WQ0042069_Application (FTSE)_20201021

State of North Carolina
Department of Environmental Quality
Division of Water Resources
DWR
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: �bb ` 4 (to be completed by DWR)
V (�
All items must be com leted or the apolication will be returned
1. APPLICANT INFORMATION:
I. Applicant's name: ToM of Nashvill (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: Randy Lansing per 15A NCAC 02T.0106(b)
Title: Town Manager
4. Applicant's mailing address: P.O. Box 287
City: Town of Nashville State: NL Zip: 27856-
5. Applicant's contact information:
Phone number: [phone] Email Address: randy.lansine(@townofnashvillenc.corri
o
II. PROJECT INFORMATION:
o
1. Project name: TIP U-50261 R-5720 •• �)gstily� Ike
2. Application/Projectscatus: Proposed (New Permit) ®Exi
raject 4L`' L3
If a modification, provide the existing permit number: WQ00 d issued date:
CL
If new construction but part of a master plan, provide the existing permit number: WQ00
u �
3. County where project is located: Nash
4. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: -
5. Parcel ID (if applicable):
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
I. Professional Engineer: Matthew W. Watt, PE License Number: 037518
Firm: HDR Ennincerine Inc.f the Carolinas
Mailing address: 100 N Main Street. Suite 1500
City: Winston Salem State: NL Zip: 27101
Phone number: [phone] Email Address: matthew.watt(a,, hdrinc.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Tor- River Rcizional Wastewater Treatcment Plan Permit Number: NCOQ30317
Owner Name: City of Rocky Mount
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
I. Permit Number(s): WQ0005568 Downstream (Receiving) Sewer Size: 8 inch
y -nt Widq ('QII"tion System Perm iI Nit rnberfsf fif, a P121lCab 16: WQCSD001
Owner Name(s): City of Rocky Mount
FORM: t:TA 04-16 Pagel 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 ®N/A
2. if the Applicant is a Developer of lots to be sold, has a Developer's rAgreement F been attached?
❑ Yes [-]No ®N/A
3. If the Applicant is a Home/Propea Owners' Association. has an Operational Agreement (FORM: H06) 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 : 100 % Domestic/Commercial % Commercial
% Industrial (S=_l5A NCAC 02T .0103(20))
bIs there a Pretreatment Program in effect? ❑ Yes ® No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(f)? ❑ Yes ® No
If yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 021.01140
Daily Design Flow'"b
No. of Units
Flow
Dwelling - 3 Bedroom
360 gal/day
24
8,640 GPD
General Business & Office Facilities
250 gal/day
13
3,250 GPD
gal/
GPD
gall
GPD
gall
GPD
gall
GPD
Total
11,890 GPD
a See 15A NCAC 02T .01 14(b). (d). fe)(1I and (e)(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 cast 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.0114] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 1.1,890 GPD (per 15A N 02T 01 14)
D Do not include future flows or previously permitted allocations
1f 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

V1I. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC(Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 3911.33 DIP
➢ Section 11 & Ill of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section [l[ contains information related to minimum slopes for gravity sewcr(s)
➢ Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
VHl. 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 NCAC 02T .0305(h)(I }:
❑ 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.
➢ 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)):
I. Does the project comply with all separations found in 15A NCAC 02T .03Q5(f) & (gJ
➢ 15A NCAC 02T.0305(f) contains minimum separatinns that shall he nrnvided fnr crurrr evicer. e-
® Yes [:]No
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below vertical
24 inches
Water mains vcrtical-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-I waters of Class I or
Class 11 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
hi h 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 s stems and interceptor drains 1
5 feet
Any swimming pools
10 feet
Final earth grade vertical
36 inches
➢ 15A NCAC 02T.0305(e) contains alternatives where separations in 02T.0305(0 cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications weboage
➢ If noncompliance with 02T.0305(f) or (" see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) [:]Yes ❑ No ® NIA
➢ Sec 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 213.0202
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 Permitting; Branch
5. Does project comply with 15A NCAC 02T.0105(rc)(fi) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T.0105(c)(6), directly related environmental permits or certification applications arc 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 arc deemed "high -priority?"
Per 15A NCAC 0210402, "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 15A NCAC U2T, the hlimmom Design Cntena for the Perinittingaf.Punm Stations
and Force Mains latest �Lr..ii�onh and the Gra, its Sewer Minimum Design C^ritria I latest version) as applicable?
® Yes ❑ No
If No, complete and submit the VarianceiAlternative 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 -
3.
I, — A yy/�" 61-) 641,7 __attest that this application for
(Professional Engineer's name from Application Item II1.1.)
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:
ti .7
SEAL 9
= a 037518 `-
• r9�,f ZnTs3
�q • �'yG I N���'fi�
Applicant's Certific on per 15A NCAC 02T .0106(b):
(Signs re Authority's na a title from Application I e 1.3.)
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 1.33-215.6A and 143-215.6f3, 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 $10,00s well asivil penalties up to $25,000 per violation.
Signature:
FORM: FTA 04-16 passe 5 nF5

