plan? ❑Yes ® No ❑ N/A
Stormwater? ❑Yes ❑ No ® N/A
171A0" 0;

FAS-r`I'RACK API'LICATEON for GRAVITY SEWERS, PUMi'S'E A1IONS, AND FORCE MAINS PAGE: 5
1 Use the Division's guidance document entitled, "DETERMINING STREAM CLASSIFICATIONS FOR FORM FTA 02103
(FAST-TRACK SEWER SYSTEMS)"to collect and record the stream classification data below(attach additional sheets as
Z necessary). This document is available from our web site or by contacting the appropriate Division of Water Quality
O regional office(see instructions for addresses)OR indicate the following-.
❑ A Stream Classification is not needed because all parts of the project are at least 100 feet away from any down slope
Q waterbody, AND,
V ® A Stream Classification is not needed because the design does not depend on wet well storage as a power reliability
LL option for any pump station near a Class C down slope waterbody.
�5 Location ID Name of Waterbody Stream Waterbody
Q on Map Waterbody County River-Basin Index Classification
VHiq Buffalo; Creek Lee Cape Fear '7-4 C
a
W
F-
U
Submit the 8.5" x 11"topographic map as required in Instruction VI regardless of whether a classification is provided!
i
1 Applicant's Certification-,
I. VIC CZAR, attest that this application for NOTTINGHAM SUBDIVISION PHASE 11
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 retumed as incomplete Note: In accordance with North Carolina
General Statutes 143-215.6A and 143-215.68, any person who knowingly makes any false statement, representation, or
certi cation in any application shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed$10,000
civil p es to$25,000 per violation.
1a - -- - � `� +C'�j
r , ing Official Signatur Dale
2. Professional Engineer' Certification_
O1 attest that this application for NOTTINGHAM SUBDIVISION PHASE I! has been
reviewed by me and is accurate, complete and consistent with the information in the engineering plans, calculations, and
all other supporting documentation to the best of my knowledge l further attest that to the best of my knowledge the
Q proposed design has been prepared in accordance with the applicable regulations. Gravity Sewer Minimum Design Criteria
U for Gravity Sewers adopted February 12, 1996, and the Minimum Design Criteria for the Fast-Track Permitting of Pump
LL Stations and Force Mains adopted June 1, 2000 and the watershed classification in accordance with Division guidance.
Although certain portions of this submittal package may have been developed by other professionals, inclusion of these
materials under my signature and seal signifies that i have reviewed this material and have judged it to be consistent with
W the proposed design. Note In accordance with NC General Statutes 143-215.6A and 143-215.6B, any person who
U knowingly makes any false statement, representation, or certifrcahon in any application shall be guilty of a Class 2
0 misdemeanor which may include a fine not to exceed$10.000 as well as civil penalties up to$25,000 per violation.
2a KEN W. BRIGHT, P E
Professional Engineer Name °�.'r��� CAR(jZ�`'i,�j
2b KEN W. BRIGHT ASSOCIATESEkS,S� '�
Engineering Firm
$ AI
2c. P.O. BOX 553 L , ]5$L
Address �t
2d SANFORD 2e. NC 2f 27331-0553 ,Y `kcI NEEQ: ` ,� ]�4J
City - State Zip --- - — '•,�FN 6Y BR�GX.1'�1� J
2g. [phone] 2h [phone] 2i. kwbnghl wave-net net °0j' )#loss, I
Telephone Facsimile E-mail Seal, Signature&Date
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FAS i-TRACK APPLICATION for GRAVITY SLWERS, PUMP STA'I IONS, AND FORCE MAINS PAGE I
OF WATF9 State of North Carolina
�O7 04 Department of I?n-ironmcnt and Natural Resources
Cl) DiN ision of Water Quality
Wa. -
oFAST-TRACK APPLICATION
for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
(Pressure scocrs s%stemti are not to be included as earl or this application package)
INSTRUCTIONS: Indicate that you have included the following list of required application package items by checking the
space provided next to each item Failure to submit all required items will lead to your application being returned as
incomplete or additional processing and review time. This form may be photocopied for use as an original.
01. Application Form Submit one original and one copy of the completed and appropriately executed app.,cation
form Any changes to this form will result in the application being returned. The Division of Water Quality
(Division) will only accept application packages that have been fully completed with all applicable items
addressed You do not need to submit detailed plans andspecifications unless Vou respond NO to Item B(12).
Il. Application Fee - Submit a check in the amount of $400 made payable to: North Carolina Department of
Environment and Natural Resources (NCDENR).
❑ ill. Certificates of Public Convenience and Necessity — If the application is being submitted in the name of a
privately-owned public utility, !;w, mit two copies of the Certif�catcc of Public Convenience and Necessity (CPCN)
which demonstrates that the public utili�r is authorized to hold the utility franchise for the area to be served by lne
sewer extension. If CPCN has not been issued, provide two copies of a letter from the North Carolina Uti!itles
Commission's Public Staff that states that an application for a franchise has been received, that the service area
is contiguous to an existing franchised area, and/or that franchise approval is expected. The project name in the
CPCN or letter must match that provided in Item A(2a)of this application.
IV. Operational Agreements — Submit one original and two copies of a properly executed operational agreement if
the sewer extension is permitted by a private applicant and will be serving residential or commercial lots (e.g.,
houses, condominiums, townhomes, outparcels, etc.) that will be sold to another entity. If the applicant is a
homeowners' association, use Form HOA 02/03. If the applicant is a developer, use Form DEV 02/03. EVEN IF
THE PROJECT WILL BE TURNED OVER TO A MUNICIPALITY, FORM DEV 02/03 IS REQUIRED.
