WQ0045174_Ridge_Road_Pump_Station_&_Force_Main_Replacement_20240223

DER
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 10-23 & SUPPORTING DOCUMENTATION
Application Numbert-440O&I7ft (to bewmpletedbyDWR)
All items must be completed or the application will be returned
1. APPLICANT INFORMATION:
1. Applicant's name: Town of Dobson (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State/County ® Municipal
3. Signature authority's name: Jeff Sedlacek per 15A NCAC 02T .0106(b)
i
Title: Town Manager
4. Applicant's mailing address:: 307 North Main Street
City: Dobson - State: NC, Zip: 27017- '
5. Applicant's contact information:
Phone number: (R6) 356-8962 Email Address: jeffsedlacek(a�dobson-nc.com
IL PROJECT INFORMATION:
❑ Privately -Owned Public Utility
❑ Other
1. Project name: 4idawAoad P=p Station & Force Main Replacement '
2. Application/Project status: ❑ Proposed (New Permit) ® Existing Permit/Project
If a modification, provide the existing permit number: W00035178s and issued date: Jan 6 2011
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: W000_
3. County where project is located: Spgy
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.39909"' Longitude:-80.717289°
5. Parcel ID (if applicable):
111. CONSULTANT INFORMATION:
(or Parcel ID to closest downstream sewer)
1. Professional Engineer: Kevin Heath, P.E. License Number: 21204
Firm: The Lane Group, Inc. I
Mailing address: 119 North Main Street'
City: Galax ' State: VAZip: 24333-_
Phone number: (2D6 236-4588 Email Address: kheath(a,thelanegroupinc.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION: NC,
1. Facility Name: Town of Dobson Wastewater Treatment Plan i Permit Number: 002132ti
Owner Name: Town of Dobson
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. PermitNumber(s): WQ33695'
2. Downstream (Receiving) Sewer Information: 12 inch ® Gravity' ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS00215
Owner Name(s): Town of Dobson
FORM: FTA 10-23 Page I 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 ® N/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached?
❑ Yes ❑ No ® 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.01 15(c) been attached?
❑ Yes ❑ No ® N/A
4. Origin of wastewater: (check all that apply)
® 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 Attachments
5. Nature of wastewater : 80 %u Domestic 20 %Commercial % Industrial (See 15A NCAC 02T .0103(20)1
If Industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 02T .0l 14(f)? ❑ Yes ❑ No
➢ If Yes, provide a coov of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow "b
No. of Units
Flow
gall
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
GPD
a See I5A NCAC 02T .0114(b). (d). (e)(1) and (e)(2) for caveats to wastewater design flow rates (i.e. 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. 42A4).
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: 0 GPD (per 15A NCAC 02T .0114 and G.S. 143-215.1)
➢ 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 tirreframe for permitting upstream sewers with flow.
❑ Flow has already been allocated in Permit Number: Issuance Date:
® Rehabilitation or replacement of existing sewers with no new flow expected
❑ Other (Explain):
FORM: FTA 10-23 Page 2 of 5

VIL GRAVITY SEWER DESIGN CRITERIA (if Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8
246
PVC or D.L
8
112
Ductile Iron i
3Sf
➢ Section II & 111 of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section III 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
Vlll. 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: Ridge Road
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude:-80.712796'
3. Total number of pumps at the pump station: 3
3. Design flow of the pump station: 0.288 millions 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): 200 gallons per minute (GPM) at 156 feet total dynamic he
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
8
4,188
PVC or D.I.
8
135
Mech Joint D.I.
8
60
Ductile Iron
1 3
4P�,�PJ ,t zw 6,044 = u
p, a 74 •y&9
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.l.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(I ):
® 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)(I)(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 10-23 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T.0305(f)):
i
1. Does the project comply with all separations/alternatives found in 15A NCAC 02T.0305(f) & M ® Yes ❑ No
15A NCAC 02T.0305(t) contains minimum separations that shall be provided for sewer systems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
'Water mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
'Water 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-1 waters of Class 1 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 (g), see Section XI 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 weboaee
2. Does this project comply with the minimum separation requirements for water mains? ® `fes ❑ No ❑ N/A
➢ If no, please refer to 15A NCAC 18C.0906(f) for documentation requirements and submit a separate document,
signed/sealed 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.
➢ Seethe 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 ®, es ❑ No
or 401 Water Quality Certifications?
➢ Please provide the permit number/permitting status in the cover letter if coverage/authorization is required.
i
6. Does project comply with 15A NCAC 02T.0105(cK6) (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).
One high priority line - replacement of existing aerial stream crossing at pump station site.
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 10-23
Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Pumo Stations
and Force Mains (latest version), and the Gravity Sewer 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 reauest will be issued
2. Professional Engineer's Certification:
1, Kevin Heath, P.E. attest that this application for Ridge Road Pump Station & Force Main Replacement
(Pmfessional Engineer's name from Application Item Ill.].) (Project Name from Application Item 1I.1)
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 DesiP-rr 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 I have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, 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. 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)
„auu•rpq
North Carolina Professional Engineer's seal, signature, and date:.CARO(4•••
.y f
SEAL
021204
T 12/15/-23 :` 2
.o KEV IN •``�
3. Applicant's Certification per 15A NCAC 02T .0106(b):
1, Jeff Sedlacek, Town Manager x , attest that this application for Ridge Road Pump Station & Force Main Replacement
(Signature Authority Name from Application Item 1.3.) (Project Name from Application Item n.l )
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. 1 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: Date: Z �� Z
FORM: FTA 10-23 Page 5 of 5

