WQ0033020_Application (FTSE)_20080502

B. R. KORNEGAY, INC.
LAND SURVEYING • ENGINEERING • PLANNING
P.O. Drawer 1435 • 300 E. Walnut Street
Goldsboro, North Carolina 27533-1435
919-735-5886
May 2, 2008
NCDENR
Division of Water Quality
943 Washington Square Mall
Washington, NC 27889-3314
Project: Randall Place
Goldsboro, NC
Wayne County
Fax [phone]
This project involves proposed sewer lines to serve a new apartment complex. The proposed
sewer lines include public and private lines. The public sewer lines will be located in a recorded
utility easement permitted through the City of Goldsboro. Please find enclosed the following
items for Fast -Track approval of the proposed sanitary sewer system.
1. One original and one copy of the application for public sewer lines.
2. One original and one copy of the application for private sewer lines.
3. Check #11188 in the amount of $480.
4. Check #11190 in the amount of $480.
5. An 8.5-inch by 11-inch color copy of the portion of a 7.5-minute USGS
Topographic Map.
6. Form FTSE 10/07 from the City of Goldsboro.
Sincerely,
Jeffrey L. Kornegay, T'E, PLS
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OFW A 7.,9 State of North Carolina
Department of Environment and Natural Resources
CDivision of Water Quality
FAST -TRACK APPLICATION
(FTA 12/07_ver2 )
for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
(Pressure & Vacuum sewer systems are not to be included as part of this 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. Forms are available from the web site or by calling the Regional Office serving your county:
http✓/h2o. enr. state. nc. us/peres/Colleciion%20SystemsiCollectionSystemApplications. html
® A.
Application Form - Submit one original and one copy of the completed and appropriately executed application
form. The application should include a project narrative describing the final build -out design (i.e. system and/or
pump station to ultimately serve 500 homes, but flow for only 100 homes being requested now). For modifications,
clearly explain 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 that has already
been Included in the original permit
Any changes to this form will result in the application being returned. The Division of Water Quality (Division) will
only accept application packages that have been fully completedwith all applicable items addressed. You do not
need to submit detailed plans and specifications unless You respond NO to Item B(13).
Separate applications should be made for non-contiguous sewer systems.
® B. Application Fee - Submit a check in the amount of $480 made payable to: North Carolina Department of
Environment and Natural Resources (NCDENR). Checks shall be dated within 90 days of application submittal.
❑ C. 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 that an 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(2)a of this application.
❑ D. Operational Agreements — Submit one original and two copies of a properly executed operational agreement, as
per 15A NCAC 02T .0115, if the application is submitted 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 home or property owner's association, use Form HOA 02/03. If the applicant is a developer,
use Form DEV 02/03. EVEN IF THE PROJECT MAY BE TURNED OVER TO A MUNICIPALITY UPON
COMPLETION, FORM DEV 02/03 IS REQUIRED.
® E. Downstream Sewer, WWTF Capacity and Flow Tracking/Acceptance — FORM FTSE 10/07 (Flow
Tracking/Acceptance for Sewer Extension Permit Applications) is required with every application. The applicant
(and owners of downstream sewers, pump stations and/or treatment facilities submitting FORM FTSE-10/07)
certifies that, to the best of their knowledge, the addition of the volume of wastewater to be permitted in this
project has been evaluated along the route to the receiving treatment plant, and that the flow from this project will
not cause capacity related sanitary sewer overflows or overburden any downstream pump station en route to the
receiving wastewater treatment plant Where the applicant is not the owner of the downstream sewer, submit two
copies of FORM FTSE 10/07 from the owner of the downstream sewer and owner of the WVVTF, if different The
flow acceptance indicated in FORM FTSE-10/07 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-10/07 Indicates that
owner has adequate capacity and will not violate G.S. 143-215.67(a). Intergovernmental agreements or other
contracts will not be accepted in lieu of project -specific FTSE 10/07.