❑ V. Flow Acceptance Letters — if the owner of the downstream sewers and/or WWTF is different from the applicant,
submit two copies of a flow acceptance letter from the owner of the downstream sewers and WWi'F, if different.
Flow acceptance letters must contain the following minimum information: applicant and project name, amount of
flow accepted, and name and permit number of the receiving sewers/WWTF. The flow acceptance must not
expire prior to permit issuance and must be dated less than a year prior to the application date.
Intergovernmental agreements or other contracts will not be accepted in lieu of a project-specific flow acceptance
letter.
®VI. Map — Submit an 8.5-inch by 11-inch copy of the portion of a 7.5-minute USGS Topographic Map along with this
form. The map should identify the entire project area location as well as the closest downslope surface waters as
clearly as possible. Each map portion must be labeled with the map name and number, the identified location,
and be of clear and reproducible quality. For instance, if the project involves 4 miles of interceptor sewer that
traverses over or near several different waterbodies (or counties, basins, etc.), the map should have location ID's
for each different waterbody (where the sewer line is within 100 feet of such waterbody- see Instruction Vll).
VII. Stream Classifications— Section C
• If any portion of the project is within 100 feet of any down slope surface water, Section C must be completed
for the pertinent sections.
• If the entire project area is a minimum of 100 feet away from any down slope surface waters BUT there is a
pump station involved where a history of power outage is to be used to provide adequate design storage
instead of dual feed or permanent or portable generator, Section C must be completed to demonstrate that
the closest down slope surface water is Class C (see 15A NCAC 2H .0219(h)(3)(D)).
• Use the guidance document entitled, "Determining Watershed Classifications for Form FTA 02/03 (Fast-Track
Sewer Systems)" available from http://h2o.enr.state.nc.us/ndpu or by contacting the appropriate regional
office.
FT n) 01

FAST-TRACK APPLICATION for GRAVIT Y SEWERS, PUMP STATIONS, AND FORCE: MAINS PACE 2
❑Vill. Environmental Assessments — If this project is subject to an Environmental Assessment (EA) [I SA NCAC
01C .0500], this application can not be used. Send the proect application on Form PSFMGSA 10/99 to the
Non-Discharge Permitting Unit, 1617 Mal Service Center, Raleigh, NC 27699.1617 Applications can not be
processed until a Finding of No Significant Impact (FONSI) or Environmental Impact Statement (EIS) has been
issued. A copy is to be submitted wT, that permit application.
❑ IX. Certifications—Section D
The application must be certified by both the applicant and a North Carolina Registered Professional Engineer
(PE). The applicant signature must match the signing official listed in Item A(1 b) The PE should NOT certify the
application if he/she is unfam.liar with 15A NCAC 2H 0200, the Gravity Sewer Minimum Design Criteria (most
recent version) and the Minimum Design Criteria for the Fast-Track Permitting of Pump Staticns and Force Mains
(most recent vers on), as app':cable to the project Certification by a PE who is unfarnCiar with these documents
is subject to NC Board referral
THE COMPLETED FTA 02/03 APPLICATION PACKAGE, INCLUDING ALL SUPPORTING DOCUMENTS AND $400
FEE, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE
REGIONAL OFFICE ADDRESS COUNTIES SERVED
Asheville Regional Office Avery, Buncombe, Burke, Caldwell,
59 Woodfin Place Cherokee, Clay, Graham, Haywood,
Asheville, North Carolina 28801 Henderson, Jackson, Macon,
[phone] Madison McDowell, Mitchell, folk
[phone] Fax Rutherford, Swam, Transyivan:,-,
Yancey
Fayetteville Regional Office
225 Green Street Suite 714 Anson, Sladen, Cumberland, !-#arnett,
E Fayetteville, North Carolina 28301 Hoke, Montgomery, Moore, Robeson,
f [phone](910) 486-0707 Fax Richmond, Sampson, Scotland
Mooresville Regional Office
919 N Main Street Alexander, Cabarrus, Catawba,
Mooresville, North Carolina 28115 Cleveland, Gaston, Iredeil, Lincoln.
[phone] Mecklenburg, Rowan, Stanly, Union
[phone] Fax
Raleigh Regional Office Chatham, Durham, Edgecombe,
1628 Mail Service Center Raleigh, North Carolina 27699-1628 Franklin, Granville, Halifax, Johnston,
[phone] Lee, Nash, Northampton, Orange,
[phone] Fax Person, Vance, Wake, Warren,
Wilson
Washington Regional Office Beaufort, Bertie, Camden, Chowan,
943 Washington Square Mall Craven, Currituck, Dare, Gates,
Washington, North Carolina 27889 Greene, Hertford, Hyde, Jones,
[phone] Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax Perquimans, Pitt, Tyrrell, Washington,
Wayne
Wilmington Regional Office
127 Cardinal Drive Extension Brunswick, Carteret, Columbus,
Wilmington, North Carolina 28405
Duplin, New Hanover, Onslow,
[phone]
[phone] Fax Pender
Winston-Salem Regional Office
585 Waughtown Street Alamance, Alieghany, Ashe, Caswell,
Winston-Salem, North Carolina 27107 Davidson, Davie, Forsyth, Guilford,
[phone] Rockingham, Randolph, Stokes,
[phone] Fax Surry, Watauga, Wilkes, Yadkin
For more information, visit our web site at http 11h2o enr state nc us/ndpul
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