WQ0043181_Application (FTSE)_20220112

State of North Carolina
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number. ,C Q, (to be completed by DWR)
All items must be completed or the application will be returned
1. APPLICANT INFORMATION:
1. Applicant's name: TOWN OF NASHVILLE (company, municipality. HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County �q Municipal ❑ Other
3. Signature authority's name: RANDY LANSING per 15A NCAC 02T -01 ON
Title: TOWN MANAGER
4. Applicant's mailing address: 499 SOUTH BARNES STREET 1VC Dc of4
City: NASHVILLE State: NC Zip: 27603- "`P� ytMme�2
fal 5. Applicant's contact information: qq �
Jry
Phone number: [phone] Email Address: rand .landsin rntownofnashvillene. v � 1d �
If. PROJECT INFORMATION:
2.
Project name: Cardinal Woods
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: WQOO
3. County where project is located: NASH
4. Approximate Coordinates (Decimal Degrees): Latitude: 35,955618' Longitude:-77.958513
5. Parcel ID (if applicable): 3800-1674-5123 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
I. Professional Engineer: SHAYNE LEATHERS License Number: 027388
Firm: BATEMAN CIVIL SURVEY COMPANY
Mailing address: 2524 RELIANCE AVENUE
City: APEX State: NC Zip: 27539-
Phone number: 9(_i,9) 577-1O80 Email Address: S.LEATHERSC4BATEMANCIVILSURVEY.COM
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
I . Facility Name: Tar River Regional WWTP Permit Number: NCO030317
Owner Name: City of Rocky Mount
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQCS00011
2. Downstream (Receiving) Sewer Information: 18 inch ® Gravity O Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s):
FORM: FTA 06-21 Page I 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 ®No ❑ NIA
2. If the Applicant is a Developer of lots to be sold, has a Devcluper's Operational AKreement � ORNI DEV) been attached?
❑ Yes ® No ❑ NIA
3. if the Applicant is a Home/Property Owners' Association, has an HOA/POA Operational Agreement i F RNI _HOA) and
supplementary documentation as required by I SA NCAC 02T.0115(c) been attached?
❑ Yes ® No ❑ NIA
4. Origin of wastewater: (check all that apply):
® Residential (Individually Owned) ❑ Retail (stores, centers, malls) ❑ Car Wash
❑ Residential (Leased) ❑ Retail with food preparationlservice ❑ Hotel and/or Motels
® School / preschool / day care ❑ Medical r dental I veterinary facilities ❑ Swimming Pool/Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 % Domestic % Commercial % Industrial ($rt� l5A NCAC 021 .01Q1f.'01)
If industrial, is there a Pretreatment Program in effect? ❑ Yes No
6. Has a flow reduction been approved under 15A NCAC 02T .0I 14t t)? ❑ Yes ❑ No
> If vesprovide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0I14(f))
Daily Design Flow'-0
No. of Units
Flow
Ex. Subdivision -St James
360 (120gal/bed•3bed)gat/unit
37
13,320 GPD
Ex. Nash County Middle School
15 gaUstudent
670
10,050 GPD
Prop. Cardinal Woods Subdivision
360 (120ga1/bed) gallunit
246
88,560 GPD
gall
GPD
gal?
GPD
gall
GPD
Total
124,170 GPD
a See 15A NCAC 02T .0l 14(bi. Md tek I 1 and e)t2] 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 42A4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A 1 AL' 0? l .ill 14] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns. and other measured data.
8. Wastewater generated by project: _ GPD (per 15A NCAC 02T .01 t4)
> 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):
FORM: FTA 06-21 Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) -027 .0305 & NIDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
12
11,163
PVC C-900
8
679
DIP
8
2969.
PVC SDR-26
8
1501
PVC C-900 SDR-18
> 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: 1
2. Approximate Coordinates (Decimal Degrees): Latitude: 35,955618' Longitude:-77.958513-
3. Total number of pumps at the pump station: 1
3. Design flow of the pump station: .125 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): 220 gallons per minute (GPM) at 129 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
6
1,608
PVC C-900
Ex. 6
5,858
PVC C-900
If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.0IC.l.b. ® Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NCAC 02T _0305fb1(1.}:
® Standby power source or ❑ Standby pump
> Must have 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 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)):
1. Does the project comply with all separationslAternatives found in I SA N °At _ 02T 3.0ftt) & ® Yes ❑ No
15A NCAC 02T.0305(fl contains minimum separations that shall be provided for sewer systems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
I8 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 IT 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 feel
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.03051 q or J0, see Section X.1 of this application
*15A NCAC 02T_0305 } contains alternatives where separations in 0,2T.03050 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 "'atcr.k'kasstfications u-cbpa�tc
2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ NIA
➢ 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 ❑ NIA
> Please provide supplementary information identifying the areas of non-conformance.
➢ Seethe Division'st$raft aaratiun regutleatients for situations where separation cannot be met.
D 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 I SA NCAC 0213 0200? ❑ Yes ❑ No
➢ This includes Trout Buffered Streams per 0:31N(, AW 20_O�i►2
5. Does the project require coveragelauthori7ation under a 404 Nationwidelindividual permits to 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.0105fcN6) (additional permitsicertifications)? ® Yes ❑ No
Per I SA NCAC 02T 0105f cj6, 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 16.,%.NC AC 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 interference/conflict boxes require a variance approval.
D 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 021', the Mlrupky�n Qniun_t< i .fi r,LhC_rermlttlnII of Palo St uem
and Flams Mains flairna nawri and the Unyillf 5cwer h+ inubum Daum Calm io ilatest 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,thq approval of the Hermit, and protects rrQuirin�_a variance approval may be subject to conger
review times. For protects reguirine two or more variances or where the variance is determined by the Division to be a
significant portion of thl groigct the full technical review Is required.
2. Professional Engineer's Certification:
1, S1-1AYNE LEATHERS attest that this application for CARDINAL WOODS.
(Professional Engineer's name from Application Item 111.1.) (Project Name from Applicatton Item 11.1)
has been reviewed by me and Is accurate, complete and consistent with the information supplied to 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,
fpt Cinydy Sswm (ltrtat yen monI and the Minimum Dmigp Cd%1:ia for the Fist-T k Prunigiap
cf P_lmap Statiuna and Fame ?A#ln6 I hltestl yonign 11, 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 143-215.68, 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: t I l l f
�O."e<1�sSi0
:a SEAL
P 7
�ri111i►�`
Applicant'4AU_tN4i._F'n4c
n per 15 CAC 02T .0I06(b):
[, attest that this application for(5-gnaiure from -cation Item I.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 143-215,,6A and 143-215. , 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:
FORM: FIFA 06-21 Page 5 of 5

