Loading...
HomeMy WebLinkAboutWQ0043699_Application (FTSE)_20220822State of North Carolina DWR Department of Environmental Quality Division of Water Resources FAST TRACK SEWER SYSTEM EXTENSION APPLICATION Division of Water Resources FTA 06-21 & SUPPORTING DOCUMENTATION Application Number:?)//06M (to be completed by DWR) All items must be completed or the application will be returned 1. APPLICANT INFORMATION: 1. Applicant's name: Town of Madison (company, municipality, HOA, utility, etc.) 2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility ❑ Federal ❑ State/County ® Municipal ❑ Other 3. Signature authority's name: Kevin Baughn per 15A NCAC 02T .0106(b) Title: Town Manager 4. Applicant's mailing address: 120 North Market Street City: Madison State: NC Zip: 27025-_ 5. Applicant's contact information: Phone number: (336) 427-0221 Email Address: kbaughn@,townofmadison.org II. PROJECT INFORMATION: 1. Project name: Sanitary Sewer Improvements to Serve Town of Madison 2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project If a modification, provide the existing permit number: W000 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: Rockingham 4. Approximate Coordinates (Decimal Degrees): Latitude: 3639° Longitude: -7997° 5. Parcel ID (if applicable): (or Parcel ID to closest downstream sewer) III. CONSULTANT INFORMATION: 1. Professional Engineer: Stephen Francis, P.E. License Number: 049975 Firm: LKC Engineering,PLLC Mailing address: 140 Aqua Shed Court City: Aberdeen State: NC Zip: 28315- Phone number: (2U0 420-1437 Email Address: stephenALKCenyineering.com IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION: 1. Facility Name: Town of Mavodan W WTP Permit Number: NCO021873 Owner Name: Town of Mayodan V. RECEIVING DOWNSTREAM SEWER INFORMATION: 1. PermitNumber(s): WQ 2. Downstream (Receiving) Sewer Information: 10-inch ® Gravity ❑ Force Main 3. System Wide Collection System Permit Number(s) (if applicable): WQCS00078 Owner Name(s): Town of Madison FORM: ETA 06-21 Page 1 of 5 VI. GENERAL REQUIREMENTS 1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached? ❑ Yes ❑ No M N/A 2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEVI been attached? ❑ Yes ❑ No M N/A 3. If the Applicant is a Home/Property Owners' Association, has an HOA/POA Operational Agreement (FORM: HOA) and supplementary documentation as required by 15A NCAC 02T.0115(c) been attached? ❑ Yes ❑ No M N/A 4. Origin of wastewater: (check all that apply): M Residential (Individually Owned) ❑ Retail (stores, centers, malls) ❑ Car Wash ❑ Residential (Leased) ❑ Retail with food preparation/service ❑ Hotel and/or Motels ❑ School / preschool / day care ❑ Medical / dental / veterinary facilities ❑ Swimming Pool/Clubhouse ❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash ❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment) 5. Nature of wastewater: 100 % Domestic % Commercial % Industrial (See 15A NCAC 02T .0103(20)) If Industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No 6. Hasa flow reduction been approved under 15A NCAC 02T .0114(fl? ❑ Yes M No ➢ If Yes, provide a copy of flow reduction approval letter with this application 7. Summarize wastewater generated by project: Establishment Type (see 02T.0114(f)) Daily Design Flow a,b No. of Units Flow No new flow planned in this project gal/ GPD gall GPD gal/ GPD gal/ GPD gal/ GPD gal/ GPD Total 15,375 GPD a See 15A NCAC 02T .0114(b), (d), (e)(1) and (e)(2) for caveats to wastewater design flow rates (i.e., minimum flow per dwelling; proposed unknown non-residential development uses; public access facilities located near high public use areas; and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined in G.S. 42A-4). b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.0114] shall be determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data. 8. Wastewater generated by project: _ GPD (per 15A NCAC 02T .0114) ➢ Do not include future flows or previously permitted allocations If permitted flow is zero, please indicate why: ❑ Pump Station/Force Main or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line. Please provide supplementary information indicating the approximate timeframe for permitting upstream sewers with flow. ❑ Flow has already been allocated in Permit Number: Issuance Date: M Rehabilitation or replacement of existing sewers with no new flow expected ❑ Other (Explain): FORM: ETA 06-21 Page 2 of 5 VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers): 1. Summarize gravity sewer to be permitted: Size (inches) Length (feet) Material 8 6,400 PVC/DIP ➢ Section II & ID of the MDC for Permitting of Gravity Sewers contains information related to design criteria ➢ Section ID 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 VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains): PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT 1. Pump station number or name: N/A 2. Approximate Coordinates (Decimal Degrees): Latitude: _ Longitude: 3. Total number of pumps at the pump station: 3. Design flow of the pump station: million gallons per day (firm capacity) ➢ This should reflect the total GPM for the pump station with the largest pump out of service. 