WQ0035620_Application_20111017

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USE THE TAB KEY TO MOVE FROM FIELD TO FIELD!
Application Number:
(to be completed by DWQ)
1.
Owner/Permittee:
la.
Town of Roseboro
Full Legal Name (company, municipality, HOA, utility, etc.)
1 b.
Roland Hall - Mayor
Signing Official Name and Title (Please review 15A NCAC 2T .0106 (b) for authorized signing officials!)
1 c.
The legal entity who will own this system is:
❑ Individual ❑ Federal ® Municipality ❑ State/County ❑ Private Partnership ❑ Corporation ❑ Other (specify):
1 d.
P.O. Box 848
1 e. Roseboro
Mailing Address
City
1f.
North Carolina
1g. 28382
State
Zip Code j
1 h.
910-525-4121 1 i. 910-525-3133
1j.
Telephone Facsimile
E-mail
2.
Project (Facility) Information:
2a.
Sanitary Sewer Replacement
2b. Sampson
Brief Project Name (permit will refer to this name)
County Where Project is Located
3.
Contact Person:
3a.
W. Brian Johnson, P.E.
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b.
919-828-0531
3c. [e-mail]
Phone Number
E-mail
1.
Project is ® New ❑ Modification (of an existing permit)
If Modification, Permit NO.:
2.
Owner is ® Public (skip to Item B(3)) ❑ Private (go to Item 2(a))
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TOWN OF ROSEBORO 11756
CENTRAL DEPOSITORY ACCOUNT
ROSEBORO, INC 28382 66-30/531
DATE o4U1 318
PAY N C O E{ `4 9 (Yo
TO THE $ 4� , lJ �/
ORDER OF I
DOLLARS
of
First Citizens AS
Bank MAYOR �_ �17 G C
0O L L 7 5 60 i:0 5 3 L00 300i:00 3 18 50 3 20 5 20
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m % Other (specify):
7. Volume of wastewater to be allocated or permitted for this particular project: 0 gallons per day
*Do not include future flows or previously permitted allocations
8. If the permitted flow is zero, indicate why:
❑ Pump Station, Outfall or Interceptor Line where flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit No.
® Rehabilitation or replacement of existing sewer with no new flow expected (see 15A NCAC Q�j� detprrpiq�a
permit is required) �L,JJ ==''VV 11"l� Ir' IH�
OCT 17 2011
nwo
FTA 12/07

W ATFR DENR-FRO State of North Carolina
QG OCT 17 2011 Department of Environment and Natural Resources
v� r Division of Water Quality
o 1 DWQ FAST -TRACK APPLICATION
(FTA 12/07 very)
for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
(Pressure & Vacuum sewer systems are not to be included as part of this application package)
INSTRUCTIONS: Indicate that you have included/addressed the following list of required application package items by
checking the space provided next to each applicable item. Failure to submit all required items will lead to your application
being returned as incomplete. Forms are available from the web site or by calling the Regional Office serving your county:
http://h2o. enr state. nc. us/peres/Collection % 20Systems/CollectionSystemApplications. html
® A. Application Form - Submit one original and one copy of the completed and appropriately executed application
form. The application should include a project narrative describing the final build -out design (i.e. system and/or
pump station to ultimately serve 500 homes, but flow for only 100 homes being requested now). For modifications,
clearly explain the reason for the modification (i.e. adding another phase, changing line size/length, etc.). Only
include the modified information in this permit application - do not duplicate project information that has already
been included in the original permit.
Any changes to this form will result in the application being returned. The Division of Water Quality (Division) will
only accept application packages that have been fully completed with all applicable items addressed. You do not
need to submit detailed glans and specifications unless you respond NO to Item 13(13).
Separate aDDlications should be made for non-contiguous sewer systems.
® B. Application Fee - Submit a check in the amount of $480 made payable to: North Carolina Department of
Environment and Natural Resources (NCDENR). Checks shall be dated within 90 days of application submittal.
❑ C. Certificates of Public Convenience and Necessity — If the application is being submitted in the name of a
privately -owned public utility, submit two copies of the Certificate of Public Convenience and Necessity (CPCN)
which demonstrates that the public utility is authorized to hold the utility franchise for the area to be served by the
sewer extension. If a CPCN has not been issued, provide two copies of a letter from the North Carolina Utilities
Commission's Public Staff that states that an application for a franchise has been received, that the service area
is contiguous to an existing franchised area, and/or that franchise approval is expected. The project name in the
CPCN or letter must match that provided in Item A(2)a of this application.
❑ D. Operational Agreements — Submit one original and two copies of a properly executed operational agreement, as
per 15A NCAC 02T .0115, if the application is submitted by a private applicant and will be serving residential or
commercial lots (e.g., houses, condominiums, townhomes, outparcels, etc.) that will be sold to another entity. If
the applicant is a home or property owner's association, use Form HOA 02/03. If the applicant is a developer,
use Form DEV 02/03. EVEN IF THE PROJECT MAY BE TURNED OVER TO A MUNICIPALITY UPON
COMPLETION, FORM DEV 02/03 IS REQUIRED.
® E. Downstream Sewer, WWTF Capacity and Flow Tracking/Acceptance — FORM FTSE 10/07 (Flow
Tracking/Acceptance for Sewer Extension Permit Applications) is required with every application. The applicant
(and owners of downstream sewers, pump stations and/or treatment facilities submitting FORM FTSE-10/07)
certifies that the addition of the volume of wastewater to be permitted in this project has been evaluated along the
route to the receiving treatment plant, and that the flow from this project will not cause capacity related sanitary
sewer overflows or overburden any downstream pump station en route to the receiving wastewater treatment
plant. Where the applicant is not the owner of the downstream sewer, submit two copies of FORM FTSE 10/07
from the owner of the downstream sewer and owner of the WWTF, if different. The flow acceptance indicated in
FORM FTSE-10/07 must not expire prior to permit issuance and must be dated less than one year prior to the
application date. Submittal of this application and FORM FTSE-10/07 indicates that owner has adequate
capacity and will not violate G.S. 143-215.67(a). Intergovernmental agreements or other contracts will not be
accepted in lieu of project -specific FTSE 10/07.
® F Map — Submit an 8.5-inch by 11-inch COLOR copy of a USGS Topographic Map of sufficient scale to identify the
entire project area and the closest surface waters. Each map or maps must show the location of the sewer line
and pump stations and be of reproducible quality. Include a street level map showing the downstream connection
point, and the permit number for the downstream sewer, if known.
FTA 12/07