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flu►► 'Fracking/Acceptanee for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: City- of Kock , Mount
Project Name for which flow is being requested: Cardinal Mtoods Subdivision
it tore than one F7:5F. nary he r egrrirecl for a snr} le lu eject iij*ihe owner of the ll'{t•TP is not respoasihle f,r till pwrrl)
stations edong the r(nat, of the proposed wasteu•vter flnrr
1. Complete this section only it'you are the owner of the wastewater treatment plant.
a. WWTP Facilitv Name: Tat• River Regional
b. WWTP facility Permit N: NC'0030317
All flowi are in MGD
c. WWTP Facility's permitted flow 21.00
d. Estimated obligated flow not yet tributary to the WWTP O.6826
e. WWTP facility`s actual avg. flow 10.83
1'. Total #low lur this specific request 0.089
g. Total actual and obligated flows to the facility 11.513
h. Percent of•permitted flow used 54.82%
1l. Complete this section for each pump station you are responsible for €slang, the route of this
proposed wastewater flow,
List pump stations located between the project connection point and the WVI"TP:
(A) (H) (C) (D)-(13+C) (E)-(A-D)
Design Obligated.
Pump Average Daily Approx. Not Yet rotaf Current
Station Minn 1;10%% Current Aug. Tributan Flow Plus
(Name or Capacity, * (t-irnt pl), Daih Flow. Daily Flog - Obligated Mailable
Number) MOT) M G D MUD Ni(A) Flow C-tpacity"*_
97 Lift St 30 12 6.5 0,683 7.183 4,817
Firm Capacity 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 i<5 the firm capacity of the pump station divided by a peaking,
factor (pt) not less than 2.5.
*** 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 Fzicilily Name (Sewer): 'I ar River ltc�ional
Dovtnstrcam Permit Number: NC' 0030317
Page 1 ti 16
F 1'S1-' 04-16

