WQ0045858_Application (FTSE)_20241001

40 WithersRavenel
August 14, 2024
PROJECT ENGINEER'S REPORT
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Project Name: Pinewild Phase 5 - Azalea Place
Location: Pinehurst, Moore County, NC
Parcel ID: 0025104, 10000679, 10000680, 10000681, 10000682
Owner/ Developer: AEP PINEWILD HOLDING, LLC
PO Box 3369
Pinehurst, NC 28374
Consultant: WithersRavenel
Sol Rios -Moore, Senior Project Manager, Residential
[e-mail]
Ph. 919.469.3340 1 Direct. 919.238.0497
PROJECT DESCRIPTION AND NARRATIVE
The proposed development is located near 34 StoneyKirk Drive, inside the Village of Pinehurst
jurisdictional limits. The project proposes the construction of 77 Single -Family units. The project
is anticipated to generate the following wastewater flows:
77 UNITS (3 BEDROOMS) AT 75 GPD/BEDROOM = 17,325 GPD
TOTAL = 17,325 GPD
The proposed gravity sanitary sewer system will consist of approximately 5,889 LF of 8" SDR-35
PVC and 117 LF of 8" C-900 PVC.
The new gravity sanitary sewer system will be owned, operated, and maintained by Moore
County.
115 MacKenan Drive I Cary, NC 27511
t: 919.469.33401 f: 919.467.6008 1 www.withersravenel.com I License No. F-1479
Asheville I Cary I Charlotte I Greensboro I Pittsboro I Powells Point I Raleigh I Southern Pines I Wilmington

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DEQIDWR State of North Carolina
R Department of Environmental Quality
Pwww� r V j
� �o� Division of Water Resources
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Dlvlslon of Water Resources Flow Tracking for Sewer Extension Applications
WQROS (FTSE 10-18)
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Entity Requesting Allocation: Moore County Public Utilities
Project Name for which flow is being requested: Pinewild Ph5 - Azalea Place
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 wasiewaterJlow.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Moore County Water Pollution Control Plant
b. WWTP Facility Permit #: NC 0037508
All flows are in MGD
c.
WWTP facility's permitted flow
10.0000
d.
Estimated obligated flow not yet tributary to the WWTP
1.05374
e.
WWTP facility's actual avg. flow
4.98800
f.
Total flow for this specific request
0.01733
g.
Total actual and obligated flows to the facility
6.05907
h.
Percent of permitted flow used
60.5907
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 / pf),
Avg. Daily
Number)
No.
MGD
MGD
Flow, MGD
PW-1
0.936
0.374
0.18
(C)
(D)=(B+C)
(E)=(A-D)
Obligated,
Not Yet
Total Current
Tributary
Flow Plus
Daily Flow,
Obligated
Available
MGD
Flow
Capacity***
0
0.18
0.194
3-4 3.600 1.440 0.45 0.007 0.457 0.983
* The Firm Capacity (design Bow) of any pump station is defined as the maximum pumped flow
that can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor
(pf) not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): Moore County Public Utilities
Downstream Permit Number: WQCS00034
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I C. Brian Pamode, PE 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 11 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.
c.
Signing OjTic
Title of Signing
Signature
• M
U-Z
Dille
Page 2 of 6
FTSE 10-18

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Docusign Envelope ID: 686B94A3-F508-426F-A27E-09032E87E378
71,
Division of Water Resources
Application Number:
State of North Carolina
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 10-23 & SUPPORTING DOCUMENTATION
WQ0045858
(to be completed by DWR)
All items must be cotnRleted or the application will be returned
1. APPLICANT INFORMATION:
1. Applicant's name: Moore County Public Works (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
�1t�1 V CiJ
❑ Federal ® State/County ❑ Municipal ❑ e rrp��p�
3. Signature authority's name: Brian Pattiode per ! I�YYR
Title: Public Works Director OCT 0 1
4. Applicant's mailing address: 5227 Hwy 15-501
City: Carthage State: NC Zip: 28327- WQROS
S. Applicant's contact information: 1=AYl= I'll I FR�nlnt+lA1
Phone number: [phone] Email Address: coatnode(r4moorecountync.gov
11. PROJECT INFORMATION:
1. Project name: Pinewild Ph5 - Azalea Place
2. Application/Project status: ® Proposed (New Permit) ❑ Existing PermiuTroject ❑ ARPA funded
If a modification, provide the existing permit number: WQ00 and issued date:
For modifications, also attach a detailed narrative description as described in Item G of the checklist.
If new construction, but part of a master plan, provide the existing permit number: WQ00_
3. County where project is located: Moore
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.1931 ° Longitude:-79.4931
5. Parcel ID (if applicable): 00025 [04 (or Parcel 1D to closest downstream sewer)
[II. CONSULTANT INFORMATION:
I . Professional Engineer: John Ihnatolya License Number: 031982
Firm: WithersRuenel, Inc
Mailing address: 167 E Chatham St, Suite 210
City: Carry State: NC Zip: 27511
Phone number: [phone] Email Address: ihratolyardWithersRavenel.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) [NFORMAT[ON:
I. Facility Name: Moore County Water Pollution Control Facility Permit Number: NC 0037508
Owner Name: Moore County
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQCS00034
2. Downstream (Receiving) Sewer Information: 8 inch Z, Gravity ❑ Force Main
3. System Wide Collection System Permit Numher(s) (if applicable): WQCS00034
Owner Name(s): Moore County Public Utilities
FORM: FTA 10-23 Page I of 5

