WQ0042893_Application (FTSE)_20211115

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iikkakiVED
I OCT' 04 2021
NCDEQ— Division of Water Resources
Water Quality Section
225 Green Street, Suite 714
Fayetteville, NC 28301-5094
To whom it may concern:
DAVIS • MARTIN • POWELL
ENGINEERS & SURVEYORS
October 4, 2021
Re:
Marion Sadler
NCDOT Project 1-5883
Improve 1-95 Interchanges and Widen
to Eight Lanes from Jonesboro Road to
North of Hodges Chapel Road
DMP Project 170273 (BF)
Davis -Martin -Powell is providing utility engineering services for NCDOT Project 1-5883, which involves the
Improvement of 1-85 Interchanges and widening to 8 Lanes from Jonesboro Road to North of Hodges Chapel
Road in Harnett County.
Marion Sadler has a section of existing force main sewer line that must be relocated and/or replaced due to
conflicts with the proposed roadway and storm drainage improvements. The project will involve the
relocation and/or replacement of 1029 LF of 2" force main sewer and associated appurtenances.
We are enclosing the following information in regards to the referenced project for your review and approval:
• One original and one copy of the executed Fast -Track Sewer System Extension Application, with the
following supporting documents:
> Flow Tracking/Acceptance Forms (City of Dunn and Marion Sadler)
➢ 8.5"x11" color USGS quad map exhibit
➢ 8.5"x11" street level map exhibit
• Review fee check in the amount of $480.00 for the review fee
We trust this information is complete and will allow you to proceed with your review of these needed sewer
system improvements. If you have any questions, please do not hesitate to contact our office.
Sincerely,
DAVIS • MARTIN • POWELL & ASSOCIATES, INC
.The -
Steve McKee, PE
cc: Ms. Marion Sadler (enc)
Mr. Rick Handlin, NCDOT
File (enc)
P:12017t 1202731 Permi tslsewer\Morion Sadler111-5883DE4 Transmittal_ Marion Sadlerl-211004. docx
T: 336-886-4821 • F: 336-886-4458 • License: F-0245
6415 Old Plank Road, High Point, NC 27265 • www.dmp-inc.com

Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
ISA NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
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 11A NCAC 02T and the Division's
Minimum Design Criteria and that plans, specifications and supporting documents have been prepared in accordance with, ISA
NCAC 02T, ISA 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 ISA 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 ISA NCACdh.itf;t,{�334/3 5 �'rfn3'- IN
Projects not eligible for review via the fast track process (must be submitted for full technical review): DECt1Dv vy
> Projects that require an environmental assessment in accordance with 15A NCAC IC .0100;
9 Projects that do not meet any part of the minimum design criteria (MDC) document; OCT 06 2021
➢ Projects that involve a variance from the requirements of 15A NCAC 2T;
➢ Pressure sewer systems utilizing septic tank -effluent pumps (STEPS) or simplex grinder pumps;
9 STEP or simplex grinder pumps connecting to pressurized systems (e.g. force mains); _/(�� (}v
➢ Vacuum sewer systems. AYTT2 (qIi E f� l�lt�;�t UF�IGE
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):
O 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 I.2 is a corporation or company, provide documentation it is registered for business with
the North Carolina Secretary of State.
O 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.
El The Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a North
Carolina licensed Professional Enaineer.
O The Applicant's Certification on Page 5 of the application shall be signed in accordance with 15A NCAC 02T .0I06(b1.
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(6).
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 1 of 3

E. Flow Tracking/Acceptance Form (Form: FTSE 04-16) (If Applicable):
El 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.
> 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):
El 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.
A Location of the project (gravity sewer, pump stations & force main)
➢ Downstream connection points and permit number (if known) for the receiving sewer
El 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.).
H. Power Reliability Plan (Required if portable reliability option utilized for Pump Station):
El Per I5A NCAC 02T.0305(h)I 11, 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 I SA NCAC 02T .0115(01) 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 1 5A NCAC 02T .Il l 15(c), submit the properly executed Operational Agreement (FORM: HOA).
❑ Per 15A NCAC 02T .0115(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
❑ Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(b), submit the properly executed Operational Aereement (FORM: DEV).
For more information, visit the Division's collection systems website
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 2 of

THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional Office
2090 US Highway 70
Swannanoa, North Carolina 28778
[phone]
[phone] Fax
Avery, Buncombe, Burke, Caldwell, Cherokee,
Clay, Graham, Haywood, Henderson, Jackson,
Macon, Madison, McDowell, Mitchell, Polk,
Rutherford, Swain, Transylvania, Yancey
Water Quality Section
Fayetteville Regional Office
225 Green Street Suite 714
Fayetteville, North Carolina 28301-5094
[phone]
[phone] Fax
Anson, Bladen, Cumberland, Harnett, Hoke,
Montgomery, Moore, Robeson, Richmond,
Sampson, Scotland
Water Quality Section
Mooresville Regional Office
610 E. Center Avenue
Mooresville, North Carolina 28116
[phone]
[phone] Fax
Alexander, Cabana, Catawba, Cleveland,
Gaston, iredell, Lincoln, Mecklenburg, Rowan,
Stanly, Union
Water Quality Section
Raleigh Regional Office
1828 Mail Service Center
Raleigh, North Carolina 27699-1628
[phone]
[phone] Fax
Chatham, Durham, Edgecombe, Franklin,
Granville, Halifax, Johnston, Lee, Nash,
Northampton, Orange, Person, Vance, Wake,
Warren, Wilson
Water Quality Section
Washington Regional Office
943 Washington Square Mall
Washington, North Carolina 27889
[phone]
[phone] Fax
Beaufort, Bartle, Camden, Chowan, Craven,
Currltudk, Dare, Gates, Greene, Hartford, Hyde,
Jones, Lenoir, Martin, Pamlico, Pasquotank,
Perquimans, Pitt, Tyrrell, Washington, Wayne
Water Quality Section
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, North Carolina 28405
[phone]
[phone] Fax
Brunswick, Carteret, Columbus, ouplin, New
Hanover, Onslow, Pander
Water Quality Section
Winston-Salem Regional Office
450 W. Hanes Mill Road
Suite 300
Winston-Salem, North Carolina 27105
[phone]
Alamance, Allegheny, Ashe, Caswell, Davidson,
Davie, Forsyth, Guilford, Rockingham, Randolph,
Stokes, Surry, Watauga, Wilkes, Yadkin
Water Quality Section
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 3 of 3

