WQ0041697_Application (FTSE)_20200513

(� State of North Carolina
Department of Environmen
DWRtal 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 compacted by DWR)
All items must be completed or the application will he returned v1l K �Y4
' C4%
I. APPLICANT INFORMATION:
1. Applicant's name: Town of Pine Level (company, municipality, WOA, utility, etc.)
2. Applicant type: ❑ Individual
❑ Corporation El General Partnership ❑Privately-Otvned Public Utility
❑ Federal ❑ State.:Counly ® Municipal ❑ Other
3. Signature authority's name: Jeff Holt per 15A NCAC'.02 !.Ol06rbl06rbl
Title: Mayor
4. Applicant's mailing address: PO Box 328
City: Pine Level State: NC Zip: 27568
5. Applicant's contact information:
Phone number: (9� 965-2284 Email Address: clerk a pinelevel.ore
11. PROJECT INFORMATION:
of graironmenta� vQ�ffity
fy��
µpY 13 2024
office
I. Project name: SCOTTIES RIDGE- PUMP STATION
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- Johnston
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.48990 Longitude:-78.21146
5. Parcel ID (if applicable): 263300-44-9916
(or Parcel ID to closest downstream sewer)
lit. CONSULTANT INFORMATION:
I - Professional Engineer: Andrew Hodge. PE License Number: 21094
Firma: Adams and Hodge Engineering, PC
Mailing address: 314 East Main Street
City: Clayton State: NC Zip. 27520-�
Phone number: (21_9) 369-1938 Email Address: andrew a adamsandhod e.com
IV. WASTEWATER TREATMENT FACILITI' (II'WTF) INFORMATION:
I. Facility Name: Central Johnston County Recional WWTF Permit Number: NC0030716
Owner Name: Johnston County
V. RECEIVING DOWNSTREAM SEWER INFO if different than WWTF):
I. Permit Number(s): WQ Downstream (Receiving) Sewer Size: 8 inch
System Wide Collection Systern Permit Number(s) (if applieablc: WQC'SDO012
Owner Name(s): Town of Pine Level
This gravity line
was installed in
+1-1978. The Town
does not know the
permit number
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 ON. -'A
2. If the Applicant is a Developer of lots to be sold, has a Developers erationA! Agreement f FORIvf: DEV} been attached?
❑ Yes ❑No ®N/A
3. If the Applicant is a Home:PponaM.Owners' Association, has an Operational Aareement,(FOR4J: H€}A) 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 andior Motels
❑ School.-: preschool day care ❑ Medical r dental veterinary facilities ❑ Swimming Pool :'Clubhouse
❑ Food and drink facilities ❑ Church
o El Businesses,' ffices! factories Swimming Pool. -Filter Backwash
❑ Nursing Home ® Other (Explain in Attachment)
5. Nature of wastewater: 100 ° o Domestic?Commercial _% Commercial
_ % Industrial (See I _NCA_C 02T _01,03(20))
2Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under I SA_NCAC 02T .01 144 Fi? ❑ Yes ®No
If yes, provide a cony of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.01 14ff1)
Daily Design Flow 10
No. of Units
Flow
/
Single Family Home - 3 Bedroom
Amenity
360 gal/unit
51
18,360 GPD
/
Center (+/-I,i00sf)
60 gal/ I00sf
I I
660 GPD
gall
GPD
gal/
GPD
gall
GPD
gall
GPD
Total
19020 GPD
a See 15A N LAC 02T .01 14(b), (d), (e)(1 )and {e}f?) for caveats to wastewater design flow rates (i.e., minimum flew per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use areas;
and residential property located south oreast of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in G_5.42A-4).
b Per 15A NCAC 02T .0I 14(c), design flow rates for establishments not identified [in table 15A \CAC 02T.01 14j shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
S. Wastewater generated by project: 19020 GPD (per 15A NCAC 02T .01 14)
Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
❑ Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit Number:
❑ Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain):
FORM: FTA 04-16 Page 2 of 5