Dccusign Envelope ID. 686B94A3-F508-026F-A27E-09032E87E37B
VI.
GENERAL REQUIREMENTS
1 if the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been auached°
❑ Yes ® No ❑ N'A
2. If the Applicant is a Developer of lots to be sold, has a been attached?
Yes M No ] N.'A
3, If the Applicant is a Home,Propert}Owners' Association, has an and
suppkmantary documentation as required by 15A NCAC 02T.0115(c) been attached'?
❑ Yes ® No ❑ N'A
d. Origin of wastewater: (check all that apply)
® Residential (individually Owned) ❑ Retail (stores; centers, malls) ❑ Car Wash
❑ Residential (Leased) ❑ Retail with food preparation/sery ice ❑ Hotel and�or Motels
❑ School' preschool / day care ❑ Medical / dental / veterinary facilities ❑ Swimming Pool/Clubhouse
❑ Food and drunk facilities ❑ Church ❑ Swimming PoohFilter Backwash
❑ Businesses 1 offices I factories ❑ Nursing Home ❑ Other (Exp!ain in Attachment)
5. Nature of wastewater : 100 % Domestic % Commercial °ti Industrial ( )
If Industrial, is there a Pretreatment Program in effect'? ❑ Ycs❑ No
6. Has a flow reduction been approved under ? ❑ Yes ❑ No
If Yes. provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project
--T
Establishment Type (sec 02"f.0114(1)) Daily Design Flow :.n uoot knits' Flow
3 bedroom homes 75 gaVdaybdnn 77 17325 GPD
;al' GPD
gall GPD
gali GPD
gah GPD
tlal' GPD
7o1a1 17,325 GPD
a See for caceatx Lo oaswNwatz: 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 ).
b Per 15:A NCAC 02T .01 I410. design flow rates for establishments not identified [in table ] shall be
determined using available flow data, water ruin_ fixtures, occupancy or operation patterns, and other measured data-
8. Wastewater generated by project: 17,325 GPD (per )
Do not inchnde himre flows or previously permitted allocations
It permitted flow is zero. please indicate why:
❑ Pump Station Foxe Alain or Cravity Server where flow will 'oc permitted in subsequent permits that connect to this line.
Please provide supplementary intonuaucn indicating ncc approximate timeframe for pennittin2 upstream ses.crs wi:L flow.
❑ Film has already been allocated in Pcnnil Yutnbcr: _ Issuance Date: .
❑ Rehabilitation or replacement of existing server v irh no new flow expected
❑ Othcr(E.xpluin): - _
RIRll FT 10-21 Paac_'of5