Division 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: vY Qt11fli{zQtslsthbecompletedbyDWR)
All items must be completed or the application will he returned
L APPLICANT INFORMATION:
1. Applicant's name: Marion Sadler (company, municipality, HOA, utility, etc.)
2. Applicant type: 0 Individual ® Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ❑ Municipal ❑ Other
3. Signature authority's name: Marion Sadler per I SA NCAC 02T .0106(b)
Title: Owner
4. Applicant's mailing address: PO Box 871
City: Emporia State: VA Zip: 23847
5. Applicant's contact information:
Phone number: [phone] Email Address: [e-mail]
II. PROJECT INFORMATION:
I. Project name: Widen 1-95 to 8 lanes from Jonesboro Rd to Hodges Chanel Rd (NCDOT Project 1-5883)
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: W000_ and issued date:
If new construction but part of a master plan, provide the existing permit number: W000_„_
3. County where project is located: Harnett
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.3 i28° Longitude:-78.5789°
5. Parcel ID (if applicable): Along Jonesboro Road
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Rane(v McNeill License Number: 10117
Firm: Davis Martin Powell & Associates
Mailing address: 6415 Old Plank Rd
City: High Point State: NC Zip: 27265-
Phone number: 336 886-482I Email Address: rmcneillComp-inc.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Black River WWTP Permit Number: NC0043176
Owner Name: City of Dunn
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. PermitNumber(s): WQ_ Downstream (Receiving) Sewer Size: 8 inch
System Wide Collection System Permit Numberlsl lil'anuiie:rbie); WQCS
Owner Name(s): City of Dunn
FORM: FTA 04-16 Page 1 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?
El Yes ❑No ®N/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached?
❑ Yes ❑No ®N/A
3. If the Applicant is a Home/Property Owners' Association, has an Operational Agreement (FORM: HOA) been attached?
El Yes ❑No ®N/A
4. Origin of wastewater: (check all that apply):
['Residential Owned
❑ Residential Leased
❑ School / preschool / day care
❑ Food and drink facilities
0 Businesses / offices / factories
O Retail (stores, centers, malls)
®Retail with food preparation/service
O Medical / dental / veterinary facilities
0 Church
❑ Nursing Home
5. Nature of wastewater : 100 % Domestic/Commercial % Commercial
% Industrial (See 15A NCAC 02T .0103(20))
) Is there a Pretreatment Program in effect?
❑ Car Wash
❑ Hotel and/or Motels
❑ Swimming Pool /Clubhouse
❑ Swimming Pool/Filter Backwash
❑ Other (Explain in Attachment)
❑ Yes
6. Has a flow reduction been approved under I5A NCAC 02T .0114(f)? ❑ Yes ® No
> If yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
® No
Establishment Type (see 02T.0114(f))
Daily Design Flow asb
No. of Units
Flow
Existing 2" force main from
gal/
0 GPD
Marion Sadler propoerty
gal/
GPD
just relocate a section of ex. 2" force main
gal/
GPD
in conflict with I-95 Roadway Project
gal/ -
GPD
NO NEW FLOW
gal/
GPD
gal/
GPD
Total
0 GPD
a See 15A NCAC 02T .0114(b). (d), (e)(l ) and (e)(2) 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 02T.0 1141 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 I5A NCAC 02T .0114)
> Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
0 Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
0 Flow has already been allocated in Permit Number:
® Rehabilitation or replacement of existing sewer with no new flow expected
0 Other (Explain):
FORM: FTA 04-16
Page 2 of 5

VH. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
> Section 11 & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
> Section 11I 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
VIIL PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pumn Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: . • Longitude: - , °
3. Design flow of the pump station: millions gallons per day (fine 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
2
1029
PVC SDR 21
6. Power reliability in accordance with I5.A NCAC 02T .0305(111( 11:
❑ 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 Tess 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(0):
1. Does the project comply with all separations found in I5A NCAC 02T .0305(I) & (ql
> 15A NCAC 02T.0305(i) 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 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, HOW, or SS 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
➢ I5A NCAC 02T.0305( el contains alternatives where separations in 02T 0305(f) cannot be achieved.
> **Stream classifications can be identified using the Division's NC Surrace Water Classifications wehpage
➢ If noncompliance with 02T.0305(f) or (4 see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) 0 Yes ® No 0 N/A
> See the Division's draft separation requirements for situations where separation cannot be meet
➢ No variance is required if the altemative 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 I5A NCAC 02B .0200? ® Yes ❑ No 0 N/A
> This would include Trout Buffered Streams per I5A NCAC 213,0202
4. Does the project require coverage/authorization under a 404 Nationwide or
individual permits or 401 Water Quality Certifications?
> Information can be obtained from the 401 & Buffer Permitting Branch
❑ Yes ® No
5. Does project comply with I5A NCAC 02'I'.0105(0(6) (additional permits/certifications)? ® Yes 0 No
Per I5A NCAC 02T.0105(c)16), 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 ® 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 ISA 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 Putnn 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 renuest is required prior to submittal of the Fast Track Application and supporting
documents.
2. Professional Engineer's Certification:
1, Randy L. McNeill of Davis Martin Powell & Associates attest that this application for
(Professional Engineer's name from Application Item III.1.)
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 143-215.6B, 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 up to $25,000 per violation.
North Carolina Professional Engineer's seal, signature, and date:
/sky
3. Applicant's Certification per 15A NCAC 02T .0106(b):
Marion Sadler, Owner attest that this application for
(Signature Authority's name & title from Application Item 1.3.)
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 143-215.6A and 143-215.6E 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.
1
Signature: I
(L / o X fit h. , It /o ,a Date: 9.
FORM: FTA 04-16 Page 5 of 5