G� Stream Classifications — Watershed Classification Attachment (Form WSCAS-12/07) If any portion of the
srewer system project is within 100 feet of any surface water or wetlands, the Watershed Classification Attachment
may need to be completed. A variance must be requested for encroachment within required setbacks or buffers
pursuant to 2T .0305 (f) and be indicated in Item B-13 with supporting documentation/justification provided.
❑ H Environmental Assessments — If this project is subject to an Environmental Assessment (EA) [I SA NCAC
01C], this application cannot be used. Send the project application on the most current version of Form
PSFMGSA to the Design Management Unit, 1633 Mail Service Center, Raleigh, NC 27699-1633. Applications
cannot be accepted until a Finding of No Significant Impact (FONSI) or Environmental Impact Statement (EIS)
has been issued. A copy is to be submitted with that permit application.
❑ I. Flow Direction — Many wastewater treatment systems are entering into agreements for regionalization efforts
and emergency treatment capacity. Parts of the system are installed so that the wastewater flow can be directed
to more than one treatment facility. If this is the case with this project, please indicate in B(12) and give the permit
number of the second treatment facility.
® J. Certifications — Section C
The application must be certified by both the applicant and the design engineer who is a North Carolina
Registered Professional Engineer (PE). The applicant signature must match the signing official listed in Item
A(1 b). The PE should NOT certify the application if he/she is unfamiliar with 15A NCAC Chapter 2T, the Gravity
Sewer Minimum Design Criteria (most recent version) and the Minimum Design Criteria for the Fast -Track
Permitting of Pump Stations and Force Mains (most recent version), as applicable to the project.
THE COMPLETED FTA 12/07 APPLICATION PACKAGE, INCLUDING ALL SUPPORTING
DOCUMENTS AND $480 FEE, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional Office
2090 US Highway 70
Avery, Buncombe, Burke, Caldwell, Cherokee,
Swannanoa, North Carolina 28778
Clay, Graham, Haywood, Henderson, Jackson,
[phone]
Macon, Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Harnett, Hoke,
Fayetteville, North Carolina 28301-5094
Montgomery, Moore, Robeson, Richmond,
[phone]
Sampson, Scotland
[phone] Fax
Mooresville Regional Office
610 E. Center Avenue
Alexander, Cabarrus, Catawba, Cleveland,
Mooresville, North Carolina 28115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
Raleigh Regional Office
1628 Mail Service Center
Chatham, Durham, Edgecombe, Franklin,
Raleigh, North Carolina 27699-1628
Granville, Halifax, Johnston, Lee, Nash,
[phone]
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
Warren, Wilson
Washington Regional Office
943 Washington Square Mall
Beaufort, Bertie, Camden, Chowan, Craven,
Washington, North Carolina 27889
Currituck, Dare, Gates, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
Wilmington Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
Wilmington, North Carolina 28405
Hanover, Onslow, Pender
[phone]
[phone] Fax
Winston-Salem Regional Office
585 Waughtown Street
Alamance, Alleghany, Ashe, Caswell, Davidson,
Winston-Salem, North Carolina 27107
Davie, Forsyth, Guilford, Rockingham, Randolph,
[phone]
Stokes, Surry, Watauga, Wilkes, Yadkin
[phone] Fax
For more information, please visit our web site at:
http://h2o.enr.state.nc. us/peres/Collection % 20Systems/CollectionSystemsHome.html
or contact the Regional Office serving your county.
FTA 12/07