V11.
VI11.
GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC Gravit Sewers):
Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 +/-1220 PVC
Section I1 & 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
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: Scotties_ Ridge _PS
2. Approximate Coordinates (Decimal Degrees): Latitude: 35.48990 Longitude:-78.21146
3. Design flow of the pump station: 0.04755 millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): 80 gallons per minute at 110 feet total dynamic head (TDH) Jaw�y
Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
4 +/-9010 PVC
6. Power reliability in accordance with I5A NCAC 02T .0 05(h)(1 l:
® Standby power source or pump with automatic activation and telemetry - I SA 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(f)):
1. Does the project comply with all separations found in 15A NC AC 02T�.0305f.&
® Yes ❑ No
15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305 t cannot be achieved.
"Stream classifications can be identified using the Division's NC SurfacE Water Classifications webnacti
If noncompliance with 02T_0305{Fl or (). see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ®Yes [:]No ❑ N'A
See the Division's draft separation requirements for situations where separation cannot be meet
No variance is required if the alternative design criteria specified is utilized in design and construction
As built documents should reference the location of areas effected
3. Does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ® Yes ❑ No ❑ N.-'A
This would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Does the project require coverage..authorization under a 404 Nationwide or ❑ Yes ® No
individual permits or 401 Water Quality Certifications?
Information can be obtained from the 401,& Buffer Aermittina Branch
5. Does project comply with 15A NCAC 0?T,.; 010S0L66) (additional permits;'certifications)? ® Yes ❑ No
Per ,ISANCAC 2T.0105(clt6_ 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 15A 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 ❑ 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: F'TA 04-16 Page 4 of 5

X. CERTIFICATIONS:
I. Does the submitted system comply with 15A N AC 021, the Minimum Design Criteria For the Pciniilting of Purno Stations
and Force Mains (latest version), and the Gravity Sewer Minimum Design Criteria (latest version) as applicable?
® Yes ❑ No
If No, complete and submit the Variance/Altcmative 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:
PE
(Professional Engineer's name from
Item III.1.)
that this application for
has been reviewed by me and is accurate, complete and consistent with the infomtation 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 143-215.68, 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 S 10,000, as well as civil penalties up to $25,000 per violation.
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per ISA NCAC 02T .0106(b):
1, Jeff Holt, Mayor of Pine Level
(Signature Authority's name
Application Item 1.3.)
oFessioyC�'
2 QQ` 9
SEAL
21094
03/24/2020
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. 1 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 _ 215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a CIass 2 misdemeanor, which may
include a fine not to exceed S 10,000 as well as civil penalties up to $25,000 per violation.
Signature:
Date: `I-, z 1, g-c
FORM: FTA 04-16 Page 5 of

Dlvttlwt of WAtt-t Re. -So ices
State of Noe -lit Cai-olina
Departinent of Environmental Quality
Division of Water Resources
Row Tracking far Sewei- Extension Applications
(rTSE 10-18)
Entity Requesting Allocation: TOWN OF PINE LEVEL
Project Name for which Flow is being requested: SCOTTIES RIDGI' - PUMP STATION
More than one FTSE nuty be required for a single project if the opener of ale IVIVTP Is not responsible f or alllururp
stallons along the route of the proposed truslelVaterflow.
I. CompIcte this section only if you are the owner of the wastewater treatnmcnI plant.
a. WWTP Facility Name:
b. WWTP Facility Permit M
C.
d.
fill flows rrre in MGD
WWTP facility's permitted flow
Estimated obligated flow not yet tributary to the WWTP
WWTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
IT. 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)
(13)
(C)
(D)=(R+C)
(F-)=(A-D)
Design
Obligated,
Pump
Pump
Average
Approx.
Not Yet
Total Cun•ent
Station
Station
Firm
Daily Flow**
Current
Tributaiy
Flow Plus
(Name or
Petiliit
Capacity, *
(Finn I pl),
Avg. Daily
Daily Flow,
Obligated
Available
Number)
No.
MGD
MGD
Flow, MOD
MGD
Flow
Capacity***
�t4yT 51m::-: �
vy)-GJ6m
a.zoz
o.e8!
0.09)
_0
0,081
O
* The Firm Capacity (design now) of any pump station is defined as Cite inaximnua pumped now
that can be achieved with the largest pump taken out of seivice.
** Design Average Daily Flow is the firin capacity of the pump station divided by a peaking factor
(pl) 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 putnp station located
behi-cen the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): (Plot LC=VL'L
Do«atstreatn Permit Number: r� G 0 001Z.
Pa.:e 1 of G
FTSE 10-18

