WQ0042567_Application (FTSE)_20210524

State of North Carolina
Department of Environmental Quality
DwR 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: AA/ [ g 56 {to be completed by DWR)
All items must be completed or the application will be returned
1. APPLICANT INFORMATION:
I. Applicant's name: Boddie -Noel] Enterprises, Inc. (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: Michael, W. Boddie per 15A NCAC 02T .0106(b)
Title: President
4. Applicant's mailing address: P.O. Box 1908
City: Rocky Mount State: NC Zip: 27804-
5. Applicant's contact information:
Phone number: [phone] Email Address: mikeboddie a,boddienoell.com
11. PROJECT INFORMATION:
l . Project name: Hardees at Cleveland and Cornwallis Road - PR! IrATE
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification provide the existing
p g permit number: WQ00 and issued date:
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If new construction but part of a master plan, provide the existing permit number. WQ00
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3. County where project is located: Johnston
4. Approximate Coordinates (Decimal Degrees): Latitude. 35.5804` Longitude:-78.542586'
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5. Parcel ID (if applicable): 163600-67-6157
(or Parcel ID to closest downstream sewer)
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III. CONSULTANT INFORMATION:
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1. Professional Engineer: J. Michael Stocks License Number: 19843
1
Firm: Stocks Engineering, P.A.
Mailing address: PO Box 1 108
City: Nashville State: NC Zip: 27856-
Phone number: 252) 459-8196 Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
I. Facility Name: Central_ Johnston County Regional WWTF Permit Number: NC0030716
Owner Name: Johnston County
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ1,5579 Downstream (Receiving) Sewer Size: 8 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS00060
Owner Name(s): Johnston County
FORM: FTA 04-16 Page[ of 5

Vl. GENERAL REQUIREMENTS
I. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑No ON, A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational FORM: DEV been attached?
❑ Yes ❑No ®N::A
3. If the Applicant is a I larnefE'roperty Owners' Association_ has an Operational A recmcnt (FORM_I { been attached?
❑ Yes ❑No ON. 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 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: % DomesticlCommercial 100 ° o Commercial
_ % Industrial (See I SA NCAC 02T 9103(20))
�Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 02T .0114ff}? ❑ Yes ® No
➢ If yes, provide a cony of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 021.01140
Daily Design Flow' b
20 gal/seat
No. of Units
Flow
Restaurant
40
800 GPD
gall
GPD
gal/
GPD
gall
GPD
gall
GPD
gal/
GPD
Total
800 GPD
a See J,M NCAC 02T .01140), (d), (e)(11 ad LWJ 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,.429--4)•
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A N A 1 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data
8. Wastewater generated by project: 800 GPD (per 15A NCAC 021.0I 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

VI1. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC(Gravity Sewers
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
N/A
➢ 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)
➢ Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
Vill. PUMP STATION DESIGN CRITERIA (if Applicable)-02T.0305 & MDC (Pump StationsiForce Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: Hardee's at Cleveland Cornwallis (Private)
2. Approximate Coordinates (Decimal Degrees): Latitude: 35,580473' Longitude:-78.542131
3. Design flow of the pump station: .0008 millions gallons per day (Firm capacity)
4. Operational point(s) of the pump(s): 20 gallons per minute at 17 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
2
185
C-900 PVC
6. Power reliability in accordance with 15A NCAC 02T .0305jhXIJ:
❑ 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 a multiple station power outage.
FORM: I:TA 04-16 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(o):
I. Does the project comply with all separations found in 15A NCAC 02T .03050) & fg)
➢ 15A NCAC 02T.0305(t) contains minimum separations that shall be provided for sewer systems-
® 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
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 1 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 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.0305(g) contains alternatives where separations in 02T.0305(il) cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Warr CWsifications
➢ If noncompliance with 02T.0305(f) or i0, see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ® Yes [:]No
➢ 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 all 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 comply with an individual 404 Permit or any 401 Certifications? ® Yes ❑ No
➢ Wetland -related permits shall be requested, obtained, and adhered to for projects that impact wetlands or surface waters
➢ Information can be obtained from the 4Qi & Buffer Permitting Branch
5. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits.'certifications)?
® Yes ❑ No
Per LSA NCAC 02T_0I05(c)(6), directly related environmental permits or certification applications are being prepared, have
been applied for, or have been obtained. Issuance of this pen -nit 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
➢ 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 JICAC 02T, the Minimum !sign Criteria for the Permitting of Ptimp Stations
and Force Maim (JW=Ly& s'rooi , and the ("vity Sewer Minimum DesipA 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:
Mi c ad'i attest that this application for
(Professional Engineer's name from Application Item IIl. 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. �ottI11tt1118+
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North Carolina Professional Engineer's seal, signature, and date: ��`� QeN •••••••���,5, �•,
SEAL
19843
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3. Applicant's Certification per 15A NCAC 02T .0106(b):
attest that this application for
(Signature Authority's name & 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 143-2 t 5-fir and 14 - .1 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: far Date: S — '],O •'3.
FORM: FTA 04-16 Page 5 of 5

