WQ0042674_Application (FTSE)_20210826

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
1SA NCAC t1ZT ,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 trains, 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 027. 5A NCAC 02T A300, Divisionyeliclet and Rood ennincert�practien.
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 02'i t130 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 13A NC ' QXV,03U:.
Projects not eligible For review via the fast track process (tnutit be submitted for full technical review);
r Projects that require an environmental assessment in accordance with 15A NCAC I .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;
r Pressure sewer system~ utilizing septic tank -effluent pumps (STEPS) or simplex grinder pumps:
k STEP or simplex grinder pumps connecting to pressurized systems (c.g, force mains);
Y 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
El 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,
i= Be specific as to the system type, number of homes served, flow allocation required. etc.
r 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 40 days of application submittal.
y Payable to North Carolina Department of Fnvironnrental Quality (NCDf:Q)
D. Fast Track (Form: FTA 04-16) Application (Required for All Application Packages):
IR Submit the completed and appropriately executed application.
Y if necessary for clarity or due to space restrictions, attachments to the application may be made.
0 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 State.
© If the Applicant Type in Item 1.2 is a partnership or dlbla, enclose a copy of the certificate filed with the Register of
Decds in the county of business.
® The Project Name in Item It.1 shall be consistent with the project nine on the flow acceptance letters, agreements, etc,
® The Professional Engineer's Certification on Page 5 of the application shall be signed, scaled and elated by a North
Carolina liccnef Profmitulal_Nngincct.
® The Applicant's Certification on Page 5 of the application shall be signed in accordance with 15A NCAC 021' .0106(b).
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).
INSTRUCTiON'i FOR FORM: FTA 04-I6 & SUPPORTING DOCUMENTATION Page 1 of 3

F. Flow Tracking/Acceptance Form (Form: FTSE 04-16) (I( Applicable):
❑ Submit the cotnplcted and executed FTSE form from the owners of the downstream sewers and treatment facility.
r Multiple fonns maybe required where the downstream sewer owner and wastewater treatment facility are different.
The flow acceptance indicated in farm F FSE must not expire prior to permit issuance and must be dated less than one
year prior to the application date.
Submittal of this application and form FTSE indicates that owner has adequate capacity and will not violate G.S. 143-
215.67(a l.
e Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific FTSE.
F. Site Maps (Ail Application Packages):
® Submit an 8.5-inch x I I -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
® Include a street level map (aerial) showing general project area so that Division staff can easily locate it in the Field.
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.).
II. Power Reliability Plan (Required if portable reliability option utilized for Pump Station):
M Per I SA NCAC 02 f A305C11K 1 , submit documentation of power reliability for pumping tiations.
Y 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)
L Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per a5A NCACUTl _4t 15tah 1) provide the Certificate of Public Convenience and Necessity from the North Carolina
Utilitita Connrtission 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 Sc%cr Division Public Su IT stating an
application for a franchise has been received and chat the service area is contiguous to an existing franchised area or
that franchise approval is expected.
J. Operational Agreements (Applications From HOAIPOA and Developers for lots to be sold):
❑ ll��mr'1'tc,},coy Uwuct:s' A:�sc+c:i:ttions
❑ Per 15A NCAC OD' .01 15(c), submit the properly executed Qpintion #I Agrti�ctne t f F Ui flC]A3.
❑ Per 15A NCAC 02T .0115(c), submit a copy of the Articles of Incorporation, Declarations and Sy -laws,
❑ Developers of lots to be sold
❑ Per 15A NCAC 02T .01 15(b), submit the properly executed Operational Ag eenwrn IFORAI: DES')
Few more infci)-motion, visit the Division 's colleclinrr systems websilc
INSTRUCTIONS FOR FORM: FfA 04-16 & SUPPORTING DOCUMENTATION Page 2 aF 3

THE COMPLETED APPLICATION PACKAGE 1NCLDING ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD HE SENT TO THE APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Ashevilte_Realanoi_ 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, 8laden, Cumberland, Harnett, Hoke,
Water Quality Section
Fayettevlile, 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 Sectlon
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.
(919) 7914200
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
Warren, Wilson
_
Washington Regional Office
943 Washington Square Mall
Beaufort, Berne, Camden, Chowan, Craven,
Water Pus_ lity Section _ _
Washington, North Carolina 27889
Currituck, Dare, Gates, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
Wif_mingtQn Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
Water QualitySeottQn
Wilmington. North Carolina 28405
Hanover, Onslow, Pender
[phone]
[phone] Fax
Winston-Salem Reallonal Office
450 W. Hanes Mill Road
Alarnance, Alleghany, Ashe, Caswell, Davidson,
Water Quality SeWon
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

