WQ0042150_Application (FTSE)_20201211

Permit Number WQ0042150
Program Category
Non -discharge
Permit Type
Gravity Sewer Extension, Pump Stations, & Pressure Sewer Extensions
Primary Reviewer
dean.hunkele
Coastal SWRule
Permitted Flow
Facility
Facility Name
Circle K at Gum Branch and Western
Location Address
Owner
Owner Name
City of Jacksonville
Dates/Events
Central Files: APS _ SWP
12/3/2020
Permit Tracking Slip
Status
Project Type
In review
New Project
Version
Permit Classification
A
Individual
Permit Contact Affiliation
Major/Minor Region
Minor Wilmington
County
Onslow
Facility Contact Affiliation
Owner Type
Government - Municipal
Owner Affiliation
Richard L. Woodruff
PO Box 128
Jacksonville
NC 2854101:
Scheduled
Orig Issue App Received Draft initiated Issuance Public Notice Issue ( Effective Expiration
11/30/2020 TSSYtied l^�

5410 Trinity Road
P 919.866.4951
T I M M O N S GROUP Suite 102
F 919.859.5663
YOUR VISION ACHIEVED THROUGH OURS. Raleigh, NC 27607
www.timmons.com
TRANSMITTAL
RECEIVED
NOV 3 0 2020
NCDEQ
NCDEQ — Water Quality
WILMINGTON RO
TO: Section
c/o Dean Hunkele
127 Cardinal Drive Ext.
Wilmington, NC 28405
Date: 11/25/20 Job#: 37630.023
Project: Circle K — NTI Gum Branch I Western
Reference: NCDEQ Sewer Fast Track
Copies Sent To: Dean Hunkele
COPIES
DATE
DESCRIPTION
2
11/25/2020
Fast Track Sewer System Extension Application
2
11/25/2020
Cover Letter
1
11/25/2020
$480 Application fee TG Check # 87839
2
11/25/2020
Fast Track Application Form FTA 04-16
2
11/25/2020
Flow Tracking / Acceptance Form Form FTSE 04-16
2
11/25/2020
Site Ma USGS & Aerial
2
11/25/2020
Street level map showing aerial
THESE ITEMS ARE TRANSMITTED:
If enclosures are not as noted, please notify us at once. Fee will be paid at time of submittal by Credit
Card.
COMMENTS:
9 . _
Brian W. Downs
Senior Project Manager
CIVIL ENGINEERING I ENVIRONMENTAL I SURVEYING I CIS I LANDSCAPE ARCHITECTURE I CONSTRUCTION SERVICES

TIMMONS GROUP
YOUR VISION ACHIEVED THROUGH OURS.
November 111h, 2020
NC Department of Environment and Natural Resources
Division of Water Resources
127 Cardinal Drive Ext.
Wilmington, NC 28405
Reference: NCDEQ Fast Track Sewer System Extension Application
Circle K — NTI Gum Branch / Western — NC.68
Timmons Group Project # 37630.023
Jacksonville, NC
To Whom it may concern,
Please see the attached Fast Track Sewer System Application for the Circle K — NTI
Gum Branch project. A 5,187 square foot convenience store is being proposed on a
2.20-acre lot. Circle K is proposing a new convenience store at the southwest corner of
the intersection of Western Boulevard and Gum Branch Road in Jacksonville, NC. The
project proposes that an existing eight -inch public gravity sanitary sewer main going
through an adjacent property to the southwest is to be extended to the Circle K site.
This existing private sewer main connects to an existing public sanitary sewer main just
east of Westmond Road. There is 268 feet of eight -inch DIP and 420 feet of eight -inch
PVC private gravity sewer to be permitted southwest of the site.
This application includes the following:
➢ One original and one copy of application and supporting documents
➢ Cover letter
➢ $480.00 check payable to NCDEQ
➢ Signed Fast Track (Form: FTA 04-16) Application
➢ Documentation showing Circle K Stores, Inc. registered with Secretary of State
➢ Signed Flow Tracking/Acceptance Form (Form: FTSE 04-16)
➢ Site map (USGS) identifying project area and sewer network
➢ Street level map of project area
We appreciate your prompt review of this fast track sewer application. If you have any
questions or if we can provide any additional information, please contact me at (919)
866-4939 or at [e-mail].
Regards,
Rick Baker, PE
Group Leader — Raleigh Commercial
0
E
E

