wq0028587_Permit (Modification)_20061222

North C Department of Environment and Natural Resources
Division of Water Quality
W AT F9QG
Michael F. Easley, Governor
December 22, 2006
William Farris, Town Manager
Town of Leland
102 Town Hall Drive
Leland, NC 28451
William G. Ross, Jr., Secretary
Alan W. Klimek, P.E., Director
Subject: Permit No. WQ0028587 MODIFICATION
Town of Leland
Brunswick Forest Sewer
Wastewater Collection System Extension
Brunswick County
Dear Mr. Farris:
In accordance with your application received December 1, 2006, and additional information
received on December 5, 2006, we are forwarding herewith Permit No. W00028587, dated December
22, 2006, to the Town of Leland for the construction and operation of the subject wastewater collection
system extension.' This permit shall be effective from the date of issuance until rescinded, shall void
Permit No. WQ0028587 issued November 3, 2006, and shall be subject to the conditions and limitations
as specified therein. This cover letter shall be considered a part of this permit and is therefore
incorporated therein by reference.
This modification if for Phase 1 Section 2 to add 13,874 linear feet of 8-inch gravity sewer and a
387-gpm pump station with 3,520 linear feet of 6-inch force main. In addition, it provides flow allocation
for an additional 193 three -bedroom residences. The Division has also clarified the flow for the
residential connections within each "section".
By copy of this permit, the Town of Leland Building Inspections Department is hereby notified that
building or occupancy permits shall only be issued for the number and type of connections shown in the
following descriptions associated with the Brunswick Forest project until a modified permit is issued by
the Division indicating additional connections. In addition, no certificates of occupancy are to be
granted prior to the submittal of a sealed engineer's certification per Condition 6 of this permit.
Please note the following s_taii6ard conditions that are contained in this permit.
_s : ­Can'&ion 3: Requires that the wastewater collection facilities be properly operated and
maintained in accordance with 15A NCAC 2T .0403 or any individual system -wide
collection system permit issued to the Permittee.
Wilmington Regional Office
127 Cardinal Drive Extension Wilmington, NC 28405
Phone: [phone] / FAX: [phone]
Internet: vvww.ncwaterquality.orq
None
rthCarolina
Naturally
An Equal Opportunity/Affirmative Action Employer
50% Recycled/10% Post Consumer Paper
Customer Service 1-877-623-6748

Town of Leland
WQ0028587
Condition 6: Requires that the system be certified upon completion of construction and prior
to being placed into operation. Please note that if an Operational Agreement
accompanies this permit, then a copy of the Articles of Incorporation,
Declarations, and Bylaws that have been appropriately filed shall be submitted
with the engineer's certification prior to operation.
Condition 9: Regarding the installation of gravity sewer at greater than ten percent below the
minimum required slope per the Division's Gravity Sewer Minimum Design Criteria
shall not be acceptable and shall not be certified until corrected.
Condition 12: Regarding Division notification should the system fail to operate including the loss
of wastewater from the collection system. In addition, note Permit Condition 13,
regarding the posting of pump stations with emergency contact information.
Permitting of this project does not constitute an acceptance of any part of the project that does
not meet 15A NCAC 2T; the Division of Water -Quality's (Division) Gravity Sewer Minimum Design Criteria
adopted February 12, 1996 as applicable; and the Division's Minimum Design Criteria for the Fast -Track
Permitting of Pump Stations and Force Mains adopted June 1, 2000 as applicable, unless specifically
mentioned herein. Division approval is based on acceptance of the certification provided by the North
Carolina -licensed Professional Engineer named in the application. It shall be the Permittee's
responsibility to ensure that the as -constructed project meets the appropriate design criteria and rules.
Failure to comply may result in penalties in accordance with 'North Carolina General Statute § 143-
215.6A through § 143-215.6C, construction of additional or replacement wastewater collection facilities,
and/or referral of the North Carolina -licensed Professional Engineer to the licensing board.
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North
Carolina as amended, and other applicable Laws, Rules, and Regulations, permission is hereby granted
to the Town of Leland for the construction and operation of approximately 13,874 linear feet of 8-inch
gravity sewer; a 387-gallon per minute pump station with duplex pumps, on -site audible and visual high
water alarms, telemetry, and on -site generator with automatic transfer switch; as well as approximately
3,520 linear feet of 6-inch force main to serve 193 three -bedroom residences as part of the Brunswick
Forest Phase 1 Section 2 project, and the discharge of 69,480 gallons per day of collected domestic
wastewater into the Town of Leland's existing sewerage system, pursuant to the application received
December 1, 2006 and in conformity with 15A NCAC 2T; the Division's Gravity Sewer Minimum Design
Criteria adopted February 12, 1996 as applicable; the Division's Minimum Design Criteria for the Fast -
Track Permitting of Pump Stations and Force Mains adopted June 1, 2000 as applicable; and other
supporting data subsequently filed and approved by the Department of Environment and Natural
Resources and considered a part of this permit;
AND
The continued construction and operation of the sewer infrastructure as described below and
previously permitted In accordance with the provisions of Article 21 of Chapter 143, General Statutes of
North Carolina as amended, and other applicable Laws, Rules, and Regulations and in conformity with
15A NCAC 2T; the Division's Gravity Sewer Minimum Design Criteria adopted February 12, 1996 as
applicable; the Division's Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and
Force Mains adopted June 1, 2000 as applicable; and other supporting data subsequently filed and
approved by the Department of Environment and Natural Resources and considered a part of this
permit:

