WQ0041335_Application (FTSE)_20191202

DWR
Didslon of ltesaee+tts
State of North Carorm
Department of Environmenta Quality
Division of Witter Resources
1SA NCAC AZT AM — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number- IA kO t f 13 (w becemoeted try DWRt
Al[ Items mast be completed or the ianliestlon of be releaed
1. APPLICANT INFORMATION: (jw
1. Applicant's name: t:duecombe Coumv (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State/County ® Municipal
3. Signature authority's name: Michael Matthews per l 5A NC Ac W I .y j, l
Title: Direr or
4. Applicant's mailing address: PO Box 10
City: Tarboro State: NC Zip: 27886-�
S. Applicant's contact information:
Phone number, G5_2) 823-7397 Email Addrcss michaelmatthc%;,-(a edeecomba o.com
11. PROJECT INFORMATION:
❑ Privately -Owned Public Utility
x,j us
❑ Other / V/v ">
(e f,.,
1. Project name: Utility Construction Plans — SR-320054
2. ApplicationlProject status: ❑ Proposed (New Permit) ® Existing PermitlProjcet
tf a modification, provide the existing permit munber: WQ00j5G and issued date: 215f2018
If new construction but part of a master plan, provide the existing permit number_ WQt10
3. County where proj= is located: Edgecombe
4, Approximate Coordinates (Decimal Degrees): Latitude: 35.9730011 Longitude:-77.7__ 15485'
5. Parcel ID (if applicable):
(or Parcel ID to closest downstream sewer)
111. CONSULTANT INFORMATION:
1. Professional Engineer Michael V Zaccardo.PE License Number. WQ21
Firm: Wetherill Engineering. Inc.
Mailing address: 1223 ]ones Franklin Road
City: Ralerg State: NC Zip: 27606
Phone numlxr (29) 851-Mn Email Address: mracraMoi6we1h=iIkmg,.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Edemmbe County Wastewater Treatment Plant Permit Number. NC 0030317
Owner Name: Edeecombe County
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ Downstream (Receiving) Sewer Sin, ff MI 1010 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s):
RA
A
U
Z
FORM: FtA 04-16 Page 1 of 3

VI. GENERAL RE.QUtREMENTS
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 Dcveloper's Oocraponal Agreement ( FORM? DEV) been attached?
❑ Yes []No ®N/A
3. !f the Applicant is a Hance ,re nrrs A.wciation, hm Ag C)vcrauunul Ag(SMnt FORM• HOAI been attached?
❑ Yes ❑No ®NIA
4. Origin of wastewater: (check all that apply):
® Residential Owned ❑ Retail (stores, centers, malls) ❑ Car Wash
❑ Residential Leased ❑ Retail with food preparadon/senic e ❑ 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 Attachment)
S. Nature: of wastewater: 100 0/9 Domestic/Commercial % Commercial
% Industrial (See 15A NCAC 021- .01Q(2n))
%Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 027 ,O k l 4((1? ❑ Yes ® No
i• If Yes. provide a EMof flow reduc . ' appmvAlletter
7. Summarize wastewater generated by project:
Establishment Type (see 21P.0114(())
Daily Design Flog a>
No. of Units
Flow
gav
GPD
gall
GPD
gal!
GPD
gay
GPD
gay
GPD
gal/
GPD
Total
GPD
a See 15A NCAC 02*1 .0114(b), (d). (c,H i I and (0Q for caveats to wastewater design flow rates (Le, 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 time Atlantic Intracoastal Waterway to be used as vacation rentals as defaud
in G.S. 42A-4).
b Per 1 SA NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A.-NCAC021.0 t 141 shall be
determined using available flow data, water using fixtures, occupancy or operation pattern;, and other measured data.
g. Wastewater generated by project GPD (per 15A NCAC 021 0114)
> 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

