WQ0042316_Application (FTSE)_20210209

Central Files: APS SWP
Permit Number WQ0042316 Permit Tracking Slip 2/12/2021
Program Category
Non -discharge Status Project Type
In review New Project
Permit Type
Gravity Sewer Extension, Pump Stations, & Pressure Sewer Extensions Version Permit Classification
A Individual
Primary Reviewer Permit Contact Affiliation
dean.hunkele
Coastal SWRule
Permitted Flow
Facility
Facility Name
Handee Hugo Bonjangles #7 Private Pump Station Major/Minor Region
Location Address Minor Wilmington
County
Brunswick
Facility Contact Affiliation
Owner
Owner Name
Sampson Bladen Oil Company Inc Owner Type
Non -Government
Owner Affiliation
Haddon M. Clark III
Dates/Events PO Box 469
Clinton NC 28328041
Scheduled
Orig Issue App Received Draft Initiated Issuance
Public Notice Issue Effective Expiration
2/9/2021
BUNN-BRANTLEY ENTERPRISES, INC.
389 INSTRUMENT DRIVE
ROCKY MOUNT, NC 27804
252-977-9111
PAY FOUR HUNDRED EIGHTY AND 00/100
TO THE
ORDER
OF VOID UNL
NCDEQ ESS CASHED WITHIN 60 DAYS
AUTHORIZED SIGNATURE
PROVIDENCE BANK
ROCKY MOUNT, NC
66-1265/531 15488
DATE
1 /25/2021
AMOUNT
$480.00

STROUD ENGINEERING, P.A.
102-D Cinema Drive
Wilmington, NC 28403
FEB 0 9 2021 JOB NO
[phone]
TO !i!
7REE:
WE ARE SENDING YOU ❑ Attached ❑ Under separate cover via
❑ Shop drawings ❑ Prints ❑ Plans
❑ Copy of letter ❑ Change order ❑
COPIES I DATE I NO.
the following items:
❑ Samples ❑ Specifications
DESCRIPTION
THESE ARE TRANSMITTED as checked below:
❑ For approval ❑ Approved as submitted ❑ Resubmit
copies for approval
❑ For your use ❑ Approved as noted ❑ Submit
copies for distribution
>
ElAs requested El Returned ❑ Return Returned for corrections corrected prints
❑ For review and comment ❑
❑ FORBIDS DUE ❑ PRINTS RETURNED AFTER LOAN TO US
REMARKS
COPY TO
if enclosures are not as noted, kindly notify us at once.

Project: PW-1309-002
Engineer: DLM
Date: 10/1/2020
Han -Dee Hugo's/Bojangles—Northwest
Project Narrative
The 2.64 acre site is located at the intersection of US 74/76 and NC 1419 within the corporate
boundaries of the City of Northwest in Brunswick County, NC. The site is zoned C-LD. Adjoining
properties are zoned RR. Proposed improvements are consistent with this zoning and include
of a 3794 sf gas station/convenient store with an attached 2810 sf single service restaurant.
The site is vacant and is cleared of woody vegetation. The site is located on a small ridge and
drains to respective R/W frontages as well as towards undeveloped property to the north.
Driveway access is proposed at a single location on NC 1419 in accordance with a TIA conducted
by Davenport Engineering. The driveway will allow right and left turn movements and will
feature a left turn lanes.
Water service will be supplied by Brunswick County. The site will be sewered by way of a
proposed private duplex grinder pump station. This pump station will be permitted to the
owner and will tie to an existing 8" force main that is owned and operated by Brunswick
County. The average daily flow was calculated as 2,780 GPD based on 02T rules. The calculated
ADF was rounded up to the next residential equivalent to arrive at the requested permitted
flow of 2,880 GPD.
Stormwater runoff will be collected by inlets and conveyed via RCP to an NCDEQ wet pond
designed to treat and release the 1.5" storm in 2-5 days. This NCDEQtreatment volume is
released at a rate that does not exceed the 1 year, 24 hour predevelopment runoff rate.
Runoff in excess of the NCDEQ design storm up to the 10 year storm is routed through an
outfall pipe to the existing US 74/76 roadside swale. A wide, vegetated emergency weir directs
runoff via sheet flow to the site's primary overland outlet to the north.
Erosion control is accomplished through the temporary use of gravel construction entrances,
silt fence, and hardware cloth and gravel inlet protection. The stormwater pond will be used as
a skimmer basin during site construction and will be converted to a stormwater basin once the
site is stabilized. Riprap apron will be installed and left in place at all pipe outlets.