Town of Leland
WQ0028587 "
October 27, 2006 Modification
Construction and operation of approximately 1,008 linear feet of 8-inch gravity sewer to serve future
development in Brunswick Forest Phase 6 Section 1 as, part of the Brunswick Forest project with no
additional discharge of collected wastewater into the Town of Leland's existing sewerage system,
pursuant to the application received September 15, 2006.
May 26, 2006 Modification
,Construction and operation of approximately 5,926 linear feet of 8-inch gravity sewer; a 380-gallon per
minute pump station with duplex pumps, ,on -site audible and visual high water alarms, telemetry, and
on -site generator with automatic transfer switch; as well as approximately 3,915 (increased from 2,821
feet per modification issued November 3, 2006) linear feet of 6-inch force main to serve 149 three -
bedroom residences as part of the Jefferson Landing at Brunswick Forest Phase 2 (aka Phase 1 Section
1-B) project, and the discharge of 53,640 gallons per day of collected domestic wastewater into the
Town of Leland's existing sewerage system, pursuant to the application originally received April 24, 2006
and subsequent modification request received September 25, 2006.
April 7, 2006 Modification
Construction and operation of approximately 100 linear feet of 8-inch, 793 linear feet of 10-inch, and
3,830 linear feet of 12-inch gravity sewer to serve as a gravity sewer outfall or interceptor line for future
upstream or tributary sewer systems as part of the Brunswick Forest Phase 3 project with no additional
discharge of collected domestic wastewater into the Town of Leland's existing sewerage system,
pursuant to the application received February 16, 2006.
March 10, 2006 Modification
Construction and operation of approximately 6,741 linear feet of 8-inch gravity sewer to serve 131 three-
bedroom residences as part of the Jefferson Landing at Brunswick Forest (aka Phase •1 Section 1-A)
project, and the discharge of 47,160 gallons per day of collected domestic wastewater into the Town of
Leland's existing sewerage system, pursuant to the application received February 14, 2006.
July 21, 2005 Modification
Construction and operation of approximately 25 linear feet of 8-inch and 3,290 linear feet of 12-inch
gravity sewer to serve as a gravity sewer outfall or interceptor line for future development upstream of
the previously approved sewer listed below as part of the Brunswick Forest Phase 2 project, and with no
additional discharge of collected wastewater into the Town of Leland's existing sewerage system,
pursuant to the application received June 15, 2005.
March 24, 2005 Original Permit
Construction and operation of approximately 868 linear feet of 8-inch, 3,414 linear feet of 10-
inch, and 3,141 linear feet of 12-inch gravity -sewer; a 1500-gallon per minute pump station with duplex
pumps, on -site audible and visual high water alarms, telemetry/auto dialer, and on -site generator with
automatic transfer switch; as well as approximately 20,650 linear feet of 10-inch force main to eventually
a large residential development and commercial development with a 100,000 ft2 shopping center with
a grocery store (12,000 gpd), a two-story restaurant with 10,000 ft2 of dining area (26,700 gpd), and a
30,000 ft2 office building (3,000 gpd) as part of the Brunswick Forest Phase 1 project, and the total
discharge of 41,700 gallons per day of collected domestic wastewater into the Town of Leland's existing
sewerage system, pursuant to the application received March 11, 2005;
3