State of North Carolina
nW Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources ETA 04-16 & SUPPORTING DOCUMENTATION
Application Number.V (J') q X� 0 (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: City of Jacksonville (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: Ronald F. Massey per 15A NCAC 02T .0106(b)
Title: Deputy City Manager
4. Applicant's mailing address: PO Box 128
City: Jacksonville State: NC Zip: 28541-
5. Applicant's contact information:
Phone number: [phone] Email Address: [e-mail]
It. PROJECT INFORMATION:
L Project name: Circle K - NTI Gum Branch / Western - NC.68
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: W000
3. County where project is located: Onslow
4. Approximate Coordinates (Decimal Degrees): Latitude: 34.798962' Longitude:-77.439464'
5. Parcel ID (if applicable): 436816843806
(or Parcel ID to closest downstream sewer)
I11. CONSULTANT INFORMATION:
l . Professional Engineer: Rick Baker, PE License Number: 22530
Firm: Timmons Group
Mailing address: 5410 Trinity Road: Suite 102
City: Raleigh State: NC Zip: 27607-
Phone number: (20) 866-4939 Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: City of Jacksonville WWTF Permit Number: W00009267
Owner Name: City of Jacksonville
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF): U
1. Permit Number(s): WQ9490946_ Downstream (Receiving) Sewer Size: 8 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS a
Owner Name(s): City of Jacksonville
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 Developer's Operational Agreement (FORM: DEV) been attached?
❑ Yes ❑No ®N/A
3. If the Applicant is a Home/Property Owners' Association, 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 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
0 % Industrial (See 15A NCAC 02T .0103(220))
"Is there a Pretreatment Program in effect? ❑ Yes ® No
6. Has a flow reduction been approved under 15A NCAC 02T .0114(fl? ❑ Yes ® No
➢ If yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow e,b
No. of Units
Flow
Gas Station / Convenience Store
60 gal/100 SF x 5187 SF
1
3,113 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
3,113 GPD
a See 15A NCAC 02T .0114(b), (d), (e)(H 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 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.01141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 3 113 GPD (per 15A NCAC 02T .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 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8
268
DIP
8
420
PVC
➢ Section Il & 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 & 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 - I5A 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(t)):
1. Does the project comply with all separations found in 15A NCAC 02T.0305(f) & (g) ® Yes ❑ No
➢ 15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
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-I waters of Class I or
Class II 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 sloe 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
➢ 15A NCAC 02T.0305(e) contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webpaee
➢ If noncompliance with 02T.0305(f) or (g), 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 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(c)(6) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T.0105(c)(6), 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: FTA 04-16 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Pump 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/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 supporting documents.
2. Professional Engineer's Certification:
that this application for
Engineer's name from Application Item Ill.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. 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 (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 143-215.6B, 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 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):
d �:, Aztssey, - Del
Authority's natRe & title from
r 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. 1 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 143-215.6A and 143-2I5.6B, 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 a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: v �""�'2f Date: l� bt 7z�iaa
FORM: FTA 04-16 Page 5 of 5

Division of Water Resources
Entity Requesting Allocation: Circle K
Project Name for which flow is being requested
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Inc
Circle K - NTI Gum Branch/Western
More than one FTSE nmy be required for a single project if the owner of fire WWTP is not responsible for all ptonp
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: City of Jacksonville Land Treatment System
b. WWTP Facility Permit #: 0009267
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. 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
Allflows are in MGD
9.0
0.523
5.446
.0031
5.613
62.9
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)
Design
Average
Pump
Pump
Daily
Station
Station
Firm Flow**
(Name or
Permit
Capacity, * (Firm / pfl,
Number)
No.
MGD MGD
(B)
(C)
(D)=(B+C)
(E)=(A-D)
Approx.
Obligated,
Total
Current
Not Yet
Current
Avg. Daily
Tributary
Flow Plus
Flow,
Daily Flow,
Obligated
Available
MGD
MGD
Flow
Capacity***
Brookview WQ0000896 6.048 2.419 1.054 .0186 1.072 1.347
Main WQ0032015 30 12 5.374 .0053 5.379 6.621
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
between the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer):
Downstream Permit Number:
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I Ronald F. Massey 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.
Signing Official Signature
Title
l 111(0 /'zap
Date
Page 2 of 6
FTSE 10-18

USGS MAP
1
SITE ERN BLVD, ... -
EN-50� WEST
CIRCLE K TO CONNECT
WITH 6"SERVICE
2 `
OA, RR\ "� PROPOSED PUBLIC 8' PVC O_vJ+
'Y BEIR ` GRAVITY SEWER MAIN
-' WITHIN 20' EASEMENT .p
`C
✓'-�l `�� EXISTING 8" PVC
GRAVITY SEWER MAIN �(
O
2
0 1.
o� IPLANTA

AERIAL VICINITY MAP
K - Mle M,