WQ0022224_Modification_20211207

Non -Discharge Branch Upload/Submittal Form
NORTH CAROLINA
EnWrvnmemfal Qualify
Version 2 - Revised June 23, 2020
Initial Review
Reviewer
Thornburg, Nathaniel D
Is this submittal an application? (Excluding additional information.)*
Yes No
Permit Number (IR) * WQ0022224
Applicant/Permittee Town of Clayton
Applicant/Permittee Address 111 East 2nd Street, Clayton, NC 27520
Is the owner in BIMS? Yes No Is the facility in BIMS? Yes No
Owner Type Municipal
Facility Name Little Creek WRF
County Johnston
Fee Category
Is this a complete application?*
Yes No
Signature Authority
Signature Authority Title
Signature Authority Email
Document Type (if non -application)
Email Notifications
Does this need review by the hydrogeologist?*
Regional Office
CO Reviewer
Admin Reviewer
Yes No
Fee Amount $0
Complete App Date
Below list any additional email address that need notification about a new project.
Email Address
Comments to be added to email notfication
Comments for Admin
Comments for RO

Comments for Reviewer
Comments for Applicant

Submittal Form
Project Contact Information
Please provide information on the person to be contacted by NDB Staff regarding electronic submittal, confirmation of receipt, and other correspondence.
Name*
Nathaniel D. Thornburg
Email Address* Phone Number*
[e-mail] 9197073653
Project Information
Application/Document Type *
New (Fee Required)
Modification - Major (Fee Required)
Renewal with Major Modification (Fee
Required)
Annual Report
Additional Information
Other
Modification - Minor
Renewal
GW-59, NDMR, NDMLR, NDAR-1,
NDAR-2
Residual Annual Report
Change of Ownership
We no longer accept these monitoring reports through this portal. Please click on the link below and it will take you to the correct form.
https://edocs.deg.nc.gov/Forms/NonDischarge_Monitoring_Report
Permit Type: *
Permit Number: *
Applicant/Permittee *
Wastewater Irrigation
Other Wastewater
Closed -Loop Recycle
Single -Family Residence Wastewater
Irrigation
Town of Clayton
WQ0022224
Has Current Existing permit number
Applicant/Permittee Address* 111 East 2nd Street, Clayton, NC 27520
Facility Name* Little Creek WRF
High -Rate Infiltration
Reclaimed Water
Residuals
Other
Please provide comments/notes on your current submittal below.
Relocation of 8" reclaimed water distribution line on NCDOT Project 80074 Shotwell Road -
Division 4 (Johnston County).
(Intersection improvements at US 70 and Shotwell Road)
At this time, paper copies are no longer required. If you have any questions about what is required, please contact Nathaniel Thornburg
at [e-mail].
Please attach all information required or requested for this submittal to be reviewed here. *
(Application Form, Engineering Plans, Specifications, Calculations, Etc.)
NCDOT Shotwell Rd Reclaimed Water Distribution P... 7.47MB
Upload only 1 PDF document (less than 250 MB). Multiple documents must be combined into one PDF file unless the is larger
than upload limit.
* By checking this box, I acknowledge that I understand the application will not be
accepted for pre -review until the fee (if required) has been received by the Non -
Discharge Branch. Application fees must be submitted by check or money order and
made payable to the North Carolina Department of Environmental Quality (NCDEQ).
I also confirm that the uploaded document is a single PDF with all parts of the
application in correct order (as specified by the application).
Mail payment to:
NCDEQ — Division of Water Resources
Attn: Non -Discharge Branch
1617 Mail Service Center
Raleigh, NC 27699-1617

Signature
Submission Date
12/7/2021

DocuSign Envelope ID: 1 D285D9C-5278-4234-9E3A-2F96BACC5F69
--/, HINDE
A A ENGINEERING
401 Harrison Oaks Blvd.
Suite 220
Cary, NC 27513
Phone: [phone]
Fax: [phone]
LETTER OF TRANSMITTAL
To: Department of Environmental Quality
512 N. Salisbury Street
Raleigh, NC 27699-1617
Phone # [phone]
Attn: Nathaniel Thornburq
Re: NCDOT Project: 80074 Shotwell Road
I am sending you the following item(s):
Date: December 07, 2021
Email
Job No.: A2021302
NCDOT - 80074
COPIES
DATE
NO.
DESCRIPTION
1
09-07-21
RWPI 06-16 & RWDL 06-16 Permit Application
1
09-07-21
Narrative
1
09-07-21
Plans and Specifications
1
09-07-21
Topo Map
These are transmitted as checked below:
❑ As requested
® For approval
❑ For review and comment
Remarks:
Copy to: File
Joshua Baird
❑ For your use
❑ For Signatures
El
DocuSigned by,
Signed: 16:"i
23F928878C49A...
Corey D. Bousquet, PE
Project Manager

DocuSign Envelope ID: F0DD3C1 B-2678-48F7-976E-5E4BCF34EF2D
State of North Carolina
Department of Environmental Quality
nwVRDivision of Water Resources
15A NCAC 02U — RECLAIMED WATER SYSTEMS — PROJECT INFORMATION
Division of Water Resources INSTRUCTIONS FOR FORM: RWPI 06-16 & SUPPORTING DOCUMENTATION
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 additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application.
For more information, visit the Water Quality Permitting Section Non -Discharge Permitting Unit website.
General —This form is required for all projects involving the generation, utilization, and or distribution of reclaimed water. At least one
of the following forms must also be included in the application package. However, multiple forms may be applicable. Unless
otherwise noted, the Applicant shall submit one original and two copies of the application and supporting
documentation. Please check the boxes below as appropriate to indicate which additional forms are included in the
application package:
❑ Reclaimed Water Generation (FORM: RWG) — for wastewater treatment facilities producing reclaimed water.
❑ Non -Conjunctive Utilization (FORM: RWNC) — for reclaimed water utilization activities, when the reclaimed water
utilization activity is required in order to meet the wastewater disposal needs of the facility.
❑ Conjunctive Utilization (FORM: RWCU) — for reclaimed water utilization activities, when the reclaimed water option is
not necessary to meet the wastewater disposal needs of the facility and other wastewater utilization/disposal methods are
available.
❑ Bulk Distribution (FORM: RWBD) — for distribution of reclaimed water in a bulk manner.
® Distribution Lines (FORM: RWDL) — for construction of reclaimed water distribution lines.
❑ Wetland Augmentation (FORM: RWWA) — for projects seeking to utilize reclaimed water for the purpose of wetland
augmentation.
❑ Local Program Approval (FORM: RWLPA) — for projects seeking permitting delegation for reclaimed water users.
A. Cover Letter (All Application Packages):
® List all items included in the application package, as well as a brief description of the requested permitting action.
B. Application Fee (All New and Major Modification Application Packages):
❑ Submit a check, money order or electronic funds transfer made payable to: North Carolina Department of Environmental
Quality (NCDEQ) according to the following fee schedules:
❑ STANDARD REVIEW —Submit the appropriate fee for all new and major modification applications as listed in the table
below.
Facility Classification
New Permit
Major Modification'
Major Generator/User (ADF > 10,000 gallons per day)
FS1,310
$395
Minor Generator/User (ADF < 10,000 gallons per day)
$810 $245
Reclaimed Water Distribution Lines
7$480 N/A
' A major modification shall be defined as any permit modification that: increases the generating facility's
average daily flow (ADF); increases the utilization area acreage; adds additional utilization areas not
previously approved; or includes the addition of new treatment units/processes not previously permitted.
There is no fee for minor permit modifications.
INSTRUCTIONS FOR FORM: RWPI 06-16 & SUPPORTING DOCUMENTATION Page 1 of 2