V11.
1.
GRAVITY SEWER DESIGN CRITERIA (If Applicable) -
Summarize gravity sewer to be permitted:
& C Grawk
y Section II & 1U of the MDC for Permitting of Gravity Sewers contains information related to design criteria
Y Section III contains information related to minim1un slopes for gravity sewer(s)
Y Oversizieg lines to meet tainlasum,hope requirement Is not allowed and a violation of the MDC
VIU. PUMP STATION DESIGN CRITERIA (IfApplieabk)-02'1-0303 & MDC eampStatloaslFor hiahLs):
CQAIPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitudm Lnu itude. -
3. Design flow of the pump station- millions gallons per day (firm capacity)
4. Operational points) of the prmop(s): gallons per minute at feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
size (iacben)
Length (feet)
Material
12"
613
R9 DIPS HDP>E,
Rd DIP
6. Power reliability in accordance with 15(% NCAC Q23 .03U51hH I is
❑ Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(hx I)(B)_
P Required for all pomp stations with an average daily flow greater than or equal to 15,000 gallons per day
Y 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(hx l)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry - ISA NCAC 02T .0305(hH l)(C):
1- 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.
Y 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

M SETBACKS & SEPARATIONS —(02B .0200 & ISA NCAC 02T .0305(I))-.
1. Does the project comply with all separations found in 15A NL(�.i' 02 UZUS &
i ISA NCAC 02T.030511) cnntainc minimimt .rnrtrtteinnc that ehull i r nm%AAnA 1'nr
❑ Yes ®No
Setback Parameter''
Separation Rc uire d
Stoma sewers and other utilities not listed below Ivertie:al)
24 inches
Water trains (vertical -water over sewer including in benched trenches)
18 inches
Water mains Ihorzzontal)
10 feet
R=Wmed water lines t vertical - reclaimed over sewer)
18 inches
Reclaimed water lines (horizontal - re claimcd over sewer)
2 feet
"Any private or public water supply source, including any wells, W S-1 waters of Class I or
Class H impounded reservoirs used as a source of drinking water
100 feet
"Waters classified WS (accept WS-1 or wS-v), B, SA, ORW, HQW, or SB from normal
hiA water for tide elevation and wetlands (see item Dt-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 nt
10 feet
Top slo • of embankment or carts of 2 feet or more vertical het ht
10 feet
Drainage system s and interceptur drains
5 fat
Anv swimming pools
10 feet
Final earth ruck (vertical)
36 inches
b 15A NCAC 02T,0305tr') contains alternatives where separations in 021.0305(fl cannot be achieved.
Y **Stream classifications can be identified using the Division's NC Surface Water Cla". 43ication% web -nag
If noncompliance with 021' 03 S r ILL see Section X of this application
2. Does the pmject comply with separation requirements for wetlands? (50 feel of separation) ® Yes ❑ No
Y Seethe Division's draft separation requirements for situations where separation cannot be meet
i No variance is required if the alternative design criteria specified is utilized in design and construction
Y As built documents should reference the: location of areas effected
3. Does the preje ct comply with all setbacks found in the river basin rules per I $A NCAC 0213 .U200? ®Yes ❑ No
Y This would include Trout Buffered Streams per 15A.NCAC 21020'
4. Does the project comply with an individual 404 Permit or any 401 Certifications! ® Yes [:]No
Y Wetland -related permits shall be requested obtained, and adhered to for projects that impact we lands or surface waters
Y Information can be obtained from the 4(1 I & buffer P ittmg grtticfi
5_ Does project comply with ISA N AC 02.1.010 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 I SA NCAC 021.040?, "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to mbanks that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes ® No
Y 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 ISA NCAC 02T.0403(a)(5) or the permiteers individual System -Wide Collection permit.
FORM: FfA 04-16 Page 4 of 5