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 04-16 & SUPPORTING DOCUMENTATION
l) �`b (to be completed by DWR)
Application Number:W9
All items must be completed or the application will be returned
1. APPLICANT INFORMATION:
1. Applicant's name: Sampson-Bladen Oil Company Inc (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ® Corporation ❑ General Partnership El Privately -owned Public Utility
❑ Federal ❑ State/County ❑ Municipal ❑ Other
3. Signature authority's name: Haddon M. Clark. III per) SA 1<CAC 02T .0106(b)
Title: President
4. Applicant's mailing address: PO Box 469
City: Clinton State: NC Zip: 28329-0469
5. Applicant's contact information:
Phone number: [phone] Email Address: [e-mail]
1I. PROJECT INFORMATION:
I. Project name: Han -Dee Hueo's/Boiantrles #7
Z Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing pen -nit 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: Brunswick
4. Approximate Coordinates (Decimal Degrees): Latitude: 34.2866' Longitude:-78.1394'
5. Parcel ID (if applicable): 0150004204
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
L Professional Engineer: David L. Menius License Number: 35677
Firm: Stroud Engineering P A
Mailing address: 102-D Cinema Drive
City: Wilmington State: NC Zip: 28403-
Phone number: 910 815-0775 Email Address: lmenius stroudengineer com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Northeast WWTF Permit Number: W60086819
Owner Name: Brunswick County NG
Pj
V. RECEIVING DOWNSTREAM SEWER INFORMATI (if different than WWTF):
1. Permit Number(s): WQ9032475 Downstream (Receiving) Sewer Size: force main -- 8 inch
System Wide Collection System Permit Number{sl (if applicable): WQCS00284
Owner Name(s): Brunswick County
FORM: FTA 04-16
Page I of 5