DocuSign Envelope ID: F0DD3C1 B-2678-48F7-976E-5E4BCF34EF2D
C. Reclaimed Water Project Information Form (FORM: RWPI 06-16) (All application packages):
® Submit the completed and appropriately executed Reclaimed Water Project Information (FORM: RWPI 06-16) form. Please
do not make any unauthorized content changes to this form.
® The applicant name in Item I.1. shall be consistent with the applicant name on the plans, specifications, agreements, etc.
® The Applicant's Certification on Page 3 of this form shall be signed in accordance with 15A NCAC 02T .0106(b). The
application must be signed by a principal executive officer of at least the level of vice-president or his authorized representative
for a corporation; by a general partner for a partnership or limited partnership; by the proprietor for a sole proprietorship;
and by either an executive officer, an elected official in the highest level of elected office, or other authorized employee for a
municipal, state, or other public entity. 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).
❑ If this project is for a renewal without modification, use the Non -Discharge System Renewal (FORM: NDSR) application.
There is no fee for permit renewal without modification.
D. 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., compliance schedules, permit description, monitoring, permit conditions, etc.).
ONE ORIGIANL AND TWO COPIES OF THE COMPLETED APPLICATION AND SUPPORTING DOCUMENTATION
SHALL BE SUBMITTED TO:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NON -DISCHARGE PERMITTING UNIT
By U.S. Postal Service:
1617 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1617
TELEPHONE NUMBER: [phone]
By Courier/Special Delivery:
512 N. SALISBURY STREET
RALEIGH, NORTH CAROLINA 27604
FAX NUMBER: [phone]
INSTRUCTIONS FOR FORM: RWPI 06-16 & SUPPORTING DOCUMENTATION Page 2 of 2

DocuSign Envelope ID: F0DD3C1 B-2678-48F7-976E-5E4BCF34EF2D
Division of Water Resources
L GENERAL INFORMATION:
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02U — RECLAIMED WATER SYSTEMS — PROJECT INFORMATION
FORM: RWPI 06-16
1. Applicant's name: Town of Clayton
Mailing address: I I I East 2nd Street
City: Clayton State: NC Zip: 27520-
Telephone number: [phone] Email Address: jbairdktownofclaytonnc.org
2. Signature authority's name: Joshua Baird (per 15A NCAC 2U .0106) Title: Town Engineer
3. Applicant type (check all that apply):
❑ Government ❑ Federal ❑ State ® Municipal ❑ County
❑ Individual
❑ Corporation
✓ For new permits, submit documentation that the company is registered for business with the NC Secretary of State.
❑ General Partnership
✓ For new permits, submit a copy of the certificate filed with the Register of Deeds in the county of business.
❑ Privately Owned Public Utility
✓ For new permits, submit a Certificate of Public Convenience and Necessity from the NC Utilities Commission, or a
letter from the NC 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.
❑ Home Owners Association
✓ For new permits, submit a properly executed Operational Agreement (FORM: HOA); and proposed or approved
Articles of Incorporation, Declarations and By-laws.
❑ Developer (where residential lots are to be sold)
✓ For new permits, submit a properly executed Operational Agreement (FORM: DEV)
4. Demonstration of historical consideration for permit approval:
Has the Applicant or any parent, subsidiary or other affiliate exhibited the following?
a. Has been convicted of environmental crimes under Federal law or G.S. 143-215.6B? ❑ Yes or ® No
b. Has previously abandoned a wastewater treatment facility without properly closing that facility? ❑ Yes or ® No
c. Has unpaid civil penalty where all appeals have been abandoned or exhausted? ❑ Yes or ® No
d. Is non -compliant with an existing non -discharge permit, settlement agreement or order? ❑ Yes or ® No
e. Has unpaid annual fees in accordance with 15A NCAC 02T .0105(e)(2)? ❑ Yes or ® No
FORM: RWPI 06-16 Page 1 of 3

DocuSign Envelope ID: F0DD3C1 B-2678-48F7-976E-5E4BCF34EF2D
II. PROJECT INFORMATION
1. Application type: Reclaimed Water Distribution Line Select (See Instruction B) Fee Submitted 0 (See Instruction B)
2. For modifications, provide the existing permit number: WQ0022224 and most recent issuance date: No Date Found
3. Provide a brief description of the activities proposed for permitting: Relocation of 185' of 8" RJ DI Reclaimed WDL
4. What is the status of the following associated permits and/or certifications ? (if not applicable, please mark as N/A)
Permit/Certification
Date Submitted
Date Approved
Permit/Certification No.
Agency Reviewer
Collection System (Q >
200,000 GPM
N/A
Dam Safety
N/A
Erosion & Sedimentation
Control Plan
N/A
Nationwide 12 / Section 404
N/A
Pretreatment
N/A
Sewer System
N/A
Stormwater Management Plan
N/A
Other:
✓ For any of the permits and certifications listed above that will directly impact the construction of the proposed reclaimed
water project, please provide documentation of permit approval or final certification. Note: This application may be
considered incomplete, or the resulting permit may be issued conditionally if a pending issuance of any of the related
permits/certifications directly impacts the proposed facility.
5. Documentation of the presence or absence of threatened or endangered aquatic species at the project site utilizing information
provided by the Department's Natural Heritage Proms is required for construction of all new WWTP projects and/or non -
conjunctive utilization sites, and for any project involving expansion of a WWTP and/or non -conjunctive utilization site in
accordance with 15A NCAC 02T .0105(c)(10). Provide the location in application package where this documentation is
located: ; or explain why this item is N/A.
6. Does this project utilize public monies or lands? ® Yes or ❑ No
✓ If yes, was an Environmental Assessment required under 15A NCAC O1C?
Yes ® No
Include one of the following final environmental documents with this submittal:
❑ Finding of No Significant Impact, or ❑ Record of Decision
Describe any mitigating factors from the Environmental Assessment that impact the design and/or construction of the
reclaimed water project:
7. Is any portion of the proposed project (reclaimed water treatment units, storage units, distribution lines, or utilization areas)
located within the 100 year flood plain? ❑ Yes or ® No
✓ If yes, specify which portion(s) of the project are affected?
✓ If yes, has the Applicant submitted written documentation of compliance with § 143 Article 21 Part 6? ❑ Yes or ❑ No
Documentation should consist of a letter from the local authority (i.e., county/municipality) stating that the project
complies with any local floodplain ordinance that may apply.
FORM: RWPI 06-16 Page 2 of 3