Town of Leland
WQ0028587
In summary, this permit authorizes the potential connection of 473 three -bedroom homes, a 100,000 ff2
shopping center with a -grocery store, a two-story restaurant with 10,000 ff2 of dining area, and a 30,000
ff2 office buildin-g for a total discharge of 211,980 -gallons per day.
The,sewage and wastewater collected by this system shall be treated in the Northeast Brunswick
Regional Wastewater Treatment Facility (Permit No. NC0086819) prior to being discharged into the
receiving stream.
This permit shall become voidable unless the agreement between the Town of Leland and
Brunswick County for the collection and final treatment of wastewater is in full force and effect.
A stormwater management plan shall be submitted to and' approved by the Wilmington
Regional Office in accordance with 15A NCAC 2H .1000. s
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the
right to request an adjudicatory hearing upon written request within 30 days following receipt of this
permit. This request must be in the form of a written petition, conforming to Chapter 150B of North
Carolina General Statutes, and filed with the Office of Administrative Hearings, 6714 Mail Service Center,
Raleigh, NC 27699-6714. Unless such demands are made, this permit shall be final and binding.
If you need additional information concerning this matter, please contact Dean Hunkele at
[phone].
Sincerely,
f Ian W. Klimek, P.E.
Cc: David Hollis, Hanover Design Services
Tim Evans, Town of Leland Building Inspections Department
Jerry Pierce, Brunswick County Public Utilities
WIRG, Surface=Water_Protection=-=NE_BiunsvvickRegion-alz(NC0086819) SewerExt. File
Central Files, Surface Water Protection Section
Pretreatment, Emergency Response and Collection Systems Unit Files
4

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH
WASTEWATER COLLECTION SYSTEM EXTENSION PERMIT
This permit shall be effective from the date of issuance until rescinded and shall be subject to the
following specified conditions and limitations:
This permit shall become voidable unless the wastewater collection facilities are constructed in
accordance with the conditions of this permit; 15A NCAC 2T; the Division of Water Quality's
(Division) Gravity Sewer Minimum Design Criteria adopted February 12, 1996 as applicable; the
Division's Minimum Design Criteria for the Fast -Track ,Permitting of Pump Stations and Force Mains
adopted June 1, 2000 as applicable; and other supporting materials unless specifically mentioned
herein.
2. This permit shall be effective only with respect to the nature and volume of wastes described in the
application and other supporting data.
3. The wastewater collection facilities shall be properly maintained and operated at all times. The
Permittee shall maintain compliance with an individual system -wide collection system permit for the
operation and maintenance of these facilities as required by 15A NCAC 2T .0403. If an individual
permit is not required, the following performance criteria shall be met as provided in 15A NCAC 2T
.0403:
a. The sewer system shall be effectively maintained and operated at all times to prevent
discharge to land or surface waters, and any contravention of the groundwater standards in
15A NCAC 2L .0200 or the surface water standards in 15A NCAC 2B .0200.
b. A map of the sewer gystem shall be developed and shall be actively maintained.
c. An operation and maintenance plan including pump station inspection frequency,
preventative maintenance schedule, spare parts inventory, and overflow response shall be
developed and implemented.
d. Pump stations that are not connected to a telemetry system (i.e. remote alarm system) shall
be inspected by the Permittee or its representative every day (i.e. 365 days per year). Pump
stations that are connected to a telemetry system shall be inspected at least once per week.
e. High -priority sewer lines shall be inspected by the Permittee or its representative at least once
per every six-month period of time.
f. A general -observation of the entire sewer system shall be conducted by the Permittee or its
representative at least once per year.
g: Overflows and bypasses shall be reported to the appropriate Division regional office in
accordance with 15A NCAC 2B .0506(a), and public notice shall be provided as required by
North Carolina General Statute § 143-215.1 C.

