WQ0043113_Application (FTSE)_20220106

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number: LACid4 I (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: City of Rocky Mount (company, municipality, HOA, utility, etc.)
2. Applicant type: ['Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
['Federal ❑ State/County ® Municipal ❑ Other
3. Signature authority's name: William B. Kerr per I5A NICA(' 02 I .01{)6(b)
Title: Director of Public Works
4. Applicant's mailing address: 331 S. Franklin St.
City: Rocky Mount State: NC Zip: 27802-
5. Applicant's contact information:
Phone number: [phone] Email Address: [e-mail]
II. PROJECT INFORMATION:
1. Project name: U-5996 - Extension of sewer main on SR 1603 (N. Old Carriage Rd.)
2. Application/Project status: ® Proposed (New Permit)
❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ00 and issued date: ,
For modifications, also attach a detailed narrative description as described in Item G of the checklist.
If new construction, but part of a master plan, provide the existing permit number: WQ00.
3. County where project is located: Nash
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.97567 Longitude: -77.89644
5. Parcel ID (if applicable): (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
I. Professional Engineer: John M. Kamprath License Number: 14101
Firm: VHB
Mailing address: 940 Main Campus Drive Suite 500
City: Raleigh State: NC Zip: 27606-
Phone number: [phone] Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
I. Facility Name: Tar River WWTP Permit Number: NC 0030317
Owner Name: City of Rocky Mount
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ City could not locate this information
2. Downstream (Receiving) Sewer Information: 8 inch
CI Gravity I- Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s): City of Rocky Mount
FORM: FTA 06-21
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?
❑ Yes No ®NA
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 HOA,'POA Operational Agreement (FORM: l IOAI and
supplementary documentation as required by 15A NCAC 02T.0115(c) been attached?
❑ Yes ❑ No ® NIA
4. Origin of wastewater: (check all that apply):
❑ Residential (Individually Owned) ❑ Retail (stores, centers, malls)
❑ Residential (Leased) ❑ Retail with food preparation/service
❑ School / preschool i day care ❑ Medical ? dental i veterinary facilities
❑ Food and drink facilities ❑ Church
❑ Businesses offices ;' factories ❑ Nursing Home
❑ Car Wash
❑ Hotel and/or Motels
❑ Swimming Pool/Clubhouse
❑ Swimming Pool. Filter Backwash
❑ Other (Explain in Attachment)
5. Nature of wastewater : % Domestic _ _ _ % Commercial _ % Industrial (See 15A NCAC 02T _01c 3(`2 ))
If Industrial, is there a Pretreatment Program in effect? ❑ YesD No
6. Has a flow reduction been approved under 15A NCAC 02T .0114(0? ❑ Yes ❑ No
➢ If yes, provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(t))
Daily Design Flow a,b
No. of Units
Flow
gal
GPD
gal
GPD
gal
GPD
gal
GPD
gal
GPD
gal.
GPD
Total
GPD
a See ISA NCAC 02T .O114(b), {dI. (e)(1) and (02) 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(e), design flow rates for establishments not identified [in table 15A NCAC 02T,0114] 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, please indicate why:
❑ Pump Station/Force Main or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line.
Please provide supplementary information indicating the approximate timeframe for permitting upstream sewers with flow.
❑ Flow has already been allocated in Permit Number: Issuance Date:
❑ Rehabilitation or replacement of existing sewers with no new flow expected
® Other (Explain): Extension is to provide access point that will not be under pavement for possible future connection.
FORM: FTA 06-21
Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
I. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8
64
PVC
➢ Section 11 & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section III contains information related to minimum slopes for gravity sewer(s)
➢ Oversizing lines to meet minimum slope requirements is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) • • 02T .0305 & MDC (Pump Stations/Force Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: - .
3. Total number of pumps at the pump station:
3. Design flow of the pump station: millions gallons per day (firm capacity)
➢ This should reflect the total GPM for the pump station with the largest pump out of service.