DocuSign Envelope ID: F0DD3C1 B-2678-48F7-976E-5E4BCF34EF2D
Applicant's Certification (signing authority must be in compliance with 15A NCAC 02U .0106):
1, Joshua Braid Town Engineer
(signing authority name — PLEASE PRINT)
attest that this application for Town of Clayton
(facility name)
(title)
has been reviewed by me and is accurate and complete to the best of my knowledge. 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.
I further certify that the applicant or any affiliate has not been convicted of an environmental crime, has not abandoned a wastewater
facility without proper closure, does not have an outstanding civil penalty where all appeals have been exhausted or abandoned, are
compliant with any active compliance schedule, and do not have any overdue annual fees under Rule 15A NCAC 02U .0105. Note:
In accordance with NC 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 b� u e,:, JJ,000 per violation.
I I
Signature: 56EAAV'/Jl, Date: 12/6/2021
F3757AB1124249F...
FORM: RWPI 06-16 Page 3 of 3

DocuSign Envelope ID: F0DD3C1 B-2678-48F7-976E-5E4BCF34EF2D
State of North Carolina
n11A11? Department of Environmental Quality
Division of Water Resources
' 15A NCAC 02U — RECLAIMED WATER SYSTEMS — DISTRIBUTION LINES
Division of Water Resources INSTRUCTIONS FOR FORM: RWDL 06-16 & SUPPORTING DOCUMENTATION
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 additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application.
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit website
General — This application is for projects involving the construction of reclaimed water distribution lines that will supply reclaimed
water for conjunctive use activities. Unless otherwise noted, the Applicant shall submit one original and two copies of
the application and supporting documentation.
Do not submit this application without an associated Reclaimed Water Project Information (FORM: RWPI) form.
A. Reclaimed Water Distribution Lines (FORM: RWDL 06-16) Application (All application packages):
® Submit the completed and appropriately executed Reclaimed Water Distribution Lines (FORM: RWDL 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to
the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
® The system name in Item II.1. shall be consistent with the user name on the plans, specifications, agreements, etc.
® The Professional Engineer's Certification on Page 5 of this form shall be signed, sealed and dated by a North Carolina licensed
Professional Engineer.
❑ The Applicant's Certification on Page 5 of this form shall be signed in accordance with 15A NCAC 02T .0106(b). The
application must be signed by a principal executive officer of at least the level of vice-president or his authorized representative
for a corporation; by a general partner for a partnership or limited partnership; by the proprietor for a sole proprietorship;
and by either an executive officer, an elected official in the highest level of elected office, or other authorized employee for a
municipal, state, or other public entity. 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).
B. Property Ownership Documentation (All Application Packages):
® Per 15A NCAC 02U .0201(e) or 15A NCAC 02U .0202(f), the Applicant shall demonstrate that they are the owner of the
property where the reclaimed water lines will be installed. Documentation shall consist of one of the following (or a
combination of):
❑ Legal documentation of ownership (i.e., GIS, deed or article of incorporation), or
❑ Written notarized intent to purchase agreement signed by both parties with a plat or survey map, or
® An easement specifically indicating the intended use of the property and meeting the requirements of 15A NCAC 02L
.0107 , (i.e. municipality right of way) or
❑ A written notarized lease agreement signed by both parties, indicating the intended use of the property, as well as a plat
or survey map.
INSTRUCTIONS FOR FORM: RWDL 06-16 & SUPPORTING DOCUMENTATION Page 1 of 2

DocuSign Envelope ID: F0DD3C1 B-2678-48F7-976E-5E4BCF34EF2D
C. Engineering Plans (All Application Packages):
® Per 15A NCAC 02U .0201(c)(1) or .0202(c), submit standard size and 11 x 17-inch plan sets that have been signed, sealed and
dated by a North Carolina licensed Professional Engineer. At a minimum, the engineering plans shall include the following
items:
® Table of contents.
® A general location map with at least two geographic references and a vicinity map.
® Plan and profile views of all pump stations and reclaimed water line extensions as well as the proximity of the reclaimed
water line extensions to other utilities and natural features.
® Depict minimum separation distances required by 15A NCAC 02U .0403(h). (i), and 15A NCAC 02T .0305).
® Minimum cover in accordance with 15A NCAC 02T .0305(g)(4).
❑ Location and details of all pump stations.
® All labeling and color coding requirements per 15A NCAC 02U .0403.
® Plans shall represent a completed design and not be labeled with preliminary phrases (e.g., FOR REVIEW ONLY, NOT
FOR CONSTRUCTION, etc.) that indicate they are anything other than final specifications. However, the plans may be
labeled with the phrase: FINAL DESIGN - NOT RELEASED FOR CONSTRUCTION.
D. Specifications (All Application Packages):
® Per 15A NCAC 02U .0201(c) or .0202(c), submit specifications that have been signed, sealed and dated by a North Carolina
licensed Professional Engineer. At a minimum, the specifications shall include the following items:
® Specifications for standard equipment may be omitted for municipalities with approved standard specifications. Use of
standard specifications must be noted on each page of the plans.
® Table of contents with each section/page numbered.
® Detailed specifications for each reclaimed water line and pump station (as applicable).
® Site Work (i.e., earthwork, clearing, grubbing, excavation, trenching, backfilling, compacting, fencing, seeding, etc.)
® Materials (i.e., concrete, masonry, steel, painting, method of construction, etc.)
❑ Electrical (i.e., control panels)
® All labeling and color coding requirements per 15A NCAC 02U .0403.
® Specifications shall represent a completed design and not be labeled with preliminary phrases (e.g., FOR REVIEW ONLY,
NOT FOR CONSTRUCTION, etc.) that indicate they are anything other than final specifications. However, the
specifications may be labeled with the phrase: FINAL DESIGN - NOT RELEASED FOR CONSTRUCTION.
E. Engineering Calculations (All Application Packages):
❑ Per 15A NCAC 02U .0201(c) or .0202(c), submit calculations that have been signed, sealed and dated by a North Carolina
licensed Professional Engineer. At a minimum, the calculations shall include the following items:
❑ Provide justification for the required pipe capacity, and details for how pipe sizes were determined.
❑ Minimum velocities to be maintained in the reclaimed water line.
❑ Friction/total dynamic head calculations and system curve analysis for each pump used.
❑ Pump selection information including pump curves, manufacturer's information, and recommended installation guidelines.
❑ Detailed specifications for each reclaimed water line and pump station (as applicable).
❑ Floatation calculations for any pump stations entirely or partially below grade.
❑ For connection to a pump station, submit an evaluation of the existing pump station's ability to handle peak flows. Provide
calculations to detail how peak flows were determined.
❑ For connection to a force main, submit an evaluation of the existing force main based on peak flows to the proposed project
and peak flows already tributary to the existing force main.
ONE ORIGINAL AND TWO COPIES OF THE COMPLETED APPLICATION AND SUPPORTING DOCUMENTATION
SHALL BE SUBMITTED TO:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NON -DISCHARGE PERMITTING UNIT
By U.S. Postal Service:
1617 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1617
TELEPHONE NUMBER: [phone]
By Courier/Special Delivery:
512 N. SALISBURY STREET
RALEIGH, NORTH CAROLINA 27604
FAX NUMBER: [phone]
INSTRUCTIONS FOR FORM: RWDL 06-16 & SUPPORTING DOCUMENTATION Page 2 of 2

