WQ0043211_Application (FTSE)_20220215

KCI ASSOCIATES OF NC
K C I ENGINEERS I PLANNERS I SCIENTISTS I CONSTRUCTION MANAGERS
February 11, 2022
NCDEQ
Water Quality Section
450 West Hanes Mill Road — Suite 300
Winston-Salem, NC 27105
RE: Fast Track Sewer System Extension Application
Town of Wilkesboro
NCDOT Express Design -Build Division 11 Bridge 960733
Wilkesboro, North Carolina
Dear Water Quality Section,
KCI is pleased to submit the enclosed Fast -Track Application for Gravity Sewer on behalf of the
Town of Wilkesboro for the relocation of the existing sewer in conflict with an NCDOT Bridge
Replacement Project.
The Town of Wilkesboro proposes to relocate the existing gravity sewer at Industrial Park Road
over Cub Creek: 299 linear feet (LF) of 8" DIP.
The following documents are enclosed in this submittal per the permit application checklist:
• One (1) original and one (1) copy of the Fast Track Application Form (FTA 04-16)
• One (1) original and one (1) copy of a USGS Topographic Map
• One (1) original and one (1) copy of a project street level map
• Application fee of $480
If you have any questions or require additional information regarding this project, please contact
me at [phone] or at [e-mail].
Sincerely,
KCI
Tucker Martin
Project Manager
Enclosures as noted

DWR.
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Town of Wilkesboro (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
D Federal ❑ State/County ® Municipal ❑ Other
3. Signature authority's name: Ken Noland per 15A NCAC 02T .0106(b)
Title: Town Manager
4. Applicant's mailing address: PO Box 1056
City: Wilkesboro State: NC Zip: 28697-
5. Applicant's contact information:
Phone number: [phone] Email Address: townmanager(a,wilkesboronc.org
II. PROJECT INFORMATION:
1. Project name: NCDOT EDB Year 9 Div 11 Bridge 960733 Project
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ00_ and issued date:
If new construction but part of a master plan, provide the existing permit number: W000_
3. County where project is located: Wilkes
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.1333° Longitude: -81.1552°
5. Parcel ID (if applicable): 2202448
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Tucker Martin License Number: 039117
Firm: KCI Associates of North Carolina, P.A.
Mailing address: 4505 Falls of Neuse Road, Suite 400
City: Raleigh State: NC Zip: 27609-
Phone number: [phone] Email Address: tucker.martinAkci.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Town of Wilkesboro WWTP Permit Number: NC0021717
Owner Name: Town of Wilkesboro
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ_ Downstream (Receiving) Sewer Size: _ inch
System Wide Collection System PermitNumber(s) (if applicable): WQCS_
Owl Name(s):
FORM: FTA 04-16 Page 1 of 5