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QWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-23)
Entity Requesting Allocation: Town of Dobson
Project Name for which flow is being requested: Ridge Rd Pump Sta/Force Main Replace'
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 wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name:
b. WWTP Facility Permit
Wastewater Treatment Plant'
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the W WTP
e. WWTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
All flows are in MGD
0.3500
0'
0.205 -
0.00
0.205 "
58.6% '
I1. 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
Approx.
Obligated, Total
Pump Pump Average
Current
Not Yet Current Flow
Station Station Firm Daily Flow"
Avg. Daily
Tributary Plus
(Name or Permit Capacity, • (Firm / pt),
Flow,
Daily Flow, Obligated Available
Number) No. MGD MGD
MGD
MGD Flow Capacity***
Ridge Rd WQ0035178 0.288 0.075 0.035 / 0.0 0.035' 0.04/
* The Firm Capacity (design Dow) 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): Dobson Wastewater Treatment Plant
Downstream Permit Number: NCO021326 '
Page 1 of 8
FTSE 10-23

III. Certification Statement:
I Jeff Sedlacek -' 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.
Jeff Sedlacek, Town Manager
Title of Signing Official
Page 2 of 8
FTSE 10-23

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Winston Salem
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February 15, 2024
NCDEQ — Division of Water Resources
Winston-Salem Water Quality Regional Operations Section
450 W. Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
Re: Ridge Road Pump Station & Force Main Replacement
DWI Project No. SRP-W-134-0020
Town of Dobson, NC
Dear Sir/Madam:
Please find enclosed for your review/ processing the following items for the above referenced project:
— original and one (1) copy of Form FTA 10-23 Fast -Track Sewer System Extension Application
— one (1) copy of Form FTSE 10-23 Flow Tracking for Sewer Extension Application
— one (1) copy of the 8.5" x l l" Site Map
— check for $600.00 made out to NCDEQ for the application fee
This project involves improvements to the Town's existing Ridge Road sewage pump station and its discharge force
main. The proposed pump station upgrades include replacement of the existing duplex pumps with a new triplex
pump assembly and wetwell, addition of a new mechanical bar screen, addition of a new permanent generator, and
addition of a SCADA monitoring system. The existing 6" AC force main will be replaced with approximately 4,390
LF of new 8" force main line. Approximately 250 LF of 8" gravity sewer line replacement is also included in the
project. The proposed project is being implemented to replace existing sewer system components that are at the end
of their useful life and will not result in any new customers or changes to the collection system service area.
If you have any questions or need anything additional, please let us know.
Sincerely,
THE LANE GROUP
rtY1J 111
Kevin Heath, P.E.
cc: Jeff Sedlacek, Town of Dobson
KH/sct
119 North Main Street • Galax, Virginia 24333
p:276.236.4588