Map — Submit an 8.5-inch by 11-inch COLOR copy of a USGS Topographic Map of sufficient scale to identify the
entire project area and the closest surface waters. Each map or maps must show the location of the sewer line
and pump stations and be of reproducible quality. Include a street level map showing the downstream connection
point, and the permit number for the downstream sewer, if known.
FTA12/07_ver2

;
Z G. Stream Classifications — Watershed Classification Attachment (Form WACAS-12/07) If any portion of the
project boundary is within 100 feet of any surface water or wetlands, the Watershed Classification Attachment
must be completed.
❑ H Environmental Assessments — If this project Is subject to an Environmental Assessment (EA) [15A NCAC
01C], this application cannot be used. Send the project application on the most current version of Form
PSFMGSA to the Design Management Unit, 1633 Mail Service Center, Raleigh, NC 27699-1633. Applications
cannot 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.
❑ I.
® J.
Flow Direction — Many wastewater treatment systems are entering into agreements for regionalization efforts
and emergency treatment capacity. Parts of the system are installed so that the wastewater flow can be directed
to more than one treatment facility. If this is the case with this project, please indicate in B(12) and give the permit
number of the second treatment facility.
Certifications — Section C
The application must be certified by both the applicant and the design engineer who is a North Carolina
Registered Professional Engineer (PE). The applicant signature must match the signing official listed in Item
A(1 b). The PE should NOT certify the application if he/she is unfamiliar with 15A NCAC Chapter 2T, 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.
THE COMPLETED FTA 12/07 APPLICATION PACKAGE, INCLUDING ALL SUPPORTING
DOCUMENTS AND $480 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 28301-5094
[phone]
[phone] Fax
Anson, Bladen, Cumberland, Hamett, Hoke,
Montgomery, Moore, Robeson, Richmond,
Sampson, Scotland
Mooresville Regional Office
610 E. Center Avenue
Mooresville, North Carolina 28115
[phone]
[phone] Fax
Alexander, Cabarrus, Catawba, Cleveland,
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
Stanly, Union
Ralelgh Regional Office
1628 Mall 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 Mali
Washington, North Carolina 27889
[phone]
[phone] Fax
Beaufort, Bertie, Camden, Chowan, Craven,
Currituck, Dare, Gates, Greene, Hertford, Hyde,
Jones, Lenoir, Martin, Pamlico, Pasquotank,
Perqulmans, Pitt, Tyrrell, Washington, Wayne
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, North Carolina 28405
[phone]
[phone] Fax
Brunswick, Carteret, Columbus, Duplin, New
Hanover, Onsiow, 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, please visit our web site at: http://h2o.enr.state.nc.us/peres/
or contact the Regional Office serving your county.
FTA12/07_ver2

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PLICATION INFORMATION ti
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USE THE TAB KEY TO MOVE FROM FIELD TO FIELD!
Application Number: I
(to be completed by DWQ) w Q D O 3 ?! 'D 20
1. Owner/Permlttee:
la. Randall Place, LLC -
Full Legal Name (company, municipality, HOA, utility, etc.) �. ; _, •-.- -.,, ;; --- . s-s
1b. JohnT. Bell, member ,4 ;I; Jf' ,'i -7_-__i; , .=-,1-_J
Signing Official Name and Title (Please review 15A NCAC 2T .0106 (b) for authorized signing officials!)
I 1 c. The legal enti who will own this system Is:
❑ Individual 0"Federal ❑ Municipality ■ State/County
■ Private Partnership
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Corporation ❑ Other, -(specify):
Id. 4819 Emperor Blvd., Suite 110
le. Durham l- :1.�'�i`J`ruf
Mailing Address
City
1 f. NC
1 g. 27703
State
Zip Code
1 h. [phone]
11. [phone]
1j. [e-mail]
Telephone
Facsimile
E-mail
2. Project (Facility) Information:
2a. Randall Place
2b. Wayne
Brief Protect Name (permit will refer to this name)
County Where Project is Located
3. Contact Person:
3a. Jeffrey L. Komegay, PE, PLS
Name and Affiliation of Someone Who Can Answer Questions About
this Application
3b. 919-735-5886
3c. [e-mail]
Phone Number
E-mail
r.