Uccusign Envelope ID: 6861394A3-F508 426F-A27E-09032E87E37B
VILL GRAVITYSER'ERDESIGN C'RITER[A(If Applicable) -
I- Summarize gravity sewer to be permitted:
Site (inches)
Length (feet)
Material
8"
5889
SDR-26 PVC
S"
117
CLASS 350 DIP
> Section II & III of the NIDC for Permitting of Gravity Sereers contains information related to design criteria
> Section Ill 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) — &
PROVIDE A SEPARATE COPY OF TI-[IS PACT FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
I. Pump station number or name:
2. Approximate Coordinates (Decimal Deg ees): Latitude: Longitude: -
3. 'Futal mmiberof puutps at the pump station:
3. Dasign Flow of the pump statinm: _millions gallons per day (firm capacity)
i' 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 (TDI I)
5. Summarize the force main lobe permitted (for this Pump Station):
Size (inches) I Length (feet) I Material
If any portion of the force main is Tess than 4-inches in diameter, please identify the method of solidi reduction per
MUCPSFM Section 2-0IC I b- ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
(i, Power F&ability in accordance with
❑ Standbv power souls C or ❑ Standhy pump
Must have automatic activation and telemetry - 15A N( AC PIT.0305(h)i 1)(B)
Required for all pump stations with an avem;c daily floss greater that or equal to I5,000 gallons per day
> Must be permanent to facility and may not be portable
Or it the pimp station has an avenge daily flow less than t5,000 gallon; per day IiA XCA('021 0305(It)(I )(C):
❑ Poi ta'ole power source wish manual activation. quick -connection receptacle and telenic" -
or
❑ Porta'a:e pumning unit Witt plugged emere,.le, pump coMCction and telemetry:
Incljde docutnettation that the portable source is ova ned or contracted by the applicant .and s compatible with the station.
It the porable lower source or pump :s dedicated to multiple pump stations, an evaluation of all the point, station,' stonee
capacities and the rotation schedule of the portable power iource of pump. inclur'.in, trascl timcframes, shall be provided
as parr of Ihts per:ni. application in the case o' a nndtiplc station porcu o.uaee.
FOIl %l- Fi a 10-1� pa--' i of 5

Docusign Envelope ID: 686B9<A3-F508426F-A27E-0^U32E87E37B
IX. SETBACKS & SEPARATIONS — (026 .0200 & 15A NCAC 02T .0305(f)):
_ Does the project comply with all separationsialternatives found in
15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
® Yes ❑ No
Setback Parameter*
Separator Required
Storm sewer, and other utilities not listed below (vertical)
18 inches
21A'ater mains (vertica' - water over sewer preferred, including in benched trenches)
18 inches
�r 2Water mains (horizontal)
t0 feet
I Reclaimed water lines (vertical - reclaimed over sewer)
18 inches
Reclaimed water lines (horizontal - reclaimed over sewer)
I. 2 feet
_
"Anv private or public water supply source, including any wells, WS-I 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-V). B, SA, ORW, HQW, or SR 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 (hmizon[al)
5 feet
10 feet
Any basement (horzontal)
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
i If noncompliance with see Section X.1 of this application
contains alternatives where separations in 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
_'. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ N, A
Y If no, please refer to 15A NCAC I8C.0906(1) ('or dUGWnCInatlml 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.
Sec the Division's for situations where separation cannot be met.
No variance is required if the alternative design criteria specified is utilized in design and construction.
. 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 over hasin rules per ❑ Yes ❑ No
This includes "front Buffered Streams per
Does the project require coverage: authorization under a 404 Nationwide,indicidual permits ❑ Yes ® No
or -III'. Water Qualm, Cel urlcatious'.
Please provide the permit num'xn penmining status in the cover laver if coverage, authorization is required.
o_ Does project comply with ) (additional permits"certitications j' ® Yes ❑ No
Por , directly related environmental permits or cortif,cation applications must he being prepared.
:ra,e been applied for. or hate been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion
and sedi:uentatioe control plans, stonnwater management plans, etc.).
Doe, this project include any sewer collection lines that are dcem:d "high -priority?" ❑ Yes ® No
Per - "high -priority sewer' means any aerial sewer. sewer contacting surf. ce waters,
siphon, or sewer positioned parallel to streambanks that are subject to erosion that undermines or deteriorates the sewer.
Siphons and sewers suspended throuwh interference/conflict boxes require a variance approval.
I yes, include an ataac':mhent hcilh details for each lire, including tVVC (aerial line s17c, material, and location).
High prior ity lines shall be inspected by the permlttee or its representative at (east once es-ery six -months and
inspections documented per I5A NCAC 021.OJ01(al(5) or the permitteCs indioidual System-IvVide Collection permit.
I ORVC FTA to--3 Pane a ors

