wq0028587_Application (FTSE)_20050311

F,ASi.TJUCK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE 3:
Application Number:
I---- - - -- --
USE THE TAB KEY TO MOVE FROM FIELD TO FIELDI (to be completed by DWQ)
1 1. Ownet � .fan nP r��., 6Lu-E.
1 a.
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Full Legal Name (company, municipality. HOA, utility, etc.)
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Signing Official Name and Title (Please review 15A NCAC 2H .0206(b) for auttWrized signing officals!) I
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The legal entity who will o - �s system is: ration ❑ Others ci I
❑ Individual ❑ Federal Municipality ❑ StatelCounty �] Private Partnership 0 Corporation (Pe fY)
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Street Address
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Zip Code
State
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Telephone Facsimile
E-mail
MAR 1 9 XIM
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.2.
Project (Facility). Information:
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2b.
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2a.
Brief Project Name_ will refer to this name)
County Where'Project is Located
p„
_(permit
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3.
Contact Person: -
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-
3a.-
'Name and Affiliation of Someone Who Can Answer.Questions
About this Application
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3b.
Phone Number
E-mail
1.
Project is D19'w ❑ Modification (of an existing permit)
If Modification, Permit No.:
2. Owner is ubl'ic (skip,,to Item t3(3)) ❑ Private,(go to Item 2(a)) _
If applicantawill�be,7., •~;� • : 2b. If sold, facilities owned by a (must choose one
2a.
private,
[IRetaining Owner :store, church,',Aingle office, etc.)
homes, etc. - skip to Item B(3))
or. ❑ Public Utility (instruction Ol) ` r
❑ Homeowner AssocJDeveloper (instruction IV)
❑ Leasing units (lots; to
11 Selling units (lots., townhomes, etc. - go to Item B(2b))
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3. hula Sc�31,
Owner of wastewater Treatment Facility (WWTF) Treating Wastewater From This Project —
aa. Nt)A(L � i- �tnc-it: t, e L F,6 - C-(- I; WI17 4b. " t-)C (00860 ' (`E!
Name of WWTF WWTF Permit No.
s.
owner of Downstream Sewer
5En- 15c. (OQ 00 C 80 7C2
Receiving Sewer Size Permit Number of Downstream Sewer (if known)'
The origin of this wastewater is (check all that apply):
<esidential Subdivision ❑ Car Wash
Apartments/Condominiums ❑ Institution t % Domestic/Commercial!
Mobile Home Park ❑ Hospital % Industrial -
ool ❑ Church ,
1 urant - _ ❑ Nursing .Home % Other (specify):
❑ Other (specify):
^•r;����-may' . .
7. Volume of wastewater tio',be'aermittedan this.project: 40" gallons per day )iir l 4�),_.7®O GPD i
8. If th,*Wr idted flow is zero, indicate why:
Q'Intercepior 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

' AND FORCE MAINS PAGE 4:
g,AST-TRACK APPLICATION,6iGRAVITY�SEWERS, PUMP STATIONS, _ f
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9Values provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2H
thatther than;
in 1 for Item B(7) or the design flow for line pump �tat station
sizing
l of this application. ubmit a separate � zero flow in the space belowprequest to
that in 15A NCAC 2H .0219p)(1-2) "must be approved�
the Division of Water Quality, Non -Discharge Permitting Unit, 1617 Mail Service Center, Raleigh, NC 27699-1617 in
accordance with 15A NCAC 2H .0219(I)(3).
[081 C)®© G Pr) t
�C-� {-lc�►vl1�s �@ �v�,a
[ 2 5+otiy o2_&tvixiaj_t-t* 101000 siP @ 40 6i' LD / f 5 5(>J Cqc 3 2G, 700 PD
/ gso-s� x_ 2�(5PD 3j00b SPU
10. Summary of Sewer Lines t4 be Permitted (attach additional sheets if necessary) --C p-A: = j 4 5)`7 6N
Gravity or Force Main
Length (feet) (use the pull down menu)
Size (inches) 4 t LF
�©,�Vl�` in '
ENTER TOTAL LINE LENGTH IN MILES
11. Summary of Pump Stations to be Permitted (attach additional sheets as necessary)
Location ID Power Reliability - Option
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(self chosen - as shown on Design Flow Operational Point (1- dual line feed; 2- permanent generator tora ,
tans for cross-reference) (MGD) GPM @ TDH portable Venerator w1telemetM 4-wet welt storage))
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12. Does a sewer system comply with the Minimum Design Criteria for the Fast Trade Permitting of Pump Stations and Force
Mai (latest version), the Gravity Sewer Minimum Design Criteria (latest version) and 15A NCAC 2H .0200 a applicable?
Yes Q No K 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 APPLICA
13. Have the
approval?
Wetland/Stream Crossings - General Permit or 401 Certification?
Sedimentation and`Eiosiori Control Plan?
Stormwater?
[-]Yes ❑ No
dYYes ❑ No
R Yes ❑ No
P/N/A'
❑ NIA
❑ N/A

