WQ0041731_Sewer Extension_20200608

t KULtI VtU State of North Carolina
MOW Department of Environmental Quality
JUN 0 8 2020
Division of Water Resources
ISA NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources W R S FTA 04-16 & SUPPORTING DOCUMENTATION
f-AYE ILI_EREGIONALOFFICE
Application Number: W 6Z 01D+J -) 31 (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Town of Wadesboro (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State/County ® Municipal
3. Signature authority's name: David Edwards per 15 02T .0106(11)
Title: Town Manager
4. Applicant's mailing address: 124 E. Wade Street
City: Wadesboro State: NC Zip: 28170-
5. Applicant's contact information:
Phone number: [phone] Email Address: Wadesboromanager(@windstream.net
H. PROJECT INFORMATION:
❑ Privately -Owned Public Utility
❑ Other
I. Project name: Wadesboro Industrial Park
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Pen-nit/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: Anson
4. Approximate Coordinates (Decimal Degrees): Latitude: 34.988635 Longitude:-80.067355
5. Parcel ID (if applicable):
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Mark Lacy License Number: 036286
Firm: LKC Engineering
Mailing address: 140 Aqua Shed ct
City: Aberdeen State: NC
Phone number: [phone]
Zip: 28315-
Email Address: mark @Ikcengineerin .cg_om
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Anson County Regional WWTP Permit Number: NCO041408
Owner Name: Anson County
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ
Downstream (Receiving) Sewer Size: 8 & 24 inch
S%SIcm `\;(j": ColIQ:: ol-1 1 Pcri I'i I: I, i.., _lF)_.'_; WQCS
Owner Name(s): Town of Wadesboro
FORM: FTA 04-16 Page 1 of 5

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑No ®N/A
2. If the Applicant is a Developer of lots to be sold, has a Dc� eloper's Operational Agreement (FORM: DI -.A;) been attached?
❑ Yes ❑No ®N/A
3. If the Applicant is a I lome%Property- (hNners' A-s-sociatimi, has an OLNrational Aureemcnt 0_01t\l: 110A) 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 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: % Domestic/Commercial % Commercial
_ % Industrial (See 15A I0 3(?0))
,Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 02"1 .01 140)? ❑ Yes ❑ No
➢ If yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.011.1(f))
Daily Design Flow' b
No. of Units
Flow
Industrial
gal/day
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
GPD
a See I5:A NCA( 0' F .01 14(b) (d). (c)( I ) and (c)(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 GS. 42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified (in table 15A NCAC' 02-F.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: GPD (per 15A \(':\( 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 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & �I DC (C,rayltN Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 590 PVC
➢ Section II & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section III contains information related to minimum slopes for gravity sewer(s)
➢ Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable)— 02T .0305 & iA1DC (Punip Stations/Force Nlains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: Pump Station 0+00
2. Approximate Coordinates (Decimal Degrees): Latitude: 34.983739 Longitude:-80.068507`
3. Design flow of the pump station: 0.185 millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): 350 gallons per minute at 120 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
8
2,200
PVC
6. Power reliability in accordance with
® Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(h)(1)(B)r
➢ 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(1)):
l . Does the project comply with all separations found in
➢ 15A NCAC 02T.0305(fl contains minimum separatinns that shall he nrovided fnr cower cvctPm,-
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 lI impounded reservoirs used as a source of drinking water
100 feet
**Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal
high water or tide elevation and wetlands see item IX.2)
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches
10 feet
Any building foundation
5 feet
Any basement
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade vertical
36 inches
➢ _ bC _l ', I ' contains alternatives where separations in ; cannot be achieved.
➢ **Stream classifications can be identified using the Division's `..
➢ If noncompliance with _ 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 ' _ _ ®Yes ❑ No ❑ N A
➢ This would include Trout Buffered Streams per
4. Does the project require coverage authorization under a 404 Nationwide or ❑ Yes ® No
individual permits or 401 Water Quality Certifications?
➢ Information can be obtained from the
5. Does project comply with _ ) (additional permits certifications)? ® Yes ❑ No
Per v `�._. C ,: 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 "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes ® No ❑ N/A
➢ If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at least once every six -months and inspections
documented per 15A NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit.
FORM: FTA 04-16 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 1 �A \VAC' uT, the \IwiniuIn CI 1,01 SLaticm>
an(a l Uo '\11Ills (i�li >� l c',C>(U_i, and the t it l 1K SCI_t(' ill:lll .tilTl_ DCS I'-':) '.1 1 [ Ia1�{,;jl YW(z•ll?fl) 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 suoportin¢ documents.
2. Professional Engineer's Certification:
Arit. 4 WGY 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 (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:
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3. Applicant's Certification per 15A NCAC 02T .0106(b):
ra-
D E ,,, ,ARDS attest that this application for
(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 1-1_=__.' iS.t, A and ;_4i oji, 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: —�2°z0
FORM: FTA 04-16 Page 5 of 5