State of North Carolina
DWR Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources INSTRUCTIONS FOR FORM: FTA 10-23 & SUPPORTING DOCUMENTATION
This application is for sewer extensions involving gravity sewers, pump stations and force mains, or any combination that has been
certified by a professional engineer and the applicant that the project meets the requirements of 15A NCAC 02T and the Division's
Minimum Design Criteria (Gravity Sewer & Pump Stations/Force Mains) and that plans, specifications and supporting documents
have been prepared in accordance with 15A NCAC 02T, 15A NCAC 02T.0300, Division policies, and good engineering Practices.
While no upfront engineering design documents are required for submittal, in accordance with 15A NCAC 02T .0305(b), design
documents must be prepared prior to submittal of a fast track permit application to the Division. This would include plans, design
calculations, and project specifications referenced in 15A NCAC 02T .0305 and the applicable minimum design criteria. These
documents shall be immediately available upon request by the Division.
Projects that are deemed permitted (do not require a permit from the Division) are explained in 15A NCAC 02T.0303.
Projects not eligible for review via the fast track process (must be submitted for full technical review):
➢ Projects that do not meet any pail of the minimum design criteria (MDC) documents;
➢ Projects that involve more than one variance from the requirements of 15A NCAC 0217;
➢ Pressure sewer systems utilizing simplex septic tank -effluent pumps (STEPs) or simplex grinder pumps;
➢ Simplex STEP or simplex grinder pumps connecting to pressurized systems (e.g. force mains);
➢ Vacuum sewer systems.
General — When submitting an application, please use the following instructions as a checklist in order to ensure all required items are
submitted. Adherence to these instructions and checking the provided boxes will help produce a quicker review time and reduce the
amount of requested additional information. Failure to submit all required items will necessitate additional processing and review
time, and may result in return of the application. Unless otherwise noted, the Applicant shall submit one original and one copy of
the application and supporting documentation.
A. One Original and One Copy (second copy may be digital) of Application and Supporting Documents
M Required unless otherwise noted. Signatures on original must be "wet ink" or secure digital signatures.
Please do not submit engineering design plans with the application unless specifically requested.
B. Cover Letter/Narrative Description (Required for All Application Packages):
M List all items included in the application package, as well as a brief description of the requested permitting action.
➢ Be specific as to the system type, number of homes served, flow allocation required, etc.
➢ Include the permit number/status of any other required sewer permits (downstream/upstream)
➢ If necessary for clarity, include attachments to the application foam.
C. Application Fee (AB New and Modification Application Packages):
® Submit a check or money order in the amount of $600.00, dated no more than 90 days prior to application submittal.
➢ Payable to North Carolina Department of Environmental Quality (NCDEQ)
D. Fast Track Application (Required for All Application Packages, Form FTA 10-23):
® Submit the completed and appropriately executed application.
➢ If necessary for clarity or due to space restrictions, attachments to the application may be made.
❑ If the Applicant Type in Item 1.2 is a corporation or company, provide documentation it is registered for business with the
North Carolina Secretary of State.
❑ If the Applicant Type in Item 1.2 is a partnership or d/b/a, enclose a copy of the certificate filed with the Register of Deeds in
the county of business.
® The Project Name in Item II.1 shall be consistent with the project name on the flow acceptance letters, agreements, etc.
® The Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a North Carolina
licensed Professional Engineer.
® The Applicant's Certification on Page 5 of the application shall be signed in accordance with 15A NCAC 02T .0106(b). Per
15A NCAC 02T .0106(c), an alternate person may be designated as the signing official if a delegation letter is provided from
a person who meets the criteria in 15A NCAC 02T .0106(b).
INSTRUCTIONS FOR FORM: FTA 10-23 & SUPPORTING DOCUMENTATION Page 1 of 3