x CERTIFICATIONS:
1. Does the submitted system comply with I i A NC A_ C 021, the Mmim m fug thc Pcnnitung vfeull]ySiatign+
noel lcprct lain;, t la y , and the Gravity wcr Molimutn De ien Cnicrip Hpitm version) as applicable?
® Yes ❑ No
If No, complete and submit the Variance/Alternadve Design Request application (VADC 10-14) and supporting documents for
review. Approval of the request Is required prior to submittal of the Fast Track ApaUcation and supporthie documents.
2. Professional Engineers Certification:
I,--- W 1G1l1-h9i'r W`...-Z-Wt!�67 d_ I attest that this application for
l JProfessions Engincer's name from Applica ion Item III.I.)
L, r,01 �rz - kezow/,c
tuts been reviewed by me and is accurate, complete and consistent with the information gpplied in the plans. spxiftcations,
engineering calculations, and all other supporting documentation to the best of my knowledge. I fiuthcr 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 Pemritting
of Pump Stations and Force Mains (latest version). Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials utter my signature and seal signifies that I have reviewed this material and
have judged it to be consistent with the proposed design.
MOTE — 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:
3. ApplicwWs Certification per 15A NCAC 02T .0106(b):
Cfin��j,
V.
6 l�
I, z,2:ke_ z attest that this application for
(Signature Authority's name & title from Application Item I3-)
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 arc 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. 1 also understand that if all requited 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
siatement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed S 10,000 as well as civil penalties up to S25,000 per violation"
Signature: Date: _
FORM: FrA 04-16 Page 5 of 5

. #-.
WETHERILL
ENGINEERING
1223 Jones Franklin Road tax Qttizlicy
Raleigh, North Carolina 27606 Tnvironoco
[phone] Fax [phone] Poi
www.wetherillenia.com
NCDENR tce
To: Raleigh Regional Office le1gh�egt���l Of
3800 Barrett Drive
Raleigh, NC 27609
ATTN: NCDENR Staff
Date: December 2, 2019
Attention: NCDENR Staff
Re: Force Main Sewer Relocation
Fast Track Application for Force Main Sewer
Relocation on Bridge No. 320054 over Tar River
on SR 1243 (Leggett Rd
NCDOT Project 17BPA.R.101
Edgecombe County, N.C.
We are sending to you lJ Enclosed ❑ Email O Under separate Cover
O Shop Drawing
O Submittal Date
❑ Progress Drawings
21 Prints O Tracings
❑ Specifications ❑ Documents
❑ Other
COPIES
DATE
NUMBER
2
11/26/19
Fast Track Application (FTA
04-16
2
10/25119
Engineers Report — Gravity
and Sewer Force Main
Relocation
1
11115 19
Check #23794 for $480
payable to NCDEQ for
application fee
2
11 /15/19
Color USGS map showing
site location and street view
2
11/26/19
Watershed Classification
Attachment (form WSCAS-
01-I5
These are transmitted as follows:
❑x For Approval
0 For Your Use
13 As Requested
0 For Review & Comment
Dear NCDENR-DWR Staff,
0 Approved as Submitted
0 Approved as Noted
13 Please Return
13 Other
Enclosed please find our Fast Track application package for the above referenced project.
If you have any questions during your review; do not hesitate to give us a call at 919-851-8077. Thanks
Date 12/2/19 Signed: 'fao e , /
Scott L. Kennedy 14