DocuSign Envelope ID: F0DD3C1 B-2678-48F7-976E-5E4BCF34EF2D
State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02U — RECLAIMED WATER SYSTEMS — DISTRIBUTION LINES
FORM: RWDL 06-16
L CONTACT INFORMATION:
1. Applicant's name: Town of Clayton
Mailing address: I I I East 2nd Street
City: Clayton State: NC Zip: 27520-
Telephone number: [phone] Email Address:
2. Signature authority's name: Joshua Baird (per 15A NCAC 02T .0106) Title: Town Engineer
3. Consulting Engineer's name: Corey Bousquet License Number: 023041 Firm: Hinde Engineering
Mailing address: 401 Harrington Oaks Blvd.
City: Caa State: NC Zip: 27513-
Telephone number: [phone] Email Address: cbousquetghindeengineering.com
IL DISTRIBUTION SYSTEM INFORMATION
1. Distribution system project name (name of subdivision, shopping center, etc.): NCDOT Project: 80074
2. Project county: Johnston
3. USGS map name: NCDOT Project: 80074 Shotwell Road and US 70 Bus
4. Owner of reclaimed water generating facility: Town of cayton
5. Permit number of reclaimed water generating facility: W00022224
6. List the owner(s) of any intermediate reclaimed water lines if different from the applicant, or the generating facility. None
7. Permit number for reclaimed water line immediately upstream: W00022224
8. Pipe diameter for for reclaimed water line immediately upstream: 8"
9. Specify the proposed destination of the reclaimed water: Pine Hollow Golf Coarse
10. Capacity of proposed distribution system: N/A gallons per day
11. Explanation of how capacity was determined: NA
III. DISTRIBUTION LINE DESIGN INFORMATION
1. Complete the table below for by providing the required information on the proposed distribution lines:
Diameter (inches)
Length
linear feet
pipe Material
High Elevation
ft
ge Elevation
F5'��(ft)
8
185
DI
282.56
282.56
2. Station location of air release valves:
Note: Air release valves must be provided at all high points along the line where the elevation difference exceeds 10 ft.
FORM: RWDL 06-16 Page 1 of 5

DocuSign Envelope ID: F0DD3C1 B-2678-48F7-976E-5E4BCF34EF2D
III. DISTRIBUTION LINE DESIGN INFORMATION (Continued)
3. Complete the table below by providing the location of each design criteria in the specification and/or plans in accordance with
15A NCAC 02U .0403. Items that are not applicable shall be marked N/A.
Design Criteria
Page Number in Plans
Page Number in Specifications
Labeling on reclaimed water piping, valves, storage
UC-4 and UC-6
facilities, and outlets
Color coding on reclaimed water piping, valves, etc.
UC-3, UC-3B, UC-3C
2,3,4
Method of securing valves and outlet for operation by
and UC-3C
2,3,4
authorized personnel onlyUC-3B
Locking mechanism for hose bibs
N/A
N/A
Cross connection control devices
N/A
N/A
IV. SETBACKS (15A NCAC 02U .0701)
1. Provide the actual minimum distance (in feet) from any reclaimed water storage units and/or pump station within the
distribution system to each item listed (distances greater than 500 feet may be marked N/A):
Setback Parameter
Pump stations within
Reclaimed Water
distribution system
Storage Units
Required
Actual
Required
Actual
Any private or public water supply source
N/A
100
N/A
Any property line
N/A:]1
50
N/A
Any well with exception of monitoring wells
100
N/A
100
N/A
Surface waters (streams — intermittent and perennial,
100
N/A
50
N/A
perennial waterbodies, and wetlands) classified as SA
Surface waters (streams — intermittent and perennial,
25
N/A
50
N/A
perennial waterbodies, and wetlands) classified as SA
2. Do the pump stations and storage units comply with all setbacks found in the river basin rules (15A NCAC 2B .0200)?
❑Yes or❑No
✓ If no, list non -compliant setbacks:
3. Are any setback waivers required in order to comply with 15A NCAC 02U .0701? ❑ Yes or ❑ No
✓ If yes, have these waivers been written, notarized, signed by all parties involved and recorded with the County Register of
Deeds? ❑ Yes or ❑ No
✓ If yes, have the required Non -Discharge Wastewater System Waiver (FORM: NDWSW) forms been included with this
application package? ❑ Yes or ❑ No
FORM: RWDL 06-16 Page 2 of 5

DocuSign Envelope ID: F0DD3C1 B-2678-48F7-976E-5E4BCF34EF2D
V. SEPARATION DISTANCES
1. Provide the actual minimum separation distance (in feet) from the reclaimed water distribution system to each item listed in
accordance with 15A NCAC 02U .0403(h), (i), and (j):
Separation Parameter
Horizontal
Vertical
Required
Actual
Required
Actual
Any water line (feet)
10
47' From Prop.
1.5
Rel.
Any well
50
N/A
N/A
Sewer lines (reclaimed over sewer)
2
200' From
1.5
Prop. Re1.
Final earth grade
N/A
3
Min. 4.3'
2. Are the separation requirements listed above met? ❑ Yes or ❑ No
✓ If No, has documentation been provided to show that piping and integrity testing procedures meet water main standards in
accordance with 15A NCAC 18C? ❑ Yes or ® No
Note: In no case shall reclaimed water lines be closer than 25 feet to a private well.
VI. PUMP STATION INFORMATION
IF MORE THAN ONE PUMP STATION, PROVIDE ADDITIONAL COPIES OF THIS PAGE AS NECESSARY.
1. Are there any reclaimed water pump stations proposed as part of the distribution system? ❑ Yes or ® No
✓ If no, then skip the remaining items in Section VI.
2. Complete the table below by providing the required information regarding the reclaimed water pump station(s)
Pump Station Design
Plan Sheet
Number
Specification
Page Number
Internal dimensions (L x W x H or (p x H)
ft
ft
ft
Volume
gallons
Inlet Elevation
ft
Outlet Elevation
ft
Number of pumps
Pump capacity
GPM
Lead pump on elevation
ft
Lag pump on elevation
ft
Lead pump off elevation
ft
Lag pump off elevation
ft
High water elevation
ft
Audible/Visual high water alarm
3. What is the 100-year flood elevation? (ft)
4. Precautions to be taken to protect the pump station from flooding (ft)
FORM: RWDL 06-16 Page 3 of 5

DocuSign Envelope ID: F0DD3C1 B-2678-48F7-976E-5E4BCF34EF2D
VILSTORAGE TANK INFORMATION
IF MORE THAN ONE STORAGE TANK, PROVIDE ADDITIONAL COPIES OF THIS PAGE AS NECESSARY.
1. Are there any reclaimed water storage tanks proposed as part of the distribution system? ❑ Yes or ® No
✓ If no, then skip the remaining items in Section VII.
2. Complete the table below by providing the required information regarding the reclaimed water storage tank(s)
Storage Tank Design
Plan Sheet
Number
Specification
Page Number
Type of storage tank
Select
Internal dimensions (L x W x H or (p x H)
ft
ft
ft
Storage Volume
gallons
Inlet Elevation
ft
Outlet Elevation
ft
High water elevation
ft
Audible/Visual high water alarm
3. What measures will be taken to reduce the risk of overflow?
FORM: RWDL 06-16 Page 4 of 5