E. Flow Tracking/Acceptance Form (Form: FTSE 10-23) (If Applicable):
® Submit the completed and executed FTSE form from the owners of the downstream sewers and treatment facility.
➢ Multiple fors maybe required where the downstream sewer owner and wastewater treatment facility are different.
➢ The flow acceptance indicated in for FTSE 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 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 a project -specific FTSE.
F. Site Maps (All Application Packages):
® Submit an 8.5-inch x 11-inch color copy of a USGS Topographic Map of sufficient scale to identify the entire project area,
including the closest surface waters.
➢ General location of the project components (gravity sewer, pump stations, & force main)
➢ Downstream connection points and permit number (if known) for the receiving sewer
® Include an aerial location map showing general project area (such as street names or latitude/longitude) so that Division staff
can easily locate it in the field.
G. Existing Permit (Application Packages for Modifications to an Existing Permit):
❑ Submit a copy of the most recently issued existing permit.
❑ Include a descriptive and clear narrative identifying the previously permitted items to remain in the permit, items to be
added, and/or items to be modified (the application form itself should include only include items to be added/modified), The
narrative should also include whether any previously permitted items have been certified.
❑ The narrative should clearly identify the requested permitting action and accurately describe the sewers to be listed in
the Final permit.
H. Power Reliability Plan (Required if portable reliability option utilized for Pump Station):
❑ Per 15A NCAC 02T .0305(h)(1), submit documentation of power reliability for pumping stations.
➢ This alternative is only available for average daily flows less than 15,000 gallons per day
➢ It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant and is compatible with
the station. The Division will accept a letter signed by the applicant (see 15A NCAC 02T A106(b)) or proposed contractor,
stating that "the portable power generation unit or portable, independently -powered pumping units, associated appurtenances
and personnel are available for distribution and operation of this pump 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 in the case of a multiple station power outage. (Required at time of certification)
1. Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per 15A NCAC 02T .0115(a)(1) provide the Certificate of Public Convenience and Necessity from the North Carolina Utilities
Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served by the sewer
extension, or
❑ Provide a letter from the North Carolina Utilities Commission's Water and Sewer Division Public Staff stating an application
for a franchise has been received and that the service area is contiguous to an existing franchised area or that franchise approval
is expected.
J. Operational Agreements (Applications from HOA/POA and Developers for lots to be sold):
❑ Home/Property Owners' Associations
❑ Per 15A NCAC 02T .0115(c), submit the properly executed Operational Agreement (FORM: HOA).
❑ Per 15A NCAC 02T .0115(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
❑ Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(b), submit the properly executed Operational Agreement (FORM: DEV).
For more information, visit the Division's collection systems website
INSTRUCTIONS FOR FORM: FTA 10-23 & SUPPORTING DOCUMENTATION
Page 2 of 3

THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional Office
2090 US Highway 70
Avery, Buncombe, Burke, Caldwell, Cherokee,
Water Quality Section
Swannanoa, North Carolina 28778-8211
Clay, Graham, Haywood, Henderson, Jackson,
[phone]
Macon, Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Fayetteville Renional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Harnett, Hoke,
Water Quality Section
Fayetteville, North Carolina 28301-5095
Montgomery, Moore, Robeson, Richmond,
[phone]
Sampson, Scotland
[phone] Fax
Mooresville Regional Office
610 E. Center Avenue
Alexander, Cabarrus, Catawba, Cleveland,
Water Quality Section
Mooresville, North Carolina 28115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
Raleigh Regional Office
3800 Barrett Drive
Chatham, Durham, Edgecombe, Franklin,
Water Quality Section
Raleigh, North Carolina 27609
Granville, Halifax, Johnston, Lee, Nash,
[phone]
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
Warren, Wilson
Washington Regional Office
943 Washington Square Mall
Beaufort, Bertie, Camden, Chowan, Craven,
Water Quality Section
Washington, North Carolina 27889
Currituck, Dare, Gates, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
Wilmington Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
Water Quality Section
Wilmington, North Carolina 28405
Hanover, Onslow, Pander
[phone]
[phone] Fax
Winston-Salem Renional Office
450 W. Hanes Mill Road
Suite 300
Alamance, Allegheny, Ashe, Caswell, Davidson,
Davie, Forsyth, Guilford, Rockingham, Randolph,
Water Quality Section
Winston-Salem, North Carolina 27105
Stokes, Surry, Watauga, Wilkes, Yadkin
[phone]
[phone] Fax
INSTRUCTIONS FOR FORM: FTA 10-23 & SUPPORTING DOCUMENTATION
Page 3 of 3

Shannon Tate
From: Boggs, Brandee C CIV USARMY CESAD (USA) <[e-mail]>
Sent: Wednesday, February 21, 2024 2:15 PM
To: [e-mail]; Shannon Tate
Cc: Chandler, Rebecca D; Andrea J Leslie
Subject: SAW 2024-00053 Ridge Road Pump Station & Force Main Replacement
Attachme12O22_NWP-3_Maintenance.pdf;
RidgeRdPumpStationForceMainReplacement_UTRockyR_Surry_NCWRCComments.pdf
Hi Jeff, I have determined your project @ 120 Ryan Street, Dobson NC, will fit within our Nationwide Permit #3 for
Maintenance (attached). I have also attached the recommendations from NCWRC to help minimize impacts to the
aquatic community.
I hope your project goes well!
Regards,
Brandee Boggs (she/her)
SAW -Regulatory Specialist
Tues, Wed & Thurs 930-1800

