WQ0041334_Application (FTSE)_20191202

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
ISA NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number. 8 (10 be compicled by DWR)
All items must be completed or the a Iication will be returned
L APPLICANT INFORMATION:
1. Applicant's name: Benson Public Works (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual
❑ Corporation ❑General Partnership
❑ Federal ❑ State/County ® Municipal
3. Signature authority's name: Tim Robbins per t.4 Nam. Cp2_T_Ol 06(b1
Title: Public 1Jtilities Director
4. Applicant's mailing address: 303 E, Church Street
City: Benson State: NC Zip: 27504-
5. Applicant's contact information:
Phone number: (919} 894-3553 Email Address: 1r_obbins0,towUDfbenson.com
II. PROJECT INFORMATION:
❑ PrivateIy-Owned Public Utility
❑ Other
I . Project name: West Hales Street Subdivision
2. Application/Project status: ® Proposed (New Permit
❑Existing PermitlProject
If a modification, provide the existing permit number: W 00
Q _ and issued date: _
If new construction but part of a master plan, provide the existing permit number: WQOO _
3. County where project is located: Johnston
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.3878- Longitude:-78.5475
5. Parcel ID (if applicable): 153910-46-5596
(or Parcel ID to closest downstream sewer)
M. CONSULTANT INFORMATION:
I. Professional Engineer: C. cott Brown PE License Number: 027452
Firm: 4D Site oiutions Inc
Mailing address: 409 Chica o Drive Suite 112
City: Fa etteviile State: NC Zip: 28306-_
Phone number: (910a 426-6777 Email Address: ALMM@kgLesoluti ns.eom
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1 Facility Name. Town of Benson WWTP Permit Number: NCO 020389
Owner Name. T wn of Bens n
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
_a,
O
E73
r_
o
0
w
o
nq
�
U
z
I. Permit Number(s): W CSo0109 Downstream (Receiving) Sewer Size: 8 inch
System 1Vide C'nllecti4j n!iylem Permit Ntiim�er{�3p,li ab : WQCS 00 4
Owner Narne(s)- I r f f" ,.�,
me(s): T�ucFBenwo� �;tZ �`
FORM: FTA 04-16
Page 1 of 5

VI. GENERAL REQUIREMENTS
L If the Applicant is a Privately -Owned Public Wility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑No ®NiA
2. If the Applicant is a Developer of lots to be sold, has a Developer's Oneratiana! Azrerment f FORM: DE V) been attached?
❑ Yes ❑No ®N'A
3. If the Applicant is a I tome Pro ert Owners' Association has an O erational A *reement FORM: HOA been attached?
❑ Yes [--]No ®N A
4. Origin of wastewater: (check all that apply):
® Residential Owned ❑ Retail (stores, centers, malls)
❑ Residential Leased ❑Car Wash
❑ Retail with food preparation service ❑ Hotel and/or Motels
❑ School a preschool i day care ❑ Medical! dental / veterinary facilities ❑ Swimming Pool,Clubhouse
❑ Food and drink facilities ❑ Church
❑ Businesses i offices i factories ❑ Swimming PoollFilter Backwash
❑ 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 ? ❑ Yes ® No
If ves rovide a cnny of flow reduction a roval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T�y
3 be
homes
Daily Design Flow Ch INo. of Units' Flow
360 galiday
32 11,520 GPD
gal!
GPD
gal/
GPD
gall
GPD
gal..'GPD
gal/
GPD
Total 11,520 GPD
a See 15A NCAC 02T 0114fb d (e I and te]f2] 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.01 14) shall
be determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 11.520 GPD (per 15A NCAC 02T 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 5

VIL GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC(Gravity Sewers
I . Summarize gravity sewer to be permitted -
Size (inches)
Length (feet)
Material
g
959.1
PVC
8°
77.5
DI
Section II & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
Z 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
VE9- PUMP STATION DESIGN CRITERIA or Applicable) — 02T .0305 & MDC (Pum n 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) j Length (feet) I Material
6. Power reliability in accordance with 15A N{; A 02T .0_.. �05{ham:
❑ Standby power source or pump with 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
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.
t If the portable power source or pump is dedicated to multiple pump stations, an evaluation of aII 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(Q):
I. Does the project comply with all separations found in I SAA(,
AC p T , 0305 f
➢ 15A NCAC 02T.0305 contains minimum se arations that shall be rovided for sewer s stems. ®Yes ❑ No
Setback Parameter* Se aration Re uired
Storm sewers and other utilities not listed below vertical
Water mains vertical -water over sewer including in benched trenches 24 inches
Water mains horizontal 18 inches
r
laimed water lines vertical - reclaimed over sewer 10 feet
laimed water lines horizontal - reclaimed over sewer 1$ inches
n p 2 feet
y private or ublic water supply source, including any wells, WS-I waters of Class I or
s II im ounded reservoirs used as a soof drinkin waterWaters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal 100 feet
high water or tide elevation and wetlands 11see item IXmm..
Any other stream, lake, impoundmentor ground water lowering and surface drainage 50 feet
ditches ,
buildini, foundation
10 feet
basement
5 feet
slo a of embankment or cuts of 2 feet or more vertical het ht
na e systems and interce for drains
swimmingpools EJ
10 feet
10 feet
5 feet
earth wade lvertiesill
10 feet
15A NC NE0002 36 inches
__3� contains alternatives where separations in 0 T.0 0
"Stream classifications can be identified using the Division's N4C Sur ace cannot
aosifc achievep
If noncompliance with Q2T`0� 03) or see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation)
See the Division's draft separation requirements for situations where separation cannot be meet Yes El Na ❑ N/A
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 wmm ® Yes ❑ No [f N/A
This would include Trout Suffered Streams per 1KS.A2,ffi 0202
4. Does the project require coveragetauthorization under a 404 Nationwide or individual permits or 401 Water Quality Certifications? ❑Yes ®No
Information can be obtained from the 401 & B fifer IP rmit i 8
5. Does project comply with 15A NCAC 02T.0]0 ) (additional permits/certifications)?
Per.l.SA I (' 02T.Oi0 "c §), directly related environmental permits or certification applications a bein2 Yes g prep No
ared,
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 N �O?,T OqO , "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 NIA
> 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 I5A NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit.
FORM- FTA 04-16
Page 4 of 5 [1