DocuSign Envelope ID: F0DD3C1 B-2678-48F7-976E-5E4BCF34EF2D
Professional Engineer's Certification:
Corey D. Bousquet
attest that this application for Relocation of 8° Reclaimed
Water Distribution Line has been reviewed by me and is accurate, complete and
consistent with the information supplied in the engineering plans, 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 this application
package and its instructions as well as all applicable regulations and statutes. 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 NC 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+1Nte>tee�rrar
•�'�Q�� r�C Ca �O( rRrr
00
w � Q � •, w
;—DofiuSigneV1E- A L �
wBEAf928878C49A... : a
.Rg9 ; •• v5 `*%
11/11/2021
Applicant's Certification (signing authority must be in compliance with 15A NCAC 02T .0106):
I, Joshua Braid Town Engineer
(signing authority name — PLEASE PRINT) (title)
attest that this application for
(facility name)
has been reviewed by me and is accurate and complete to the best of my knowledge. 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. I further certify
that the applicant or any affiliate has not been convicted of an environmental crime, has not abandoned a wastewater facility without proper
closure, does not have an outstanding civil penalty where all appeals have been exhausted or abandoned, are compliant with any active
compliance schedule, and do not have any overdue annual fees under Rule 15A NCAC 02U .0105. Note: In accordance with NC 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. F;SI.Docusigned b.y:dSignature: 1J��0� Date: 12/6/2021
F3757AB1124249F...
FORM: RWDL 06-16 Page 5 of 5

DocuSign Envelope ID: 4719B2A7-6B5F-4B10-8861-79DD9DEF606B
_A40HINDE
Idd ENGINEERING
401 Harrison Oaks Blvd., Suite 220,
Cary, NC 27513
Office: 919-653-0001
December 07, 2021
Nathaniel D. Thornburg,
Branch Chief
Non -Discharge Branch
Department of Environmental Quality
919-707-3653
Subject: Reclaimed Water Distribution Line Permit Narrative
Town of Clayton — Relocation of 8" DI Reclaimed Water Distribution Line
NCDOT Project: 80074 Johnston County
Intersection Improvement US 70 and Shotwell Road
Johnston County
Dear Mr. Thornburg:
An 8-inch DI reclaimed water distribution line relocation is proposed at the southeast quadrant of
the intersection of US 70 and Shotwell Road in the Town of Clayton. The existing 8-inch DI
reclaimed water distribution line is being relocated away from the proposed guardrail. There will
be 185 feet of 8-inch DI reclaimed water distribution line installed to the east side of the
proposed guardrail. The existing air release valve will be relocated to the proposed 8-inch DI
reclaimed water distribution line in a new manhole. The proposed 8-inch DI reclaimed water
distribution line joints will be restrained using mechanical restrained retainer glands. Concrete
blocking will be used to restrain the tie-in points to the existing 8-inch DI reclaimed water
distribution line. There will be no additional flow generated with the installation of the new 8"
DI reclaimed water distribution line. The 8" reclaimed water distribution line provides irrigation
to the Pine Hollow Golf Club in Johnston County.
There is no permit fee.
Sincerely,
DocuSigned by:
Cow. �. �oT�:
siiet
Hinde Engineering Project Engineer
Cc: Joshua Baird, PE ([e-mail])
Engineering Director
Town of Clayton
Hinde Engineering
401 Harrison Oaks Blvd., Suite 220,
Cary, NC 27513
Office: 919-653-0001

z U
aW
3 w a
va
N
N
$ e F
z
¢
7
O
v,� mz` h v
jj 3°
CC^
a 0 i
O w
00
a
2
oa
e�
a
to a N
k ti
A
o
Eey,m_
N
2 G
N
W
d J
O
U O
U O
I I Io W
W�G
j ow
w°�
O O
4 C 4
-
=z
w m
J
e
y
+
oa
s�
W
o
o
~�
`� �+ \\
�1
U
W
°
W o w s a x
p
l
w
Q
a'I
n.un
M
U
o
m `O �_
U U
D
Z
Q
O
b
U
O
N �
Q
U
Q
Boos
-uD-7 'ow r
im
u6p 4sd-IJO-4s1-/O-bL008\ford/�O/6u �aau 6u $$$$�Wd JGA�a$$$$
I 3\sal/Illlfl/u6lsaQ/pooa llaMio4S-Id35-00'ZO£IZOZtl\IZOZ\S1J3f 02$$$$a" 5\5
OZ'01 IZOZ-OOtl-b0

Wz
�w
w
z33`'
=z
w ;
U)
J
O
CD
CO
LU
i
r >
J m
r a
O
z
Q
J
J
LU
U
CO
H
m
0
LU
o b o
CL
O
CL
VJ
J
O
m
i
U)
LU
Q
LU
U)
O
CL
O
CL
m
J J
m �n
o
o
O
a
w
o
0 o
0 o
0 0
0 0
0 0 0
LU
J
H
H
CD
Z
H
H
H
X
w®®.o®o
0 o
a d
E
m
1 1
1 o
�
a a
a m
F
i
9 0
® 4 0
y �
x
U
m
0 0
`
m �
~ m
m
°
�
0 0
o
a
E
w a
co
00
LU
W
3LU
m
m
> E
lI1 vi N E
0 I to o x
o o O E E
m m
N >
�6 I L
u6pysd-Z�fl wM1s-��-b L008 \ford ����6u