® North Carolina Wildlife Resources Commission 9
Cameron Ingram, Executive Director
February 12, 2024
Ms. Brandee Boggs
U.S. Army Corps of Engineers, Regulatory Branch
151 Patton Avenue, Room 208
Asheville, North Carolina 28801-5006
SUBJECT: Ridge Road Pump Station and Force Main Replacement
UT to Rocky River, Surry County
Dear Ms. Boggs:
Biologists with the North Carolina Wildlife Resources Commission (NCWRC) reviewed an
application to impact 20 ft of an unnamed tributary (UT) to the Rocky River in Surry County.
Our comments on this application are offered for your consideration under provisions of the
Clean Water Act of 1977 (33 U.S.C. 466 et. seq.) and Fish and Wildlife Coordination Act (48
Stat. 401, as amended; 16 U.S.C. 661-667d).
Wild trout reproduction should not be impacted by project activities, and a trout moratorium is
not needed.
The application proposes to upgrade a pump station and replace a section of force main that has
experienced numerous blockages and breaks. A stream will be crossed twice via trench cut
crossings and banks stabilized with riprap or with riprap.
We offer the following recommendations to minimize impacts to the aquatic community:
1. In -channel work should be accomplished as quickly as possible and vigilance used in
sediment and erosion control during site preparation, construction, and clean up. Disturbed
areas should be stabilized at the end of each work day.
2. Any erosion control matting used should be free of nylon or plastic mesh, as this type of
mesh netting frequently entangles wildlife and is slow to degrade, resulting in a hazard that
may last for years.
3. Seeding specifications are not provided; temporary and permanent seed mixes in riparian
areas should not include invasive species such as Weeping Lovegrass, Bermudagrass, Tall
Fescue, and Sericea Lespedeza. We recommend using an annual grain such as Oats or Rye,
Mailing Address: Habitat Conservation • 1721 Mail Service Center • Raleigh, NC 27699-1721
Telephone: [phone] • Fax: [phone]

Ridge Rd Pump Station and Force Main Page 2 February 12, 2024
UT Rocky R, Surry Co
Red Clover, and Creeping Red Fescue. A permanent native riparian seed mix should be used
within the riparian corridor.
4. Stream channels at sewer crossings should be restored to near pre -disturbance conditions.
Channel dimensions should mimic the existing dimensions, and the stream bed should set be
at the pre-existing elevation. At least 6-8 inches of natural bed material should be placed on
top of the restored stream channel bed; this bed material should mimic that which is found in
the stream bed.
5. We strongly recommend grading banks and planting native shrubs and trees instead of using
riprap. Even a narrow line of woody vegetation can afford wildlife benefits, bank
stabilization, and stream shading. Banks should be stabilized with a seed mix that includes a
quick -growing temporary seed and native riparian vegetation.
Thank you for the opportunity to review and comment on this project. Please contact me at
[phone] if you have any questions about these comments.
Sincerely,
Andrea Leslie
Mountain Region Coordinator, Habitat Conservation Program
cc: Jeff Sedlacek, Town of Dobson
Rebecca Chandler, NC Division of Water Resources

From: Boone. Ron
To: Kevin Heath; ieff.sedlaceKbdobson-nc.com
Cc: Graznak, Jenny; Shannon Tate
Subject: RE: [External] RE: Fast Track Sewer System Extension Permit No. WQ0045174, Town of Dobson, Ridge Road
Pump Station & Force Main Replacement, Surry County, Additional Information Request
Date: Friday, February 23, 2024 8:34:00 AM
Attachments: image002.p_ng
imaae004.Dna
image005.p_ng
imaae008.Dna
Sounds good. I will complete processing your application.
Best Regards,
Ronald C. Boone, EnvironmentaCProgram Consultant
North Carolina Deportment of Environmental Quolity
Division of Water Resources, Winston-Salem Regional Office
450 West Hones Mill Rood, Suite 300, Winston-Salem, NC 27105
Office: [phone] / Cell: [phone]
[e-mail]
Q:>
NORTH CAROLINA -
Department of Environmental Quality
Email correspondence to and from this address is subject to the North
Carolina Public Records Law and may be disclosed to third parties.
Email correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third
parties by an authorized state official.
From: Kevin Heath <[e-mail]>
Sent: Friday, February 23, 2024 6:12 AM
To: Boone, Ron <[e-mail]>; [e-mail]
Cc: Graznak, Jenny <[e-mail]>; Shannon Tate <[e-mail]>
Subject: [External] RE: Fast Track Sewer System Extension Permit No. WQ0045174, Town of Dobson,
Ridge Road Pump Station & Force Main Replacement, Surry County, Additional Information Request
CAUTION: External email. Do not click links or open attachments unless verified. Report suspicious emails with the
Report Message button located on your Outlook menu bar on the Home tab.
Ron:

