WQ0042692_Application (FTSE)_20210621

DW. R
Dlvlslon of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: W0W14Z�(iobecompletedbyDwtt)
All items must be completed or the application will be returned
1. APPLICANT INFORMATION:
1.
Applicant's name: __ City of Wilson, North Carolina (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: W.T. Bass, IV, P.E. per 15A NCAC 02T A 106(b)
Title: Public Works Director
4.
Applicant's mailing address: — 1800 Herring Avenue E / P.O. Box 10
City: Wilson State: North Carolina Zip: 27894-0010
5.
Applicant's contact information:
Phone number: [phone] Email Address: bbassCwilsonnc.org
11. PROJECT
INFORMATION:
l .
Project name: _ City of_Wilson _- Upper Bloomery Swamp Sewer Improvements
2.
Application/Project status: ® Proposed (New Permit) ® Existing Permit/Project
a
If a modification, provide the existing permit number: WQ00 and issued date:
r
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: Wilson
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4.
Approximate Coordinates (Decimal Degrees): Latitude: 35.715FLongitude:-77.9738'
5.
Parcel lD (if applicable): 3701-47-7881.000
(or Parcel ID to closest downstream sewer)'
III. CONSULTANT INFORMATION:
U
Z
1.
Professional Engineer: W. Landon Younce, PE License Number: 030003
Firm: Green Engineering, PLLC
Mailing address: 303 Goldsboro St E / P.O. Box 609
City: Wilson State: North Carolina Zip: 27893-
Phone number: 2(_52-) 237-5365 Email Address:.__ I.younce0greeneng.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name:. _ Hominy Creek Water Reclamation Facility Permit Number: NCO023906
Owner Name: City of Wilson, North Carolina
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1, Permit Number(s): WQ0042330 Downstream (Receiving) Sewer Size: 24- inch
System Wide Collection System Permit Numbers) (if applicable): WQCS
Owner Name(s): City of Wilson
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FORM: FTA 04- l6 Page 1 of 5

THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Re ional Office
2090 US Highway 70
Avery, Buncombe, Burke, Caldwell, Cherokee,
Water Quality Section
Swannanoa, North Carolina 28778
Clay, Graham, Haywood, Henderson, Jackson,
[phone]
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,
[phone]
Sampson, Scotland
[phone] Fax
Mooresville Regional Office
610 E. Center Avenue
Alexander, Cabarrus, Catawba, Cleveland,
Water Quality Section
Mooresville, North Carolina 28115
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,
[phone]
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
Warren, Wilson
Washington Regional Office
943 Washington Square Mall
Beaufort, Bertie, Camden, Chowan, Craven,
Water Quality Section
Washington, North Carolina 27889
Currituck, Dare, Gates, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
Wilminaton Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
Water Quality Section
Wilmington, North Carolina 28405
Hanover, Onstow, Pender
[phone]
[phone] Fax
Winston-Salem Re Tonal Office
450 W. Hanes Mill Road
Alamance, Alleghany, Ashe, Caswell, Davidson,
Water Qualily Section
Suite 300
Davie, Forsyth, Guilford, Rockingham, Randolph,
Winston-Salem, North Carolina 27105
Stokes, Suny, Watauga, Wilkes, Yadkin
[phone]
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 3 of 3

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 Agreement (FOR(wl_ DEV) been attached?
❑ Yes [:]No ®NiA
3. If the Applicant is a Homc_ProPcrty Owners' Association, has an Operational Agreement (FORNI: I10A) 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
% Industrial (See 15A NCAC 02T .0103(20))
:.Is there a Pretreatment Program in effect? ® Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 021 .01l4(f}? ❑ Yes ® No
➢ If yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 021.01 14(f))
Daily Design Flow e,b
No. of Units
Flow
N/A - All Flows Existing as Permitted
gal/
N?A GPD
gal/
GPD
gal:
GPD
gal+
GPD
gal
GPD
gale
GPD
Total
N/A GPD
a See 15A NCAC 02'1 .01 14(b), (d), (c)(1) and {e,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 021-.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: 0 GPD (per 15A NCAC 02T. 0 114)
➢ 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 & INIDC (Cravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
24"0
10,965
PVC
24"0
230
DIP
15"0
365
PVC
81P0
290
PVC
➢ 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
VI11. 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: NIA
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
NIA
NIA
NIA
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
D 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: FTA 04-16 Page 3 of 5