State of North Carolina
` Department of Environmental Quality
' x Division of Water Resources
Division of Wxter 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: TIP U-50206.1 R-5720
,More than one FTSE maybe required for a single project if the owner of the It 1UP is not responsible for all pump
stations along the ratae of the proposal wastewater flow.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a.
WWTP Facility Name: Tar River Regional
b.
�
WWTP Facility Permit #: NCO030317
-
A11 f lows are in MGD
J�
c.
WWTP facility's permitted flow
2i.00
d.
Estimated obligated flow not yet tributary to the WWTP
0.604
e.
WW3`P facility's actual avg. flow
10.83
f.
Total flow for this specific request
0.01189
g.
Total actual and obligated flows to the facility
11.446
h.
Percent of permitted flow used
54.50%
1I. 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)
(F)=(A-D)
Design
Obligated.
Pump Average Daily
Approx.
Not Yet
Total Current
Station Firm Flow"
Current Avg.
Tributary
Flow Plus
(Name or Capacity, ' (Firm.: pf),
Daily Flow,
Daily Flow,
Obligated
Available
Number) MGD MGD
MGD
MGD
Flow
Capacil%***
97 Lift St 30 12
6.5
0.604
7.104
4,896
* 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 (pi) 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): Tar River Regional
Downstream Permit Number; NC 0030317
n
d
Page 1 of 6
FTSE 04-16

IIl. Certification Statement.
I William Brad Kerr certif} 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 besu
Lwallable data. This certification applies to those items listed above in Sections I and II plus all
attached planning assessment addendums for which 1 am the rc ponsible part%.. Signature of this
form indicates acceptance of this wastewater flow.
Sig iirrg i`1�fleicr! Sign
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hdrinc.com
October 14, 2020
N.C. Department of Environmental Quality
Division of Water Resources
Raleigh Regional Office
1628 Mail Service Center
Raleigh, North Carolina 27699-1628
Re: TIP Project U-50261R-5720
15A NCAC 02T .0300 — Sewer Extension Application
HDR Project Number 10496959
NC Dept nfEnvironmcntat Quaitty
OCT 21 2020
Raicigh Regional Office:
On behalf of the Town of Nashville, please find enclosed the following permit application and
supporting documents for the TIP Project U-50261R-5720 for your review and approval:
1. One original and one copy of the Fast Track Sewer System Extension Application
2. One original and one copy of the Flow Tracking for Sewer Extension Application
3. $480 Application Fee
4. Two (2) Copies of USGS Site Map
5. Two (2) Copies of Aerial Map
The proposed project contains 3,911 LF of 8" ductile iron gravity sewer. The wastewater generated
from this extension is 11,890 GPD which will feed into an existing manhole in the Town of Nashville.
Wastewater generated from this project will end at The City of Rocky Mount's Tar River Regional
Wastewater Treatment Plant.
Should you have any questions or need additional information, please do not hesitate to contact
me.
Sincerely,
HDR Engin g, Inc., of the Carotin s
Matthew W. Watt, PE
Water/Wastewater Project Manager
100 N Main Street Suite 1500 Winston-Salem. NC 27101
(704)338-67008259