Responses to your comments are provided below in RED. Please let us know if you need anything
additional. Thanks.
Kevin Heath, PE I Vice President
276.236.4588 — Galax Office 1276.206.8571 — Abingdon Office
276.233.7167 - Mobile
J1e
LANEcrchileclure
G O U Pi envuomenlpl
Abingdon I Big Stone Gap I Galax
n 13 n1a
Notice: The Information contained in this message may be privileged, confidential and exempt from disclosure
under law. If you are not the intended recipient of this message or if have received this message in error, please
immediately notify the sender by return e-mail and delete the message.
From: Boone, Ron <ron.boone(@deq.nc.g_ov>
Sent: Thursday, February 22, 2024 4:56 PM
To: ieff.sedlacekCcDdobson-nc.com; Kevin Heath <I<[e-mail]>
Cc: Boone, Ron <ron.boonePdeq.nc.gov>; Graznak, Jenny <jenny_graznakPdeq.nc.gov>
Subject: Fast Track Sewer System Extension Permit No. WQ0045174, Town of Dobson, Ridge Road
Pump Station & Force Main Replacement, Surry County, Additional Information Request
Good Afternoon,
We have received your Fast Track Sewer System Extension application for the
subject project and assigned it permit number WQ0045174. However, we cannot
finish processing your application until the following corrections are made to the
application and/or additional information is provided:
Your answer to the second question #3 of Section VIII indicates the pump
station's firm capacity is 0.288 million gallons per day (MGD), but your answers
to the first question #3 and question #4 indicate the pump station will have three
200 gallon per minute (GPM) pumps. Since the firm capacity of the pump
station is "...the total GPM for the pump station with the largest pump out
of service.", as indicated in the bulleted note below the second question #3,
then 2 pumps * 200 GPM per pump * 1,440 minutes per day = 576,000 gallons
per day (GPD) or 0.576 MGD. Please verify this information and update your
answers in Section VIII accordingly.
The pump station upgrades include conversion to a triplex pump arrangement.
The pump station controls for the three pumps will be for a Lead -Lag -Standby

sequence of operation. With that arrangement, no more than two pumps
would be operating simultaneously — the third pump would be held in reserve
as backup in case one of the other two pumps fail. The predicted equilibrium
operating point for one pump alone is 200 GPM.... equivalent to the 0.288
MGD flow entered on the form. Also note that during high flow conditions with
two pumps operating simultaneously, the predicted equilibrium operating point
is 160 GPM per pump or 320 GPM combined. So, it is believed that the
submitted entry of 0.288 MGD is correct.
2. Your answer to Question #5 in Section IX indicates the project is subject to 404
and or 401 coverage, but you did NOT provide the permit number and status as
required. Please provide the 404/401 details as requested or on another
separate sheet.
At the time of submission of the FTA application, we had not received
responses from the PCN which had been submitted to USACE/DWR in
January. However, we have received confirmation from the USACE (on
02/21/24) that the project is covered under Nationwide Permit #3 — copy of
confirmation is attached..
Since the application pages that require correction do not require signature and are
completed by you, as the applicant, you can simply correct those pages and send
them to me in pdf format via email.
We will hold your application in abeyance until all corrections have been made and
additional information provided as requested above.
Thank you in advance for your cooperation.
Best Regards,
RonaCd C Boone, Environmental Program Consultant
North Carolina Deportment of Environmental Quality
Division of Water Resources, Winston-Salem Regional Office
450 West Hones Mill Rood, Suite 300, Winston-Solem, NC 27105
Office: [phone] / Cell: [phone]
ron.boone(@deq.nc.gov
DE Q2�
NORTH CAROLINA -
Department of Environmental Quality
Email correspondence to and from this address is subject to the North
Carolina Public Records Law and may be disclosed to third parties.