X. CERTIFICATIONS:
Does the submitted system comply with 15A t;CA . 07 r, the AMiniTI! Desi riteri for the PermittinI.g 0Qk ni talions
and Force sins lairs[ k er5ipn and the Gr.Ly Sewer linim Desi Crit rip Iat versi as applicable?
® Yes ❑ No
If No, complete and submit the Variance/Alternative Design Request application (VADC 10-14) and supporting documents
for review. AoDroval of the request is required prior to submittal of the Fast Track Application and sunnorting
documents.
2. Professional Engineer's Certification:
I, S46* r6W N attest that this application for
(Professional Engineer's name 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 (Iatest 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_-,<<,r,,,,_
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b);
ro._Kobb; n 1% Pu6l, c U+i I Tf
(Signature Authority's name & title
Application Item I.3.)
1 •Fes • ..0
EAL
027452
O�TT �BaO 1,,1
attest that this application for
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 143-215.6A and 14 -215. 13, 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:
�l �� Date: 1 Zo
FORM. FTA 04-16 Page 5 of 5

Tn it r
e!
%a fix.
Dlvlsion of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: o tad J if c,
Project Name for which flow is being requested: 0 Qsk
More than one FTSE may he required for a single project if the owner of the WWTP is not responsible for all pump
stations along the route of the proposed wastervater,low.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: jo, f 3a„s.„ wwr
b. WWTP Facility Permit #: Coo 2.0 S
fl
C. WWTP facility's permitted flow All f1'ows are in MGD
d. Estimated obligated flow not et tributary M
Y ary to the WWTP 2CAD
e. WWTP facility's actual avg. flow b
Cb
f. Total flow for this specific request g. Total actual and obligated flows to the facility S. ' r, I M Crh
i 1 Cl b
h. Percent of permitted flow used p
II. 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: N/A
(A)
Design
(B)
(C)
(D)'(B+C) (E)=(A-D)
Pump
Station
Pump
Station
Average
Firm Daily FIow**
Approx.
Obligated,
Not Yet
Total Current
(Name or
Number)
Permit
No.
Capacity, * (Firm ;` pfl,
Current
Avg. Daily
Tributary
Daily Flow,
Flow Plus
Obligated Available
MGD MGD
1
Flow, MGD
MGD
Flow Capacity***
The Firm Capacity (design flow) of 90y pump station as the maxima~ 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 Iocated
between the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): T,, w, f &Asus, r i
Downstream Permit Number: wacs o01 D
Page 1 of 6
FTSE 10- 18

rtff
III. Certification Statement:
I [;,.. ?;L6,; - 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.
Signing Official Signature
341-C I I �e--r 1recAl r
Title of Signing Official
Page 2 of 6
ETSE IO-IS

it � • � iic� f 'I �J 1' �� � � +' r r. ti. � �� i �•
In
h 70,
of }, � I • [[[ + + + i�f +�. l� •� +}F Y -'�.S !'
.47 %/. � '
•YS '�. I �1r � it , _� ..� ��..
' + .. 3
' � '; � � . ✓ 4 •mil. //
West Hales Street •r� -Y
.�v.. -Subdivision .�
1 ff •• • �1•�• +ti•3•'•lti•�': •• •' �• '• ' i
4 cut
lh4pe4 MAT*
.041
IMP
1" = 2,000'

` I Alk
. X\ 1
January 13, 2020
NCDEQ
Fayetteville Regional Office
Attn: Erin Deck
225 Green Street, Suite 714
Fayetteville, NC 28301
RE: Sewer Application, West Hales Street Subdivision, Benson, North Carolina
Erin;
The sanitary sewer application package for West Hales Street Subdivision was submitted
on November 21, 2019 along with the $480 review fee. This letter provides the
additional information as required in Part 8 of the application.
West Hales Street is a 32 lot residential subdivision located in Benson, NC. The
requested flow 11,520 gpd (360 gpd/lot). The extension proposed is a gravity sewer
extension that will connect to an existing gravity sewer owned and maintained by the
Town of Benson. The requested extension will be owned and maintained by the Town of
Benson after construction and certification are completed.
I look forward to working with you on this project. If you have any questions or
concerns, please feel free to contact us.
Sincerely,
4D Site Solutions, Inc.
'�U V�—
Scott Brown, PE
sbrown @4dsitesoluti ons.com
f
t'. 910-426-6777 i. 910-426-5777
On time, every time. .. %., 4Dsttesolutions