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
ISA NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Nlsmber; _ _ _ _ _ 4o tx: completed by DWR)
All items must be completed or the applicafion will be returned
1. APPLICANT INFORMATION:
l . Applicant's name: Nash County (company, municipality, HOA, utility, etc.)
?. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ® StatelCounty ❑ Municipal
3. Signature authority's name: Zee S. Lamb per 15A NCAC 02T .6106th)
Title: County Manager
4. Applicant's mailing address: 120 W_ Washtn �toi_ n St.
City: Nashville State: NC. Zip; 27856-:
5. Applicant's contact information:
Phone number: (252) 462-261313 Email Address: JonathanAioonc rtttashcouni ne. ov
II. PROJECT INFORMATION:
❑ Privately -Owned Public Utility
❑ Other
1, Project name: Nash Comity Detention Facility Addiiun
2, ApplicationlPrcject status: ® Proposed (New Permit] ❑ Existing Permit/Project
Ica modification, provide the existing permit number: WQOO and issued date:
If new construction but part of master plan, provide the existing permit number: WQOU
3. County where project is located: Nash
4. Approximate Coordinates (Decimat Degrees): [.a[itude: 35.976411 Longitude:-77.9�'
5. Parcel 11) (if applicable): 3801-1951-2631
(or Parcel ID to closest downstream sewer)
III. CONSUI:FANT INFORMATION:
1. Professional Engineer: David Revoir License Number: 26959
Firm: Appian Consulting Engineers, PA
Mailing address: 154 Roundabout Court
City: Rocky Mont State: NC Zip; 27804-
Phone number: 2( 52j 972-7703 Email Address: drev�ogsci��auianeir, itiecr,.cum
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. facility Name; 'far River Wastewater Treatment Plant Permit Number: NCO030317
Owner Name: City of Rocky Mount
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ Downstream (Receiving) Sewer Size. 8 inch
System Wide CohectionS1strm Penuit Nunibcr(1lif applicable): WQCS00329
Owner Name(s): [own of Nashville
FORM: FTA 04-16 Page I of

VI. 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 1)eyelpRr's Qxrational ASrLrtnent ( FORM: DL V! been attached'?
❑ Yes ❑No ®NIA
3. If tine Applicant is a liumelPrc> r Owners' Ass s ar(rI i been attached?
❑ Yes []No ®NIA
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 /Clubliouse
❑ 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 {Sec 15A NCAC 021 .0103(_'Or}})
b Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6, Has a flow reduction been approved under 15A NCAC 021 01141 r)? ❑ Yes Z No
r IfyyN, Provides rev of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see QZ7.0l 14 O)
Daily Design Flaw e,n
No. of Units
Flow
Detention Center (increase)
60 gal/person
63
3,780 GPD
gall
GPD
gal/
GPD
gall
GPD
gat/
GPD
gal/
GPD
Total
3,780 GPD
a See 15A NCAC 031 .011A3 b d e I acid NX21 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 '.S(, 42A].
b Per 15A NCAC 02T .0114(c), design flaw rate,, for establishments not identified [in table ISA NCAC021,01141 shall
be determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 3,780 GPD (per 15A N 4)
r 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'-, of 5

Vll. GRAVITY SEWER DESIGN CRITERIA (if Appikable) - 02T .0305 & MI ' (Grarill Sewers):
1. Summarize gravity sewer to be permitted:
Sire (inches) Length (feet) Material
.209 PVC
Section lI & 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)
r Oversi'ring lines to meet minimum slope requirement is not allowed and a violation of the MDC
Vlll. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & .%IDC (Pump stations/Force 1lai11s):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
I. Pump station number or name: n/a
?. Approximate Coordinates ;Decimal Degrees]; Latitude: Longitude. -
3. Design flow of the pump station: millions gal ions per day (firm capacity)
4. Operational point(s) of the pump(s): gallons per minute at feet total dynatnic head (TDIIy
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) I Length (feet) ! Material
6. Power reliability in accordance with 1 SA NJAi'Us'I' .b305(hk I1:
❑ Standby power source or pump with automatic activation and telemetry - i 5A 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
Y Must be permanent to facility
Or it the pusnp 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(I3)(1)(C):
it shall be demonstrated to [lie 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 lump 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: FT A 04-1 b Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B ,0200 & 15A NCAC 02T .0305(f)):
1: Does the project comply with all separations round in I SAC 021 .030511) &_{ - ® Yes ❑ No
1�1 15A NCAC 02T.0305(t) contains minimum separations that shall be provided for sewer systems:
Setback Parameter*
Se aration Re hired
Storm sewers and other utilities not listed below (vertical)
24 inches
Water mains (vertical -water over scwer includ i ng in benched trenches)
18 inches
Water mains (horizontal)
10 feet
Reclaimed water lines vertical - reclaimed over sewer)
18 inches
2 feet
Reclaimed water lines horizontal - reclaimed over sewers
**Any private or public water supply source, including any wells, WS-1 waters of Class 1 or
Class LI impounded reservoirs used as a source of drinking water
100 Feet
**Waters classified WS (except W5-I or WS-V), B, SA, ORW, HQW, or SB from normal
high water for tide elevation) and wetlands (see item LX.2y
50 feet
**Any other stream, fake, impoundment, or ground water lowering and surface drainage
ditches
l Q feet
AnX building foundation
5 feel
Any basement
10 feet
Top slope of embankment or cats of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming Dols
10 feet
Final earth grade (vertical)
36 inches
i- I SA lu 'AC 02T.0305contains alternatives where separations in 02T.0305M cannot be achieved,
**Stream classifications can be identified using the Division's W er 'iassi i�astagrs webpa��g
If noncompliance with 02T.032Ma or Itl. see Section x or this application
2. Does the project comply with reparation requirements for wetlands? (50 feet of separation) ❑ Yes [—]No ® NIA
y 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
Y This would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Does the project require coveragelauthorization under a 404 Nationwide or ❑ Yes Z No
individual permits or 401 Water Quality Certificat'sons?
], Information can be obtained From the 401 & Buffer Permitting Branch
5. Does project comply with 15A NCAC 02T.0105(cHf•) )(additional permitslcertifications)? ® Yes ❑ No
Per 51 A NCAC 021 d1105i )(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.)_
h. Docs this project include any sewer collection lines that are deemed "high -priority?"
Per 1 SA NCAU 021.0402. "high -priority sewer" means 'any aerial sewer, sewer contacting surface waters, siphon, or sewer
pusitioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer.
[--]Yes 9 No ❑NIA
lryes, 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 -mouths and
inspections documented per 15A NCAC 02T.0403(a)(5) or the permitee's individual Systern-Wide Collection permit.
FORM: FTA 04-1 b Page 4 or 5