4. Operational point(s) per pump(s): _ gallons per minute (GPM) at _ feet total dynamic head (TDH) 5. Summarize the force main to be permitted (for this Pump Station): Size (inches) Length (feet) Material If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per MDCPSFM Section 2.01C.Lb. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify) 6. Power reliability in accordance with 15A NCAC 02T .0305(h)(1): ❑ Standby power source or ❑ Standby pump ➢ Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(1)(B): ➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day ➢ Must be permanent to facility and may not be portable Or if the pump station has an average daily flow less than 15,000 gallons per day 15A NCACO2T.0305(h)(1)(C): ❑ Portable power source with manual activation, quick -connection receptacle and telemetry - or ❑ Portable pumping unit with plugged emergency pump connection and telemetry: ➢ Include documentation that the portable source is owned or contracted by the applicant and is compatible with the station. ➢ If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations' storage capacities and the rotation schedule of the portable power source or pump, including travel timeframes, shall be provided as part of this permit application in the case of a multiple station power outage. FORM: FTA 06-21 Page 3 of 5 IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)): 1. Does the project comply with all separations/alternatives found in 15A NCAC 02T.0305(f) & W? ® Yes ❑ No 15A NCAC 02T.0305 contains minimum separations that shall be provided for sewers stems: Setback Parameter* Separation Required Storm sewers and other utilities not listed below (vertical) 18 inches zWater mains (vertical - water over sewer preferred, including in benched trenches) 18 inches zWater mains (horizontal) 10 feet Reclaimed water lines (vertical - reclaimed over sewer) 18 inches Reclaimed water lines (horizontal - reclaimed over sewer) 2 feet **Any private or public water supply source, including any wells, WS-I waters of Class I or Class II impounded reservoirs used as a source of drinking water, and associated wetlands. 100 feet **Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal high water (or tide elevation) and wetlands associated with these waters (see item IX.2) 50 feet **Any other stream, lake, impoundment, or ground water lowering and surface drainage ditches, as well as wetlands associated with these waters or classified as WL. 10 feet Any building foundation (horizontal) 5 feet Any basement (horizontal) 10 feet Top slope of embankment or cuts of 2 feet or more vertical height 10 feet Drainage systems and interceptor drains 5 feet Any swimming pools 10 feet Final earth grade (vertical) 36 inches ➢ If noncompliance with 02T.0305(f) or W, see Section X.1 of this application * 15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(f) 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 NC Surface Water Classifications webpage 2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ N/A ➢ If no, please refer to 15A NCAC 18C.0906(f) for documentation requirements and submit a separate document, signed/scaled by an NC licensed PE, verifying the criteria outlined in that Rule. 3. Does the project comply with separation requirements for wetlands? ® Yes ❑ No ❑ N/A ➢ Please provide supplementary information identifying the areas of non-conformance. ➢ See the Division's draft separation requirements for situations where separation cannot be met. ➢ No variance is required if the alternative design criteria specified is utilized in design and construction. 4. Is the project located in a river basin subject to any State buffer rules? ❑ Yes Basin name: ®No If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ❑ Yes ❑ No ➢ This includes Trout Buffered Streams per 15A NCAC 2B.0202 5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ❑ Yes ® No or 401 Water Quality Certifications? ➢ Please provide the permit number/permitting status in the cover letter if coverage/authorization is required. 6. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? ® Yes ❑ No Per 15A NCAC 02T.0105(c)(6), directly related environmental permits or certification applications must be being prepared, have been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion and sedimentation control plans, stormwater management plans, etc.). 7. Does this project include any sewer collection lines that are deemed "high -priority?" ❑ Yes ® No Per 15A NCAC 02T.0402, "high -priority sewer" means any aerial sewer, sewer contacting surface waters, siphon, or sewers positioned parallel to streambanks that are subject to erosion that undermines or deteriorates the sewer. Siphons and sewers suspended through interference/conflict boxes require a variance approval. ➢ If yes, include an attachment with details for each line, including type (aerial line, size, material, and location). High priority lines shall be inspected by the permittee or its representative at least once every six -months and inspections documented per 15A NCAC 02T.0403(a)(5) or the permittee's individual System -Wide Collection permit. FORM: FTA 06-21 Page 4 of 5 X. CERTIFICATIONS: 1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Pump Stations and Force Mains (latest version), and the Gravity ewer Minimum Design Criteria (latest version) as applicable? ® Yes ❑ No If no, for projects requiring a single variance, complete and submit the Variance/Alternative Design Request application (VADC 10-14) and supporting documents for review to the Central Office. Approval of the request will be issued 2. Professional Engineer's Certification: 1, Stephen Francis, attest that this application for Sanitary Sewer Improvements to Serve Town of Madison 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, Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains (latest version). Although other professionals may have developed certain portions of this submittal package, inclusion of these materials under my signature and seal signifies that Ihave reviewed this material and have judged it to be consistent with the proposed design. NOTE — In accordance with General Statutes 143-215.6A and 143-215.613, any person who knowingly makes any false statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation. Misrepresentation of the application information, including failure to disclose any design non-compliance with the applicable Rules and design criteria, may subject the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NCAC 56.0701) North Carolina Professional Engineer's seal, signature, and date: •J_•a'(1A CA06,`,,,�'g4 SEAL 049975 3. Applicant's Certification per 15A NCAC 02T .0106(b): ////'' 1 I, /' ay;t' CLGI.{n(D , 1"gtt dQf�attest that this application for Sanitary Sewer Improvements to Some Town of Madison (Signature Authority Na from Application Item .) (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 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. Signature: / C Date: U/ 2 C 2 FORM: FTA 06-21 Page 5 of 5 DWR Dlvlslon of Water Resources State of North Carolina Department of Environmental Quality Division of Water Resources Flow Tracking for Sewer Extension Applications (FTSE 10-18) Entity Requesting Allocation: Town of Madison Project Name for which flow is being requested: Madison Sanitary Sewer Improvements 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 wastewaterJlow. 1. Complete this section only if you are the owner of the wastewater treatment plant. a. WWTP Facility Name: Town of Mayodan WWTP b. WWTP Facility Permit #: NC0021873 All flows are in AfCD c. WWTP facility's permitted flow 4.5000 d. Estimated obligated flow not yet tributary to the WWTP 1.1316 e. WWTP facility's actual avg. flow 0.9348 f. Total flow for this specific request 0.0000 g. Total actual and obligated flows to the facility 2.0665 It. Percent of permitted flow used 45.92% 11. 