WQ0042083_Application (FTSE)_20201027

State of North Carolina
DWR
Department of Environmental 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: �" b o 0 0 3 (to be complcled by DW R)
All items must be completed or the anplication will be returned
1. APPLICANT INFORMATION:
1. Applicant's name- CitK-of Rocky Mount (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: William B. Kerr, PE per 15A NCAC 02T .0106(b)
Title: Public Works Director
4. Applicant's mailing address: 331_S._Franklin, St., PO Box 1 180
City: Rocky Mount State: NC Zip: 27802-1 180
5. Applicant's contact information:
Phone number: [phone] Email Address: brad.ke_rr mrock -1nountnc.eov
11. PROJECT INFORMATION:
1. Project name: TIP U-5026/ R-5720
2. App I ic at ion/Project status: ❑ Proposed (New Permit) ® Existing Permit/Project
If a modification, provide the existing permit number: WQOO and issued date:
If new construction but part of a master plan, provide the existing permit number: WQOO
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)
111. CONSULTANT INFORMATION:
I. Professional Engineer: Matthew W. Watt. PE License Number: 037518
Firm: HDR Engineering Inc. of the Carolinas
Mailing address: 100 N. Main Street, Suite 1500
City: Winston Salem State. NC Zip: 27101-
Phone number: (L36) 995-7056 Email Address: mattliew.watt(&hdrinc.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
I. Facility Name: Tar River Regional Wastewater Treatement Plant Permit Number: NCO030317
Owner Name: City of Roc - Mount
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQO005568 Downstream (Receiving) Sewer Size: 8 inch
System „Wide Collection_ System Permit Number(s,Z_Lf applicable): WQCSOOOI l
Owner Namc(s): City of Rocky Mount
FORM: FTA 04-16 Page I of

THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND
MATERIALS, 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,
Water Quality Section
Swannanoa, North Carolina 28778
Clay, Graham, Haywood, Henderson, Jackson,
(828) 2964500
Macon, Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Harnett, Hoke,
Water Quality_ Section
Fayetteville, North Carolina 28301-5094
Montgomery, Moore, Robeson, Richmond,
(910) 433-33DO
Sampson, Scotland
[phone] Fax
Mooresville Regional Office
610 E. Center Avenue
Alexander, Cabarrus, Catawba, Cleveland,
Water Quali Section
Mooresville, North Carolina 26115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
Raleigh Regional Office
1628 Mail Service Center
Chatham, Durham, Edgecombe, Franklin,
Water Quality Section
Raleigh, North Carolina 27699-1628
Granville, Halifax, Johnston, Lee, Nash,
(919) 79141200
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
Warren, Wilson
Washington Regional Office
943 Washington Square Mall
Beaufort, Bertie, Camden, Chowan, Craven,
Water Ouali Section
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
Water Quality Section
Wilmington, North Carolina 28405
Hanover, Onslow, Pender
[phone]
(910) 350-20D4 Fax
Winston-Salem Regional Office
450 W. Hanes Mill Road
Alamance, Alleghany, Ashe, Caswell, Davidson,
Water Quality Section
Suite 300
Davie, Forsyth, Guilford, Rockingham, Randolph,
Winston-Salem, North Carolina 27105
Stokes, Surry, Watauga, Wilkes, Yadkin
[phone]
INSTRUCTIONS FOR FORM: TTA 04-16 &SUPPORTING DOCUMENTATION Page 3 of 3