X. C'ER'rIFICATIONS:
Dues the submitted system comply with ISA NCAC 02T, [he Minn to Design Criji2ol for t c Pgrnitfing ol'hMg Sladyn
d Force Maiwid the 0mvity Sewer plitinjum Dcsi r't t versionj as applicable?
'es l}� ❑ No
IrNo, complete and submit the Variance Altern2,i' ve I)effs�L3''gn Request application (`w.'IDC' 10-14) un�{ suppurtilt� rf+ciularnts
for review. Ap[trnsal of the rectuest is rerutired urior to subtnitial of.the Fart 'Intel. Anolicatiou and slutnurrins=
documents
G. Professional F_ngineer's Certiticrincil
Cavid C. Revoir, P'1=
attest that this application I'or
(Protes5ional Engincer's name from Application Item ill. I
has been reviewed by inn and is accurate, complete and consistent with She 111t0rnla11011 St1Uplled In the plaits. specifications,
emgiueering calculations. and all other supporting documentation to [fie best of my knowledge i tur0er attest that to the best
of in} knowledge the proposed design has been prepared in accordance with the applicable regtu(ations. Gravity Sewer
Minimum Design Criteria for Gravity Sewers (latest version). and the Minimum Design Criteria foe the Casr-Yrack
Permitting of Punip Stations and force Mairs ilatest versions. Although other professionals may have developed certain
portions of this submittal package. inclusion of these materials under my signahrre and seal signifies that I have reviewed this
inaterial and have judged it to be consistent with the proposed design.
tifJ'i'F. — lit accordance Kith Cieneral Statutes I43-215.4A and 1 I3-215.68. any person who knowingly makes any false
+;tatcnient, representation. or certification in any application package shall be guilty of a Class 2 nnstfwanor, whirl: ina-v
Include a fine not to exceed S10,000. as well as civil penalties up to 535,000 per vio'atwn. .
i.
North Carolina Professional Engineer's seal, signature, and date:
4 ► -_
1
a A hcant's Certification per 15A NCAC' 02T .0106(b) C. RE4-0 PP
I_ Zee f3. Lamb, County Manager attest that this application for
(Sigra'aire At41101+ity's name g tide from Application item I., 1
has been reviewed by me and isaccurate and complete to the best of my knout ledge- i understand that if all rrgtdred parts of
tltis application are not compiewd and that if all regok-ed supporting doctumentati0n and attachments are Iuat included, this
application package is subject to being returned as incomplete. I undemland that any discharge of wastewater Front this non -
discharge ,ystem to surface waters or the land will result in an immediate enforcement action that may include civil penalties.
injunctive relief, andior criminal prosecution. I will make 11t, claim against the Dkision of Water Resources should :I
condition of this permit be violated 1 also understand that if all required parts or this application package are not conipleted
and that ifall required supporttng int'ormat}on and arlachnlents are not included. Ihis application package will be returned [o
Inc as incomplete,
NOTE - in accordance n ith General Statutes 143-215,6A and 1_43-215.613, any person who knowingly makes any false
statement, rrpresentatior3, Or certification in any application pa&tge shall he guilty ai a Class 2 misdenwartor, N hwh may
Include a line not to exceed $111 )00 as well as civil penalties up to S25.000 per violation
Signature ;�Vk Date. 5" 2 7-4
FORM 1• I- A 04-16 Page 5 01,5