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HomeMy WebLinkAboutWQ0041204_Application (FTSE)_20190925State of North Carolina DWR Department of Environmental Quality Division of Water Resources 15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION Division of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION Application Number: � W l2M (to be completed by DWR) All items must be completed or the application will be returned I. APPLICANT INFORMATION: 1. Applicant's name: Town of Mocksville (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: Matt Settlemyer per 15A NCAC 02T .0106(b) NC Deoartrrrint. of Title: Town Manage Environmental Quality 4. Applicant's mailing address: 171 S. Clement Street Reed'. ed City: Mocksville State: NC Zip: 27028-_ SET 2 0 2010 5. Applicant's contact information: Winston S21em Phone number: (336) 753-6701 Email Address: msettlemver(o,mocksvillenc.Qov RO&i )Ei v -i ice 1. Project name: Special Event Services 2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project If a modification, provide the existing permit number: W000 and issued date: If new construction but part of a master plan, provide the existing permit number: W000 3. County where project is located: Davie County 4. Approximate Coordinates (Decimal Degrees): Latitude: 35.912816' Longitude:-80.586983' 5. Parcel ID (if applicable): 5729506809 (or Parcel ID to closest downstream sewer) III. CONSULTANT INFORMATION: 1. Professional Engineer: Brian Crafford, P.E. License Number:044053 Firm: Stimmel Associates, P.A. Mailing address: 601 N. Trade St. City: Winston-Salem State: NC Zip: 27101- Phone number: 336) 723-1067 Email Address: beraffordAstimmelua.com IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION: 1. Facility Name: Cooleemee W WTP Permit Number: NC 0024872 Owner Name: Davie County V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF): 1. Permit Number(s): WQ Downstream (Receiving) Sewer Size: 8 inch System Wide Collection System Permit Number(s) (if applicable): WQCSCS00156 Owner Name(s): Town of Mocksville FORM: FTA 04-16 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 NN/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 NN/A 3. If the Applicant is a Home/Property Owners' Association, has an Operational Agreement (FORM: HOA) been attached? ❑ Yes ❑No NN/A 4. Origin of wastewater: (check all that apply): ❑ Residential 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 N Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment) 5. Nature of wastewater: 100 % Domestic/Commercial % Commercial % Industrial (See 15A NCAC 02T .0103(20)) "Is there a Pretreatment Program in effect? ❑ Yes ❑ No 6. Has a flow reduction been approved under 15A NCAC 02T .0114(fl? ❑ Yes N No ➢ If yes, provide a copy of flow reduction approval letter 7. Summarize wastewater generated by project: Establishment Type (see 02T.0114(fl) Daily Design Flow',b No. of Units Flow gal/ GPD gal/ GPD gal/ GPD gal/ GPD gal/ GPD gal/ GPD Total 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-41. b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.01141 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, indicate why: N Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line ❑ Flow has already been allocated in Permit Number: ❑ Rehabilitation or replacement of existing sewer with no new flow expected N Other (Explain): Flow for this project is requested as part of the Private Sewer Extension Application FORM: ETA 04-16 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 8 210 DU PVC ➢ Section II & III 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 requirement is not allowed and a violation of the MDC VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains): COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT 1. Pump station number or name 2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: - ° 3. Design flow of the pump station: millions gallons per day (firm capacity) 4. Operational point(s) of the pump(s): _ gallons per minute at feet total dynamic head (TDH) 5. Summarize the force main to be permitted (for this Pump Station): Size (inches) Length (feet) Material 6. Power reliability in accoFdance with 15A NCAC 02T .0305(h)(1): ❑ Standby power source or pump with automatic activation and telemetry -15A NCAC 02T .0305(h)(1)(13): ➢ 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 Or if the pump station has an average daily flow less than 15,000 gallons per day: ❑ Portable power source with manual activation, quick -connection receptacle and telemetry - 15A NCAC 02T .0305(h)(1)(C) or ❑ Portable pumping unit with plugged emergency pump connection and telemetry - 15A NCAC 02T .0305(h)(1)(C): ➢ It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant (draft agreement) 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 in the case of a multiple station power outage. FORM: FTA 04-16 Page 3 of 5 IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(t)): 1. Does the project comply with all separations found in 15A NCAC 02T .0305(fl & (g) ® Yes ❑ No ➢ 15A NCAC. 02T.0305(fl contains minimum separations that shall be provided for sewer systems: Setback Parameter* Separation Required Storm sewers and other utilities not listed below vertical 24 inches Water mains vertical -water over sewer 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-I waters of Class I or Class Il impounded reservoirs used as a source of drinking water 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 see item IX.2 50 feet **Any other stream, lake, impoundment, or ground water lowering and surface drainage ditches 10 feet Any building foundation 5 feet Any basement 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 ➢ 15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(fl cannot be achieved. ➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webpage ➢ If noncompliance with 02T.0305(fl or (g), see Section X of this application 2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ® Yes ❑ No ❑ N/A ➢ See the Division's draft separation requirements for situations where separation cannot be meet ➢ No variance is required if the alternative design criteria specified is utilized in design and construction ➢ As built documents should reference the location of areas effected 3. Does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ®Yes ❑ No ❑ N/A ➢ This would include Trout Buffered Streams per 15A NCAC 2B.0202 4. Does the project require coverage/authorization under a 404 Nationwide or ❑ Yes ® No individual permits or 401 Water Quality Certifications? ➢ Information can be obtained from the 401 & Buffer Permitting Brunch 5. 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 are 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.). 6. Does this project include any sewer collection lines that are deemed "high -priority?" Per 15A NCAC 02T.0402, "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer. [:]Yes ® No ❑ N/A ➢ 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 permitee's individual System -Wide Collection permit. FORM: FTA 04-16 Page 4 of 5 X. CERTIFICATIONS: 1. Does the submitted system comply with 15A NCAC 021', the Minimum Design Criteria for the PermittingOf f Pump Stations and Force Mains (latest version), and the Gravity Sewer Minimum Design Criteria (latest version) as applicable? ® Yes ❑ No If No, complete and submit the Variance/Alternative Design Request application (VADC 10-14) and supporting documents for review. Approval of the request is required prior to submittal of the Fast Track Application and supporting documents 2. Professional Engineer's Certification: that this application for Engineer's name from Application Item I1I.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, Gravity Sewer 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 I have reviewed this material and havejudged 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. North Carolina Professional Engineer's seal, signature, and date: a SEAL / � . r 044053 dp' W. cihob_" a 3. Applicant's Certification per 15A NCAC 02T .0106(b): attest that this application for & title fi•onn Application Item 1.3.) has been reviewed by me and is accurate and complete to the best of illy 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.irclude 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 he guilty of a Class 2 misdemeanor, which may include a fine not to exceed $10,000 as well ns civil penalties up to $25,000 per violation. SignatureDate: : UV q 3) 01 rOPhA• PTA ndJr Poor S of S 41 A, t m V N U uosipew__ 0 w O m O O 0 NEW COVE Wil PAYTOTHE NODE ORDER OF Four Hundred Ei NCDEQ 450 W.I Suites30 Winston% MEMO Public Sev NEW COVENANT PARTNERS IX LLC NCDEQ loll Rd'Macksville N 9/13/2019 Public Sewer Application Fee for NCP IX Angel Knoll First Bank Public Sewer - NCP IX Angel Knoll Rd Mocksvill 1014 C 480.00 480.00