WQ0041595_Application (FTSE)_20200330

DWR1111�
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
1SA NCAC 02T.0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: W�-0 q t f (to be completed by DWR)
All items must be completed or the apiffleation will be returned
1. APPLICANT INFORMATION:
3 3
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I. Applicant's name: Town of Nashville. (company, municipality, HOA, utility, etc.)
2. AppIicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State. -County ® Municipal ❑ Other
3. Signature authority's name: Rangy Lansing per 15A NCAC t.M2T .0106{b_f 24C Dept ofEnVironmetltAl gIIA11ty
Title: Town Manager
4. Applicant's mailing address: Po Box 987 MAR 3 0 2020
City: Nashville State: NC Zip: 27856-
5. Applicant's contact information: PA1018h Regional Office
Phone number: 2{ 52) 4594511 Email Address: randy,.lansingatownofnashvillenc.gov
11. PROJECT INFORMATION:
1. Project name: Macon's Ridge Senior Living Facility
2. Application -'Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
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
3. County where project is located: Nash
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.971347' Longitude:-77.952213'
5. Parcel ID (if applicable): 380008998349
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
I- Professional Engineer: Stocks Engineering, P.A. License Number: 19843
Firm: C-1874
Mailing address: PO Box 1108
City: Nashville State: NC Zip: 27856-
Phone number: 2(_52) 459-8196 Email Address: kvarnell stocksen ineerin .com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
I. Facility Name: Tar River Regional WWTP
Owner Name: City of Rocky Mount
Permit Number: NCO030317
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s). WQUnknown Downstream (Receiving) Sewer Size: 8 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS nkn 0 O
OwnerName(s): Town of Nashville
FORM: FTA 04-16 Page i of 5

VI. GENERAL REQUIREMENTS
I. If the Applicant is a Privately -Owned Public Utility, 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 Operational Agreement (FORM: DEV] been attached?
❑ Yes [:]No ®NIA
3. If the Applicant is a Home?ProperVi Owners'. Association has Operational Agreement (FORM: HOAR 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 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 Attachment)
5. Nature of wastewater: 100 % Domestic/Commercial % Commercial
_ % Industrial (fee_ 15A NCAC 02T .0103(20))
bIs there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under I SA NCAC 02T_0114f 0 El Yes ® No
➢ If yes, provide a cony of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 91 .011411)
Daily Design Flow x,n
No. of Units
Flow
Domestic - Residential
240 gal/day
84
20,160 GPD
gall
GPD
gal/
GAD
gal/
GPD
gall
GPD
gall
GPD
Total
20,160 GPD
a See 15A NBC 02T .01 14(b), (d}, (e)(1) and le)(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. 42A4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.01 14] shaIl be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 20,160 GPD (per 1 A NCA . 02T .0114)
i- 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 & MDC(Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) I Length (feet) I Material
j 8 1 1,180 1 PVC
D 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
VI11. 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 accordance with 15A NC AC 02T .0305[h1c1):
❑ Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(h)(I)(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 I5,000 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- l6 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
I. Does the project comply with all separations found in 15A NCAC 02T .0305(f) & (
15A NCAC 02T.0305( contains minimum separations that shall be provided for sewers stems:
® Yes [-]No
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-1 waters of Class I or
Class 11 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 Iowering and surface drainage
ditches
10 feet
AnX 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
D 15A NCAC 02T.0305 contains alternatives where separations in 02T.0305(f1 cannot be achieved.
D **Stream classifications can be identified using the Division's NC Surface Water Classifications weboaee
If noncompliance with 02T.0305 origh see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ® Yes ❑ No
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 all setbacks found in the river basin rules per 15A NCAC 02B .0200? ® Yes ❑ No
This would include Trout Buffered Streams per.15A NCAC 2B.0202
4. Does the project comply with an individual 404 Permit or any 401 Certifications? ® Yes ❑ No
Wetland -related permits shall be requested, obtained, and adhered to for projects that impact wetlands or surface waters
Information can be obtained from the 401 & Buffer Permittinp, Branch
5. Does project comply with I5A NCAC 02T.0105(c)(6) (additional permits/certifications)?
® Yes [:]No
Per 15A NCAC 02T.010_5 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 l5A 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
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