IX. SETBACKS & SEPARATIONS (02B .0200 & 15A NCAC 02T .0305(f)):
I. Does the project comply with all separations found in 15A NCAC 02T .0305( & (a) ® 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-1 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
Anybuilding 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(a} contains alternatives where separations in 0_21_,0305(cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webpakc
➢ If noncompliance with 02T.0305(0 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 2B.0202
4. Does the project require cove ragetauthorization 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 021.0105(c)(6) (additional permits?certifications)? ® Yes ❑ No
Per 15A NCAC 02T.0 1 05(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 02 F.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 021', the Minimum Design Criteria for the Pcrnnittin , of Pump Station,
and Force Mains (latest ver tor4J, 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, W Landon Younce attest that this application for
(Professional Engineer's name from Application Item Ill. 1.)
Upper Bloomery Swamp Sewer Improvements
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 1 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: S aOl�'
,,7
0 3 0 0 0 _1
Applicant's Certification per 15A NCAC 02T .0106(b):
1, W T_ Bass, IV, PE — Public Works Director attest that this application for
(Signature Authority's name & title from Application Item 1.3.)
Upper Bloomery Swamp Sewer Improvements
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. l 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 143-215.6B, 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: J► Date:
FORM: FTA 04-16 Page 5 of 5

June 16, 2021
NCDEQ
Water Quality Regional Operations Section
Raleigh Regional Office
3800 Barrett Drive
Raleigh, North Carolina 27609
Attention: Mr. Scott Vinson
Water Resources Regional Supervisor
SUBJECT: Fast -Track Sewer System Extension Application
Upper Bloomery Swamp Sewer Improvements
City of Wilson, North Carolina
PN: 20-141
Dear Mr. Vinson:
NC Dept ofEavironmental Qualm,
Raleigh Regional Office
The City of Wilson has now begun the design phase for the installation of approximately 11,850
LF of 8-inch through 24-inch diameter gravity sewers and Forty-six (46) prefab. concrete manholes as a
replacement of the aging Upper Bloomery Swamp sewer interceptor. All existing flows contributing to the
gravity system flow downstream through the recently permitted Lower Bloomery Swamp mains
(WQ0042330) and are then collected at the City's existing Contentnea Pump Station.
Please find attached two (2) copies of each of the following documents for your review and
approval:
Fast -Track Sewer Application Form - One (1) original and one (1) copy
8 `/2" x 11" copy of project location on USGS Quadrangle Maps
Street Level Aerial Photography for location reference
Also, please find attached check in the amount of $480.00 to cover the application review fee. If
you should have any questions or require additional information, please call.
Respectfully,
r—�
onathan L. Meade, E.
Enclosures: As stated.
cc: Mr. W. T. Bass, IV, P.E. Public Works Director, City of Wilson
Mr. Barry Parks Director of Water Resources, City of Wilson
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June 16, 2021
NCDEQ
Water Quality Regional Operations Section
Raleigh Regional Office
3800 Barrett Drive
Raleigh, North Carolina 27609
Attention: Mr. Scott Vinson
Water Resources Regional Supervisor
SUBJECT: Fast -Track Sewer System Extension Application
Upper Bloomery Swamp Sewer Improvements
City of Wilson, North Carolina
PN: 20-141
Dear Mr. Vinson:
NC
01%7 0
"'`mere
JUG � 4v terry
Re�Oaal
The City of Wilson has now begun the design phase for the installation of approximately 11,850
LF of 8-inch through 24-inch diameter gravity sewers and Forty-six (46) prefab. concrete manholes as a
replacement of the aging Upper Bloomery Swamp sewer interceptor. All existing flows contributing to the
gravity system flow downstream through the recently permitted Lower Bloomery Swamp mains
(WQ0042330) and are then collected at the City's existing Contentnea Pump Station.
Please find attached two (2) copies of each of the following documents for your review and
approval:
• Fast -Track Sewer Application Form One (1) original and one (1) copy
• 8 V2" x I I" copy of project location on USGS Quadrangle Maps
• Street Level Aerial Photography for location reference
Also, please find attached check in the amount of $480.00 to cover the application review fee. If
you should have any questions or require additional information, please call.
Respectfully,
_X 4
onathan L_ Meade, E.
Enclosures: As stated.
cc: Mr. W. T. Bass, IV, P.E. Public Works Director, City of Wilson
Mr. Barry Parks Director of Water Resources, City of Wilson
W WI SO20141 WicePERMITSSmcrPermit sconriamn NCDEQ-fat trackse- alo{6•16.211dot

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 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 15A 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 engineering 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 permit 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 NCAC 02T.0303.
Projects not eligible for review via the fast track process (must be submitted for full technical review C Dcpt ofEnvironmenW Quality
➢ Projects that require an environmental assessment in accordance with 15A NCAC IC .0100;
➢ Projects that do not meet any part of the minimum design criteria (MDC) document;
➢ Projects that involve a variance from the requirements of 15A NCAC 2T; f UN 1 ����
➢ Pressure sewer systems utilizing septic tank -effluent pumps (STEPS) or simplex grinder pumps;
➢ STEP or simplex grinder pumps connecting to pressurized systems (e.g. force mains); Raleigh Rcgional Office
➢ Vacuum sewer systems.
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 d/b/a, enclose a copy of the certificate filed with the Register of
Deeds in the county of business.
® The Project Name in Item II.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 En gib, neer.
® The Applicant's Certification on Page 5 of the application shall be signed in accordance with 15A NCAC 02T .0106(bl.
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 of 3