Docusign Envelope ID: 686B94A3-F508.426F-A27E-09032E87E37B
X. CERTIFICATIONS:
I. Does the submitted system comply with , the !mtP Station=
and the 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 approval of the permit, and protects renuirine a variance approval may be subject to longer
review times. For projects requiring two or more variances or where the variance is determined by the Division to be a
significant portion of the protect, the full technical review is required.
2. Professional Engineces Certification:
,,Sohn ihnatol ya attest that this application for Pinewild Ph5 - Azalea Place
(Professional Engineer's name from Application Item ❑l.1.) (Project Name from Application Item It.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. I further
attest that to the best of my knowledge the proposed design has been prepared in accordance with the applicable regulations,
�Sli lnurn ik,ow t Irma lur litavity Sewed; jln I. , and the
o' ['fligp_Slnpgltt3!OS_Fyrce JaifL_(latest vpi=ion,. 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 noncompliance 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: �•°QZN
SEAL '
31982 €�
�irh;���oeo
3. Applicant's Certification per 15A NCAC 02T .0106(b): t
I, C 60" ?A l NbDC' , attest that this application for 1' {� (MW 11..(i Ns ^ s t zALz A
(Signatu a Authority Name from Application Item 1.3.) (Project Name from Application Item 11.1)
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 and , 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
tttooeexceed
)$10,000 as well as civil penalties up to $25,000 per violation.
Signature: <•—. Date: �_ 2
FORM: FTA 10-23 Page 5 of 5

Dowsign Envelope ID: 686B94A3-F508-426F-A27E-09032E87E37B
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
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 and the Division's
Minimum Design Criteria ( & ) and that plans, specifications and supporting documents
have been prepared in accordance with - Division policies, and
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. ppppp��.�. pppppp������,,,,,,lllllluuuuuude plans, design
calculations, and project specifications referenced in and the applicable tt�e�riteria. These
documents shall be immediately available upon request by the Division. LLJJ 11''[[
Projects that are deemed permitted (do not require a permit from the Division) are explained in 0 C r G 1 10 a f
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; 'fit �(�
➢ Projects that involve more than one variance from the requirements of 15A NCA£ QROS
➢ Pressure sewer systems utilizing simplex septic tank -effluent pumps (STEPS) or Sim I , t y,;Fut?g,=lnh)A I r)Fr/CV
➢ 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 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):
® 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 (downstre m/upstream)
➢ If necessary for clarity, include attachments to the application form.
➢ If the project is funded by American Rescue Plan Act (ARPA) funds, please include the ARPA project number in the cover
letter and in parentheses under Project Name (Section II.I. of the application).
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
❑ If the Applicant Type in Item 1.2 is a partnership or d/b/a, enclose a copy of the certificate filed with the Register of Deeds in
the county of business.
❑ The Project Name in Item 11.1 shall be consistent with the project name on the flow acceptance letters, agreements, etc.
® The Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a
INSTRUCTIONS FOR FORM: FTA 10-23 & SUPPORTING DOCUMENTATION Page 1 of 3

Docusigr Envelope ID. 686B94A3-F508426F-A27E-09032E87E378
❑ "rhe Applicant's Certification on Page 5 of the application shall be signed in accordance with . Par
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).
E. Flow TrackinglAeeeptanee Form (Form: FTSE 10-23) (If Applicable):
M Submit the completed and executed FTSE form from the owners of the downstream sewers and treatment facility.
I Multiple forms maybe required where the downstream sewer owner and wastewater treatment facility arc differcm.
1 The flow acceptance indicated in fomt 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 no, violate
Intergovernmental agreements or other contracts kill not be accepted iu lieu Ufa project -specific FTSE.
Site Maps (All Application Packages):
® Submit an 8.5-inch x I I -inch color copy of a USGS Topographic Map of sufficient scale to identify the entire project area,
including the closest surface wa:ers.
General location of the project components (gravity sewer, pump stations, & force main)
�- Downstream connection points and permit number (if known) for the receiving sewer
M Include an aerial location map showing general project area (such as street names or lantude/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 persnt.
❑ 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 Conn 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.
11. Power Reliability Plan (Required if portable reliability option utilized for Pump Station):
❑ Per . submit documentation of power reliability for pumping stations.
"Phis 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 I5A NCAC 02T .0106(b)) or proposed contractor,
stating that "the portable power generation unit or portable, indapendcntly-powered pumping [mils, 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)
Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per provide the Ccrti Gcate of Public Convenience and Necessity from the
demonstrating the Applicant is authorized to hold the utility franchise for the area to be smell by the sewer
extension_ or
❑ Provide a letter from the stating an application
fora franchise has been received and that the sere ice area is COuti2rlorG to an existing franchised area or t'oat franchise approval
is expected_
.1. Operational Agreements (:Applications from IIOA/POA and Developers for lots to be sold):
❑ Homy Propertv Owncrs- Associations_
'] Per , sulntit .he properly executed
] Per 15A NCAC 0-T .011S(c), submit a copy of tho Articles o ricomoration. Declarations and By laws_
❑ Developers of Tots In he sold
❑ Per submit :lie properly executed
For mow in/utm,uiat. t S'l the Di, Eiun o rune', lion
[ V;I RUCTIONS -Oil FORM, I-1 .-A 10-7- l: St PPOR [ ING DOCI;%IGN1 1 I ION Pae_ 2 of