NC Dept of Environmental Quality
Raleigh
11�L
%IM36NOB
7ranspoddon
PlerreN
8*19WStrudwal
WE Oeslgn Your Torn now
CIVMee
Raleigh Regional Office
C°� °"°"
Swmft
October 24, 2019
Engineers Report
Sewer Force Main Relocation
Bridge No. 3200S4 over Tar River
On SR 1243 (Leggett Rd)
NCDOT Project # 17BP.4.R.101 Bridge No.54
Edgecombe County, NC
Sewer System Owner /Applicant:
Edgecombe County
PO Box 10
Tarboro, NC 27866
252-623-7387
Michael Matthews
Project Description
The purpose of this 613' t/- sanitary sewer force main relocation is due to the fact that NCDOT
will be replacing the existing bridge across Tar River and the existing sewage forcemain will be
In conflict with the new bridge construction. The location of this work is along SR 1243 (Leggett
Rd.) between SR 1250 (Old Rocky Mount Battleboro Rd) and SR 1252 (Dunbar Rd).
The improvements include the construction of approximately 184 LF of 12" RJ DIP and
429 LF of IT DR 9 (IPS) HDPE force main which will be placed via directional drill
method beneath Tar River. This work will be performed in accordance with the NCDOT
BMP for Construction and Maintenance Activities dated August 2003.
The new relocated 1Y RJ DIP and 12" DR 9 (DIPS) HDPE sanitary sewage force main
will be owned, operated, and maintained by Edgecombe County, N.C. Water and Sewer
Department. All construction will be In accordance with the latest standards and
specifications of the NCDOT, North Carolina Department of Transportation and the
NCDEQ, Division of Water Resources, Water Quality Permitting, PERCS Unit.
2223 Jones Franklln Road
Raleigh, NC 27606
Phone: [phone]
Fax: [phone]
1209 Floral Parkway
Wilmington, NC 29403

DWR
�� • LG e State of North Carolina
tz�t������ artment of Environment and Natural Resources
Division of Water Resources
Division of Water Resources Watershed Classification Attachment (WSCAS 01-15)
Along with this form, submit a color copy of a USGS Topographic Map to identify the project area and
waterbodies. Each map or maps must show the location of the sewer system and include location identifiers
where the system traverses over or near waterbodies. The map should have location In's for each different
waterbody and corresponding classifications should be recorded.
Include the completed form and map portions with the permit application for submittal to the appropriate review
agency. A list of the Division's regional offices, their county coverage, and contact information can be obtained
from: http://Portal.ncdenr.org/web/wd/home/ro
Location ID
Name of Waterbody'
River
Basin
Waterbody
Index No.
Waterbody
Classification
A
Tar River
Tar-
Pamlico
28-(69)
C;NSW
1 It unnamed, indicate "unnamed tributary to X", where X is the named waterbody to which the unnamed tributary joins.
1 certify that as a Registered Professional Engineer in the State of
North Carolina that l have diligently followed the Division's
instructions for classifying waterbodies and that the above
classifications are inclusive of the stated project complete and
correct to the best of my knowledge and belief.
PE Seal, Signature and Date
r
L _�� • w
21 Y " � b
• •o
r GINS
••q�r.v�° P V4
:r�,ZAGQti��
I Flafii;flsVVSt

Deck, Erin M
From: Michael Matthews <[e-mail]>
Sent: Monday, January 13, 2020 3:52 PM
To: 'Mike Zaccardo'
Cc: 'Scott L. Kennedy'; 'Greg Purvis'; Deck, Erin M
Subject: [External] RE: Utility Construction Plans-BR-320054 Fast Track Sewer Extension
• rnal a ii. l]o not 611W6 if arnpen atta ch merft unless you verify. Sendd-aU:suspiaiou's email as an attad ei tto
WQCS00356 is Edgecombe County's Permit #
NCO030317 is Rocky Mount's Permit ##
Erin, I'm fine with you updating the permit on our behalf.
Thanks,
Michael C. Matthews
Utilities Director-
Edgecombe Count3-
[phone] o / [phone] f
"Never tape down a fence until ,.ou hnow whi- it eras put up"- Robert Frost
From: Mike Zaccardo <[e-mail]>
Sent: Monday, January 13, 2020 3:42 PM
To: Michael Matthews <[e-mail]>
Cc: Scott L. Kennedy <[e-mail]>; Greg Purvis <[e-mail]>; Deck, Erin M
<[e-mail]>
Subject: RE: Utility Construction Plans-BR-320054 Fast Track Sewer Extension
Michael,
Scott and I just spoke to Erin Deck about her three comments. The third comment is on us, we checked the
wrong box by accident.
The Answer to IV: Facility Name -Tar River Regional WWTP, Permit Number NC: Nc 0030317 is correct
Owner Name: City of Rocky Mount
Erin will make these changes to the application with my and your email confirmation.
We need the following info for Section V.
Permit for the collection System - WQ�_??
- this would be an Edgecombe permit # and
System Wide collection System permit #: WQCS: - this will be a Rocky Mount #. Is it WQCS 00356?