Project is
@
New
•
Modification (of an existing permit) If Modification, Permit No.:
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Owner is
•
Public (skip to item 8(3))
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Private (go to Item 2(a))
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+a. If applicant will be:
2b. If sold, facilities owned by a (must choose one)
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private,
Retaining Ownership (.e. store, church, single office, etc.) or
Leasingunits (lots, townhomes, etc. - skipto item B
( (3))
Selling units (lots, townhomes, etc. - go to item B(2b))
•
•
public Utility (Instruction C)
Homeowner AssocJDeveloper (Instruction D)
City of Goldsboro
Owner of Wastewater Treatment Facility (VWVTF) Treating Wastewater From This Project
• a. y of Goldsboro
4b. 23949
Name of WWTF
WWTF Permit No.
City of Goldsboro
5b. 18 inch
Gravity
5c.
Owner of Downstream Sewer
Receiving Sewer Size
Force Main
Permit # of Downstream Sewer (Instruction E)
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.. The origin of this wastewater is (check all that apply):
100 % Domestic/Commercal
•
CA
Residential Subdivision
Apartments/Condominiums
II
•
Retail (Stores, shopping centers)
Institution
% Industrial (attach
■
■
•
Mobile Home Park
School
Restaurant
Office
•
■
•
•
Hospital
Church
Nursing Home
Other(specify):
description.)
(RO: contact your Regional Office
Pretreatment staff)
% Other (specify):
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Volume
of wastewater to be allocated or permitted for this particular project: 0 gallons per day
"Do
not Include future flows or previously permitted allocations
If the
■
0
permitted flow Is zero, Indicate why:
Pump Station, Outfall or Interceptor Line where flow will be permitted in subsequent permits that connect to this line
Flow has already been allocated in Permit No. Randall Place proposed public 8-inch sewer lines
■
expected
Rehabilitation or replacement of existing sewer with no new flow expeed (see 15A NCAC 02T .0303 to determine if a
permit is required)
FTA12J07_ver2

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J. Provide the wastewater flow calculations used In determining the permitted flow In accordance with 15A NCAC 2T .0114 for
the value in Item B(7) AND/OR the design flow for line or pump station sizing if a reduced or zero flow Is being requested In
Item B(7). Values other than that in 15A NCAC 2T .0114 (b) and (c) must be supported with actual water or wastewater use
data in accordance with 15A NCAC 2T .0114 (f).
The flow in these proposed 6-inch sewer lines is induded in the proposed public 8-inch sewer lines permit application.
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches)
Length (feet)
New Gravity or Additional
Force Main
6
457
New Gravity
,1
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.W_
p .Pump
Summary of Pump Stations w/ associated Force Mains to be Permitted (attach additional sheets as necessary)
Station Location ID N/A (self chosen - as shown on plans/map for reference)
Design Flow
(MGD)
Operational Point
GPM �TDH
Power Reliability Option
1 - permanent generator w/ATS;
2 - portable generator w/MTS
Force Main Size
Force Main Length
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Pump Station Location ID (self chosen - as shown on plans/map for reference)
Design Flow
(MGD)
Operational Point
GPM @TDH
Power Reliability Option
1 - permanent generator w/ATS;
2 - portable generator w/MTS
Force Main Size
Force Main Length
12. Will
n Yes
the
0
wastewater flow in the proposed sewer lines or pump stations be able to be directed to another treatment facility?
No If Yes, permit number of 2"d treatment facility
— if "yes' to 6,12 please contact the Central Office PERCS Unit)
13.
Does the
Mains (latest
applicable?