4. Operational point(s) per pump(s): gallons per minute (GPM) at feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
If any portion of the force main is less than 4-inches in diameter, please identify the me hod of solids reduction per
MDCPSFM Section 2.01 C.1.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with I5A NCAC 02T .0305(h)111:
❑ Standby power source or ❑ Standby pump
➢ Must have automatic activation and telemetry - l5A 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 and may not be portable
Or if the pump station has an average daily flow less than 15,000 gallons per day 15A NCACO2T.0305(h)(1)(C):
❑ Portable power source with manual activation, quick -connection receptacle and telemetry -
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry:
➢ Include documentation that the portable source is owned or contracted by the applicant 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
as part of this permit application in the case of a multiple station power outage.
FORM: FTA 06-21 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
I. Does the project comply with all separations/alternatives found in 15A NCAC 02T .0305(f) & (g)?
I 5A NCAC 02T.0305(fl 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)
18 inches
2Water mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
2Water 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, and associated wetlands.
100 feet
**Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal
high water (or tide elevation) and wetlands associated with these waters (see item IX.2)
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches, as well as wetlands associated with these waters or classified as WL.
10 feet
Any building foundation (horizontal)
5 feet
Any basement (horizontal)
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
> If noncompliance with 02T.0305(fl or (g)a see Section X.1 of this application
*15A NCAC 02T.0305W contains alternatives where separations in 02T 4305.W cannot be achieved. Please check "yes"
above if these alternatives are used and provide narrative information to explain.
**Stream classifications can be identified using the Division's NC %Ace W ier Classif ratio.ns webpage
2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ N;'A
> If no, please refer to 15A NCAC 18C,0906(f) for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? ❑ Yes ❑ No ® N/A
> Please provide supplementary information identifying the areas of non-conformance.
> See the Division's draft separation requirements for situations where separation cannot be met.
> No variance is required if the alternative design criteria specified is utilized in design and construction.
4. Is the project located in a river basin subject to any State buffer rules? ® Yes Basin name: Tar Pamlico ❑ No
If yes, does the project comply with setbacks found in the river basin rules per.15A NCAC 02B .0200? ® Yes ❑ No
> This includes Trout Buffered Streams per I 5A NCAC 2B.0202
5. Does the project require coverage.'authorization under a 404 Nationwideiindividual permits ❑ Yes ® No
or 401 Water Quality Certifications?
> Please provide the permit number: permitting status in the cover letter if coverage.'authorization is required.
6. Does project comply with 15A NL'AC 02T.010c)(b) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T.0105(c)(61, directly related environmental permits or certification applications must be 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, stornnwater management plans, etc.).
7. Does this project include any sewer collection lines that are deemed "high -priority?" ❑ Yes ® No
Per 15A NCAC 02T1040?, "high -priority sewer" means any aerial sewer, sewer contacting surface waters,
siphon, or sewers positioned parallel to streambanks that are subject to erosion that undermines or deteriorates the sewer.
Siphons and sewers suspended through interference/conflict boxes require a variance approval.
> 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 permittee's individual System -Wide Collection permit.
FORM: FTA 06-21 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design; Ciiteria for the Permitting of Pump Stations
and Force Mains (latest version), and the Gravity Sewer Minimum Design Criteria (latest version) as applicable?
® Yes ❑ No
If no, for projects requiring a single variance, complete and submit the Variance/Alternative Design Request application
(VADC 10-14) and supporting documents for review to the Central Office. Approval of the request will be issued
concurrently with the approval of the permit, and projects requiring a variance approval may be subject to Ioneer
review times. For projects requiring two or more variances or where the variance is determined by the Division to be a
significant portion of the project, the full technical review is required.
2. Professional Engineer's Certification:
I, John M. Kamprath, attest that this application for U-5996 — Extension of sewer main on SR 1603 (N. Old Carriage Rd.)
