WQ0031218_Application (FTSE)_20061220

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE 3
, 8
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD!
Application Number.
�'
�ri� kj '� U
(to be completed by DWQ) —
A. APPLICATION INFORMATION
1. Owner. DiCa01006
1 a. City of Goldsboro
Full Legal Name (company, municipality, HOA, utility, etc.)DWOrAikf
1 b. Joseph R. Huffman, City Manager'}
Signing Official Name and Title (Please review 15A NCAC 2H .0206(b) for authorized signing officials!)
1 c. The legal ent' who will
• Individual DI Federal
own this system
►'4 Municipality
is:
■ State/County
U Private Partnership
•
Corporation
■ Other (specify):
1 d. P.O. Drawer A
1 e. Goldsboro
Mailing Address
City
1 f. North Carolina
1 g. 27533
State
Zip Code
1 h. [phone]
1'. [phone]
1j. [e-mail]
Telephone
Facsimile
E-mail
2. Project (Facility) Information:
2a. New Ho Road SanitarySewer Extension
b. Wayne
Brief Project Name (permit will refer to this name)
County Where Project is Located
3. Contact Person:
3a. David A. Sutton, Civil Engineer
Name and Affiliation of Someone Who Can Answer Questions About
this Application
3b. [phone]
3c. [e-mail]
Phone Number
E-mail
B. PERMIT INFORMATION
1. Project is
►ii
New
• Modification (of an existing permit) If Modification, Permit No.:
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
2. Owner is
►ii
Public (skip to Item B(3))
• Private (go to Item 2(a))
2a. If private, applicant will be:
2b. If sold, facilities owned by a (must choose one)
•
•
■
Retaining Ownership (i.e. store, church, single office, etc.) or
Leasing units (lots, townhomes, etc. - skip to Item B(3))
Selling Units (lots, townhomes, etc. - go to Item B(2b))
•
•
Public Utility (Instruction III)
Homeowner Assoc./Developer (Instruction IV)
3. City of Goldsboro
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
4a. Goldsboro Wastewater Treatment Plant
4b. NC0023949
Name of WWTF
WWTF Permit No.
5a. City of Goldsboro
5b. 24"
® Gravity
5c. WQ0023541
Owner of Downstream Sewer
Receiving Sewer Size
r�l Force Main
Permit Number of Downstream Sewer (if known)
6. The origin of this wastewater is (check all that apply):
0
•
IN
•
Residential Subdivision
Apartments/Condominiums
Mobile Home Park
School
II
•
•
L
Car Wash
Institution
Hospital
Church
100 % Domestic/Commercial
% Industrial
•
Restaurant
■
Nursing Home
% Other (specify):
■
Office
• Other (specify):
7.
Volume
of wastewater to be allocated for this particular project: gallons per day
*Do
not include previously permitted allocations 2110 5.p .
8.
If the
•
IN
permitted flow is zero, indicate why:
Interceptor Line - Flow will be permitted in 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
FTA 02/03 - Rev. 3 04/05

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE 5
C. STREAM CLASSIFICATION
1. Use the Division's guidance document entitled, "DETERMINING STREAM CLASSIFICATIONS FOR FORM FTA 02103
(FAST -TRACK SEWER SYSTEMS)" to collect and record the stream classification data below (attach additional sheets as
necessary). This document is available from our web site or by contacting the appropriate Division of Water Quality
regional office (see instructions for addres-sPs) 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
(self chosen - as shown on
map for cross-reference)
Name of
Waterbody
County
River Basin
Waterbody Stream
Index
Waterbody
Classification
A
Reedy Branch
Wayne
Neuse
27-6-2
C; NSW
Submit the 8.5" x 11" COLOR topographic map as required in Instruction VI
regardless of whether a classification is provided!
Z
0
I--
Q
0
LL
I—
Ce
LLI
0
CImisdemeanor
1. Applicant's Certification:
1, Joseph R. Huffman, attest that this application for New Hope Road Sanitary Sewer Extension
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 143-215.68, 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 we civil penalties up to $25, 000 per violation.
1a. lZ /s` Cris(
nin 0 icia Sign re Date
Professional Engineer's Certification:
/ attest that this application for New Hope Road Sanitary Sewer Extension 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 l 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 143-215.68, any person who
knowingly makes any false statement, representation, or certification in any application shall be guilty of a Class 2
which may include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
2a. David A. Sutton, P.E..+nam
a40"--fi1‘ CARoi •
`v,``,�pF�'y `/•4 . -
t
_ . q E
1 (IO
DA. .
(� ,ft�, r
�" r'� �a�l..iw,ic `c3�#�•
.• raysµ 0%*,
Seal, Signature & Date
Professional Engineer Name
2b. City of Goldsboro Engineering Department
Engineering Firm
2c. P.O. Drawer A
Mailing Address
2d. Goldsboro �2e. NC 2f. 27533
City State Zip
2g. [phone] 2h. [phone] i. dsuttont�ci.goldsboro.nc.us
Telephone Facsimile I E-mail
FTA 02/03 - Rev. 3 04/05

