wq0042078_Application (FTSE)_20201028

Dlvlsion of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number 0 (to be completed by DWR)
All items mast be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: City of Wilson (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State/County ® Municipal
3. Signature authority's name: W.T. Bass IV. PE per 15A NCAC 02T .0106(b)
Title: Director of Public Works
4. Applicant's mailing address: 1800 Herring Ave. E.
City: Wilson State: NC Zip: 27893-
5. Applicant's contact information:
Phone number: {252) 399-2453 Email Address: bbassAwilsonnc.org
H. PROJECT INFORMATION:
to —d $
❑ Privately -Owned Public Utility
❑ Other
1. Project name: Lake Wilson Rd Gravity Sewer Extension
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number. WQ00Nr1A and issued date: MA
1f new construction but part of a master plan, provide the existing permit number: WQ000
3. County where project is located: Wilson
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.789496 Longitude:-77.918075`
5. Parcel ID (if applicable): 3724-04-5034 & 3724-04-7110
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Robert S. Bartlett License Number: 20106
Firm: Bartlett Engineering & Surveying, PC
Mailing address: 1906 Nash Street N.
City: Wilson State: NC Zip. 27893-
Phone number: 2( 52) 399-0704 Email Address: robert(a7bartletten2.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Hominy Creek Water Reclamation Facility Permit Number: NCO023906
Owner Name: City of Wilson
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
L Permit Number(s): WQ Downstream (Receiving) Sewer Size: 8 inch
System Wide C'ollction Svstem Permit Number(s) (if applicable): WQCS00021
Owner Name(s): City of Wilson
M
41
FORM: FTA 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 Operational &rccmLmLJ ORM: DF,V) been attached?
❑ Yes ❑No ®N.:A
3. If the Applicant is a IloineTro eny Uwnus' Associatian has an Operational Agreement (FORM: HOA) 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 preparatioNservice ❑ Hotel and/or Motels
❑ School ? preschool / day care ❑ Medical."' dental I 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 See 15A NBC 02T .0103[20))
4 Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .01 14(f)? ❑ Yes [:]No
r If yes, provide a cony of flow reduction annroval letter
7. Summarize wastewater generated by project:
Establishment Type (see 021.0114 IJ)
Daily Design Flow °''
No. of Units
Flow
Residential
120 gal/room/day
3
360 GPD
Residentail
120 gal/room/day
4
480 GPD
gal/
GPD
gall
GPD
gall
GAD
gall
GPD
Total
840 GPD
a See 15A NCAC 02T .01 14(b), (d). {e)(I 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 east ofthe 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.01 141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 840 GPD (per 15A NCAC 02T .0l 14)
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

VI1. GRAVITY SEWER DESIGN CRITERIA or Applicable) - 02T .0305 & MDC (Gravity, Sewers):
L Summarize gravity sewer to be permitted:
FSize (inches) j Length (fect) Material
8 1 391 1 PVC I
`r• Section II & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
r 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 & MDC (Puma Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: N/A
2. Approximate Coordinates (Decimal Degrees): Latitude: - Longitude: -
3. Design flow of the pump station: N/A millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): N/A gallons per minute at N/A feet total dynamic head (TDH)
5. Summarize the force main to be permitted (far this Pump Station):
Size (inches) Length (feet) Material
N/A N/A N/A
6. Power reliability in accordance with t5A NCAC 02T.030SIh)W:
❑ Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(h)(1)(13):
Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
1r 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)(I)(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 multiple station power outage.
FORM: rTA 04-16 Page 3 of 5