(Professional Engineer's name from Application Item 111.1•) (Project Name from Application Item II. I)
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,
Minimum Design Criteria for Gravity .Sewersklatest version, and the Minimum Design Criteria for the t-TrackYertai Ring
of Pump Stations ajFor. Mains (latest version). Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that 1 have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation. Misrepresentation of the application
information, including failure to disclose any design non-compliance with the applicable Rules and design criteria, may subject
the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NCAC 56.0701)
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I, William B. Kerr, attest that this application for U-5996 • Extension of sewer main on SR 1603 (N. Old Carriage Rd.)
(Signature Authority Name from Application Item 1.3.) (Project Name from Application Item 11.1)
attest that this application 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 I43-215.6A, and 143-215,6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature:
FORM: FTA 06-21 Page 5 of 5

'4aviihb
Transportation
Land Development
Environmenta!
VHB Engineering, NC, P.C.
Venture I
940 Main Campus Drive, Suite 500
Raleigh, NC 27606
919.829.0328 • Fax [phone]
To: Raleigh Regional Office -. Water Quality Section
3800 Barrett Drive
Raleigh, NC 27609
TRANSMITTAL
'
Date: 1.f04/2022
VHB
38564.20
Project No.:
Re: U-5996 Sewer Permit Applications
NC Dept of Environmental Quality
JAN 06 2022
Raleigh Regional Office
We are sending you: ® Attached El Under Separate cover via Regular Mail the following items:
❑ Shop drawings ❑ Prints ❑ Plans El CD ❑ Specifications ❑ Copy of Letter ❑ Change Order
Copies
Date
No.
Description
2
Jan 4, 2022
Fast Track Sewer System Extension Application
2
Jan 4, 2022
Site Maps
I
Application Fee
These are transmitted as checked below:
❑ For approval El Approved as submitted ❑ Resubmit Copies for approval
❑ For your use ❑ Approved as noted ❑ Submit Copies for distribution
❑ As requested ❑ Return for corrections 0 Return Corrected prints
❑ For review and comment ❑ For bids due
❑ Returned prints on loan to VHB
REMARKS: Permit application for extension of 64 LF of 8" sanitary sewer and 1 manhole. Sewer extension is to allow future tie to
main outside of roadway pavement. No flow will be added to the sewer system due to this project. City could not locate existing permit.
VHB agrees to provide materials to the Client stored electronically. The Client recognizes that data, plans, specifications, reports, documents, or other
information recorded on or transmitted as electronic media, including, but not limit to, CADD Documents (together, 'Electronic Documents") are subject to
undetectable alteration, either intentional or unintentional, due to, among other causes, transmission, conversion, media degradation, software error, or
human alteration. Accordingly, the Electronic Documents are provided to the Client for informational purposes only and not as an end product. VHB makes
no warranties, either express or implied, regarding the fitness or suitability of the Electronic Documents.
The Electronic Documents are instruments of professional service, and shall not be used, in whole or in part, for any project other than that for which they
were created, without the express written consent of VHB and without suitable compensation to VHB. Accordingly, the Client agrees to waive any and all
claims against VHB resulting in any way from the unauthorized alternation, misuse or reuse of the Electronic Documents, and to defend, indemnify, and hold
VHB harmless for any claims, losses, damages, or costs, including attorney's fees, arising out of the alteration, misuse or reuse of any Electronic
Documents.
Copy to: File By:
Mark Kamprath, PE
Project Engineer

U-5996 Proposed Horizontal
Alignment
0
Prepared for:
toy ,
41,
0.15 0.3 Miles
Prepared by:
� �f
Figure 2: USGS Topographic Map
U-5996 Widen SR 1603 (N. Old Carriage Rd.)
Nash County, North Carolina
December 2021
Source: 2019 USGS 7.5 Minute Nashville
Quadrangle

0
Prepared for:
0.15 0.3 Miles
Prepared by:
4141i h b®
Figure 1: Project Location
U-5996 Widen SR 1603 (N. Old Carriage Rd.)
Nash County, North Carolina
December 2021
Source: 2021 ESRI World Imagery