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS •
PAGE 1
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
FAST -TRACK APPLICATION
for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
(Pressure sewers systems are not to be included as part ofthis application package)
INSTRUCTIONS: Indicate that you have included/addressed the following list of required application package items by
checking the space provided next to each applicable item. Failure to submit all required items will lead to your application
being retumed as incomplete. This form may be photocopied for use as an original.
I.
Application Form - Submit one original and one copy of the completed and appropriately executed application
form. Any changes to this form will result in the application being retumed. The Division of Water Quality
(Division) will only accept application packages that have been fully completed with all applicable items
addressed. You do not need to submit detailed plans and specifications unless you respond NO to Item B(12).
® II. Application Fee - Submit a check in the amount of $400 made payable to: North Carolina Department of
Environment and Natural Resources (NCDENR). Checks shall be dated within 90 days of application submittaL
❑ III. Certificates of Public Convenience and Necessity — If the application is being submitted in the name of a
privately -owned public utility, submit two copies of the Certificate of Public Convenience and Necessity (CPCN)
which demonstrates that the public utility is authorized to hold the utility franchise for the area to be served by the
sewer extension. If a CPCN has not been issued, provide two copies of a letter from the North Carolina Utilities
Commission's Public Staff that states thatan application for a franchise has been received, that the service area
is contiguous to an existing franchised area, and/or that franchise approval is expected. The project name in the
CPCN or letter must match that provided in Item A(2a) of this application.
❑ IV. Operational Agreements — Submit one original and two copies of a properly executed operational agreement if
the sewer extension is permitted by a private applicant and will be serving residential or commercial lots (e.g.,
houses, condominiums, townhomes, outparcels, etc.) that will be sold to another entity. If the applicant is a
homeowners' association, use Form HOA 02/03. If the applicant is a developer, use Form DEV 02/03. EVEN IF
THE PROJECT WILL BE TURNED OVER TO A MUNICIPALITY, FORM DEV 02/03 IS REQUIRED.
El V. Flow Acceptance Letters — If the owner of the downstream sewers and/or WWTF is different from the applicant,
submit two copies of a flow acceptance letter from the owner of the downstream sewers and WWTF, if different
Flow acceptance letters must contain the following minimum information: applicant and project name, amount of
flow accepted, and name andpermit number of the receiving sewers/WWTF. The flow acceptance must not
expire prior to permit issuance and must be dated less than a year prior to the application date.
Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific flow acceptance
letter.
® VI. Map — Submit an 8.5-inch by 11-inch COLOR copy of the portion of a 7.5-minute USGS Topographic Map along
with this form. The map should identify the entire project area location as well as the closest downslope surface
waters as clearly as possible. Each map portion must be labeled with the map name and number, the identified
location of the sewer line and pump stations, and be of clear and reproducible quality. For instance, if the project
involves 4 miles of interceptor sewer that traverses over or near several different waterbodies (or counties,
basins, etc.), the map should have location ID's shown for each different waterbody (where the sewer line is within
100 feet of such waterbody - see Instruction VII). This location ID is self chosen and used to cross reference the
location in Section C of the permit application.
® VII. Stream Classifications — Section C
• If any portion of the project is within 100 feet of any down slope surface water, Section C must be completed
for the pertinent sections.
• If the entire project area is a minimum of 100 feet away from any down slope surface waters BUT there is a
pump station involved where a history of power outage is to be used to provide adequate design storage
instead of dual feed or permanent or portable generator, Section C must be completed to demonstrate that
the closest down slope surface water is Class C (see 15A NCAC 2H .0219(h)(3)(D)).
• Use the guidance document entitled, "Determining Watershed Classifications for Form FTA 02/03 (Fast -Track
Sewer Systems)" available from http://h2o.enr.state.nc.us/peres or by contacting the appropriate regional
office.
FTA 02/03 - Rev. 3 04/05

