WQ0043154_Application (FTSE)_20220131

imp.WithersRavenel
Our People. Your Success.
115 MacKenan Drive
Cary, NC 27511
t: 919.469.3340 I f: 919.467.6008
TO: NCDEQ - DWR- Water Quality Section
943 Washington Square Mall
Washington, NC 27889
WE ARE SENDING
YOU THE
FOLLOWING
ITEMS:
® Attached
❑ Shop Drawings
❑Copy of Letter
WQoo¢3654
Letter afEakeesinittal
JAN 31 2022
Water Quality
Regional 0peraUons section
DATE:I
ATTENTION:;
01/28/2022
PROJ. NU
s..
021 I'31.02
Robert Tankard - Asst Regional Supervisor
Goldboro Business Campus Phase 1 - Sewer
Extension Permit Submittal
❑Under Separate Cover Via
❑Prints ❑Plans ❑Samples ❑Specifications
❑Change Order DDisk DOther
COPIES
DESCRIPTION -
1
Cover Letter/Narrative
1
Completed Fast Tracker Application
1
Completed FTSE Form
1
Aerial Map
1
USGS Topographic Map
1
Check for $480 application review fee (sent via FedEx)
THESE ARE TRANSMITTED as checked below:
®For approval DApproved as submitted
❑For your use ❑Approved as noted
❑As requested ❑Returned for corrections
® For review and comment DOther
❑ Resubmit copies for approval
❑Submit copies for distribution
❑Return corrected prints
❑FOR BIDS DUE ❑PRINTS RETURNED AFTER LOAN TO US
REMARKS:
COPY TO:
Alissa Pelham
[e-mail]
Dave Bartone, PE
SIGNED: [e-mail]
QA/QC:
If enclosures are not as noted, kindly notify us at once.

FIECEIVED/NCD
EN
• WfthersRavenet
/4Our People. Your Success.
January 28, 2022
Department of Environmental Quality
Water Quality Section
Attn: Mr. Robert Tankard,
943 Washington Square Mall
Washington, NC 27889
RE: Goldsboro Business Campus Phase 1- Sewer System Extension Permit
Dear Mr. Robert Tankard,
JAN 31 2022
Water Quality
Regional Operations
Section
Washington
On behalf of the City of Goldsboro, please find the attached documentation in support of a FastTrack
Application (FTA 04-16) for the Goldsboro Business Campus, Phase 1 project As noted in the application,
this project will consist of 159 LF of 8" SDR-35 PVC pipe that will serve the Goldsboro Business Campus
Phase 1 development site.
The proposed project will meet all DWR's minimum design criteria for sanitary sewer extensions. The daily
design flow rate for this project is calculated at 8,800 GPD based on 15A NCAC 02T.00114 (d) Rules for
wastewater flow rates and the anticipated flow from the General Industrial (Non -Residential) site. The
proposed sanitary sewer line size is more than adequate to convey the design flow rates.
Please find attached the following information in support of the application:
• Fast Track Sewer System Extension Application (FTA 06-21)
• Flow Tracking/Acceptance Form for Sewer Extension Applications (FTSE 10-18)
• USGS Map
• Street Level Map
• $480 Check for payment of Application Fee
If you have any questions regarding this request or if you require any additional information, please feel free
to contact me at 919-238-0464 or [e-mail].
Sincerely
WithersRavenel
0,0
Dave Bartone, PE
Project Manager
115 MacKenan Drive I Cary, NC 27511
t: 919.469.3340 I f: 919.467.6008 I www.withersravenel.com I License No. C-0832
Cary I Greensboro I Pittsboro I Raleigh I Wilmington