'af
e�
°va
o�
sm
r O
oz O O m Z
W p Z J W Q
0 0 0 am> mpx�wo
W r r r JJQ m fn wS
a a a U J S W U p LL r
F- F- F-a w m= m.z C C a m O z
m} mJ O_ mJW ' Z } mJ OW VO)QZ� Op
zUZ U UZ WOZW CdCHW WrQp ZQr UQJ YC WLLLL J LLm
U QLL J Q=0Qp
_' WOW O� ¢QO m> r
ZvVmOW2Jr N- UQMQLLWJ JUw J w Jv W W - W
Ud Q J x J OC C r WJ WOw� r W W-rm Q,OrW
W F-- U F-- U a F--U a JLL—UW F--r0ZW U5
Q Q Q Z - WW
?:Opp 3Oor 3Oor wwopr OcsSr
m pzr}
C/) _ F Z _ F Z _ F Z mZr`;Z i"iZ� W YO ••Z OQJ
¢ O¢ Q¢ Q z a O U Q¢ S J N O W p W
p U)Jp OU)_p F-- U) U]_p i..i rrm Inr2JrZ
w mOpz mOr Lu mOpz m�00 oZ WpWr[cwQrQQrw
0 w_ 0 w_ 0 w_ 07 w— z J p UIOZU •r W z a
7 W� m a W� m a W� m a W mom ¢ W J ¢ 0= - m 0
O o a U) ^ a U) �' a U) )� Q 0 Z U) r J r Q r iZi ~ Z Z W
f1�f1 as=w W*�=w W�=w WNW=w �z¢r=a.,m w.,�x
Mom W' �p—m W 0"z�< �C .JM=
z W p O U ? w w Z
O
m Q N J LZ z m Q z W W p F 0 z 0} O = O Z~ O
aW (n r— Z ZW'W NOr QW Q WZ rZ -JWr
J N (� K C7 r 7- O W w' 7 Z W = a } M Lb r
> m r O ?= W X Z 2 0 r 3 O a W W O D U O= LU m 0 N W EE 2 Z r r
}U 0<0007OF-wWWoo W If W2>2Jr<r W LULu Ir
XZQK000wQ OWMO }LL>Z
�= �wrrO N
wO U W W p
W QFO W 0 WrzN¢a wWmZ
W OnnzawoO
< ao 0ui mwmOz )m ZrOz}O U j ZQU
a Z U
_ z Z J
UJ a = ZUa =N OQ WU U)¢OUSQz W W 2M 0rOrWz W JZ m=W QULL7 WJ ZUWUQFr=
J p F-J�r0 WLL Zr
U z 0W AOw F-- W ZZpd aZ 0 F-- w O 0 )? m
r WOOWW'Up
W
U` W r
aFW F-- 0 W= >
W
zDa�Z<¢r7 U¢20ZZU W } WW' mzn 0z000
OWaLLgffwP0wQZxz waO¢m¢¢W0 0¢UOZO9w >FpLL' 0O
xzM:mwNwWw>,EiFwUQ0LiJ°p7O�zQ rE>O
r w z QOO DO O :0 mzZzOamw� ow=OO�0=OU W Ww WQ U W¢ Y 3Z 6 i¢ a W' U) ,> r m W J U r
W
r
F W U W
Z W
0�
w
H
p a J W¢= Q
rw
U
0
M
0 z Z
r0¢
ZZ¢ U)Jr
W
W cn Od.20Fr
2}Z
¢ 7 W W w Qer
�NZ}O
Q<aQUWZ
JH OZ0m
pZ
21 m¢y
O
OQJ
-
O
=UwOOr
W � >O LU
UJp
<0�aa
omZ
0LLm
W=Q
a U� 0
U r
UZ)¢°LU
Fd2NK�'FQD
JO
on
00a�O
7arn0 W
z a K z W
rZr K=
Lu =>=mL
U)Ur W LL' W J000 W Km
W W 7¢ 7 r
p a
J mO F w
J O W Q W
r a °�
Z LL r Z a 0
? J� O Q Of Z J d� J
a 0 u7
W r 0 r F W
LLI of ¢?
Z a
r J = p
O J a
Wfr Z Z LL r W J W N¢ W
z0c
W aLLL,U
WOZo�
>>����3om�zu�a
z = J F Z U=
W
= Z 0 LL�
J= D Q O J w S r O W J
~=LL<aw
�U)O rcnm
rOw�w
�;r Wpm
a~ww>jz,Ozwwa
�,i§LL'pp W=OZ W � W a
W
S UJ
r
= r
O } Z W W r W
WU W W
Z W m� W Q m W r< r
r z W o � fr 0== m r a z
Z m z r O az 0 mX=zo F-- F--
m� W mLLU S
=�wr0 OO�wW 0=zz
U 0 Of
cO a s} n Q N r a r O 0
ZJQarFUJ W LL' W LL. Z
W O m r O m
O w p Q O p= r r Z r 2 r
_ Oar
wa¢ zr a¢r¢woi-Oz
r
W W_ZO W ZOO W W aO LL'LL'
0rrwz>OrzJ�wz0Q
}JJ�OF�U zc7 W cnpDr
r rrQa¢O�azFZmz
�QQmU�Uw?F Ir -- W
F LL LL a K m Z z z U W 0= W o
yy}} wyy
W rFQ U) 0] W ZrYw�Q
Z � J
rrr=OpO=OOZrO��W
v»rO< F- ow�30<M
Y
of
O
3: m Z
Z OZ OLLF
W Q Y } W
� LLrrLL U)��r
r OZx0 a0Z
¢ mgzZwz�~¢
m OawpU
2>>'O OOZ
= w W w F U W H W W O
Z J Z O 2 0 U
r J M J W O J W 7
LL rQmzr�r�o0m00OWLLD00jz>W F W OWm
m
NW OOawW
¢a>a>
oa0¢QowOU
LU
v;W 7 am W� W
0pZZ W�wr
�zWawOawQm
W WOwWw E
WrrC),—
frW?
u6pP d-Esn- .... tin—ooeAr-,—nA6.......6—.... ,,nW6,--oAp— 11aM,-- sld3S 00'zocizozh Aizoz\s

ZN fq 0
e.�.m. 0 o QLn O
U U)
U
cn W
W
r Y 0 O Lu W W
CO
W Q Q H
o - } p� U�Z W
o m Q
J o o a Y w d m
H mo LU
cw ¢
¢¢ z i�
a w m U' O rL C7
m
N?a F0 z z
wz �w w00¢
�w H o<w mw
w
Zz 1:_ -� ooa >¢° z
2zz uz _ H N>
0 W
w
m
Y
d Y Xa X w
O F N 0
0
O
a w J
< a w LL
J ow - o, �1 Z
H w °W w� U O
Z Lg m
Q i QLU �
z 0
Q�
J W
L
a W Q� w w
U Q a Y LU
a Y NN
H D� o m 00 w o � L.1_
LL CL w 3 w w w CwC w
U O W U O W C
W U W U W Z
Z wma Wma w
F 0 F— L
Lj
W a
7
O o ID
_ Z
N
W
C U H
K < w
a w
OO wa W Z
w -m a 0
1 O F
y p
`_____LL___ ___ o -j W
f r----L--- F -I- i Z W> U
z O o w g
5 FOa W
Q � F
_moo OQOQ
a H
J Z (L
w
� W Z
0 LL
W
rz rm W Y C7
>
z o�� w Z
_ a z � U
I I�_� cmaa haw r� m U — _
UJ v �mm>��4 ZO U) Z m W
ir
W—NU
W U) o W J W 0_~ ~ III -�03� a a Y < E
K
�r�¢ °LLI
� wQU)
z o oW
w�Fw or> -- mc7>Uw
Qw¢z a� s / z 0�
LL 0-000 `--- -wwwI za / a-
O Y z oz >zw� a i ���/// H J (J
Z�02'Jzw CD U) m W Q
OYWa0 `� wo >LLz ='m mj zzW}
U °Foa uriz ww �J
Q COm 0 F Q m
J� �o�� w0 UQJ U)
H��
Om JLL>z aaoa S) ~� LLdWW
J 0 Q W> o t w W F
W ZSSO aww IFj rm Jo U)
2'QtnHH ImoI I U) Q
�bpvsd-aeon na �n ecmma�ro�d��mb���aa��b�a��a�+�i�+nwe«aa�ae�y naM��4s�das mmzme¢mzd�¢mz�si�aroedCe a{+)..rax�asJs
o�si izw-onv-no