►:i Yes
sewer
•
system comply with the Minimum Design Criteria for the Fast Track Permitting of Pump Stations and Force
version), the Gravity Sewer Minimum Design Criteria (latest version) and 15A NCAC Chapter 2T as
No If 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 APPLICATION
F 1Al2/07—Ver2

•
14. Have the following permits/certifications been submitted for approval for the system or project to be served?
Wetland/Stream Crossings - General Permit or 401 Certification? ❑ Yes ❑ No ® N/A
Sedimentation and Erosion Control Plan? ® Yes ❑ No ❑ N/A
Stormwater? ® Yes ❑ No ❑ WA
15. Does this project include any high priority lines, [see 15A NCAC 02T .0402 (2)] Involve aerial lines, siphons, or interference
manholes)? These lines will be considered high priority and must be checked once every six months
Check if Yes: ❑ and provide details
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1. Owner/Permittee's Certification: (Signature of Signing Official and Project Name)
/, John T. Bell , attest that this application for Randall Place has been reviewed
by me and is accurate and
application are not completed and
PPI� P
application package is subject to
Statutes 143-215.6A and 143-215.6B,
in any application shall be guilty of
as civil penalties up to $25,000 per
complete to the best of m knowledge. I understand that if allrequired arts of this
P Y 9• P
that if all required supporting documentation and attachments are not included, this
being returned as Incomplete. Note: In accordance with North Carolina General
any person who knowingly makes any false statement, representation, or certification
a Class 2 misdemeanor, which may include a fine not to exceed $10,000 as well
violet!�
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Si in cial Signature ate
A: 'APPLICATION.
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ENGINEE-RING DESIGN DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL OF THIS
THESE DOCUMENTS MUST INCLUDE PLAN AND PROFILE OF SEWERS, THEIR PROXIMITY
OTHER UTILITIES, DESIGN CALCULATIONS. ETC. REFER TO 15A NCAC 02T .0305
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. Professional Engineer's Certification: (Signature
/, Jeffrey L. Komegay, PE, PLS , attest that
of Design
this application
in the
further attest that
regulations,
Design Criteria
classification
of this submittal
this material
143-215.6A and
application shall
up to $25,000
Engineer and Project Name)
for Randall Place has been reviewed by me and is
accurate, complete and consistent with the Information
documentation to the best of my knowledge. I
been prepared in accordance with the applicable
adopted February 12, 1996, and the Minimum
Mains adopted June 1, 2000 and the watershed
professionals may have developed certain portions
and seal signifies that I have reviewed
9 9n
Note: In accordance with NC General Statutes
statement, representation, or certification in any
fine not to exceed $10,000 as well as civil penalties
engineering plans, calculations, and all other supporting
to the best of my knowledge the proposed design has
Gravity Sewer Minimum Design Criteria for Gravity Sewers
for the Fast -Track Permitting of Pump Stations and Force
in accordance with Division guidance. Although other
package, Inclusion of these materials under my
and have judged It to be consistent with theproposed desl
j 9 design.
143-215.6B, any person who knowingly makes any false
be guilty of a Class 2 misdemeanor which may include a
per violation.
�—
2a. Jeffrey L. Komegay, PE, PLS
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NC PE Seal, Signature & Date
Professional Engineer Name
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b. B.R. Komegay, Inc.
Engineering Firm
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P.O. Drawer 1435
Mailing Address
Goldsboro
2e. NC
r2f. 27533
City
State
Zip
g. 919-735-5886
2h. 919-580-9053
21. [e-mail]
Telephone
Facsimile
E-mail
FTA12/07_ver2

1'1' 1 rt PY-r f I"r I I I 'Mil rl riff I"r 1 [ 1
Aidtdib
Name: NORTHEAST GOLDSBORO
Date: 4/18/2008
Scale: 1 inch equals 2000 feet
YI1(I PY-r`i lyr I 1 1 l Y1' 1 r h"P-Y`t Ivr I'i tl FY'Y Cr I_ I I
Location: 035° 22' 50.71" N 077° 55' 12.36" W NAD83
Caption: Randall Place
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