State of North Carolina
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
INSTRUCTIONS FOR FORM: FTA 06-21 & 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 15A NCAC 02T and the Division's
Minimum Design Criteria (Gravity Sewer & Pump Stations/Force Mains) and that plans, spedflcations and supporting docamenb
have been prepared in accordance with 15A NCAC 02T, 15A NCAC 02T .0300. Division polices, 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 15A NCAC 02T .0305 and the applicable minimum design criteria. These
documents shall be immediately available upon request by the Division.
Projects that are deemed permitted (do not require a permit from the Division) are explained in 15A NCAC 02T.0303.
Projects not eligible for review via the fast track process (must be submitted for full technical review):
> Projects that do not meet any part of the minimum design criteria (MDC) documents;
> Projects that involve more than one variance from the requirements of 15A NCAC 02T;
> Pressure sewer systems utilizing simplex septic tank -effluent pumps (STEPs) or simplex grinder pumps;
> Simplex STEP or simplex grinder pumps connecting to pressurized systems (e.g. force mains);
> Vacuum sewer systems.
General — When submitting an application, please use the following instructions as a checklist in order to ensure all required items are
submitted. Adherence to these instructions and checking the provided boxes will help produce a quicker review time and reduce the
amount of requested additional information. Failure to submit ail 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 (second copy may be digital) of Application and Supporting Docnments
® Required unless otherwise noted. Signatures on original must be "wet ink" or secure digital signatures.
Please do not submit engineering design plans with the application unless specifically requested.
B. Cover Letter/Narrative Description (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.
> Include the permit number/status of any other required sewer permits (downstream/upstream)
> If necessary for clarity, include attachments to the application form.
C. Application Fee (All New and Modification Application Packages):
® Submit a check or money order in the amount of $480.00, dated no more than 90 days prior to application submittal.
➢ Payable to North Carolina Department of Environmental Quality (NCDEQ)
D. Fast Track Application (Required for All Application Packages, Form FTA 05-21):
® Submit the completed and appropriately executed application.
➢ If necessary for clarity or due to space iest,ictions, attachments to the application may be made.
❑ If the Applicant Type in Item L2 is a corporation or company, provide documentation it is registered for business with the
North Carolina Secretary of State.
❑ If the Applicant Type in Item I.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 IL1 shall be consistent with the project name on the flow acceptance letters, agreements, etc.
® The Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a North Carolina
licensed Professional Engineer.
® The Applicant's Certification on Page 5 of the application shall be signed in accordance with 15A NCAC 02T .0106(4 Per
15A NCAC 02T .0106(c), an alternate person may be designated as the signing official if a delegation letter is provided from
a person who meets the criteria in 15A NCAC 02T .0106(b).
INSTRUCTIONS FOR FORM: FTA 06-21 & SUPPORTING DOCUMENTATION Page 1 of 3

E. Flow Tracking/Acceptance Form (Form: FTSE 04-16) (If Applicable):
El Submit the completed and executed F 1'SE 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):
® Submit an 8.5-inch x 11-inch color copy of a USGS Topographic Map of sufficient scale to identify the entire project area,
including the closest surface waters.
> General location of the project components (gravity sewer, pump stations, & force main)
> Downstream connection points and permit number (if known) for the receiving sewer
® Include an aerial location map showing general project area (such as street names or latitude/longitude) so that Division staff
can easily locate it in the field.
G. Existing Permit (Application Packages for Modifications to an Existing Permit):
❑ Submit a copy of the most recently issued existing permit.
❑ Include a descriptive and clear narrative identifying the previously permitted items to remain in the permit, items to be
added, and/or items to be modified (the application form itself should include only include items to be added/modified). The
narrative should also include whether any previously permitted items have been certified.
❑ The narrative should clearly identify the requested permitting action and accurately describe the sewers to be listed in
the final permit.
H. Power Reliability Plan (Required if portable reliability option utilized for Pump Station):
❑ Per 15A NCAC 02T .0305(10(1), 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 pip, including travel timeframes, shall
be provided in the case of a multiple station power outage. (Required at time of certification)
L Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per 15A NCAC 02T .0115( a)(1) 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 saved 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/Pronert,/ Owners' Associations
❑ Per 15A NCAC 02T-0115(e), 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 .01151 b)• submit the properly executed Operational Agreement ( FORM: DEV ).
For more information, visit the Division's collection systems website
INSTRUCTIONS FOR FORM: FTA 05-21 & SUPPORTING DOCUMENTATION Page 2 of 3