June 4, 2020 DEQ!IDWR
Mr. Trent Allen, PE
NCDENR Fayetteville Regional Office
225 Green Street, Suite 714
Fayetteville, NC 28301
Re: Wadesboro Industrial Park
Town of Wadesboro, Anson County
Public Water Supply Systems Permit
Mr. Allen,
Regarding the above referenced project, please find enclosed:
1. Two Copies of the Fast Track Application Package
2. One application fee check for $480.00
JUN 0 S 2020
PAYETTEvILWORO� A( OFFICE
The proposed project will include the installation of approximately 600 If of 8-inch PVC gravity
sewer, 2,200 If of 8-inch PVC force main, and a new sewer pump station. The pump station will
have a firm capacity design flow of 0.185 MGD, and will discharge to an existing 8-inch gravity
sewer. The attached application does not include any flow because there will be no flow to the
system initially and proposed use in unknown. Flow will be permitted prior to making any
connections to the system.
If you have any questions, please do not hesitate to contact me at [phone] or by email at
[e-mail].
Sincerely,
LKC Engineering, PLLC
"'�/z
--6/
Mark Lacy, P.E.
LKC Engineering, 111.1,C, 140 Aqua Shed C ourt, Aberdeen, North Carolina 28315
P11: 910/420-1437 * FAX: [phone] * License No. P-1095

LKC ENGINEERING, PLLC
PO Box 888
Aberdeen, NC 28315
[phone]
REGtivLu
DEQIDWR
Rj N 0 8 2020 u
Wail P°c�
WQROS
7914
i✓ _ 66-3
DATE
58/531
PAY $
THE �� (���
ORDERER OF ti v � , p�1i � 9
A� I I U \A, 11A Ak/A A PA- i/�1/ " rMAI-A wl I IM nnl I woe
Fidelity Bank
FOR rL� t �' �� �P I�n�Q,� �i1� Sf T-YC4 �

State of North Carolina
nWR
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Town of Wadesboro (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: David Edwards per tJ T_11 —, i R1z(►t1 VCL)
DEQIDWR
Title: Town Manaeer
4. Applicant's mailing address: 124 E. Wade Street JUN 0 8 202Q
City: Wadesboro State: NC Zip: 28170- Y' ;,q P
5. Applicant's contact information: WOEGIONAL OFFICEROS
Phone number: [phone] Email Address: Wadesboromanager(a�windstream.net F�AYETTEVILI_E R
II. PROJECT INFORMATION:
1. Project name: Wadesboro Industrial Park
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, providCe
'ber: WQ00 and issued date:
If new construction but pn, pr vide the existing permit number:WQ00
3. County where project is4. Approximate Coordinate : Latitude: 34.988635 Longitude:-80.067355
5. Parcel ID (if applicable):
(or Parcel ID to closest downstream sewer)
7914
LKC ENGINEERING, PLLC
PO Box 888
Aberdeen, NC 28315
[phone] L 66-358/531
DATE
PAY TO THE �n G I ORDER OF ' v "mot , �b . Uo
Fidelity Bank
Vl�
FOR Hly' OH 1P &V 'P-09r TYCA AL `
Owner Name(s): Town of Wadesboro
FORIM: FTA 04-16 Page I of 5

Central Files: APS _ SWP .
6/9/2020
Permit Number W00041731 Permit Tracking Slip
Program Category Status Project Type
Non -discharge Active New Project
Permit Type Version Permit Classification
Gravity Sewer Extension, Pump Stations, & Pressure Sewer Extensions 1.00 Individual
Primary Reviewer Permit Contact Affiliation
stephanie.zorio
Coastal SWRule
Permitted Flow
Facility
Facility Name
Major/Minor Region
Wadesboro Industrial Park
Minor Fayetteville
Location Address
County
Anson
Facility Contact Affiliation
Owner
Owner Name
Owner Type
Town of Wadesboro
Unknown
Owner Affiliation
David Edwards
Manager Town
124 E Wade St
Dates/Events
Wadesboro NC 28170
Scheduled
Orig Issue App Received Draft Initiated
Issuance Public Notice Issue Effective Expiration
6/9/2020 6/8/2020
6/9/2020 6/9/2020
Regulated Activities
Requested /Received Events
Wastewater collection
Additional information requested
Additional information received
Outfall
Waterbody Name
Streamindex Number Current Class Subbasin