A Grease Control Elan shall be implemented as follows:
1. For publicly owned collection systems, the Program shall include at least bi-annual
distribution of educational materials for, both commercial and residential users and the
legal means to require grease interceptors for new construction and retrofit, if necessary, of
grease interceptors at existing establishments. The Program shall also include legal means_
for inspections of the grease interceptors, enforcement for violators, and the legal means
to control grease entering the system from other public or private satellite sewer systems.
2. For privately owned collection _'systems, the Program shall include at least bi-annual
distribution of educational materials to all users of the collection system by the Permittee or
its representative.
3. Grease education materials shall be distributed more often than required in Parts 1 or 2 of
this sub -paragraph if necessary to prevent grease -related sanitary sewer overflows.
i. Right-of-ways and easements shall be maintained in the full easement width for personnel and
equipment accessibility.
j. Documentation shall be kept on file for Sections (a.) through (i.) of this rule for a minimum of
three (3) years with the exception of the map, which shall be maintained for the life of the
system.
This permit -shall not be transferable. In the event there is a desire for the wastewater collection
facilities to change ownership, or there is a name change of the Permittee, a formal permit request
shall be submitted to the Division accompanied by documentation from the parties involved, and
other supporting materials as may be appropriate. The approval of this request shall be considered
on its merits and may or may not be approved.
5. Construction of the gravity sewers, pump stations, and force mains shall be scheduled so as not to
interrupt service by the existing utilities nor result in an overflow or bypass discharge of wastewater
to the surface waters of the State.
Per 15A NCAC 2T .01 16, upon completion of construction and prior to operation of these permitted
facilities, the completed Engineering Certification form. attached to this permit shall be submitted
with the required supporting documents, (as -built or recording drawings and pump station designs,
if applicable) to the address provided on the form. A complete certification is one where the form
is fully executed and the supporting documents are provided as applicable. If the permit is issued
to a private entity with an Operational Agreement, then a copy of the Articles of Incorporation,
Declarations and Bylaws that have been appropriately filed shall be submitted with the
certification.
7. A copy of the construction record drawings and pump station designs, if applicable, shall be
maintained on file by the Permittee for the life of the wastewater collection facilities.
8. Failure to abide by --the conditions and limitations contained in this permit; 15A NCAC 2T; the
,Division's Gravity Sewer Design Criteria adopted February 12, 1996 as applicable; the Division's
Minimum Design Criteria for the Fast -Track Permitting of Pump Station and Force Mains adopted
June 1, 2000 as applicable; and other supporting materials may subject the Permittee to an
enforcement action by the Division, in accordance with North Carolina General Statutes § 143-
215.6A through § 143-215.'6C.
9. Gravity sewers installed greater than ten percent below the minimum required slope per the
Division's Gravity Sewer Minimum Design Criteria shall not be acceptable and shall not be certified
until corrected. If there is an unforeseen obstacle in the field where all viable solutions have been
examined, a slope variance can be requested from the Division with firm supporting
documentation. This shall be done through a permit modification with fee. Such variance requests
will be evaluated on a case -by -case basis. Resolution of such request shall be evident prior to
completing and submitting the construction certification.

