WQ0042440_Application (FTSE)_20210331

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: abW�u Io be completed by D NC Dept ofEnviroamental Quality
All items must be completed or the application will be returned
I. APPLICANT INFORMATION: MAR 11 2021
I. Applicant's name: Town of Pine Level (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State/County ® Municipal
3. Signature authority's name: Jeff Holt per 15A NCAC 02T .0106 b
Title: Mayor
4. Applicant's mailing address: PO Sox 328
City: Pine Level State: NC Zip: 27568-`
5. Applicant's contact information:
Phone number: 919) 965-2284 Email Address: de clerk winelevel.ors
II. PROJECT INFORMATION:
Raleigh Regional Office
❑ Privately -Owned Public Utility
❑ Other
Ral@igb Regional Offices
I. Project name: SCOTTIES RIDGE
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. WQ00
3. County where project is located: Johnston
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.4956 Longitude:-78.2142
5. Parcel ID (if applicable): 263300-35-8602
(or Parcel ID to closest downstream sewer)
ill. CONSULTANT INFORMATION:
1. Professional Engineer: Andrew Hodge, PE License Number: 21094
Firm: Adams and Hodge Engineerine, PC
Mailing address: 314 East Main Street
City: Clayton State: NC Zip: 27520-
Phone number: [phone] Email Address: andrew a adamsandhodse.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
I. Facility Name: Central Johnston County Regional WWTF Permit Number: NCO030716
Owner Name: Johnston County
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
I. Permit Number(s): WQ0041697 Downstream (Receiving) Sewer Size: 8 inch
System Wide C ullection Svswrn Permh Numbers) (if aprlica It:: WQCSDO012
Owner Name(s): Town of Pine Level
FORM: FTA 04-16 Page 1 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 At�,reement {FORM: DEVJ been attached?
[--]Yes [—]No ®NIA
3. If the Applicant is a Home;Tra ert Owners' Association, has an Operational Agreement FORM: HOAJ been attached?
[:]Yes []No [EN. -'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 I preschool I day care ❑ Medical I dental I veterinary facilities ❑ Swimming Pool /Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming PooVFilter Backwash
❑ Businesses / offices I factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater :_ % DomesticiCommercial % Commercial
_ % Industrial (See 15A NCAC 02T .0103{20))
bIs there a Pretreatment Program in effect? [—]Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 02T .0l 141f)? ❑ Yes ❑ No
Z If yes, Provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (sec 02T�0I 14(1)
Daily Design Flow °''
No. of Units
Flow
galf
GPD
gal/
GPD
gall
GPD
gaff
GPD
gal;`
GPD
gal.-'
GPD
Total
0 GPD
a See ,15A NCAC 02T .01 14t6). 01. (e)f I) � ii €l 'IM 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 15A NCAC 02T .0114(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, Q2T .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: W 0041697
❑ Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain):
FORM: FTA 04- f 6 Page 2 of 5

4
VI1. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
I . Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 +/-2707 PVC
8 +/-197 DIP
Section 11 & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
Section Ill 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
VII1. 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)
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{hy I }:
❑ 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
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.
i- 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 tinieframes, shall be provided
in the case of a multiple station power outage.
FORM: FTA 04- i 6 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
I. Does the project comply with all separations found in l.SA NCAC 02 T ,0305(Q & (g)
> 15A NCAC 02T.0305(6 contains minintum senaratinnc that ch-111 h,- nrnvir6d r e mow.. ­fA -
® Yes ❑ No
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)
I8 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-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
Drainage s stems and interceptor drains
5 feet
Any swimming pools
Final earth grade (vertical)
10 feet
36 inches
7 I5A NCAC 02 0 05 contains alternatives where separations in 02T.0305(a cannot be achieved.
"Stream classifications can be identified using the Division's NC Surface Water Classifications wehna�e
If noncompliance with 02T_0305 or EVIL see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ❑ Yes ® No
t 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
Where sewer crosses wetlands, the sewer will be bored under the wetlands with a 16" steel casing with 8" DIP carrier pipe.
There are no proposed wetland impacts,
3. Does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ® Yes ❑ No
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?
i Information can be obtained from the 401 & Buffer Perutiain , Broncli
5. Does project comply with 15A iNCAC 0?T.0105tc1U6 (additional permitslcertifications)? ® Yes ❑ No
❑NA
❑ WA
Per 1.SA NCAC 02T.01 05fc}f6). 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
r> 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 (cast once every six -months and inspections
documented per 15A NCAC 02T.0403(a)(5) or the permilee's individual System -Wide Collection permit.
FORM: FTA 04-16 Page 4 of 5

X. CERTIFICATIONS:
Does the submitted system comply with 15A NGAC 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/Altemative Design Request application (VADC 10-14) and supporting documents for
review. Approval orthe request is required prior to submittal of the Fast Track A lication and supporting documents.
Professional Engineer's Certification:
1, Andrew W. Hodge 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 143-215.613, 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:' H C a.R`
�` Q` EEssI !�''#�
r 2 Quo y
SEAL �
21094
03123/2021
3. Applicant's Certification per 15A NCAC 02T.0106(b):
[, Jeff Holt Mayor _attest that this application for
(Signature Authority's name & title from Application Item 1.3.)
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. 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 14320.6A 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.
Nit Atae__
Signature: Date: V , 2-4
FORM: PTA 04-16 Page 5 of

JAM ADAMS & HODGE
ENGINEERING, PC
March 29, 2021
Ted Cashion
NC DWQ
3800 Barrett Dr
Raleigh, North Carolina 27609
Subject: Scottie's Ridge
Town of Pine Level
Johnston County
NC Dept of Environmental Quality
MAR 31 202,
Raleigh Regional Office
Attached is one original and one copy of a complete Fast Track Application for Gravity Sewers,
Pump Stations, and Force Mains, which includes the following:
1. Complete Fast Track Application for Gravity Sewers, Pump Stations, and Forcemains
(Form FTA 04-16), signed by Engineer & Town
2. $480.00 Check for Application Fee
3. USGS Quad Map showing approximate site location
4. Street Level Map
This application is for +/-2,904 if of 8" gravity sewer to serve 48 single family residential lots
and an amenities center. There is zero flow requested in this application. The flow was approved in permit
WQ0041697.
If you have any questions or comments, please give me a call at 919-369-1938 or
email to [e-mail].
Sincerely,
Andrew Hodge, PE
ADAMS & HODGE ENGINEERING, PC . 314 East Main Street, Clayton, NC 27520 a Office: 919-243-1332 0 Firm license ii C•4187

•,CAMPGROUNDRO USGS MAP - SCOTTIES RIDGE
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Ti` Force Main
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SCOTTIES RIDGE
Pump Station Site
Permit WQ0041697
Scale: 1 in. 2000 feet
(The scale is only accurate when printed portrait'
ADAMS & HODGE
} on a 8 112 x 11 size sheet with no page scaling.) 0. PG
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