FAYE
R.ECOVEr'
DEQ/Dv R
OCT 062021
WOWS
ESY LLE REGJONA 1 OFFICE
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: Marion Sadler
Project Name for which flow is being requested: NCDOT Project I-5883
More than one FTSE may be required for a single project if the owner of the WWTP is not responsible for all 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: Black River WWTP
b. WWTP Facility Permit #: NC0043176
All flows are in MGD
c. WWTP facility's permitted flow 3.750
d. Estimated obligated flow not yet tributary to the WWTP 0
e. WWTP facility's actual avg. flow 2.624
f. Total flow for this specific request 0
g. Total actual and obligated flows to the facility 2.624
h. Percent of permitted flow used 70.0 %
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:
Pump
Station
(Name or
Number)
Eastside
Pump
Station
Permit
No.
Firm
Capacity, *
MGD
3.310
(A)
Design
Average
Daily Flow**
(Firm / pf),
MGD
(B)
Approx.
Current
Avg. Daily
Flow, MGD
1.324 0.824
(C) (D)=(B+C) (E)=(A-D)
Obligated,
Not Yet Total Current
Tributary Flow Plus
Daily Flow, Obligated
MGD Flow
0 0.824
Available
Capacity***
0.50
* 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, 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): 8" sewer line at Cooper and Carolina Dr
Downstream Permit Number: Permit number unknown
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I Steven Neusehafer 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. 'Phis certification applies to
those items listed above in Sections 1 and II plus all attached planning assessment addendums for which I
am the respons bl arty. Signature of this form certifies that the receiving collection system or treatment
works hM a I capacity to transport and treat the proposed new wastewater.
Z,Jvo zeto
Signing (Vidal Signature Date
Steven Neuschafer, City Manager
Title of Signing Official
Page 2 of 6
VISE 10-18

KELLIVETE
OCT 062021
State of North Carolina
Department of Environmental Quality
Division of Water Resources
W(,1PO
pw Tracking for Sewer Extension Applications
F �'Ef7E:UfLLF�'EGIOIVACOFr�I�E (FTSE 10-18)
Entity Requesting Allocation: Marion Sadler
Project Name for which flow is being requested: NCDOT Project I-5883
More than one FTSE may be reguiredfor a single project if the owner of the WWTP is not responsible for all 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: Black River 'WWTP-See Dunn FTSE for this Project
b. WWTP Facility Permit #i NC0043176
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e, WWTP facility's actual avg. flow
f. Total flow for this specific request 0.0
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
All flows are in MGD
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) (0)-(B+C) (E)H(A-D)
Design Obligated,
Pump Pump Average Approx. Not Yet Total Current
Station Station Firm Daily Flows Current Tributary Flow Plus
(Name or Permit Capacity, * (Firm / pf), Avg; Daily Daily Flow, Obligated Available
Number) No. MOD MOD Flow, MGD MOD Flow Capacity***
* The Firm Capacity (design slow) 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, per Section 2.02(A)(4)(e) 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): 8". gravity at Cooper and Carolina Dr
Downstream Permit Number: permit number unknown
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I Marion Sadler 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.
Sign Official Signature
tkDnpr
Title of Signing Official
distal
Date
Page 2 of 6
FTSE 10-18

DRAWING NAME: P: \2017\170313\Civil\SadlerM.dwg — FM — 6/8/2021 2:12 PM
EXISTING
FORCE MAIN
EXISTING MOTEL
PUMP STATION
PROPOSED 2"-
FORCE MAIN
EXISTING
FORCE MAIN
EXISTING TRUCK STOP
PUMP STATION
N 571,213.997
E 2,126,775.389
LAT N35.318770°
LONG W78.575002
SADLER
TRUCK STOP
GRAPHIC SCALE
500 25 ``. 0 500
= 500 FEET
1000
DAVIS • MARTIN • POWELL
ENGINEERS & SURVEYORS
6415 OLD PLANK RD, HIGH POINT, NC 27265
[phone] I WWW.DMP-INC.COM I LICENSE: F-0245
NCDOT PROJECT 1-5883
1-95 WIDENING
SADLER TRUCK STOP FM