Cl)
J
H
H
W
0
J
U
/h-
LI
L
CU
W
O
CL
_ l 3
w3G
¢Q
_ 1I Oda
'o A
a�
-
�� a�dr>r �e�eaw duo LLo>�o m
„0-,9 X021ddV ��
»0 loz
s00000� Q
�� o w g
p�00Vh�0� j 3
a a arm
w ow
zo o 00l7i F O
w x
woo
�3�0'JO0)( of �¢ - -
o z N �oo(I)do_O
� o`rb° o(��`
ovpo °O00 - - -
p°:cu0o6
o
lo
Q
3o
-
z< n r
i 3 O
III
III III-
III
— — - I<wz
-- =
F ro
III
o
- Q
- - - - -
- NH¢
- Q
3
cn
z
/ 2Q�+ mU
O U
III III_I.I.I_I I_I. \ I O
E a
a
�"
w
FlQ
a Ems'
E "�
O
r03
Z !�
0
-`oE
- �--
- - NU
- p3
LU
o
W
LU
— - - -
W
-
a 3
_ = z E U
~
a3�
N m
m$p m
30<
¢o
n�z
Z
o�
�i aNaoNNN
xo aammNl�r
U ti
IN
N W
O
�N
a
z w
wo
Fa
O
�H
X ¢
Z 2
O V O N N m V
0 w z z
dH NNMMa CI[1
a
p�
M
� w
WN N M M M M M O O
H V
I IN
Zmu'
a om
owzx o'amm
za..
,Bp v­8C e+a -,n ecmma\ro,daa 6.......6',...,�(�,nwd=�aa�aeoa naM�ovs�das mmzme¢mzd�¢mzas

15
cn
way oU
mom -
M - }
_ Fy
- J F
W� ofP�§ �e tln a g3a
0
Ro M
=w oNLj
age
,Ve ai.. •re.�� € "ma`s@�� u &��a� �R�e �' a,z, �'. e $ x E:
co
0
z �
L1J e \ &=a O r - o\ c JW E zFa 66FyF @ Ne z3d{� c
J
U gexg gag 9 Z F 6
3
3 3 ,
MEMMEN
W o0 0
d
SZ
cc:
CL
9z
w
40
s 0
HN
mg -
a -
a8o
va;
,Bp
vsd-zezn na -,n ecmma\ro,dzzmb...aa..b',.a.+�i�+nwe«aa�ae°y nax�°4s�das smmzme¢mzd�¢mzzsizaroedCaa{+�.%axzas�-�
z�zi izoz-no
vsd-zezn na -,n ecmma\ro,dzzmb...aa..b',.a.+�i�+nwe«aa�ae°y nax�°4s�das smmzme¢mzd�¢mzzsizaroedCaa{+�.%axzas�-�
z�zi izoz-no

z
0
� W O
1 J
W W F H
Jam LL
M M G
criaNQo
�z
oorao
LL r W H N
Oco=r0
rcoNa00
rxz�Y
�uri�oa
oz..rJ
W St.)M
LU
r3zWa)
¢ 0.00
�o r1I
z
rocs •r-i
N nnZNrr
••warlo....
W J r z LL 0
OSW OLLO
zrxLLaoc�
o
P'
<o
> o
> a
o
3
- 1
Tu
o
QU
U'=
C5w
02
W
J 3l7
M
z Q❑
C5z
J QO ?
Q¢r+ Q
M
<U
W
J2
la
o lo"aI
0l IC I I
of
ICI
<
o�
zz
O
H 2
��W U
`�
>
alI"i
II
Q
oII
N J f.'
LLma.w
FWW<0 >ww
a
Y
�ti¢_ Ntio
U
�J
�voi �—'x
N
�r
iB\P
I
¢
WNH�a
r
O Ud a� J
<`
fl
rmi0
ry
o NJ
• _N
. o w
o m < > w
•U U W UO
o mm
ih¢
III
op -WO
O�NNJf(M/JN�w
O¢f WO
t" III
VI
2
\
p
Z
o v
0
zrz
owQ
mw
_ } z
LLJN r O
J z r 0
r J Q N
c�a�Q
� om
LLxas
or�a
r>
�oaJ
J
zc1x3
7MrNN
or •oz
...
or. ozi 2
awo..o
�aaLLzo
a) 0 0
W¢a0
W W M W J
r W r 6 W
zH3�1LL
b!
x P
m�
G
>z
I - >J¢
>1
I
ti¢cJn
QW U w
w H ¢
R 2
I
n Q ¢ H W fL
NI IG �1 III � zOw 6o O_ Ir _
Ali II
l �I o'
ICI _ T O
3c0¢W0 �. ¢ O Fw 00
>
Od0~<, S = J MICA O
8 l m.+aww U w moo¢ rcLL
<�w �o
SIN I.II loll o�w��wi mx `"w
a—
,,Y�= mlllFm � I t � �
oJrcxo� Jx
_ OQ�J J UM
mFw�QU [t0
�Fw Fw
o]Q2W¢ = M
U W M
arox�-
oMJtiwro�wz
d0[Y�M�>MJ
,Bp '4sd-b9n-b6P'tin—ooeAAo'd A9nA6.......6—.... ,,nW6,--oAPeokl lla^'+o451d3S BBZBE20ZH\2mZ\S193 rokld�sa{�
�Ix c

<\!j>d \
Qj
DE{
\
�
\
2\;
§
§
e■)
■■:
G
r
/
w
}
.
/
\
�
.
}
°
§
j
\
°
\
\
�
\

w c
o
ob� -
U U t/J 1
Y Y ❑ -
m
ar
wz
'ma
-
Zz
�_�
=z ==
�z
a�
Cl)
W
Z
H
J
Z
O
o
H
m
H
H
in
cc
W
Q
LU
W
Q
J
U
W
cc
W
,dp-q -ud-sin ,n e ooa\Fo \,m6�......d�3�sa �+�i �+nwb«aa�ae�e naM��4s�das mmzme¢mzd�¢mz�si�a roedC�a{+�..rax�asJs
-60-Z-noN-u

DocuSign Envelope ID: E2AB68EA-095E-461 D-8E24-CBE2A2B98FB9
Project: 80074 UC-1 County: Johnston
AJ HINDEENG�E
License No. C-2639
401 Harrison Oaks Blvd.
Suite 145
Cary, NC 27513
[phone]
PROJECT SPECIAL PROVISIONS
Utility Construction
,s.f,Its ff:ttf
`` ?I H CAR
�S$I0.■• y
B423F928878C49A... • ~
'�� Y��i'• • r
s
11/11/2021
Revise the 2018 Standard Specifications as follows:
Page 15-1, Sub -article 1500-2 COOPERATION WITH UTILITY OWNERS, paragraph 2:
add the following sentences:
The utility owner is the Town of Clayton. The contact person for the Town of Clayton is
Mr. Joshua Baird, Mr. Baird can be reached by phone at [phone].
All proposed water and reclaimed water distribution line relocation work shall be performed at a
time to be coordinated with the utility owner. Water and reclaimed water distribution lines shall
not be taken out of service without prior approval of the utility owner and service interruptions
shall not exceed four hours.
Page 15-2, Sub -article 1500-7 SUBMITTALS AND RECORDS, paragraph 3: add the
following sentences:
As -built plans shall be provided to the Town of Clayton showing the size and type of material
installed with the horizontal and vertical coordinates of all installed piping and appurtenances.
As -built plans and associated documentation shall be provided to the Engineer prior to
acceptance of the work.
Page 15-8, Sub -article 1515-3C Backflow Prevention Assembly: add the following sentences:
A licensed backflow tester is required to test the relocated backflow preventers and shall submit
passing tests to www.bsionline.com under CCN 9L63-L7FA before the water service lines can
be activated. The tester must be registered with BSI Online, and shall be proficient in the latest
testing certification and test kit calibration.
11/11/2021 1/4