USE THE TAB KEY TO MOVE FROM FIELD TO FIELD! Application Number: (to © 3 sp
(to be completed by DWQ) � (>(, o
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1.
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Owner/Permittee:
la.
Town of Roseboro
Full Legal Name (company, municipality, HOA, utility,. etc.)
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1 b.
Roland Hall - Mayor
Signing Official Name and Title (Please review 15A NCAC 2T .0106 (b) for authorized signing officials!)
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1 c.
The legal entity who will own this system is: j
❑ Individual ❑ Federal ® Municipality ❑ State/County ❑ Private Partnership ❑ Corporation ❑ Other (specify):
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1d.
P.O. Box 848 le. Roseboro
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Mailing City
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1 f.
ina 1 g. 28382
North Carolina
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State Zip Code
0
1 h.
910-525-4121 1 i. 910-525-3133 1j.
QTelephone
Facsimile E-mail
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2.
Project (Facility) Information:
J
2a.
Sanitary Sewer Replacement 2b. Sampson
a
Brief Project Name (permit will refer to this name) County Where Project is Located
a
3.
Contact Person:
_ _ _-
3a.
W. Brian Johnson, P.E.
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Name and Affiliation of Someone Who Can Answer Questions About this Application
3b.
919-828-0531 333c. [e-mail]
Phone Number E-mail
I
1.
Project is ® New ❑ Modification (of an existing permit) If Modification, Permit No.:
2.
Owner is ® Public (skip to Item B(3)) ❑ Private (go to Item 2(a))
I
2a.
2b. If sold, facilities owned b must choose
If private, applicant will be: y a ( one)—
❑ Retaining Ownership (i.e. store, church, single office, etc.) or ❑ Public Utility (Instruction C)
❑ Leasing units (lots, townhomes, etc. - skip to Item B(3)) El Homeowner Assoc./Developer (Instruction D)
❑ Selling units (lots, townhomes, etc. - go to Item B(2b))
3.
Z
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
4a.
Roseboro WWTP 4b. NCO026816
H
Name of WWTF WWTF Permit No.
5a.
Town of Roseboro b. 12-inch ®Gravity 5c. Unknown
of Downstream Sewer Receiving Sewer Size ❑Force Main Permit # of Downstream Sewer (Instructio E)
OnOwner
0
6.
The origin of this wastewater is (check all that apply):
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100 % Domestic/Commercial
® Residential Subdivision ❑ Retail (Stores, shopping centers)
❑ Apartments/Condominiums ❑ Institution % Industrial (attach
❑ Mobile Home Park ❑ Hospital description.)
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El School El Church (RO: contact your Regional Office
a
❑ Restaurant ❑ Nursing Home Pretreatment staff)
❑ Office ❑ Other (specify):
% Other (specify):
7.
Volume of wastewater to be allocated or permitted for this particular project: 0 gallons per day
"Do not include future flows or previously permitted allocations
8.
If the permitted flow is zero, indicate why:
I
❑ Pump Station, Outfall or Interceptor Line where flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit No.
® Rehabilitation or replacement of existing sewer with no new flow expected (see 15A NCAC 02T .0303 to determine if a
I
permit is required)
'
FTA 12/07

9. Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2T .0114 fc
the value in Item 13(7) AND/OR the design flow for line or pump station sizing if a reduced or zero flow is being requested it
Item 13(7). Values other than that in 15A NCAC 2T .0114 (b) and (c) must be supported with actual water or wastewater us,
data in accordance with 15A NCAC 2T .0114 (f).
N/A
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches)
Length (feet) New Gravity or Additional
Force Main
8
55 Gravity
11. Summary of Pump Stations w/ associated
Force Mains to be Permitted (attach additional sheets as necessary)
W
D
Pump Station Location ID
N/A
(self chosen - as shown on plans/map for reference)
Z
H
Design Flow
Operational Point
Power Reliability Option
Z
(MGD)
GPM @TDH
1 -permanent generator w/ATS; Force Main Size Force Main Length
0
2 - portable generator w/MTS
Z
O
QPump
Station Location ID
(self chosen - as shown on plans/map for reference)
Design Flow
Operational Point
Power Reliability Option
(MGD)
GPM @TDH
1 -permanent generator w/ATS; Force Main Size Force Main Length
0
2 - portable generator w/MTS
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12. Will the wastewater flow in the proposed sewer lines or pump stations be able to be directed to another treatment facility?
❑ Yes ® No If Yes, permit number of 2"d treatment facility
(RO — if "yes" to 6,12 please contact the Central Office PERCS Unit)
13. Does the sewer system comply with the Minimum Design Criteria for the Fast Track Permitting of Pump Stations and Force
Mains (latest version), the Gravity Sewer Minimum Design Criteria (latest version) and 15A NCAC Chapter 2T as
applicable?
® Yes ❑ No If No, please reference the pertinent minimum design criteria or regulation and indicate why a
variance is requested. SUBMIT TWO COPIES OF PLANS, SPECIFICATIONS OR CALCULATIONS
PERTINENT TO THE VARIANCE WITH YOUR APPLICATION
FTA 12/07

.14. Haye the following permits/certifications been submitted for approval for the system or project to be served?
A
Wetland/Stream Crossings - General Permit or 401 Certification? ❑ Yes ❑ No ® N/A
Sedimentation and Erosion Control Plan? ❑ Yes ® No ❑ N/A
Stormwater?
❑ Yes ❑ No ® N/A
15. Does this project include any high priority lines, [see 15A NCAC 02T .0402 (2)] involve aerial lines, siphons, or interference
manholes)? These lines will be considered high priority and must be checked once every six months
Check if Yes: ❑ and provide details
1. Owner/Permittee's Certification: (Signature of Signing Official and Project Name)
1, Roland Hall , attest that this application for the Sanitary Sewer Replacement Proiect
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. Note: In accordance with North Carolina
General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement, representation, or
certification in any application shall be guilty of a Class 2 misdemeanor, which may include a fine not to exceed $10,000
a ell civil penalties uil to $25,000 per violation.
Q
Signing Official Signature
ENGINEERING DESIGN DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL OF THIS
APPLICATION. THESE DOCUMENTS MUST INCLUDE PLAN AND PROFILE OF SEWERS, THEIR PROXIMITY
TO OTHER UTILITIES, DESIGN CALCULATIONS. ETC. REFER TO 15A NCAC 02T .0305
2. Professional Engineer's Certification: (Signature of Design Engineer and Project Name)
1, W. Brian Johnson. P.E. , attest that this application for the Sanitary Sewer Replacement Proiect
has been reviewed by me and is accurate, complete and consistent with the information in the engineering plans,
calculations, and all other supporting documentation to the best of my knowledge. 1 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 adopted February 12, 1996, and the Minimum Design Criteria for the Fast -Track
Permitting of Pump Stations and Force Mains adopted June 1, 2000 and the watershed classification in accordance with
Division guidance. 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 judged it to be
consistent with the proposed design. Note: In accordance with NC General Statutes 143-215.6A and 143-215.6B, any
person who knowingly makes any false statement, representation, or certification in any application 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.
2a. W. Brian Johnson, P.E.
Professional Engineer Name
2b. The Wooten Company
Engineering Firm
2c. 120 N. Boylan Avenue
Mailing Address
2d. Raleigh 2e. NC 2f. 27603
City State Zip
2g. 919-828-0531
Telephone
2h. 919-834-3589
Facsimile
2i. [e-mail]
E-mail
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nature & Date
FTA 12/07