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) (C) (D)=(B+C) (E)-(A-D) Design Obligated, Pump Pump Average Approx. Not Yet Total Current Station Station Firm Daily Flow" Current Tributary Flow Plus (Name or Permit Capacity, • (Firm I pf), Avg. Daily Daily Flow, Obligated Available Number) No. MGD MGD Flow, MGD MGD Flow Capacity** PS#9 2.520 1.008 0.515 0.134 0.649 0.359 * The Firm Capacity (design flow) of any pump station is defined as the maximum pumped flow that can be achieved with the largest pump taken out of service. ** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor (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): Town of Mayodan Downstream Permit Number: WQCS00078 Page I of VI'SV 10-18 Ill. Certification Statement: I Kevin Baughn, Town Manager 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 1 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. Signing Official Signature Date Title of Signing Official Page 2 ot'6 FTSli 10-18 Divi5lon of Water ke-0ota'res State of North Carolina Department of Environmental Quality Division of Water Resources Flow Tracking for Sewer Extension Applications (FTSE 10-18) Entity Requesting Allocation: Town of Madison Project Name for which flow is being requested: Madison Sanitary Sewer Improvement More than one FTSE maybe required jar a single project if the owner of the J"VTP is not responsible for all pump stations along the route of the proposed wastewaterJ(ow. I. Complete this section only if you are the owner of the wastewater treatment plant. a. WWTP Facility Name: Town of Mayodan WWTP b. WWTP Facility Permit #: NC0021873 Ail lows are in MGD c. WWTP facility's permitted flow 4,5000 d. Estimated obligated flow not yet tributary to the WWTP 1.1316 e. WWTP facility's actual avg. flow 0.9348 f. Total flow for this specific request 0.0000 g. Total actual and obligated flows to the facility 2.0665 h. Percent of permitted flow used 45.92% 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: Pump Pump Station Station (Name or Permit Number) No. N/A (A) (B) Design Average Approx. Firm Daily Flow** Current Capacity, * (Firm / pf), Avg. Daily MOD MOD Flow, MOD (C) (D)=(B+C) (E)=(A-D) Obligated, Not Yet Total Current Tributary Flow Plus Daily Flow, Obligated Available MOD Flow Capacity*** * The Firm Capacity (design flow) of any pump station is defined as the maximum pumped flow that can be achieved with the largest pump taken out of service. ** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor (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): Town of Mayodan Downstream Permit Number: Not Applicable Page 1 of 6 VTQV III IQ III. Certification Statement: I Kathleen Patterson, Town Manager certify to the best of my knowledge that the addition of the volume of wastewater to be permitted in this project has been evaluated along the route to the receiving wastewater treatment facility and that the flow from this project is not anticipated to cause any capacity related sanitary sewer overflows or overburden any downstream pump station en route to the receiving treatment plant under normal circumstances, given the implementation of the planned improvements identified in the planning assessment where applicable. This analysis has been performed in accordance with local established policies and procedures using the best available data. This certification applies to those items listed above in Sections I and II plus all attached planning assessment addendums for which I am the responsible party. Signature of this form certifies that the receiving collection system or treatment works has adequate capacity to transport and treat the proposed new wastewater. Page 2 of 6 CTCC in io August 16, 2022 Mr. Lon Snider, Reg. Supervisor NCDEQ— Winston-Salem Regional Office 450 W. Hanes Mill Road, Suite 300 Winston-Salem, NC 27105 Re: Town of Madison Sanitary Sewer Improvements Fast -Track Sewer Application Mr. Snider, NC Department of ' Environmental Quality Received AUG 2 2 2022 '" Winston-Salem Regional Office Regarding the above referenced project, please find the following items: 1. One original & one copy of the Fast Track application and supporting documents 2. one check for the $480.00 application fee The project involves the installation of approximately 6,400 feet of 8" PVC sanitary sewer main and associated manholes. This project will not serve any new customers and therefore shows zero new flow. While this type of submittal typically does not require the flow acceptance and tracking forms, we have had the various downstream Towns verify they are aware of the project by signing and including them with this submittal. If you have any questions, please do not hesitate to contact me at (910) 420-1437 or by email at sara@LKCengineering.com. Sincerely, LKC Engineering, PLLC a Sara Mirek LKC Engineering, PLLC, 140 Aqua Shed Court, Aberdeen, North Carolina 28315 PH: 910/420-1437 * FAX: 910/420-1438 * License No. P-1095 N m w 1 W A N oU Z' ii m. m o �m v Z D _ O N L „ ex- i w LU CL C oS (6 � _. ono " zun