WQ0041257_Application (FTSE)_20191009

State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
I5A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: 1 (lo becomptetLd by DWR)
All items must be completed or the aQplication will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: City of Oxford (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ GeneraI Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ® Municipal ❑ Other
3. Signature authority's name: Amy Ratliff PE per .1.5.E NCAC 02T .0106(b1
Title: City Engineer
4. Applicant's mailing address: PO Box 1307
City: Oxford State: NC Zip: 27565-�'
5. Applicant's contact information:
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Phone number: [phone] Email Address: aratliff(doxfordnc.org
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II. PROJECT INFORMATION:
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1. Project name: 2018 Sewer Line Replacements
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2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
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If a modification, provide the existing permit number: WQ00 and issued date:
If new construction but part of a master plan, provide the existing permit number: WQ00�
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3. County where project is located: Granville
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4. Approximate Coordinates (Decimal Degrees): Latitude: 36.310914` Longitude:-78.588615"
5. Parcel ID (if applicable):
(or Parcel ID to closest downstream sewer)
111. CONSULTANT INFORMATION:
1. Professional Engineer: Bill Roark, PE License Number: 027788
Firm: McGill Associates
Mailing address: 5400 Trinity Road, Suite 107
City: Raleigh State: NC Zip: 27607-
Phone number: [phone] Email Address: bill.roark(a.mc011eneineers.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Cityof Oxford Wastewater Treatment Plant Permit Number: NCO025054
Owner Name: City of Oxford
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
I. Permit Number(s): WQ Downstream (Receiving) Sewer Size: inch
System Wide Collection System PermitNumber(s) (ifappiicab[e): WQCS00086
Owner Name(s): Ci of Oxford
FORM: FTA 04-16 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 ZWA
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Aereement (FORNNI;_DEV been attached?
❑ Yes []No ®N.A
3. If the Applicant is a Home?Propert,v Owners' Association, has an OperaiionaI Aereement (FORM: H. OA) been attached'?
❑ Yes ❑No ON -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 r preschooI / day care ® Medical dental / veterinary facilities ® Swimming Pool iClubhouse
® Food and drink facilities ® Church ® Swimming PooI/Filter Backwash
® Businesses I offices / factories ® Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: 85 % Domestic.iCommercial 5 % Commercial
10 % Industrial (S�ee_15A NCAC 02T .0103(20))
1 b Is there a Pretreatment Program in effect? ® Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 02T .0114I(? ❑ Yes ® No
If yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 021.01140
Daily Design Flow
No. of Units
Flow
gall
GPD
gall
GPD
gaU
GPD
gal/
GPD
gall
GPD
gal?
GPD
L7To7t
GPD
a See 15A NCAC 02T .01 14Lb)jd), (00 ) and (eH3) 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.01141 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 .01.14)
Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
❑ 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
❑ Other (Explain):
FORM. FTA 04-16 Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & NIDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8„
2975
12816
DIP
PVC
5
D Section II & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
D Section III contains information related to minimum slopes for gravity sewer(s)
D 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 Stationsr 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 accordance with 15A NCAC 02`I' .0305(hh I x:
❑ Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(h)(1)(B)t
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(f)):
1. Does the project comply with all separations found in 15A NCAC 02T .0305i Q & (c} ® Yes [:]No
D 15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer syslems:
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 II 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 ools
10 feet
Final earth grade vertical
36 inches
t5A FCAC 02T.0305(g) contains alternatives where separations in 02T,0305t t7 cannot be achieved.
t **Stream classifications can be identified using the Division's Nt<' Surface Water Classifications webpag*e
If noncompliance with 02T.030 or ► 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?
D Information can be obtained from the 401 & Buffer Permittine Branch
5. Does project comply with 15A NCAC 02T.0105(c1(6) (additional permits/certifications)? ® Yes ElNo
Per 115A NCAC 02T.0105(cli61, 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) $A N{'AC 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:
i. Does the submitted system comply with 1. A NCAC 02T, the Minimum De sig ('riteria for the Permittin of Pump Stations
and Force Mains i latest version, and the Gr vit Seaver 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 re uest is required prior to submittal of the Fast Track Application and supporting documents.
2. Professional Engineer's Certification:
I, xlkjt J. LWL - _— attest that this application for
(Pro essional Engineer's nae from Application Item III.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
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.
North Carolina Professional Engineer's seal, signature, and date:
SEAL. r _
027788 1=
VJ RO,, . . �"W.JAA
3. Applicant's Certification per 15A NCAC 02T ,0106(b):
i, w.'1 It Le FF P4- ' & t7-? f- u&.t.�, c!L attest that this application for
— e!
(Signature Authority's name & title from Application Item I.3.)
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 143-21 -6and 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. °I IZG 1) `I
FORM: FTA 04-16 Page 5 of 5