State of North Carolina
Department of Environmental Quality
' w Division of Water Resources
Division of WMer Re%oui(e% Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: Johnston Country
Project Name for which flow is being requested: Hardees at Cleveland & Cornwallis
More than one FTSE utay be requiredfor a single project if the owner of the WWTP is not responsible for allpump
stations along the route of the proposed wasteivater flo►v.
I. Complete this section only if you are the owner of the wastewater treatment plant,
a. WWTP Facility Name: Central Johnston County Regional WW Facility
b. WWTP Facility Permit #: NC 030716
ACC flo )vs are in MGD
c. WWTP facility's permitted flow 9.5
d. Estimated obligated flow not yet tributary to the WWTP 2.002
e. WWTP facility's actual avg. flow 7.091
f. Total flow for this specific request 0.0008
g. Total actual and obligated flows to the facility 9.0935
h. Percent of permitted flow used 74.6 actual/95.7 paper
11. 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 Obligated,
Pump Pump Average Approx. Not Yet Total Current
Station Station Firm Daily Flow** Current Tributary Flow Plus
(Name or Permit Capacity, * (Firm! pf), Avg. Daily Daily Flow, Obligated Available
Number) No. MGD MGD Flow, MGD MGD Flow Capacity***
Josephine R rt_ 28867Mod 3.384 1.3536 0.7524 0.4082 1.1607 0.1929
Landfill rn 20340 1.9296 1.6718 0.92819 0.6368 1.5650 0.1069
* 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, pet- 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): Weston Woods
Downstream Permit Number: WQ0015579
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I Chandra C. Farmer, P.E. _ 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 Official
Page 2 of b
FTSE 10-1 S

Sewer Project Narrative
For
Cleveland and Cornwallis Road Hardee's
The private sewer pump station to serve the Hardee's at Cleveland and Cornwallis Rd. is
located on the on the 1.4 Ac. (Leased Lot Acreage) parcel owned by Boddie -Noel)
Enterprises, Inc. The sewer pump station will only serve the restaurant on the parcel. The
flow was calculated using the NCAC 02T daily flow of 20 gal.'seat for restaurant with
single service articles. Since the restaurant will have 40 seats, the daily flow for the
project will be 800 GPD. It will consist of 100% commercial flow. The force main in the
public right-of-way will consist of approximately 1,230 LF of 2-inch C-900 PVC that
connects to an existing gravity manhole. The force main in the right of way is permitted
by Johnston County Public Utilities. The private lift station and force main located
outside the public right-of-way will be permitted separately by Boddie-Noell Enterprises.
The wastewater treatment plant facility that will be handling this flow is the Central
Johnston County Regional WWTF (Permit # NC 0030716).
NC Dept of Environmental Quality
MAY 7 4 2021
Raleigh Regional Office