Michael - If you can get us this information or possibly just touch base with Erin and clear up these last 2
Section IV items, we will be all set.
Erin —you have my permission to revise the application due to these few permit Ws changes. Also, please
check YES to the box in Section IX regarding "does the project comply with all separations found in 15A NCAC
02T.0305 (f) and (g)
Thank you for your time
Mike Zaccardo
From: Deck, Erin M <erin.deck ncdenr. ova
Sent: Monday, January 13, 2020 1:54 PM
To: michaelmatthews ed ecombeco.com; mzaccardo0wetherillene.com
Subject: Utility Construction Plans-BR-320054 Fast Track Sewer Extension
Good afternoon,
We are in the process of reviewing the subject application and require additional information.
Section IV. The permit number does not match the facility name. Please clarify where the waste will be treated.
Section V. was not filled out. A collection system permit number needs to be provided.
Section XI 1. "No" is checked for the project complying with separations found in 15A NCAC 021.035(f) & (g). Please
explain.
Once this information has been received with can move forward with our review. Thank you.
Erin Deck
Department of Environmental Quality
Division of Water Resources
Raleigh Regional Office
Office. 919-791-4258
Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be disclosed
to third parties.

State of North C;zroliaa
Mpuftent of Environmental Quality
W'R Division of Water Resources
Dkishm of Wader Re so-wc 15A NCAC 02T MN - FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 04-16 & SUPPORTING DOCUNIMA13ON
Application Number: tm bewm0cted by 0WRF
AD Item most be eom leted or the application will be rett reed
I. APPLICANT INFORMATION:
1. Applicant's name: Ednecombe County (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: Michael Matthews per l�& `lot.} : ,tti{w6tb1
Tile: Dirrctor
4. Applicant's mailing address: PO Box 10
City: Tarboro State: NC Zip: 27— 886-�
5. Applicant's contact information:
Phone number 2(iS2J 823-7387 Email Address: michaeltnatthcu _kMaiedLecomheco_com +
11. PROJECT INFORMATION: 0,
l . Project name: Utility Construction Plans — BR-320054 w
c
2. Application/Project status: ❑ Proposed Mew Permit) ® Existing Permit/Prrojeu
if a modification, provide the existing permit number: WQ00I�L6 and issued date: ZU/2018 o
O
If new construction but part of a master plan, provide the existing permit number. WQ00 ,r
3. County where project is located: FAQ w
0
4. Approximate Coordinates (Decimal Degrees); Latitude: 35.973001' Longitude: -77.7. 1 S4$5°
op
5. Parcel ID (if applicable): A ly
(or Parcel ID to closest downstream sewer) U
z
111. CONSULTANT INFORMATION:
1. Professional Engineer. Michael V Zaccardo.PE License Number. 022321
Firm: Wetherill Enstineemg. Inc.
Mailing address: 1223 Jones Franklin Road
City Raleigh State: NC Zip: 27§gk-_
Phone number. WD 81-M Email Address: mzaccardoi&wetherilleng.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: EdeecombS County Wastewater Treatment Plant Permit Number. NC 0030317
Owner Name: Edeecombe Count
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WV*"M-
1. Permit Number(s): WQ Downstream (Receiving) Sewer Size: (FM) 10 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s):
FORM: I`I'A 04-16 Page I of 5