10. In the event that the wastewater collection facilities fail to, perform satisfactorily, including the
creation of nuisance conditions, the Permittee shall take immediate corrective action, including
those as may be required by this Division, such as the construction of additional or replacement
facilities.
11. The issuance of this permit shall not exempt the Permittee from complying with any and all statutes,
rules, regulations, or ordinances that may be imposed by other government agencies (local, state
and federal) which have jurisdiction, including but not limited to applicable river buffer rules in 15A
NCAC 2B .0200, erosion and sedimentation control requirements in 15A NCAC Ch. 4 and under the
Division's General Permit NCG010000, and any requirements pertaining to wetlands under 15A
NCAC 2B .0200 and 15A NCAC 2H .0500.
12. Noncompliance Notification:
The Permittee 'shall verbally report to a Division of Water Quality staff member at the Wilmington
Regional Office, telephone number [phone], as soon as possible, but in no case more than
24 hours or on the next working day, following the occurrence or first knowledge of the occurrence
of either of the following:
a. Any failure, due to known or unknown reasons, that renders the system incapable of
adequate wastewater transport, such as mechanical or electrical failures of pumps, line
blockage or breakage, etc.; or
b. Any failure of a pumping station or sewer line resulting in a by-pass of any wastewater directly
to receiving waters from the station or sewer line.
Voice mail messages or faxed information is permissible, but shall NOT be considered as the initial
verbal report. Overflows and spills occurring outside normal business hours may also be reported to
the Division of Emergency Management at telephone number [phone] or [phone].
Persons reporting any of the above occurrences shall file a spill report by completing Part I of Form
CS-SSO (or the most current Division approved form), within five days following first knowledge of the
occurrence. This report shall outline the actions taken or proposed to ensure that the problem does
not recur. Part' II of Form CS-SSO (or .the most current Division approved form) can also be
completed to show that the SSO was,beyond control.
13. Each pump station including simplex stations shall, be clearly and conspicuously posted with the
telephone number and name of the owner/operator of the sewer system and instructions to call
the number in the event of alarm activation.
14. The Permittee shall provide for the pump station and force main the following items:
a. Pump on/off elevations located so that 2-8 pumping cycles may be achieved per hour in
the pump station,
b. An air relief valve located at all high points along the force main,
C. A screened vent for the wetwell,
d. Fillets located in the wetwell at the intersection of the flooring and sidewalls,
e. Three feet of cover (minimum) over the force main or the use of ferrous material where
three feet cannot be maintained,
f. Sufficient devices which will protect the pump station from vandals, and
g. Flood protection if the pump station is located below the 100-year flood elevation.
3

Permit issued this day: . December 22, 2006
NORTH CAROLINA'ENVIRONMENTAL MANAGEMENT COMMISSION
for Alan W. Klimek, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission
Permit Number WQ0028587

Fast Track Engineering Certification
PERMIT NO. WQ0028587
Brunswick Forest Phase 1 Section 2
December 22, 2006
Brunswick County
CERTIFICATION: This project shall not be considered complete nor allowed to operate until the Division has
received this Engineer's Certification and all required supporting documentation. Consequently, the PERMITTEE
should submit this certification in a manner that documents proof -of -receipt by the Division.
Complete and submit this unmodified form to the permit issuing regional office with the following:
• One originally sealed/signed set of the project record drawings (plan & profile views of sewer lines & force -
mains) of the wastewater collection system extension. Record drawings are defined as the design drawings
that are marked up or annotated with after construction information and show required buffers, separation
distances, material changes, and other utilities including water lines, stormwater systems, etc.
• One originally sealed/signed set of the supporting pump station design calculations (selected pumps, system
curve, operating point, buoyancy calculations, available storage if portable generator(s) or storage greater
than longest past three year outage reliability option selected) for any pump stations permitted under this
permit
• Changes to the project that do not result in non-compliance with this permit, regulations, or the minimum
design criteria should be clearly identified on the record drawings, on this certification in the space provided, or
in written summary form.
PRIOR TO CERTIFICATION (FINAL OR PARTIAL): Permit modifications are required for any changes resulting in non-
compliance with this permit (including total pipe length increase of 10% or greater, increased flow, or increases in
the number/type of connections), regulations, or the minimum design criteria. Requested modifications or
variances to the minimum design criteria will be reviewed on a case -by -case basis and each on its own merit.
Please note that variances to the minimum design criteria should be requested and approved during the permitting
process prior to construction. After -construction requests are discouraged by the Division and may not be
approved, thus requiring replacement or repair prior to certification & activation.
ENGINEERS CERTIFICATION
❑ Final ❑ Partial
Comments:
I, , as a duly registered Professional Engineer in the State of North Carolina, having been
authorized to observe (❑ periodically, ❑ weekly, ❑ full time) the construction of the project name and location as
referenced above for the Permittee hereby state that, to the best of my abilities, due care and diligence was used
in the observation of the construction such that the construction was observed to be built within substantial
compliance of this permit; 15A NCAC 2T; the Division of Water Quality's (Division) Gravity Sewer Minimum Design
Criteria adopted February 12, 1996 as applicable; the Division's Minimum Design Criteria for the Fast -Track
Permitting of Pump Stations and Force Mains adopted June 1, 2000 as applicable; and other supporting materials.
North Carolina Professional Engineer's Seal w/signature & date
SEND THIS FORM & SUPPORTING- DOCUMENTATION
WITH REQUIRED ATTACHMENTS TO THE FOLLOWING ADDRESS
REGIONAL SUPERVISOR
SURFACE WATER PROTECTION SECTION
DIVISION OF WATER QUALITY
WILMINGTON REGIONAL OFFICE
. ... ........ .... ................ ..............1 127 CARDINAL DRIVE EXTENSION
WILMINGTON, NC 28405-3845
The PERMITTEE is responsible for tracking all partial certifications up until a final certification is received. A final
certification shall be a complete set of record drawings and design calculations regardless of whether partials have
been submitted. Any wastewater flow made tributary to the wastewater collection system extension prior to
completion of this Engineer's Certification shall be considered a violation of the permit and shall subject the
Permittee to appropriate enforcement actions.