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DWR
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION
This application is for sewer extensions involving gravity sewers, pump stations and force mains, or any combination that has been
certified by a professional engineer and the applicant that the project meets the requirements of ISA NCAC 02T and the Division's
Minimum Design Criteria and that plans, specifications and supporting documents have been prepared in accordance with, 15A
NCAC 02T, 15A NCAC 02T .0300, Division policies and good enginecring practices.
While no upfront engineering design documents are required for submittal, in accordance with 15A NCAC 02T .0305(b), design
documents must be prepared prior to submittal of a fast track pen -nit application to the Division. This would include plans, design
calculations, and project specifications referenced in 15A NCAC 02T .0305 and the applicable minimum design criteria. These
documents shall be available upon request by the Division.
Projects that are deemed permitted (do not require a permit from the Division) are explained in 15A NCAT Tom.
Projects not eligible for review via the fast track process (must be submitted for full technical review): �'otOf-
➢ Projects that require an environmental assessment in accordance with 15A NCAC IC .0100; iron
➢ Projects that do not meet any part of the minimum design criteria (MDC) document; Mqy
➢ Projects that involve a variance from the requirements of I SA NCAC 2T; �i QUaI!
➢ Pressure sewer systems utilizing septic tank -effluent pumps (STEPS) or simplex grinder pump
➢ STEP or simplex grinder pumps connecting to pressurized systems (e.g. force mains); R
➢ Vacuum sewer systems. Cglp��
General — When submitting an application, please use the following instructions as a checklist in order to ensure all required —items
are submitted. Adherence to these instructions and checking the provided boxes will help produce a quicker review time and
reduce the amount of requested additional information. Failure to submit all required items will necessitate additional
processing and review time, and may result in return of the application. Unless otherwise noted, the Applicant shall submit
one original and one copy of the application and supporting documentation.
A. One Original and One Copy of Application and Supporting Documents
® Required unless otherwise noted
B. Cover Letter (Required for All Application Packages):
® List all items included in the application package, as well as a brief description of the requested permitting action.
➢ Be specific as to the system type, number of homes served, flow allocation required, etc.
➢ If necessary for clarity, include attachments to the application form.
C. Application Fee (All New and Major Modification Application Packages):
® Submit a check or money order in the amount of $480.00 dated within 90 days of application submittal.
➢ Payable to North Carolina Department of Environmental Quality (NCDEQ)
D. Fast Track (Form: FTA 04-16) Application (Required for All Application Packages):
® Submit the completed and appropriately executed application.
➢ If necessary for clarity or due to space restrictions, attachments to the application may be made.
® If the Applicant Type in Item 1.2 is a corporation or company, provide documentation it is registered for business with
the North Carolina Secretary of State.
❑ If the Applicant Type in Item 1.2 is a partnership or dlb/a, enclose a copy of the certificate filed with the Register of
Deeds in the county of business.
® The Project Name in Item I1.1 shall be consistent with the project name on the flow acceptance letters, agreements, etc.
® The Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a North
Carolina licensed Professional Engineer.
® The Applicant's Certification on Page 5 of the application shall be signed in accordance with 15A NCAC 02T .0106Ib].
Per 15A NCAC 02T .0106(c), an alternate person may be designated as the signing official if a delegation letter is
provided from a person who meets the criteria in 15A NCAC 02T .0106(b).
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Pagel of3

E. Flow Tracking/Acceptance Form (Form: FTSE 04-16) (If Applicable):
® Submit the completed and executed FTSE form from the owners of the downstream sewers and treatment facility.
➢ Multiple forms maybe required where the downstream sewer owner and wastewater treatment facility are different.
➢ The flow acceptance indicated in form FTSE must not expire prior to permit issuance and must be dated less than one
year prior to the application date.
D Submittal of this application and form FTSE indicates that owner has adequate capacity and will not violate G.S. 143-
215.67(a].
➢ Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific FTSE.
F. Site Maps (All Application Packages):
® Submit an 8.5-inch x 11-inch color copy of a USGS Topographic Map of sufficient scale to identify the entire project
area and closest surface waters.
➢ Location of the project (gravity sewer, pump stations & force main)
➢ Downstream connection points and permit number (if known) for the receiving sewer
M Include a street level map showing general project area.
G. Existing Permit (All Modification Packages):
❑ Submit the most recently issued existing permit.
❑ Provide a list of any items within the permit the Applicant would like the Division to address during the permit
modification (i.e., permit description, flow allocation, treatment facility, etc.).
H. Power Reliability Plan (Required if portable reliability option utilized for Pump Station):
❑ Per 15A NCAC 02T .0305(h)(I ), submit documentation of power reliability for pumping stations.
➢ This alternative is only available for average daily flows less than 15,000 gallons per day
➢ It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant and is compatible
with the station. The Division will accept a letter signed by the applicant (see 15A NCAC 02T .0106(b)) or proposed
contractor, stating that "the portable power generation unit or portable, independently -powered pumping units, associated
appurtenances and personnel are available for distribution and operation of this pump 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. (Required at time of certification)
I. Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per 15A NCAC 02T .0115L41) provide the Certificate of Public Convenience and Necessity from the North Carolina
Utilities. Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served by
the sewer extension, or
❑ Provide a letter from the North Carolina Utilities Commission's Water and Sewer Division Public Staff stating an
application for a franchise has been received and that the service area is contiguous to an existing franchised area or that
franchise approval is expected.
J. Operational Agreements (Applications from HOA/POA and Developers for lots to be sold):
❑ Home/Property Owners' Associations
❑ Per 15A NCAC 02T .0115(c), submit the properly executed Operational A.&reement JFORM: HOA).
❑ Per 15A NCAC 02T .01 15(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
❑ Developers of lots to be sold
❑ Per 15A NCAC 02T .01 15(b), submit the properly executed Operational Agreement (FORM: DEV).
For more information, visit the Division's collection systems website
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 2 of 3