Docusign Envelope ID. 686094A3-F308-420E-A27Er09032E87E370
THE COtNIPLETED APPLICATION PACKAGE LNCLDING ALL SUPPORTING INFORSIATION AND
MATERIALS, SHOULD BE SENT TO THE,
REGIONAL OFFICE
ADDRESS
2090 US Highway 70
Swannanoa, North Carolina 28778-8211
[phone]
[phone] Fax
225 Green Street Suite 714
Fayetteville, North Carolina 28301-5095
[phone]
[phone] Fax
610 E. Center Avenue
Mooresville, North Carolina 28115
[phone]
[phone] Fax
3800 Barret• Drive
Raleigh, North Carolina 27609
[phone]
[phone] Fax
943 Washington Square Mall
Washington, North Carolina 27889
[phone]
[phone] Fax
127 Cardinal Drive Extension
Wilmington, North Carolina 28405
[phone]
[phone] Fax
450 W. Hanes Mill Road
Suite 300
Winston-Salem, North Carolina 27105
[phone]
[phone] Fax
COUNTIES SERVED
Avery, Buncombe, Burke, Caldwell, Cherokee.
Clay, Graham, Haywood, Henderson, Jackson,
Macon. Madison, McDowell, Mitctell. yolk,
Rutherford, Swain, Transylvania, Yancey
Anson, Planar, Cumberland, Harnett, Hoke,
Montgomery, Moore, Robeson, Richmond,
Sampson, Scotland
Alexander, Cabarrus. Catawba, Cleveland,
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
Stanly, Union
Chatham, Durham. Edgecombe, Franklin,
Granv Ile, Halifax, Johnston, Lee, Nash.
Northampton, Orange, Person, Varce, Wake,
Warren, Wilson
Beaufort, Bartle, Camden, Chowan. Craven,
Currituck, Dare, Gates, Greene, Hertford, Hyde,
Jones. Lenoir, Martin, Pamlico, Pasquotank,
Perqu'.. mans, Pitt, Tyrrell, Washington, Wayne
Brunswick, Carteret, Columbus, Duplin, New
Hanover, Onslow, Pander
Alarnance, Alleghany, Ashe, Caswell, Davidson,
Davie, Forsyth, Guilford, Rockingham, Randolph,
Stokes, Surry, Watauga, Wilkes, Yadkin
INFTRL IlONS FOR I ORM PTA 10-_'; 3 SUPPORTING DOGt'V11 A IA I ION Pa-'' J of 7

/ / I
CONNECTION TO EXISTING
MOORE COUNTY GRAVITY
SEWER
EXISTING STREAM (USGS MAP)
EXISTING WETLANDS
(FIELD SURVEY
DELINEATED) Q
EXISTING STREAM
(FIELD SURVEY
DELINEATED) ,
J
V
c�
P��F
-0-
1
WithersRavenel
115 Ma,Kenan Drive I Cary, NC 27511
License#: F-1479 t: 919.469.33401—wAtheraav d.—
BLUE
POND
EXISTING 8" PVC GRAVITY SEWER
� s
PROPOSED 8" GRAVITY SEWER
FLOW DIRECTION (TYP.)
EXISTING STREAM
(FIELD SURVEY
DELINEATED)
46�PVMOST UPSTREAM MANHOLE PROPOSED LINE
o,Q EN RD
PINEWILD PH5
AZALEA PLACE
WQ00454858
EDINBURG DR
VILLAGE OF PINEHURST
MOORE CO.
USGS QUAD MAP
N
EI
0 250 500
SCALE: 1 inch = 500 ft.
WR lob No. DATE
02180498 10/04/2024
DRN: WR DGN: WR CKD: WR
FIGURE 1
W
3
0