VI. GENERAL REQUIREMLENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
[--]Yes ®No QN/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Oprrahonal Ayrcrntent (FORM, DEV) been attached?
❑ Yes [3No ®NIA
3. If the Applicant is a Home Promi-ty Owners A,,tiocia0on.] aM Owauunttl Aur ment (FORM HOA t been attached?
❑ Yes []No ®N/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 andlor Motels
® School / preschool I day cars ❑ Medical l dental / veterinary facilities ❑ Swimming Pool /Clubhouse
❑ Food and drink facilities ❑ Clttirch ❑ Swimming Pool/Filter Backwash
® Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 •A Domestic/Commemial % Commercial
% Industrial (See 15A NCAC 021' .0103(201)
-Is there a PrcMtment Program in effecC? ❑ Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 021 .0114(f)? ❑ Yes ® No
'i+ Ifprovide it pMof flow reduction approvA letter
7. Summarize wastewater generated by project:
Establishment Type (see 2YI'.0I 14f 1))
Daily Design Flow
No. of UnIb
Flow
gay
GPD
gay
GPD
gay
GPD
gay
GPD
Say
GPD
gay
GPD
Total
GPD
a See 15A NCAC 02'1 .01141b). (d). (c)(I 1 and {cltw) for caveats to wastewater design flow rates (it, minimum flow per
dwelling; proposed unlmown non-rmidential development uses; public access facilities located near high public use areas;
and residential property located south or cast of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in (;.S, 42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not idmtificd [in table 1 �611CP('02 LV 1141 shall be
determined using available flow data. water using fixtures, occupancy or operation pattertrs, and other measured data
8. Wastewater generated by project GPD (per 15A NCAC W 1 0114)
): 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 3

VIL GRAVITY SEWER DESIGN CRITERIA (If Applicable)- 027' .03U5 & MDC(Grnyy% 1SrMcrsl;
1. Summarize gravity sewer to be permitted:
Size (inches) I LuMM (feet) I Material
y Section U & M of the MIX for Permitting of Gravity Sewers contains infornation related to design criteria
Y Section ill contains information related to minimum slopes for gravity sewe(s)
Y OversDfag limes to meet minimum mope requh=ent Is not allowed and a violation of the MM
VHL PUMP STATION DESIGN CRITERIA (1f Applicabk) — 02T .0305 & MN Pu m Statiuus/For Mainsj:
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 bead (TDH)
5. Summarize the fa= main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
12"
613
R9 DIPS HDPI=
.PJ DIP
6. Power reliability in accordance with l5jkNCAC 42`I 03951hM 1 r
❑ Standby power soarcc or pump with automatic activation and tclrsrrctry - 15A NCAC 02T .0305(hx I XH)_
Y Required for all pomp stations with an average daily How greater than or equal to 15,000 gallons per day
Y Must be permanent to facility
Or if the pump station has an average daily How less than 15,000 gallons per day.
❑ Portable power source with manual activation, quick -connection receptacle and telemetry -15A NCAC 02T
_0305(h)( I)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry - 15A NCAC 02T .0305(h)(1)(C):
I- 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.
1- 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 04-1 b Page 3 of 5