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑No ®N/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached?
❑ Yes ❑No ZN/A
3. If the Applicant is a Home/Property Owners' Association, has an Operational Agreement (FORM: HOA) been attached?
❑ Yes ❑No ZN/A
4. Origin of wastewater: (check all that apply):
® Residential Owned Z Retail (stores, centers, malls)
® Residential Leased ❑ Retail with food preparation/service
® School / preschool / day care ❑ Medical / dental / 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 : 100 % Domestic/Commercial % Commercial
% Industrial (See 15A NCAC 02T .0103(20))
there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 02T .0114(fl? ❑ Yes ® No
> If yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f1)
Daily Design Flow a,b
No. of Units
Flow
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
/
Total
0 GPD
a See 15A NCAC 02T .0114(b) (d) (e)(1) and (e)(2) for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access faciF ies 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.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 15A NCAC 02T .0114)
> Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
❑ Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit Number:
® Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain):
FORM: FTA 04-16
Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8
304
DIP
> 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)
> Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: -
3. Design flow of the pump station: _ millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): gallons per minute at _ feet total dynamic head (TDH)
5. Summarize the force main tobe_permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
a
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(1):
❑ Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(h)(1)(B):
> Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
> Must be permanent to facility
Or if the pump station has an average daily flow less than 15,000 gallons per day:
❑ Portable power source with manual activation, quick -connection receptacle and telemetry - 15A NCAC 02T
.0305(h)(1)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry - 15A NCAC 02T .0305(h)(1)(C):
> It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant (draft agreement)
and is compatible with the station.
> If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel timeframes, shall be provided
in the case of a multiple station power outage.
FORM: FTA 04-16 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations found in 15A NCAC 02T .0305(f) & (g)
➢ 15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
® Yes ❑ No
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
24 inches
Water mains (vertical -water over sewer including in benched trenches)
18 inches
Water mains (horizontal)
10 feet
Reclaimed water lines (vertical - reclaimed over sewer)
18 inches
Reclaimed water lines (horizontal - reclaimed over sewer)
2 feet
**Any private or public water supply source, including any wells, WS-I waters of Class I or
Class II impounded reservoirs used as a source of drinking water
100 feet
**Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal
high water (or tide elevation) and wetlands (see item IX.2)
50 feet
* *Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches
10 feet
Any building foundation
5 feet
Any basement
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains,
5 feet
Any swimming pools F
10 feet
Final earth grade (vertical)
36 inches
➢ 15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webnage
➢ If noncompliance with 02T.0305(f) or (g). see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) Z Yes ❑ No ❑ N/A
➢ See the Division's draft separation requirements for situations where separation cannot be meet
➢ No variance is required if the alternative design criteria specified is utilized in design and construction
➢ As built documents should reference the location of areas effected
3. Does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? Z Yes ❑ No ❑ N/A
➢ This would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Does the project require coverage/authorization under a 404 Nationwide or
individual permits or 401 Water Quality Certifications?
➢ Information can be obtained from the 401 & Buffer Permitting Branch
❑ Yes
11
5. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? Z Yes ❑ No
Per 15A NCAC 02T.0105(c)(6), directly related environmental permits or certification applications are being prepared, have
been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion and
sedimentation control plans, stormwater management plans, etc.).
6. Does this project include any sewer collection lines that are deemed "high -priority?"
Per 15A NCAC 02T.0402 "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes ❑ No ® N/A
➢ If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at least once every six -months and inspections
documented per 15A NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit.
FORM: FTA 04-16 Page 4 of 5

X. CERTIFICATIONS:
I. Does the submitted system comply with 15A NCAC 02T. the Minimum Design Criteria for the Permitting of Pumo Ste4 ^ns
and Force Mains (latest version). and the Gravity Sewer Minimum Design Criteria (latest versionl as applicable?
® Yes/ ❑ No
If No, complete and submit the Variance/Alternative Design Request application (VADC 10-14) and supportingdocuments for
review. Approval of the rawest is recruhnsi orlortonbmlttal of the Fast Track Application and auanortina documents,
2. Professional Engineer's Certifcation: �1{A`
lissik2i ✓VC7Tn
I, attest that this application for
(Professional Engineer's name from Application Item IB.1.)
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans, specifications,
engineering calculations, and all other supporting documentation to the best of my knowledge. 1 further attest that to the best
of my knowledge the proposed design has been prepared in accordance with the applicable regulations, Gravity Sewer
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for dta 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 exceed410,000, as well as civil penalties up to S25,000 per violation.
North Carolina Profeaslonal Engineer's sad, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
Ken Noland, Town Manager
(Signature Authority's name & title from Application Item 1.3.)
attest that this application for
has been reviewed by me and is accurate and complete to the beat of my knowledge. 1 understand that if all required parts of
this application are not completed and that if all required swotting 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 wlI 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 requited supporting information and attachments are not included, this application package will be returned to me es
incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6E any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed S10,000 as well as civil penalties up to 525,000 perviolation.
Signature: 14-4..
Date: all
FORM: FTA 04-16 Page 5 of 5

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KCI ASSOCIATES OF NC
C I ENGINEERS I PLANNERS I SCIENTISTS I CONSTRUCTION MANAGERS
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STREET LEVEL MAP
BRIDGE 960733 SEWER LINE
RELOCATION TOWN OF
WILKESBORO
Wilkesboro, North Carolina