WQ0042809_Application (FTSE)_20210823

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: fa/afim g Q (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
I. Applicant's name: Roanoke Rapids Sanitary District (company, municipality, I IOA, utility, etc.)
2. Applicant type: ❑ individual ❑ Corporation ❑ Gcncral Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State.:County ® Municipal ❑ Other
3. Signature authority's name: Dan Brown per i SA NCAC 02T .0I06(bl
Title: Chief Executive Officer
4. Applicant's mailing address: 1000 Jackson Street
City: Roanoke Rapids State: NC Zip: 27870-
5. Applicant's contact information:,
Phone number: [phone] Email Address: dbrowitttirrsd.oEg
II. PROJECT INFORMATION:
1. Project name: Chickovotte Creek Sanitary Sewer Line Replacement
2, Application, Project status: ® Proposed (New Permit) ❑ Existing Permit Project
If a modification, provide the existing permit number: WQ00 and issued date:
If new construction but part of a master plan, provide the existing permit number: WQ00
3. County where project is located: Halifax
4. Approximate Coordinates (Decimal Degrees). Latitude: N_36.433 Longitude:-W.77.649
5. Parcel I D (if applicable):
(or Parcel ID to closest downstream sewer)
111. CONSULTANT INFORMATION:
I. Professional Engineer: William B. Keaton License Number: 045626
Finn: Freese and Nichols
Mailing address: 222 S. Caldwell Street
City: Charlotte State: NC Zip: 28202-
Phone number: [phone] Email Address: bill.keaton0frcese.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Roanoke River Wastewater Treatment Plant Permit Number: NCO024201
Owner Name: Roanoke Rapids Snitary District
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ Downstream (Receiving) Sewer Size_ 30 inch
S� stem Wide ('ollcction Svstem Permit Number(s)lif applicablel; WQCS00027
Owner Name(s): Roanoke Rapids Sanitary District
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FORM: FTA 04-16 Page I of 5

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 ®N:`A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement {FORM DEVI been attached"
❑ Yes ❑No ®N::A
3. If the Applicant is a Home Propertl. Owners' Association, has an Operational Agreement I FORM HOA1 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 preparationlservice ❑ Hotel and/or Motels
❑ School / preschool i 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: N;'A % Domestic. -Commercial N+A % Commercial
NIA % Industrial (Scc 15A N('A(' 02T _0103(20 )
I �AIs there a Pretreatment Program in effect? ❑ Yes ® No
6. I(as a flow reduction been approved under I SA NCAC 02T .0114tft? ❑ Yes ® No
If yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T,0114(f1)
Daily Design Flow '•b
No. of Units
Flow
gal'
0 GPD
gal.
0 GPD
gal:
0 GPD
gal
0 GPD
gal.
0 GPD
gal
0 GPD
Tolal
0 GPD
a See 15A NCAC 02T _01 14 b d c 1 J and (cS21 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 .01 14(c), design flow rates for establishments not identified (in table I SA NCAC 02T.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 _0114)
> Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
❑ Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit Number:
® 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 (I( Applicable) - 02T .0305 & MDC (Gravity Sewersf:
I. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8
68
PVC SDR 35
8
80
DIP
> Section II & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
v 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
Vlll. PUMP STATION DESIGN CRITERIA (if Applicable) — 02T .0305 & 11IDC(Pump StationsJForce .Nlains
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
I . Pump station number or name:
2. Approximate Coordinates (Decimal Dcgrccs): 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) I Length (feet) I !Material �
6. Power reliability in accordance with 15A NCAC 02T._030511i}t I };
❑ Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T 0305(h)(1)(13)_
> Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
> Must be permanent to facility
Or if the pump station has an average daily flow less than 15,000 gallons per day:
❑ Portable power source with manual activation, quick -connection receptacle and telemetry - 15A NCAC 02T
.0305(h)(1)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry - 15A NCAC 02T .0305(h)(1 )(C):
> It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant (draft agreement)
and is compatible with the station.
> 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(f) & f eU [-]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 litres 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 I 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 nor ial
hi h 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 gLade (vertical)
36 inches
i 15A NCAC 02T.0305(a) contains alternatives where separations in 02T.0305(f) cannot be achieved.
> **Stream classifications can be identified using the Division's NC -Surface Walcr C'las4iftw,L11t14tx W!J� LI
> If noncompliance with 02T_03.05(f) or ML 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 2B4O202
4. Does the project require coveragelauthorization under a 404 Nationwide or ® Yes ❑ No
individual permits or 401 Water Quality Certifications?
> Infonnation can be obtained from the 401 & Buffer Pemutung Branch
5. Does project comply with 15A NCAC 02T.010540( ) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T_0I05(c)(6), directly related environmental permits or certification applications arc being prepared, have
been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion and
sedimentation control plans, stormwater management plans, etc.).
6. Does this project include any sewer collection lines that are deemed "high -priority?"
Per 15A NCAC 02T.0402, "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer.
® Yes ❑ No ❑ N A
> 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 02T, the Minimum Design Criteria for the Permitting of Pumn Stations
and Force Mains ilatest version . and the Gravity Sewer Minimum Design Criteria (latest version 3 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.
Professional Engineer's Certification:
,, � � fill � ,B. �•,�, ,
(Professional Engineer's name from Application Item 111.1.)
attest that this application for
has been reviewed by me and is accurate, complete and consistent wills 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 (lie 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 Willi 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:
Ott
a SEAL r
045626
tiGIN
3_ Applicant's Certification per 15A NCAC 02T .0106(b): ��11111100
4, i41 R CAI attest that this application for
(Signature A thority'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, 1 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 tore 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 line not to exceed $10,000 as well as civil penalties tip to $25,000 per violation.
t
Signature: Date: 1
FORM: FTA 04-16 Page 5 of 5

222 S. Caldwell Street • Charlotte, North Carolina 28205 • 980 729 5810 www.Freese.cor„
March 01, 2021
NCDEQ, Division of Water Resources
3800 Barrett Drive
Raleigh, NC 27609
Re: Roanoke Rapids Sanitary District
Chockoyotte Creek Sanitary Sewer Line Replacement
Fast Track Sewer System Extension Application (FTA 04-16)
To Whom it May Concern,
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On behalf of the Roanoke Rapids Sanitary District, and in accordance with 15A NCAC subchapter 02T and
the Division of Water Resources Minimum Design Criteria, please find enclosed the following documents
associated with the proposed Chockoyotte Creek Sanitary Sewer Line Replacement:
Fast Track Sewer System Extension Application
Figure 1 USGS Topographic Map of Project Area
Figure 2 — Aerial Map of Project Area
The Roanoke Rapids Sanitary District is proposing the replacement of a segment of 8-inch sanitary sewer
that has failed within their system. Due to the nature of the failure the existing segment will be
abandoned in place and a proposed segment of approximately 150 LF of 8-inch sanitary sewer will be
installed from an upstream manhole and tied in with a doghouse manhole to a point in the gravity sewer
downstream. No additional flow will be generated by this project.
If you have any questions or need additional information, I can be reached at 980-729-5810 or
[e-mail].
Sincerely,
Bill Keaton
Engineer V
Freese & Nichols, Inc.

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Chockoyotte Creek Sanitary Sewer
Line Replacement
Topograpic Map
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Figure 1
FREESE 222 S. Caldwell St,
Charlotte,336790-6744202
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