DocuSign Envelope ID: E2AB68EA-095E-461 D-8E24-CBE2A2B98FB9
Project: 80074 UC-2 County: Johnston
RECLAIMED WATER DISTRIBUTION LINE
Reclaimed water distribution line shall be installed in accordance with the applicable utility
provisions herein, as shown on the utility plans, and/or as directed by the Engineer.
Reclaimed water distribution line shall be ductile iron pipe conforming to ANSUAWWA
C151/A21.51.
Use either mechanical joints or push -on joints conforming to ANSUAWWA C111/A21.1L
Use approved type joint restraint devices with a minimum working pressure rating of 200 psi and
a factor of safety of 2.
Reclaimed water distribution line, installed in accordance with the plans and provisions herein
and accepted, will be measured along the pipe from end to end, with no deduction for fittings,
valves or other fixtures and paid for at the contract unit price per linear foot for "8" Reclaimed
Water Distribution Line". Such prices and payments will be full compensation for all materials,
excavations, labor, testing, backfilling, and incidentals necessary to complete the work as
required.
2. RECLAIMED WATER DISTRIBUTION VALVE:
Valves shall be installed in accordance with the applicable utility provisions herein, as shown on
the utility plans, and/or as directed by the Engineer.
Valves shall be iron body and shall conform to ANSUAWWA C509 for resilient seat type valves.
Valves shall have non -rising stems with a 2-inch square operating nut and 0-ring seals and shall
open by turning counterclockwise. Valves shall have mechanical joint ends conforming to
ANSUAWWA CI I I/A21.11 unless otherwise shown on the plans or directed by the Engineer.
Valves shall have a design working water pressure of 200 psig.
All valves shall be installed with an approved valve box, normally flush with the ground or
pavement with lockable cover. Valve boxes shall be of the screw type with a base to fit the valve
yoke and removable cover with the word "CAUTION: RECLAIMED WATER -DO NOT DRINK"
cast therein. Valve boxes shall be made of cast iron conforming to ASTM A48, Class 25, unless
otherwise shown on the utility plans and/or as directed by the Engineer.
The quantity of valves and valve boxes, installed in accordance with the plans and provisions
herein and accepted, will be measured, and paid for at the contract unit price per each for
"8" Reclaimed Water Distribution Valve ". Such prices and payments will be full compensation
for all materials, excavations, labor, testing, backfilling, and incidentals necessary to complete the
work as required.
11/11/2021 2/4

DocuSign Envelope ID: E2AB68EA-095E-461 D-8E24-CBE2A2B98FB9
Project: 80074 UC-3 County: Johnston
3. DUCTILE IRON RECLAIMED WATER DISTRIBUTION PIPE FITTINGS:
Ductile iron fittings shall be installed in accordance with the applicable utility provisions herein,
as shown on the utility plans, and/or as directed by the Engineer.
Use ductile iron pipe fittings and specials conforming to ANSUAWWA C 110/A21.10 for standard
size fittings or ANSUAWWA C153/A21.53 for compact fittings. Manufacture fittings with a
cement mortar lining and a seal coat in accordance with ANSUAWWA C 104/A21.4.
Use either mechanical joints or push -on joints conforming to ANSUAWWA CI I I/A21.11.
Use approved type joint restraint devices with a minimum working pressure rating of 200 psi and
a factor of safety of 2.
The quantity of ductile iron reclaimed water distribution pipe fittings will be measured and paid
per pound based on the published weights for ductile iron fittings, exclusive of the weights of any
accessories, as listed in the DI fittings weight chart located on the Utilities Unit web site. If the
Contractor elects to use compact ductile iron pipe fittings, measurement will be based on the
weight of standard size ductile iron water pipe fittings. Any fitting not listed will be measured
based on the published weights for ductile iron fittings listed in ANSUAWWA C25 110/A21.10.
This is limited to pressure pipe 4 inches or larger.
The quantity of ductile iron reclaimed water distribution pipe fittings, installed in accordance with
the plans and provisions herein and accepted, will be measured, and paid for at the contract unit
price per pound for "Ductile Iron Reclaimed Water Distribution Pipe Fittings ". Such prices and
payments will be full compensation for all materials, excavations, labor, testing, backfilling, and
incidentals necessary to complete the work as required.
4. RELOCATE AIR RELEASE VALVE WITH NEW MANHOLE:
Relocated air release valves and new manholes shall be installed in accordance with the applicable
utility provisions herein, as shown on the utility plans, and/or as directed by the Engineer.
Relocated air release valves and new manholes shall consist of the relocated air release valve,
8"x 8" x 2" DI tapped tee, inlet pipe or nipple, inlet valve, necessary fittings and a precast doghouse
manhole with manhole ring and cover.
The relocated air release valve shall be put back in service on the proposed reclaimed water
distribution line with the same inlet pipe diameter as on the existing reclaimed water distribution
line. Prior to installation, review all materials used tapping saddle, inlet pipe, inlet valve, and
necessary fittings with the Town of Clayton for approval.
11/11/2021 3/4

DocuSign Envelope ID: E2AB68EA-095E-461 D-8E24-CBE2A2B98FB9
Project: 80074 UC-4 County: Johnston
The precast doghouse manhole to house the relocated air release valve shall be precast concrete
conforming to ASTM C478 and the Standard Specifications for Roads and Structures Section
1525.
Manhole frames and covers shall be of cast iron conforming to ASTM A48 Class 30, shall be
traffic bearing, and shall have machined contact surface with the word "CAUTION: RECLAIMED
WATER -DO NOT DRINK" cast in the center of the manhole cover. The manhole frame and cover
shall be watertight with a lockable cover. Manhole frames and covers shall be as shown on plans
or an approved equal.
The quantity of relocated air release valves with new manholes, installed in accordance with the
plans and provisions herein and accepted, will be measured, and paid for at the contract unit
price each for "Relocate Air Release Valve with New Manhole". Such prices and payments shall
be full compensation for all labor, materials, excavation, backfilling, equipment, relocated air
release valve, inlet valve, inlet pipe, fittings, manhole and frame/cover, and incidentals necessary
to complete the work as required.
END OF SECTION
11 / 11 /2021 4/4

8/11/2021 Map produced by GISsurfer from mappingsupport.com
.l1 tl 1`A 3Y fS1
;ems, � 7 '1�'�' ESRI scanned topo USA♦
�• ��. �� s
` ff � H �' _ f � •' i �
Nc
6 AP
C.
;.
} i f
LATITUDE 35.6559360
- LONGITUDE-78.4801050
ADJACENT TO PNC BANK SHOTWELL — -
' ROAD AND US HWY 70 BUS f .�*+•
f r
. do _ }
f mm PROP. 8" DI RECLAIMED WATER ep
# DISTRIBUTION LINE {
X. 7r,
• ►
07,
TT
or
40
NCDOT PROJECT 80074 �� ;x�'
SHOTWELL ROAD AND
US HWY 70 BUS
1000 ft
8" RECLAIMED WATER LINE max} 'Center__� -
� 35.655134,-78.466501r,