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 28778-8211
[phone]
[phone] Fax
Avery, Buncombe, Burke, Caldwell, Cherokee,
Clay, Graham, Haywood, Henderson, Jackson,
Macon, Madison, McDowell, MftcheL, Polk,
Rutherford, Swain, Transylvania, Yancey
Water Quality Section
Fayetteville Regional Office
225 Green Street Suite 714
Fayetteville, North Carolina 28301-5095
[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 28115
[phone]
[phone] Fax
Alexander, Cabarrus, Catawba, Cleveland,
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
Stanly, Union
Water Quality Section
Raleigh Regional Office
3800 Barrett Drive
Raleigh, North Carolina 27609
[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, Bertie, Camden, Chowan, Craven,
Currituck, Dare, Gates, Greene, Hertford, Hyde,
Jones, Lenoir, Martin, Pamlico, Pasquotank,
Perqulmans, Pitt, Tyrrell, Washington, Wayne
Water Quality Section
Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, North Carolina 28405
[phone]
[phone] Fax
Brunswick, Carteret, Columbus, Duplin, New
Hanover, Onslow, Pander
Water Quality Section
Winston-Salem Regional Office
450 W. Hanes Mill Road
Suite 300
Winston-Salem, North Carolina 27105
[phone]
[phone] Fax
Alamance, Allegheny, Ashe, Caswell, Davidson,
Davie, Forsyth, Guilford, Rockingham, Randolph,
Stokes, Surry, Watauga, Wilkes, Yadkin
Water Quality Section
INSTRUCTIONS FOR FORM: FTA 05-21 & SUPPORTING DOCUMENTATION Page 3 of 3

Dlvlslo■ 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 NUMberNiNgWi It 3 1 S tbe convicted by DWR)
All items must be convicted or the application vial be returned
L APPLICANT INFORMATION:
1. Applicant's name: City of Goldsboro (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal 0 State/County ® Municipal
3. Signature authority's name: Tim Salmon, per 15A NCAC 02T .0106(b)
Title City Manager
4. Applicant's mailing address: PO Drawer A
City: Qgthifilma State: Nc Zip: 27530-
5. Applicant's contact information:
Phone number: [phone] Email Address: tsalmonAgoldsboronc.uov
❑ Other
IL PROJECT INFORMATION:
1. Project name: Goldsboro 13usimess Campus —Phase I
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ00 and issued date: ,
For modifications, aLo 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: Wayne
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.41078° Longitude:-77.97584°
5. Parcel ID (if applicable): 3600-44-6857; 3601-54-2776; 3600-56-1041: 3600-44-7467 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer Pave Barton. PE. License Number: 031365
Firm: WithersRavenel. Inc.
Mailing address: 115 MacXenan Drive
City: Sant State: Lc Zip: 27511-
Phone number (919) 23$44K4 Email Address: dbartone(a�withersravcael.co,
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Goldsboro Wastewater Treatment Plant Permit Number NC0023949
Owner Name: City of Goldsboro
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ
2. Downstream (Receiving) Sewer Information: inch 0 Gravity 0 Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s):
FORM: FTA 06-21
Page 1 of 5