IX SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC OZT ,0305(f)):
t_ Does the project comply with all separations found in 15A N( %C 021, .0305(f) & iel ❑ Yes ® No
Y 15A NCAC 02T.0305(1) contains minimum separations that shall he nmvided few Rawer woprnc-
Setback Parameter*
Separation Etc uired
Storm sewers and other utilities not listed below (vertical)
24 inches
Water mains (vertical -water over sewer includin K in benched trenches)
1$ inches
Water mains (horizontal)
10 feet
Reclaimed water lines 1 vertical - reclaimed over sewer)
I a inches
Reclaimed waterlines (horizontal - reclaimed oversewed
2 feet
**Any private or public water supply source, including any wells, WS-1 waters of Class I or
Class II impounded reservoirs used as a source of drinking water
100 feet
"Waters classified WS (except WS-1 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
Anv building foundation
5 feet
Any basement
10 feet
Top slo c of embankment or cuts of 2 feet or more vertical height
10 feet
Drama a sweets and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade ( vertical)
36 inches
)- 15A NCAC 02T,0305(s!1 contains alternatives where separations in 021 Wg5l cannot be achieved
**Stream classifications can be identified using the Division's biC Surface WgiCE Classifs ations WCbppge
Y if noncompliance with 021'.0305(f) or 11). see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ®Yes ❑ No
Y Seethe 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
Y As built documents should reference the location of areas effected
3. Does the project comply with all setbacks found in the river basin rules per 15A NQAC 0)200? ® Yes ❑ No
);, This would include Trout Buffered Streams per 12A h!CAC 213.0--102
4. Dogs the project comply with an individual 404 Permit or any 401 Certifications? ®Yes ❑ No
Y Wetland -related permits shall be requested, obtained, and adhered to for projects that impact wetlands or surface waters
'- Information can be obtained from the iQl & Buffer PWAiMg BrnAch
5. Does project comply with 15A NCAC 0211.010510(6) (additional permits/certifications)? ® Yes ❑ No
Per 15A_NCAC_ 02T Q 105(c)(61, 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 dependcot 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 021.041)2, "high -priority sewer'' means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streambanks that is subject to erasion that undermines or deteriorates the sewer.
❑ Yes ® No
Y If yes, include an attachment with details for each line, including type (aerial litre, size, material, and location).
Nigh priority lines shall be Inspected by the permittee or Its representative at least once every six-mentlts and im ilmdons
documented per 15A NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit.
FORM: FI'A 04-16 Page 4 of 5

X. CERTIFICATIONS:
t. Does the submitted system comply with I SA NCAC 021, the Mrnccn m .i n C11100 LIE tk 1' n , ' ti %
and 1 rce MaIns (1att.q1.vgrsionJ. and the 6 d t w _berjimupi PkstenSntsna tlatcst ymigol as applicable?
® Yes ❑ No
If No, complete and submit the VariancdAltemative Design Request application (VADC 10-14) and supporting documents for
review. Approval of the rr uest Is re aired prior to submittal of the Fast Track Application and supportine documents.
2. Professional Engineer's Certification:
6 j6,149L �� G QAg� attest that this application for
JProfessionqj Engincer's name from Applica ion Item 111.1.) A _
has been reviewed by me and IS accurate, complete and consistent with the information sdpphed in the plans, specifications,
enginecring 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 1 have reviewed this material and
have judgesd 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 S25,000 per violation.
North Carolina Professional Engineer's seal, signature, and date:
t• OF 1
3. Applicant's Certification per 15A NCAC 02T .01065(b)=
1, ��l1el Z ,�l�fS -- — attest that this application for
(Signature Authority's name & title from Application Item I3,)
has been reviewed by the 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 requited supporting documentation and attachments are not included, this
application package is subject to being returned as incomplete. I understand that any disrlmrge 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 pans of this application package are not completed and that if
all required supposing 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 143-215.6E, any person who knowingly makes any false
stwcmcnt, r W==tation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed S10,000 as well as civil penalties up to S25,000 per violation.
Signature: _-� _ — Late: //�
FORM: FTA 04-16 Page 5 of 5