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 2
❑ VIII. Environmental Assessments — If this project is subject to an Environmental Assessment (EA) [15A NCAC
01C], this application can not be used. Send the project application on Form PSFMGSA 10/99 to the PERCS
Unit, 1617 Mail Service Center, Raleigh, NC 27699-1617. Applications can not be accepted until a Finding of No
Significant Impact (FONSI) .or Environmental Impact Statement (EIS) has been issued. A copy is to be submitted
with that permit application.
E . IX. Certifications — Section D
The application must be certified by both the applicant and a North Carolina Registered Professional Engineer
(PE). The applicant signature must match the signing official listed in Item A(1b). The PE should NOT certify the
application if he/she is unfamiliar with 15A NCAC 2H .0200, the Gravity Sewer Minimum Design Criteria (most
recent version) and the Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains
(most recent version), as applicable to the project. Certification by a PE who is unfamiliar with these documents
is subject to NC Board referral.
® X. Downstream Sewer & Wastewater Treatment Plant Capacity
The applicant has assured downstream pipe, pump station and treatment plant capacity: The addition of new
sources of wastewater from this project has been evaluated along the route to the receiving treatment plant. The
flow from this project will not cause capacity related sanitary sewer overflows or overburden any downstream
pump station en route tothe receiving wastewater treatment plant. If the applicant is not the owner of the
downstream sewer or receiving treatment plant, submittal of flow acceptance letter(s) indicates that owner has
adequate capacity and will not violate G.S. 143-215.67(a).
THE COMPLETED FTA 02/03 APPLICATION PACKAGE, INCLUDING ALL SUPPORTING DOCUMENTS AND $400
FEE, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE
REGIONAL OFFICE
'ADDRESS
COUNTIES SERVED
Asheville Regional Office
2090 US Highway 70
Swannanoa, North Carolina 28778
[phone]
[phone] Fax
Avery, Buncombe, Burke, Caldwell,
Cherokee, Clay, Graham, Haywood,
Henderson, Jackson, Macon, Madison,
McDowell, Mitchell, Polk, Rutherford,
Swain, Transylvania, Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Fayetteville, North Carolina 28301
[phone]
[phone] Fax
Anson, Bladen, Cumberland, Harnett,
Hoke, Montgomery, Moore, Robeson,
Richmond, Sampson, Scotland
Mooresvllle Regional Office
610 E. Center Avenue, Suite 301
Mooresville, North Carolina 28115
[phone]
[phone] Fax
Alexander, Cabarrus, Catawba,
Cleveland, Gaston, Iredell, Lincoln,
Mecklenburg, Rowan, Stanly, Union
Raleigh Regional Office
1628 Mail Service Center
Raleigh, North Carolina 27699-1628
[phone]
[phone] Fax .'
Chatham, Durham, Edgecombe, Franklin,
Granville, Halifax, Johnston, Lee, Nash,
Northampton, Orange, Person, Vance,
Wake, Warren, Wilson
Washington Regional Office
943 Washington Square Mall
Washington, North Carolina 27889
[phone]
[phone] Fax
Beaufort, Bertle, Camden, Chowan,
Craven, Currituck, Dare, Gates, Greene,
Hertford, Hyde, Jones, Lenoir, Martin,
Pamlico, Pasquotahk, Perquimans, Pitt,
Tyrrell, Washington, Wayne
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, North Carolina 28405
[phone]
[phone] Fax
Brunswick, Carteret, Columbus, Duplin,
New Hanover, Onslow, Pender
Winston-Salem Regional Office
585 Waughtown Street
Winston-Salem, North Carolina 27107
[phone]
[phone] Fax
Alamance, Allegheny, Ashe, Caswell,
Davidson, Davie, Forsyth, Guilford,
Rockingham, Randolph, Stokes, Surry,
Watauga, Wilkes, Yadkin
For more information, visit our web site at: httpi/h2o.enr.state.nc.us/peres/
FTA 02/03 - Rev. 3 04/05

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PROPOSED 18 INCH
SANITARY SEWER LINE
EXISTING 24 INCH
SANITARY SEWER LINE
Name NORTHEAST GOLDSBORO
USGS Entity ID MPTNC1093PP01
400 200 0 400 Feet