FAST -TRACK APPILICATION for GRAVITY SEWERS, P' MP STATIONS, AND FORCE MAINS PAGE 3
A I
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD! ;
9_ Owner -
_
Application Number:
(to be completed by DWQ)
?5,9 2 -
Full Legal
Name
(company,municipality, HOA, utility, -etc.)
_ ®, 1b. - -
F. Signing Official Name and Title (Please review 15A NCAC 2H .0206(b) for authorized signing officials!)
"
t i1 c. The legal entity who will own this system is:
— ❑ Individual ❑ Federal ["Municipality ❑ State/County Private Partnershi //// -- a ,— p ❑ CorRoration Other (species _
�s "t1d. f02 Milldl 1011 �riy�° !1e.
Mailing Address
City
State Zip Code
h.Oi
O. 9/O z
3 - 1 i.
i Telephone i Facsimile_ _ E-mail
,
Q- 2. Project (Facility) Information:
-J -- 2a............ --- — -- _
Zb.
Brief Project Namename) . (permit will refer to this
County Where Project is Loca ed� �.:,,�3a•�..�----•--------•--
_ - �, � Name and Affiliation of Someone ho Can Answer Questions About this Aoolicatign
� .� i.�-
Phone Number E-mail
Project is ❑ New Modification (of an existing narmit) if nnnrl;f*r +;. oe'.. 4 K1_ .
For modifications, attach a separate sheet clearly explaining the reason for the modification (i.e. adding another
phase, changing line size/length, etc.). Only include the modified information in this permit application - do not
duplicate project information in B(7) and B(10-11) that has already been included in the original permit.
i2. Owner is Public (skip to Item B(3)) ❑ Private (go. to Item 2(a))
_' 2a. If private, applicant will be: I2b. If sold, facilities owned by 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 B(3)) ❑ Homeowner Assoc./Developer (Instruction IV)
❑ Selling units (lots, townhomes, etc. - go to Item B(2b))
Owner of Wastewater Tre ent Facility (WWTF) Treating Wastewater From This Project
4a.
Name of7WWTF f1b WWTF Permit No. -
;5a. b. L Gravity c.
Owner ostream ewer Receiving Sewer Size ❑ Force Main Permit Number of Downstream Sewer (if known)
6. The origin of this wastewater is (check all that apply):
# [►Residential Subdivision ' ❑ Car Wash
❑ Apartments/Condominiums ❑ Institution le"o
/o
El Mobile Home Park ❑Hospital Domestic/Commercial
l
❑ School' ❑ Church % Industrial
❑ Restaurant i ❑ Nursing Home o
j ❑ Office ❑.Other (specify): /o Other (specify):
7. Volume of wastewater to be allocated for this particular project: gallons per day�30
*Do not include previously permitted allocations
F
8. If the permitted flow is zero, indicate why:
❑ Interceptor Line - Flow will be permitted in subsequent pen -nits that connect to this line
❑ Flow has already been allocated in Permit No.
❑ Rehabilitation or replacement of existing sewer with no new flow expected
FTA 02/03 - Rev. 3 04/05