VL GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes 0 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 HOA/POA Operational Agreement (FORM: HOA') and
supplementary documentation as required by 15A NCAC 02T.0115(c) been attached?
❑Yes ID No ®N/A
4. Origin of wastewater. (check all that apply):
❑ Residential (Individually Owned)
O Residential (Leased)
O School / preschool / day care
❑ Food and drink facilities
® Businesses / offices / factories
❑ Retail (stores, centers, malls)
RRetail with food preparation/service
Medical / dental / veterinary facilities
❑ Church
❑ Nursing Home
❑ Car wash
O Hotel and/or Motels
0 Swimming Pool/Clubhouse
Swimming Pool/Filter Backwash
DI Other (Explain in Attachment)
5. Nature of wastewater : % Domestic 100 % Commercial % industrial (See 15A NCAC 02T .0103(200
If Industrial, is there a Pretreatment Program in effect? ❑ Yes❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(0? ❑ Yes ❑ No
Jives, Provide a copy of flow reduction approval letter with thli application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow'
No. of Units
Flow
General Industrial (Non -Residential)
880 gal/acre
10 acres
8,800 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
8,800 GPD
a See 15A NCAC 02T .0114(b). (d), (c)(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.01141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 8,800 GPD (per 15A 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.
0 Flow has already been allocated in Permit Number. Issuance Date:
❑ Rehabilitation or replacement of existing sewers with no new flow expected
❑ Other (Explain):
FORM: FTA 06-21
Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & mDC (Gravity Sewersl:
1. Summarize gravity sewer to be permitted:
Size (Indies)
Length (feet)
Material
s"
159 feet
SDR-35 PVC
> Section II & 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)
➢ Overaizing lines to meet minimum slope requirements is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .034E & 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: - 0
3. Total number of pumps at the pump station:
3. Design flow of the pump station: millions gallons per day (firm capacity)
D. 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 flinches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.01C.1.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NCAC 02T .0305f h)(1):
❑ Standby power source or ❑ Standby pump
> Must have automatic activation and telemetry - 15A NCAC 02T.0305(hx1)(B)_
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
> Mast 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(hx1XC):
❑ 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(0):
1. Does the project comply with all separations/alternatives found in 15A NCAC 02T ,0305(f? & (k )?
l5A NCAC 02T.0305(t) 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
'Water mains (vertical - water over sewer preferred, 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 11 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 sloe 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(f) or (g), see Section X 1 of this application
*15A NCAC 02T.0305(u) contains alternatives where separations in 02T,0305(f) 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 Surface Water Classifications 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: Neuse ❑ 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 15A NCAC 2B.0202
5. Does the project require coverage/authorization under a 404 Nationwide/mdividual 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 NCAC 02T,0105(c)(6) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T.0105(c)(6), 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, stormwater management plans, etc.).
7. Does this project include any sewer collection lines that are deemed "high -priority?" ❑ Yes ® No
Per 15A NCAC 02T.0402, "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 interferencelconflict 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 permitine or its representative at least once every six -months and
inspections documented per 15A NCAC 02T.0403(aX5) or the permlttee'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 Criteria 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
concurreutiv with the approval of the permit, and protects requtripi a variance approval may be subject to loner
review time!. For,orojects requiring two or more variances or where the variance Is determined by the Division to be it
pkktnt portion of the protect, the full tecbnieal review is required,.
2. Professional Engineer's Certification:
Dave Barton, PE , attest that this application for Goldsboro Business Campus - Phase 1
(Professional Engineer's name from Application Item 1II.1.) (Piojeit Name from Application Item II.1)
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans,
specifications, engineering calculations, and ail 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 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 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
North Carolina Professional Engineer's seal, signature, and date:
64021
°§� 031366 t
••
%‹9 '•rGlNEA�f .�° �
'••4:. D. BAR�..••
•••••e0000a•
3. Applicant's Certification per 15A NCAC 02T .0106(b):
M.�
.4d„ , attest that this application for zaW clkz& krb rd CAers — -1(Signature Atalim* Name from Application Item I3.) (Project Name from Application ItemmI.11)
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 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.
Signature: �`'—'
Date: Z d: 2.6 Z Z
FORM: FTA 06-21
Page 5 of 5

DIvf -ltm cL Water ReLources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(1i"1'SE 10-18)
Entity Requesting Allocation: City of Goldsboro
Project Name for which flow is being requested: Goldsboro Business Campus, Phase 1
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: City of Goldsboro
b. WWTP Facility Permit #: NC0023949
All flows are in MGD
c. WWTP facility's permitted flow 14.2
d. Estimated obligated flow not yet tributary to the WWTP 0.8773
e. WWTP facility's actual avg. flow 11.39
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
0.0088
12.2761
86.45%
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) (D)—(B+C) (E)n(A-D)
Design Approx.
Average Current Obligated, Total
Pump Daily Avg. Not Yet Current
Pump Station Station Firm Flow** Daily Tnbntary Flow Plus
(Name or Permit Capacity, * (Firm / pf), Flow, Daily Flow, Obligated Available
Number) No. MGD MGD MGD MGD Flow Capacity***
WESTBROOK 40 16 10.62 0.8861 11.5061 4.4939
* 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): City of Goldsboro
Downstream Permit Number: NC0023949
Page 1 of 6
FTSE 10-18

III. Certification Statement:ii/wa
I / /Y1- i n 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 mute 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 addendimms 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.
Signin Official Signature
Title of Signi{ig Official �%
Z( ✓ Z e Z Z
Date
Page 2 of 6
FTSE 10-18

11/18/21, 7:44 PM
ConnectGlS Feature Report
•CONNECTGIS
YE8HO5T1NG
WAYHECOU,`ITY
Wayne
Printed November 18, 2021
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s:.
re -
a
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GOLDSBORO BUSINESS CAMPUS
WAYNE COUNTY NORTH CAROLINA
USGS QUAD (2019) - WAYNE
al, WithersRavenel