Ill. Certification Statement:
1 Jeff Holt, Mayor of Pine Level certify to the best of my knowledge that the addition of
tite volume of wastewater to be permitted in this project has been evaluated along the route to the reccivitug
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 Il 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.
Signature
-A4 /-I -%9, -
Title of Signing Official
.rS--Za
Date
Page 2 of 6
FTSE 14-18

PLANNING ASSESSMENT ADDENDUM (PAA)
Submit it plannhig assessment addendum for each pump station listed in Section II where Available Capacity is-,
Q.
Pump Slation (Narttc or Number): C-M r 51 0E
Given that:
a. The proportion and amount of Obligated, Not Yet Tributary Daily Flow (C) accounts for
_ Q % and MGD of the Available Capacity (E) in Pump Station
fir 5112 - ; and that
b. The rate of activation of this obligated, not yet tributary capacity is currently approxiniately
MGD per year; and that
c. A funded Capital Project (list will provide the required planned capacity, namely
4917 Wt?:7TG-T2 0 r�-� Aeal;cr-r is in design or under construction with
planned completion in �c_L-t a&-z I ; and/or
d. The following applies:
Therefore:
Given reasonably expected conditions and }Manning inforniation, there is sufficient justification to allow
this flow to be permitted, without a significant likelihood of over -allocating capacity in the system
infrastructure.
I understand that this does not relieve the collection system owner from complying with G.S. 143-
215.67(a) which prohibits the introduction of any waste in excess of the capacity of the waste disposal
system.
lgnalure e�E
MPS 1� 100CA
gel
Ra�oi�r
Page 3 of 6
_ / Zo
Dale
FTSE 10-18

44
State of North Carolina
• ..? Department of EnvironmentalQuality
Division of Water Resources
nivb.iarl of Water ItesmiILes
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting AIlocation: Pine Level (connection to JC System)
Project Name for which flow is being requested: Scotties Ridge r I�."
More than one FTSE nray be required for a single project if the owner of the 11117P is not responsible for all pump
stations along the route of the proposed wasteipater flop.
1. Complete this section only if you are the owner of the wastewater treatment plant
a. WWTP Facility Name: Central Johnston _County Regional WW Facility
b. WWTP Facility Permit 4: NC 030716
A!lflows are in MGD
c. WWTP facility's permitted flow 9.5
d. Estimated obligated flow not yet tributary to the WWTP 1.842
e. WWTP facility's actual avg. flow 5.970
f. TotaI flow for this specific request 0.01902
g. Total actual and obligated flows to the facility 7.8312
h. Percent of permitted flow used 62.8% actual, 82.4% paper
I1. 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:
Pump
Pump
Station
Station
(Name or
Permit
Number)
No.
Pine
Buffalo ?
(A)
Design
Average
Firm Daily Flow**
Capacity, ' (Firm / pf),
MGD MGD
0.5184 0.2074
7.2000 2.8800
(B)
(C)
(D)=(B+C)
(E)=(A-D)
Obligated,
Approx.
Not Yet
Total Current
Current
Tributary
Flow Plus
Avg. Daily
Daily Flow,
Obligated
Available
Flow, MGD
MGD
Flow
Capacity***
0.2033
0.03463
0.2529
(0.0455)
2.2841
0.1026
2.3866
0.4934
* The Firm Capacity (design flow) 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, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located
behveen the project connection point and the WWTP where the Available Capacity is ¢ 0.
Downstream Facility Name (Sewer): Pine Level WWPS
Downstream Permit Number:
Page 1 of 6
FTS E 10-18

4
III. Certification Statement:
I Chandra C. Farmer, P.E. 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 iz-here 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
Title of Signing Official
Date
Page 2 of 6
FTSE 10-18