UtNK-MU
OCT 17 2011
DWO
YEARS
October 14, 2011
THE Review Engineer
Department of Environment and Natural Resources
W O OT E N Division of Water Quality
Washington Regional Office
COMPANY
225 Green Street
Suite 714
ENGINEERING Fayetteville, NC 28301-5094
P L A N N I N G Re: Fast Track Application for Gravity Sewers, Pump Stations and Force Mains
ARCH ITECTU RE Town of Roseboro
Sanitary Sewer Replacement Project
Roseboro, North Carolina
TWC No. 2608-AM
Dear Review Engineer:
On behalf of the Town of Roseboro, we are submitting two (2) copies of the following
documenxs for review and approval for the above referenced project:
• Fast Track Application (FTA 12/07—ver5)
• Project Narrative
• $480.00 Application Fee
• Downstream Sewer, WWTF Capacity and Flow Tracking/Acceptance (FTSE
10/07)
• USGS Quad Map of Project Area
• Watershed Classification Attachment (WSCAS — 12/07)
If you should have any questions or need additional information, please do not hesitate to
contact us.
i
Sincerely,
THE WOOTEN COMPANY
Brian J. P. Oschwald, E.I.
Enclosures: As Stated.
120 North Boylan Avenue
Raleigh NC 27603-1423 cc: Roland Hall — Town of Roseboro (Letter only)
TWC File
919.828.0531
fax [phone]

PROJECT NARRATIVE
SANITARY SEWER REPLACEMENT PROJECT
ROSEBORO, NORTH CAROLINA
PROJECT DESCRIPTION
The scope of this project involves the replacement of sewer mains in Roseboro, North Carolina.
The project includes the in -situ replacement of 302 LF of 8-inch sewer main, 373 LF of 10-inch
sewer main and 1591 LF of 12-inch sewer main. The project also includes new construction of
255 LF of 8-inch sewer.
The majority of the project is located in Right of Ways and through existing easements through
Town. There will be work performed in or along Clinton Street (SR 1274), Church Street, North
Street, Railroad Street, Culbreth Street, Gold Street and Bullard Street. The areas of the project
not located within Right of Ways are located in existing 20 foot utility easements. There will be
an additional 10 feet of temporary construction easement acquired in order to install the new
sewer mains that are currently through existing easements.
SITE DESCRIPTION
There are multiple sites for this project. There will be areas of this project in roadway, in
roadway shoulders and cross country through existing easements. The construction in the
roadway shoulders is located between the edge of pavement and the Right of Way. The areas
that are located in the existing easements will require clearing and grubbing in order to install the
new sewer mains. There will be 3 ditch crossings as a result of this project.

OF W ATF9 State of North Carolina
A OG Department of Environment and Natural Resources
Division of Water Quality
o c Flow Tracking/Acceptance for Sewer Extension Permit Applications
(FTSE—10/07)
Project Applicant Name: Town of Roseboro.
Project Name for which flow is being requested: Town of Roseboro Sanitary Sewer
Replacement Project
More than one FTSE-10107 may be required for a single project if the owner of the WWTP is not responsible for all
pump stations along the route of the proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Town of Roseboro WWTP.
b. WWTP Facility Permit #: NC0026816.
All flows are in MGD
c. WWTP facility's permitted flow 0.490
d. Estimated obligated flow not yet tributary to the WWTP 0
e. WWTP facility's actual avg. flow 0.265
f. Total flow for this specific request 0.000
g. Total actual and obligated flows to the facility 0.265
h. Percent of permitted flow used 54.08%
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
Pump Station Name Approx. Capacity, MGD Approx. Current Avg.
(Firm/Design) Daily Flow, MGD
N/A
III. Certification Statement:
I, Roland Hall , certify that, to the best of my knowledge, 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. 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 for which 1 am the responsible party. Signature of this form indicates acceptance of this
was0vatcr flow./-� 1
Signing Official Signature Date

Roseboro Sanitary Sewer Replacement Project
Quad Map: Roseboro
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FORM WSCAS-12/07 \o�oFWATF9pG
WATERSHED CLASSIFICATION ATTACHMENT >_
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FOR SEWER SYSTEMS
Applicant Name
Project Name
Town of Roseboro
Town of Roseboro Sanitary Sewer Replacement Project
Professional Engineer Name
Engineering Firm Name
W. Brian Johnson, P.E.
The Wooten Company
License No. F-0115
Location
ID
Name of Waterbody'
County
River
Basin
Waterbody Stream
Index No.
Waterbody
Classification
1
LIT to Little Coharie Creek
Sampson
Cape Fear
C, Sw
18-68-1-17
' If unnamed, indicate "unnamed tributary to X", where X is the named waterbody to which the unnamed tributary joins.
I certify that as a Registered Professional Engineer in the State of
North Carolina that I 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
*** END OF FORM WSCAS-12/07 ***
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FORM: WSCAS-12/07 Page 1 of 1