IPrA NC Dept of Environmental QualitySha in Communities To ether
Ii1CJ I11 � � g
OCT - 9 Zug
Raleigh Regional Office
City of Oxford, NC - USGS Quad Map - 2016
MCGILL ASSOCIATES 5400 TRINITY ROAD, SUITE 107, RALEIGH, NC 27607 J 919.378,9111 { MCGILLASSOCIATES.COM

October 7, 2019
Danny Smith
Raleigh Regional Office
North Carolina Department of Environmental Quality
3800 Barrett Drive
Raleigh, NC 27609
RE: Fast Track Sewer Extension Application
2018 Sewer Line Replacements
Granville County, North Carolina
Dear Mr. Smith:
Shaping Communities Together
NC Dept of Environmental Quality
OCT -- 9 200
Raleigh Regional 00I.ce
Please find enclosed for your review one (1) original and one (1) copy of a Fast -Track Sewer System
Extension Application package for the above referenced project. Also enclosed is a check in the
amount of $480.00 to cover the application fee.
This project includes the replacement of existing, aged sewer lines with new lines of modem
materials. The new lines will be installed using a combination of alternate route, and remove and
replace in the same location.
As the System will replace an existing aerial crossing with a new one, we have included the plan
sheet that include the section of line. The full plan set is not included, but can be provided if so
desired.
As the project will replace existing lines, it will not add any additional flow to the system.
If you have any questions or require additional information regarding this application, please feel free
to contact me at [phone].
Sincerely,
McGILL ASSOCIATES, P.A.
eilloark, PE, CPSWQ
Office Manager 1 Principal
Sewer Permit — Cover Letter
MCGILL ASSOCIATES 5400 TRINITY ROAD, SUITE 107, RALEIGH, NC 27607 { 919.378.9111 I MCGILLASSOCIATES.COM

Cashion, Ted
From: Spenser Meekins <[e-mail]>
Sent: Tuesday, November 19, 2019 9:41 AM
To: Cashion, Ted
Cc: [e-mail]'; Bill Roark
Subject: [External] RE: 2018 sewer line replacements fast track sewer extension application
(External email Do not cllak links or iRen attaahme-n-ts unless you verify, Send all suspldous emal as . . attachrrtent to
Ted,
For the 2018 project, there are 6 separate outfalls. See the table below for the approximate ages and
downstream size of the sewer lines.
AGE ears
Diameter inches
Lewis St.
—43
8"
Hillsboro St.
>72
8"
GilliamlWilliamsboro St.
>72
8"
Main St.
>72
10"
College St.
>72
8"
College St Medical Center
9
8"
Thanks,
LJ
ommashapingc
Mcgili Ommunit lCz
iagether
Spenser Meekins, El
Engineering Associate
McGill Associates, P.A.
5400 Trinity Road, Suite 107, Raleigh, NC 27607
T 919,378.9111
[e-mail]
mcgillassociates.com
We launched a refreshed brand Please note email / web address changes above.
From: Bill Roark <[e-mail]>
Sent: Tuesday, November 19, 2019 8:52 AM
To: Spenser Meekins <[e-mail]>
Cc:'[e-mail]' <[e-mail]>
Subject: FW: 2018 sewer line replacements fast track sewer extension application
Spenser,
Can you take care of these questions from Ted?
Thanks,

mcLgdl
Bill Roark, PE, CPSWQ
Raleigh Office Manager I Prmcipa
McGill Associates, P.A.
5400 Trinity Road, Su'te 107, Raleigh, NC 27607
T 919.378.9111
C 919.338.6615
bill. roark me lllassociates.com
mcgillassoc; ates.com
We launched a refreshed brand. Please note email / web address changes above.
From: Cashion, Ted <ted.cashion ncdenr. ov>
Sent: Tuesday, November 19, 2019 8:28 AM
To: Amy Ratliff (aratliff oxfordnc.or ) <aratliff oxfordnc.or >; Bill Roark <Bill.Roark me illassociates.com>
Cc: Robinson, Jason <as [e-mail]>
Subject: 2018 sewer line replacements fast track sewer extension application
Hi Amy and Bill,
We are reviewing the subject application. Item V of the application was not fully completed. Please provide:
The downstream sewer permit number ( if not known, include the approximate age of the line)
The downstream sewer size
Thx
ted
Ted Cashion
Water Quality Regional Operations
Division of Water Resources
NC Department of Environmental Quality
Raleigh Regional Office
919-791-4254
ted.cashion(@ncdenr.eov
1628 Mail Service Center
Raleigh, NC 27699-1628
3800 Barrett Drive
Raleigh, NC 27609

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