1X. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(t)):
1. Does the project comply with all separations found in I5A N—CAC 02T _030Sf t& ( ® Yes ❑ No
➢ 15A NCAC 02T.0305(f) contains minimum separations that shall be nrovided for sewer systems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below vertical)
24 inches
Water mains vertical -water over sewer mcludin 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-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 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
Draina e systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
15A NCAC 02T.0305(e) contains alternatives where separations in 02T.03054f) cannot be achieved.
**Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
If noncompliance with 9?T.0305(f) or i , see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) [:]Yes ❑ No [ON '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 025 .0200? ❑Yes []No ®NiA
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 Permittinpch
5. Does project comply with 15A NCAC 02T,9 Q cJ6) (additional permiWcertifications)? ® Yes ❑ No
Per I SAN�;AC 02T.0105 ci }i6], 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.04U2, "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 ❑ NiA
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:
I. Does the submitted system comply with 15A 14CAC, 02T, the Minimum Design Criteria "q Permitting of P�nnn Stations
ansf Force Mains (latest version and the Gravity Sewer Minimafn Design 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 (lie reguest is re uired prior to submittal of the Fast Track Apolication and supporting documents.
2. Professional Engineer's Certification:
1:S1_i7`Z _attest that this application for
(Professional Engineer's name from Application Item III. I.)
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:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
WIME
Authority's name & title from Application Item 1.3.)
•
0106,tJ
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. 1 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 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 aline not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature:
Date:.A bokoze,
FORM: FTA 04-16 Page 5 of 5

State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
Division of Water Resources Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: City of Wilson
Project Name for which flow is being requested: Lake Wilson Rd Gravity Sewer Ext.
More than one FTSE pray he required for a single project if the owner of the iVH'TP is not responsible far all pinup
stations along the route of lire proposed waste►eater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Hominy Swamp Water Reccamation Facility d
b. WWTP Facility Permit #: NCO023906 o
All flows are in MG*, C:)
c. WWTP facility's permitted flow 14 MGD
d. Estimated obligated flow not yet tributary to the WWTP 1.175086
e. WWTP facility's actual avg. flow 8.86 MGD
f. Total flow for this specific request 0.00084 o,
g. TotaI actual and obligated flows to the facility 10.03509 p
h. Percent of permitted flow used 71.68
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:
(A)
(B)
(C)
(D)=(B+C)
(E)=(A-D)
Design
Average
Approx.
Obligated,
Total
Pump
Pump
Daily
Current
Not Yet
Current Flow
Station
Station
Firm
riow**
Avg. Daily
Tributary
Plus
(Name or
Permit
Capacity, *
(Firm pi},
Flow,
Daily Flow,
Obligated
Available
Number)
No.
MGD
MGD
MGD
MGD
Flow
Capacity***
17
WQCS00021
0.778
0.311
0.0996
0.07064
0.1702
0.1408
1
WQCS00021
12.96
5.184
2.91
0.204
3.114
2.07
2
WQCS00021
25.92
10.368
3.01
0.3378
3.3478
7.0202
* 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
(p f) 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
between the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): Hominy Swamp Water Reclamation
Downstream Permit Number: NC 0023906
Page I of 6
FTSE 10-18

III. Certification Statement:
I W.T. Bass IV, PE 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 certifies that the receiving collection system or treatment
works has adequate capacity to transport and treat the proposed new wastewater.
10/00 12O2v
Signing OfficiN Signature Date
Title of Signing Official
Page 2 of 6
FTSE 14-1 S

-:!Ait •
D gas
1906 Nash street North Wilson, NC 21893-1726
Phone: [phone] Fax- [phone]
www-bartlett.us.com
October 21, 2020
z
State of North Carolina
Department of Environment and Natural Resources
C
Division of Water Quality
—+
Raleigh Regional Office
ono
o'
1628 Mail Service Center
o'
Raleigh, North Carolina 27699-1628
�.
0
Reference: Fast Track Application for Gravity Sewers
Public Sewer Extension
Lake Wilson Road
Wilson, North Carolina
To Whom It May Concern:
Enclosed for your review and approval are two (2) copies of the following items related to the
above referenced project:
■ Fast Track Application for Gravity Sewers
■ Flow Tracking / Acceptance Form
■ USGS Topographic Map
• GIS Aerial Photo
This request is for approximately 381 L.F. of 8" gravity sewer system tying into an existing public
sewer manhole located at the Lake Wilson Park entry drive. This system will provide service for two
(2) existing residences located along the north side of Lake Wilson Road within the City of Wilson.
Also enclosed is the $480.00 sewer permit application fee. Should you have any questions or
require further information during your review, please let us know.
ZReZ;Iuvv�er
e
Project Manager
Enclosures
P­ _PJt0XCT FILES Wilson City, IS-307 Lake Wilson Park Pe nining�Sewer Main Emention to 4651 Late Wilson R& IB 367 NCDENR Cova Lena.doc

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