Vf. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
[:]Yes ❑No ®NIA
2. If the Applicant is a Developer of lots to be sold, has a Developer's_Operational Agreement (,FORM: DEV) been attached?
❑ Yes ❑No ®NIA
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 1 offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: % Domestic/Commercial % Commercial
.% Industrial (See 15A NCAC 02T .0103(201)
1,Is there a Pretreatment Program in effect? ❑ Yes ® No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(]? ❑ Yes ®No
If yes,, provide a cony or flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.01140
Daily Design Flow'-b
No, of Units
Flow
gal/day
GPD
gal?day
GPD
gal/
GPD
gal/
GPD
gal,
GPD
gal?
GPD
Total
GPD
a See .15A NCAC O7 T -01 14(b), (d). (c)(1) and (c)(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 42A4).
b Per I SA NCAC 02T A 114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.01 14] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 0 GPD (per 15A NCAC" 02T .01 14)
3✓ 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 (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
10
723
DIP
12
768
DIP
16
2081
DIP
Section 11 & 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)
Y Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
Vlll. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & NIDC (Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: T
2. Approximate Coordinates (Decimal Degrees): Latitude: 0Longitude: - °
3. Design flow of the pomp 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 (incites) Length (feet) Material
6 480 DIP
6. Power reliability in accordance with 15A NCAC 02T .0305_(h)(1):
❑ 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
Y 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.
Y 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 _NCAC 02T.0305(f) & (g)
D 15A NCAC 02T.0305(f) contains minimum separations that shall be nrnvided for sewer systemv
® Yes ❑ No
Setback Parameter'
Separation Required
Stone 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-1 waters of Class I or
Class 11 im ounded 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
Anv basement
10 feet
_T4?p slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interce for drains
5 feet
Any swimming pools
10 feet
Final earth grade vertical
36 inches
15A NCAC 02T,0305(a) contains alternatives where separations in 02T.03050) cannot be achieved.
"Stream classifications can be identified using the Division's NC Surface Water Classifications web -Me
D If nancompliance with 02T.0305(fl or (g), see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ® Yes ❑ No ❑ NIA
Seethe Division's draft separation requirements for situations where separation cannot be meet
D 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 ❑ NIA
i► 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?
i+ Information can be obtained from the 401 & Buffer Permittinz Branch
5. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? ® Yes ❑ No
Per I5A NCAC 02T_OIQS(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 I SA 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 ❑ NIA
D 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 permitter 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 14A NCAQ 021., the A m mum Design Criteria fir the I'ernntltng off 11jnip titatians
tnid Force 41.linti latest .�L rsiotj), and the (Jravtly Sewer Minimum 11¢sian Critcri.t (latest ver92 as applicable?
® Yes ❑ No
If No, complete and submit the VariancelAlternative Design Request application (VADC 10-14) and supporting documents for
review. Approval orthe re uest is required prior to submilial of the Fast Track Application and supporling documents.
2. Professional Engineer's Certificalion:
ATIK�_t,� (,cJ W4dt attest that this application for
(Professional Engineer's name from Application Item 111.1.)
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 143-215.6B, 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:
a 9
037518 '—
' 0 Sri-1l- t�tr
•f>i h,�W W �P`��
/%ir,IIII%\\\
3. Applicant's Certification per 15A NCAC 02T .0106(b):
W 44_LY4M d. LLRk Pull(—IG W0R.1C,5 Di t? Ec-'M6, attest that this application for
(Signature Authority's nAe & title from Application Item I.3.)
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 143-215.6A and 1.1 1_:'.1.5 611, 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.
f
Signature. l`� />y� iDate;
FORM: FTA 04-16 Page 5 of 5

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hdrinc.com
December 11, 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
On behalf of the City of Rocky Mount, please find enclosed the following permit application and
supporting documents for the TIP Project U-5026IR-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 2,081 LF of 16" ductile iron gravity sewer, 768 LF of 12" ductile iron
gravity sewer, 723 LF of 10" ductile iron gravity sewer, and 480 LF of 6" ductile iron force main.
The construction of these sewer lines are replacements and no new flow is expected. Flow from
this area is to continue to Tar River Regional Wastewater Treatment Plant, as previously permitted.
Should you have any questions or need additional information, please do not hesitate to contact
me.
Sincerely,
HDR Engineering, Inc, of the Carolinas
V
Matthew W. Watt, PE
Water/Wastewater Project Manager
100 N. Main Street, Suite 1500 Winston-Salem. NC 27101
[phone]