PLANNING ASSESSMENT ADDENDUM (PAA)
Submit a planning assessment addendum for each pump station listed in Section 11 where Available Capacity is
0.
Pump Station (Name or Number):
Given that:
a. The proportion and amount of Obligated, Not Yet Tributary Daily Flow (C) accounts for
23 % and 0.0496 MGD of the Available Capacity (E) in Pump Station
Pine Level ; and that
b. The rate of activation of this obligated, not yet tributary capacity is currently approximately
0.01 MGD per year; and that
c. A funded Capital Project that will provide the required planned capacity, namely
Pine Level FM Replacement is in design or under construction with
planned completion in 2021 ; and/or
d. The following applies:
The Town of Pine Level is responsible for the transport of the wastewater through their
system to the Pine Level WWPS. A project is under design to u size the forcemain from
Pine Level to Selma that will allow the Pine Level Pu pp Station to pump at a higher rate.
Therefore:
Given reasonably expected conditions and planning information, there is sufficient justification to allow
this flow to be permitted, without a significant likelihood of over -allocating capacity in the system
infrastructure.
I understand that this does not relieve the collection system owner from complying with G.S. 143-
215.67(a) which prohibits the introduction of any waste in excess of the capacity of the waste disposal
system.
Signing Official Signature
Sao
Irvept
oEF,nvirnnr"cnt,+ti
MAC ) .a Z°�a
�e$ian� 0 too
Page 3 of 6
FTSE 10-18

UMAGROUNVAD Al - � �f USGS MAP - SCOTTIES RIDGE � 4 �.` (�`� � `��11 4
,
'RAINS CAOfSROADS,RD
�.♦ - � �%'�} r� �� � _ _ +' \�E- ��� sir \--
� k k/ rK t 3_ i �+�ltr\ •1F� ; � ^ -atF
Y.` I y_
:Pine Lev = Tie to existing
gravity
r
FaP Sl �,� � , � � - - -•- r � ter. v �
l
IL jg.
Merm
fto
/ - 0 ilk t ; •� LL (+ - G
SCOTTIES RIDGE
►13Pump Station SiteCt
! z.
-'_ Scale: 1 in. = 2000 feet
The sca
le ale is only accurate when printed portrait
ADAMS & HODGE
on a 8 112 x 11 size sheet with no page scaling.) nNumBUIRmia,_

I OHINbl-ON `
(QLIN
NO HTI[- CAHOL[NA

ADAMS s Noose
'ENGINE
May I2, 2020
Ted Cashion
NC DWQ
3800 Barrett Dr
Raleigh, North Carolina 27609
Subject: Scotties Ridge — Pump Station
Town of Pine Level
Johnston County
Please find attached one original and one copy of the following:
1. Complete Fast Track Application for Gravity Sewers, Pump Stations, and Forcemains
(Form FTA 04-16), signed by Engineer & Town of Pine Level
2. $480.00 Check for Application Fee
3. A Flow Tracking/Acceptance for Sewer Extension (Form FTSE 10-18) from Pine Level
and another FTSE form from Johnston County
4. USGS Quad Map showing approximate site location
5. Street Level Map
Project Narrative:
Scotties Ridge-- Pump Station project includes ++-1,2201f of 8" outfalI gravity sewer main, a pump station
and +l-9,01 Olf of 4" force main to serve 51 single family homes and an amenity center in the future
Scotties Ridge subdivision. The 4" force main will tie into an existing Town of Pine Level gravity sewer
manhole. Wetlands and buffers have been located and to avoid impacts at these locations the FM will be
installed by directional drill. There are places where the proposed FM could not avoid being within 100'
of private wells, but never closer than 25', at these places all appurtenances shall be outside the 100'
radius. Where the FM is within the 100' radius of private wells, piping materials, testing methods and
acceptability standards meeting water main standards shall be used.
If you have any questions or comments, please give me a call at 919-369-1938 or email to
andrew adamsandhod e.com .
Sincerely,
Andrew Hodge, PE
VC Dept Of Environmeatai Quality
MAY 13 242.0
U1ei&gegi0aal Office
ADAMS & HODGE ENGINEERING, PC • 314 East Main Street, Clayton, NC 27520 . 919-243-1332 . Firm # C-4187