FAST-TkACIK APPLICATION
VITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 5
F' - 1. use the Division's guidance'document entitled; "DETERMINING STREAM CLASSIFICATIONS FOR FORM FTA 02/03 : , j
(FAST -TRACK SEWER SYSTEMS)" to 1 m� and record
seAe or by coma g � �PProPria� �tion data below (attach
of Water additional
ty eats as!
• necessary). This document is available from
Z region 1 office (see instructions for addresses) OR indicate the following:
0 �tream Classification is not needed because all parts of the project. are at least It)0 feet away from- any down slope
waterbody; AND.. _ .. =
A Stream Classification is not needed because the(age_
- design does not depend on wet well stoas_a owe f reliability i
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option for any pump station near a Class C down slope Waterbody.-
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Location ID on Map ' Waterbody Stream Waterbody
(self chosen - as shown on . Name of
map for a.reference)- Waterbody , County River Basin Index Classification
Felzv
174111{'419'1,'
Submit the 8.5" x 11" topographic map as required in Instruction VI regardless of whether a classification is provided!
1. Applicant's Certification:
1, SIGNING OFFICIAL NAME, attest that this application for PROJECT N ME
e ! understand that if all required
has been reviewed by me and is accurate and complete to the best of my knowledge. ,
parts of this application are not completed and that if all required supporting documentation and attachments are not
inA
this application package is subject to being ►eturned as incomplete. Note: In accordance with North Carolina
GeStatutes 143-215.6A nd 143215.68, any person whoowingly makes any false statement, representation, c
ceonin any applicati haltbe guilty of a Class2 misdemeanor which may includ6 a fine rot ex®ged $10,000
ass civil penalties up o $25,000 per violation.
1
2. - Pro"io4al Engineees Cerification:
W__ G� y w" R1f1C.Lc.c`5L C/
I attest that this application --for,' has been reviewed by me and is accurate; complete
and consistent witli,44irifoimation 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 applicatile`regulations; Gravity Sewer Minimum -Design Criteria for Gravity Sewers adopted February
12, 1996,.and the Mlnlmum-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
�Qpeeee eeeej�i '
exceed'$10,000 as well as civil penalties up to $25,000 per violation. eoOX�� CAR®�y�9e'•�
•.......•
2a.� ''eqip.•�FESSIp,"9 '
Professional Engineer Name = _ �� SE AL _
-.y�cc�s . o
2b. t°--t-iAOZ?� 20007 a
Engineering Firm'
2c. Z 1-3 Q)G
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Address
2d. its i 1 r A cw*�v�, 2e.
City State Zip
2g. 'J�-�`���- 2h::.'J��t 21.����s� �td5c(�.Cl�►�vl
r E-mail
Telephone ='�'''` "Facsimile
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Seal, Signature & Date

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06FB3l2044) 07.:1-0 19102534304 ,PUBLIC UTILITIES PAGE , 02
COUNTY OF BRUNSWICK PO $OX 249
PUBLIC UTILITIES b&ARTMENT . BOLIVIA, NC 28422
[phone]
[phone] FAX
May, 2, 2005
Mr. David Hewett, Town Manager
Town of -Leland
102 Town Hall Drive
Leland, NC 28451
Re: Brunswick Forest
-Acceptance of Sewer Flow.
'Northeast Brunswick Regional WWTP
-NPDES Permit No. NC 0086819
Dear Mr. Hewett:
We have received and reviewed your request for the proposed connection of Brunswick Forest, a
single family subdivision and commercial area to the Town of Leland's sanitary sewer collection
system (WQ,0018076). The sewer flow from this -project is estimated to be 149,700 gallons per
day to serve 300 single,family homes, one 2 story, restaurant, one 30,000 sq. ft office building and
one 100,000 sq ft grocery store complex.
This letter Is hereby written notice of acceptance of the estimated daily sanitary sewer flow for the
above referenced project from the Town of Leland's sanitary sewer collection system into the
County's Northeast Brunswick Regional Wastewater System. The County will accept this flow for
treatment; an estimated daily average daily'flow of 149,700 of sanitary sewer only per the Fast
Track Application for Gravity Sewers, Pump, Station's and Force Mains dated March 10, 2005.
The sewer flow from this project shall comply with the County's Sewer Use Ordinance at all'times.
If problems occur that may have a detrimental impact on the County's collection system and/or'
treatment facility, the Town shall notify the County's Public Utilities Department as soon as -
possible and provide a written record of the incident within fifteen (15) calendar days Including an
action plan to help prevent recurrence of the problem.
If you have any questions or concerns regarding _this correspondence please feel. free to contact
US.
6nc,,rel.,y111 d Pierce, P.E.
Director of Public Utilities
Attachment
cc: Marty Lawing, County Manager
Donald Dixon, WRF Superintendent (NBWRF)
Steve Hlastala, Wastewater Collection Superintendent
David S. Hollis, P.E. Hanover Design Services