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 4
9. Provide the wastewater flow
calculations used in determining the permitted 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(1)(1-2) must be supported with actual water or wastewater use data in accordance with 15A
NCAC 2H .0219(I)(3).
—are 6
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches) Length (feet) Gravity or Force Main
_ (use the pull down menu)
I
ENTER TOTAL LINE LENGTH IN MILES'
f11. Summary
of Pump Stations to be Permitted (attach additional sheets as necessary)
Z-
j Location ID i ;----__ — ��`�
-. { Power Reliability Option
(self chosen - as shown on Design Flow Operational Point ,f (1- dual line feed; 2- permanent generator w/ATS; 3-
E'' I
plans for cross-reference)�MGD GPM @ TDH _� portable ecennerator w/telemetry;_4-wet well storage)T
1307(973)
p �J
_—
12. Does the sewer system comply with the Minimum Design Criteria for the Fast Track Permitting of Pump Stations and Force
Mains (latest version), the Gravity Sewer Minimum Design Criteria latest version and 15A NCAC 2H .0200 as applicable?
LlV.:-; 21Yes ❑ No If no, please reference the pertinent minimum design criteria or regulation and indicate why a
a - : variance is requested. SUBMIT TWO COPIES OF PLANS, SPECIFICATIONS OR CALCULATIONS
PERTINENT TO THE VARIANCE WITH YOUR APPLICATION
..}
113. Have the following permits/certifications been submitted for approval?
Wetland/Stream Crossings - General Permit or 401 Certification? ❑ Yes ❑ No 9J/N/A
Sedimentation and Erosion Control Plan? [✓Yes ❑ No ❑ N/A
Stormwatel? ❑ [Yes No ❑ N/A
' ; °•,14. Does this project involve aerial lines or siphons? Check if yes: ❑
ITheseJines_w.ilLbe considered-hioh_oriofity and-mus-t-beobecked once e-v_er_v_stx months
15. Does this project have gravity sewer lines designed at minimum slopes? ❑
Be aware that the Division will not accept installed lines more than 10% flatter than the minimum slope. Lines installed outside this tolerance should be
corrected prior to submitting the final engineering certification..
. i
FTA 02/03 - Rev. 3 04/05

` FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE 5
1. Use the Division's guidance document entitled, "DETERMINING STREAM CLASSIFICATIONS FOR FORM FTA 02/03
(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
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
waterbody; AND,
;'
❑ A Stream Classification is not needed because the design does not depend on wet well storage as a power reliability
option for any pump station near a Class C down slope waterbody.
{ Location ID on Map
--�-' j (self chosen - as shown on ; Name of i ? Waterbody Stream ! Waterbody
map for cross-referenceL i_ W�a�terbody
--- Count�r`� River Basin_ _ Index �A -Classification
-✓�//�e����iiG
j
Submit the 8.5" x 11 CARM topographic map as required in Instruction VI
I
l - -1
regardless of whether a classification is providedl
A....I:__.-u_
nl.lp ICEI IL J I -VI LIIIL;d LIUn.
I, SIGNING OFFICIAL NAME, attest that this application for PROJECT NAME
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. Note: In accordance with North Carolina
General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement, representation, c
certification in a t application shall be guilty of a Class 2 misdemeanor which may include a fine not to exceed $10, 000
as well a;civil nalties up to $25,000 per violation.
./-------^i.�—�r------
Signing Official Signature 664_1'j�� .
Professional Engineer's Certification:
I attest that this application for ,'iW11V1G1- dri�.�-es74 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. I further attest that to the best of my knowledge the proposed design has been prepared in
accordance with the applicable regulations, Gravity Sewer Minimum Design Criteria for Gravity Sewers adopted February
12, 1996, and the Minimum Design Criteria for the Fast -Track Permitting of Pump 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 the proposed design. Note: In
accordance with NC General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement,
representation, or certification in any application 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.
Professional Engineer Name
Engineering Firm
Mailing Address
2d.
2f. D
1 city State Zip
?g. 3y3-� '2h. Vs�f3-9y1 2i.
_;; Telephone Facsimile E-mail
y 1
SEAL
20007
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I. Sionature & Date
FTA 02/03 - Rev. 3 04/05

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