X: CERTIFICATIONS:
I . Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permittina of Eqmp.Stations
and Force Mains (latest version), and the Cravity Sewer Minimum ( sign 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:
t , . attest that this application for
(Professional Engineer's name from Application Item Ill.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.
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North Carolina Professional Engineer's seal, signatur , and date:
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3. AppIicant's Certification per 15A NCAC 02T .0106(b):
attest that this application for
(Sign a Authority's e & title from Application,/ m 1.3.)
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 143-215.6A 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 astj as civil peenalties up to $25,000 per violation.
Signature: Date:
FORM: FTA 04- l6 Page 5 of 5

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NC Dept of Environmental Quallty
MAR 3 0 2020
Sewer Project Narrative Raleigh Regional Office
For
Macon's Ridge Senior Living Facility
The proposed Macon's Ridge Senior Living Facility Project involves the construction of
a road which generates two Commercial Lots as well as an 84 unit senior living facility.
The uses for the two Commercial Lots are unknown at this time and will need to be
permitted once the uses are known. The 84-unit Senior Living Facility should be
considered the same as an apartment use which requires 120 GPD per bedroom. The
units will be two bedroom units for a total of 168 bedrooms and a total flow request of
20,160 GAD.

State of North Carolina
4 ti Department of Environmental Quality
Division of Water Resources
Dlvlslon of Water Resources Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: Town of Nashville
Project Name for which flow is being requested: Macon's Ridge Senior Living Center
More than one FTSE pray be required for a single project if the owner of the WIVTP is not responsible for all pump
stations along the route of the proposed waste►vater flow.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: City of Rocky Mount - Tar River Regional WWTP
b. WWTP Facility Permit #: NCO030317
All flows are in MGD
c. WWTP facility's permitted flow 21.00
d. Estimated obligated flow not yet tributary to the WWTP 0.563
e. WWTP facility's actual avg. flow 10.83
f. Total flow for this specific request 0.020
g. Total actual and obligated flows to the facility 11.41
h. Percent of permitted flow used 54.33 %
H. 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
Obligated,
Pump
Average Daily
Approx.
Not Yet
Total Current
Station
Firm
Flow*'
Current Avg.
Tributary
Flow Plus
(Name or
Capacity, '
(Firm i pf),
Daily FIow.
Daily Flow,
Obligated
Available
Number)
MOD
MOD
MOD
MOD
Flow
Capacity'"
30.00
12.0
6.5
0.563
7.063
4.937
* The Firm Capacity 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.
*** 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): Unknown
Downstream Permit Number: Unknown
Pagc I of 6
FTSE 04-16

111. Certification Statement:
I William Brad Kerr 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 indicates acceptance of this wastewater flow.
Date
Page 2 of 6
FCSE 04-16

Cashion, Ted
From: Cashion, Ted
Sent: Saturday, May 2, 2020 7:22 AM
To: Brad Kerr (Brad. Kerr@ rockymountnc.gov); Kevin Varnell
([e-mail])
Cc: Robinson, Jason
Subject: Fast track sewer extension application, Town of Nashville, Macon's Ridge Senior Living
Facility
We are reviewing the subject application. The FTSE form submitted with the application shows a pump station with a
firm capacity of 30 mgd and 4.937 mgd available capacity. The name of the PS was omitted from the application. Please
provide the name of the PS.
Thx
ted
Ted Cashion
Water Quality Regional Operations
Division of Water Resources
NC Department of Environmental Quality
Raleigh Regional Office
919-791-4254
[e-mail]
1628 Mail Service Center
Raleigh, NC 27699-1628
3800 Barrett Drive
Raleigh, NC 27609
E
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