V1. GENERAL REQUIREMENTS
L 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 Develops r"s Op-qrational Aareement {FORM DI Y) been attached?
❑ Yes []No ®N/A
3. If the Applicant is a Home/Prot)erty Owners' Association has an Operational A0�ement (FORM fiQA) 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 El Other (Explain in Attachment)
5. Nature of wastewater: % Domestic/Commercial 100 % Commercial
_ % Industrial (See 15 iv'CAC 02T .0103( �0))
1,Is there a Pretreatment Program in effect? 0 Yes ❑ No
Hasa flow reduction been approved under 15A NCAC 021 01 1 D? ❑ Yes ®No
> If Yes, provide..a copy of flow reduction annroval letter
Summarize wastewater generated by project:
Establishment Type (see 021.0114{W
Convenience store w/o food preparation.
Restaurant with single service articles.
Round up to next REU (8060)
a
Daily Design Flow a,b
250 gal/fixture
20 gal/seat
gal/
gal/
gal/
gal/
�No. ofUnits
Flow
6
1500 GPD
64
1280 GPD
GPD
GPD
GPD
GPD
7Total
-M94 GPD
See 15A NCAC 021' 0114(b) (d) (e){ 1) and L _) 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 OTF 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: 2880 GPD (per 15A NCAC 021 .01 14)
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
0
➢ Section II & 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 (Pumt) Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
i. Pump station number or name: PS
2. Approximate Coordinates (Decimal Degrees): Latitude: 34.28660 Longitude:-78.1394"
3. Design flow of the pump station: 0.002880 millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): 21 gallons per minute at 155 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
2 145 HDPE
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
➢ 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 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 0;05(f} ( ® Yes ❑ No
➢ 15A NCAC 02T.0305(f) contains minimum
se arat�ons that shall be provided for sewer
Setback Parameter*
systems:
Re red
Storm sewers and other utilities not listed below (vertical)
4724
inches
Water mains (vertical -water over sewer includin in benched trenches)
inches
Water mains (horizontal)
10 feet
Reclaimed water lines (vertical - reclaimed over sewer)
18 inches
2 feet
Reclaimed water lines (horizontal -reclaimed over sewer)
**Any private or public water supply source, including any wells, WS-I waters of Class I or
Class lI im ounded reservoirs used as a source of drinking water
100 feet
50 feet
10 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)
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches
Any buildin foundation
5 5 feet
Any basement
feet
,...Top slope 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 030{(Q) contains alternatives where separations in 02T.0305(t) cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications��
➢ If noncompliance with 02T.0345 t 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? ®1'es ❑ 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 Pcrmittingy Branch
5. Does project comply with 15A NCAC 02T 0I05(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 0 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:
Does the submitted system comply with 15A NCAC 029', the Minimum Desicn Criteria for the Permittinly 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:
1, I v►d L. /t ,
(Professional Engineer's name from Application Item III.1.)
that this application for
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
I,
per 15A NCAC 02T .0106(b):
�J11" M. ( _la`L I lJ
Authority's name & title from Application Item 1.3.)
�\? SS/py•'��%
•4:Z-
SEAL
35677
rr,0,•.'�,GINt •5 ��
y1 V Z1
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 143-215.bA and 14,-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.
Signature: U j Date: y 1
ft Cc
FORM: FTA 04-16
Page 5 of 5

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: Sampson-Bladen Oil Company, Inc
Project Name for which flow is being requested: Han -Dee Hugo'sBoiangles #7
More than one FTSE may be required for a single project if the owner of the WWTP is not responsible for al1 pump
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: NORTHEAST BRUNSWICK REGIONAL WWTF
b. WWTP Facility Permit #: WQ 0086819
All flows are in MGD
c.
WWTP facility's permitted flow
2.475
d.
Estimated obligated flow not yet tributary to the WWTP
1.006
e.
WWTP facility's actual avg. flow
2.014
f.
Total flow for this specific request
0.00288
g.
Total actual and obligated flows to the facility
3.023
h.
Percent of permitted flow used
122%
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
Pump
Pump
Average
Approx.
Obligated,
Total
Station
Station
Firm
Daily
Flow**
Current
Avg. Daily
Not Yet
Tributary
Current Flow
Plus
(Name or
Number)
Permit
No.
Capacity, *
(Firm / p fl,
Flow,
Daily Flow,
Obligated
Available
MGD
MGD
MGD
MGD
Flow
Capacity***
Commerce
WQ0028422
1.160
0.464
0.162
0.0590
0.221
0.243
* 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
(pi) 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): Northwest Regional Sewer System
Downstream Permit Number: WQ0032475
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I William L. Pinnix, 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.
Signing Official Signature
Title of Signing
1 n UOI rn
Page 2 of 6
Date
FTSE 10-18

Sampson-Bladen Oil Company, Inc.
3309 Drake Circle
Raleigh, NC 27607
Phone — 919-961-0303
January 25, 2021
NCDEQ
Attn: Mr. Dean Hunkele
127 Cardinal Drive Extension
Wilmington, NC 28405
Re: Han -Dee Hugo's/Bojangles #7
Pump Station Power Reliability
Mr. Hunkele,
Please accept this letter as formal written notification attesting that a portable power generator,
associated appurtenances, and personnel are available for distribution and operation of this pump
station in accordance with 15A NCAC 02T .0305(h)(1).
Thank you for your attention to this matter.
Respe tfully,
Haddon M. Clark, Ell, President
Sampson-Bladen Oil Company, Inc

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