��E_N SNEERING
1223 Jones Franklin Road
Raleigh, North Carolina 27606
[phone] Fax [phone]
www.wetherilleng.com NC Dept of Environmental Qua
To: NCDENR
Raleigh Regional Office
3800 Barrett Drive
Raleigh, NC 27609
ATTN: NCDENR Staff
galeigh Regional Oiftee
Date: December 2, 2019
Attention: NCDENR Staff
Re: Force Main Sewer Relocation
Fast Track Application for Force Main Sewer
Relocation on Bridge No. 320054 over Tar River
on SR 1243 (Leggett Rd
NCDOT Project 17BPA.R.101
Edgecombe County, N.C.
We are sending to you ❑X Enclosed ❑ Email 0 Under separate Cover
0 Shop Drawing
0 Submittal Date
0 Progress Drawings
1] Prints O Tracings
❑ Specifications ❑ Documents
❑ Other
COPIES
DATE
NUMBER
2
11/26/19
Fast Track Application (FTA
04-16
2
10/25/19
Engineers Report ^ Gravity
and Sewer Force Main
Relocation
1
11/I5/19
Check #23794 for $480
payable to NCDEQ for
application fee
2
11/15/19
Color USGS map showing
site location and street view
2
11/26/19
Watershed Classification
Attachment (form W SCAS-
OI-15
These are transmitted as follows:
0 For Approval 0 Approved as Submitted
0 For Your Use 0 Approved as Noted
0 As Requested 0 Please Return
0 For Review & Comment 0 Other
Dear NCDENR-DWR Staff,
Enclosed please find our Fast Track application package for the above referenced project.
If you have any questions during your review; do not hesitate to give us a call at 919-85I -8077. Thanks
Date 12/2/19 Signed:
Scott L. Kennedy

., fir,
Raleigh
Transportation
��
Planning
Bridge/Structural
WE Design Your Tomorrow _ ..
Civil/Site
Consiruction Observation
Surveying
ram —
October 24, 2019
Ennineers Report
Sewer Force Main Relocation
Bridge No. 320054 over Tar River
On SR 1243 (Leggett Rd)
NCDOT Project # 17BP.4.R.101 Bridge No.54
Edgecombe County, NC
Sewer System Owner /Applicant:
Edgecombe County
PO Box 10
Tarboro, NC 27866
252-823-7387
Michael Matthews
Project Description
C
The purpose of this 613' +/- sanitary sewer force main relocation is due to the fact that NCDOT
will be replacing the existing bridge across Tar River and the existing sewage forcemain will be
in conflict with the new bridge construction. The location of this work is along SR 1243 (Leggett
Rd.) between SR 1250 (Old Rocky Mount Battleboro Rd) and SR 1252 (Dunbar Rd).
The improvements include the construction of approximately 184 LF of 12" RJ DIP and
429 LF of 12" DR 9 (IPS) HDPE force main which will be placed via directional drill
method beneath Tar River. This work will be performed in accordance with the NCDOT
BMP for Construction and Maintenance Activities dated August 2003.
The new relocated 12" RJ DIP and 12" DR 9 (DIPS) HDPE sanitary sewage force main
will be owned, operated, and maintained by Edgecombe County, N.C. Water and Sewer
Department. All construction will be in accordance with the latest standards and
specifications of the NCDOT, North Carolina Department of Transportation and the
NCDEQ, Division of Water Resources, Water Quality Permitting, PERCS Unit.
1223 Jones Franklin Road Phone: [phone] Floral Parkway
Raleigh, NC 27606 Fax: [phone] Wilmington, NC 28403

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State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Division of Water Resources Watershed Classification Attachment (WSCAS 01-15)
Along with this form, submit a color copy of a USGS Topographic Map to identify the project area and
waterbodies. Each map or maps must show the location of the sewer system and include location identifiers
where the system traverses over or near waterbodies. The map should have location ID's for each different
waterbody and corresponding classifications should be recorded.
Include the completed form and map portions with the permit application for submittal to the appropriate review
agency. A list of the Division's regional offices, their county coverage, and contact information can be obtained
from: httr)://Dortal.ncdenr.ore/web/wa/home/ro
Location ID
Name of Waterbody'
River
Basin
Waterbody
Index No.
Waterbody
Classification
A
Tar River
Tar.
Pamltcp
28-(69)
C-.NSW
I If unnamed, indicate "unnamed tributary to X", where X is the named waterbody to which the unnamed tributary joins
l certify that as a Registered Professional Engineer in the State of
North Carolina that l have diligently followed the Division's
instructions for classifying waterbodies and that the above
classifications are inclusive of the stated project, complete and
correct to the best of my knowledge and belief.
PS Seal, Signature and Date