111. Certification Statement:
I William Brad Kerr certify to the: best of my knowledge that the addition ol'
the volume of wastewater to be pennitted in this project has been eValuated along the route to the
receiving w�astew�ater treatment facility and that the flow from this project is not anticipated to
cause an%- capacity related sanitary sewer oxerflows or overburden any downstream pump station
en route to the receiving treatment plant under normal circumstances, given the implementation oC
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 hest
available data. 'I his certitication applies to those items listed above in Sections I and 11 plus all
attached planning assessment addendums for which I any the responsible part} . Signature of this
firm indicates acceptance oi'this wastewater flow.
,S mrn�r Uffic•iuI .Sigi�crticl•Y
Page. 2 of 6

BCSC
aa�
BATEMANCMLSURVEY COMPANY
2524 Reliance Avenue
Apex, North Carolina 27539
TO. NCDEQ-DWR
Raleigh Regional Office- WQS
3800 Barrett Drive
Raleigh, NC 27609
DATE: January 14, 2022
RE: Cardinal Woods Subdivision — Fast Track Sewer Application
Glover Park Memorial Drive, Nashville, Nash County NC
Site Information
PIN# 380-1674.5123
Approximately 108.42 AC
To Whom It May Concern:
Phone: [phone]
[e-mail]
NC Dept of Bnvi0=enW QU81,tY
JAN 12 2022
H V f :,y {ll � 4� ►:
Please find the enclosed application, plans and supporting documentation for the Cardinal Woods for your review
and approval.
This project proposes the addition of approximately 246 residential single-family units. Currently, we are seeking to
provide sewer service for all 246 lots.
Town of Nashville was consulted and agreed to the number and types of units to reach an average daily flow that
could be accommodated. The flows, number of units and total daily Flow are included on the application form as
required.
If you require additional information to complete the review and approval for this project, please contact me by phone
or email using the information below.
Kind Regards,
S. Shayne Leathers, PE
Civil Engineering & Land Development
P: 919.577.1080
s.leathers(cb-batemancivilsurvey.com

BCSC
HATEMAN 01AL SURVEY COMPANY
s_.
2524 Reliance Avenue
Apex, North Carolina 27539
TO: NCDEQ-DWR
Raleigh Regional Office- WQS
3800 Barrett Drive
Raleigh, NC 27609
DATE: January 17, 2022
Revised January 17, 2022
RE: Cardinal Woods Subdivision — Fast Track Sewer Application
Glover Park Memorial Drive_ Nashville, Nash County NC
Site Information
PIN# 380-1674-5123
Approximately 108.42 AC
To Whom It May Concern:
Phone: [phone]
[e-mail]
Please find the enclosed application, plans and supporting documentation for the Cardinal Woods for your rev ew
and approval.
This project proposes the addition of approximately 246 residential single-family units. Currently, we are seeking to
provide sewer service for all 246 lots.
The project will construct a new pumpstation down stream of the existing Essex Road Pumpstation currently
maintained by the Town of Nashville. Through conversations with the State of North Carolina, Town of Nashville, and
Town of Rocky Mount we could not determine the existing sewer extension permit number for the existing Essex
Road Pumpstation. Currently 37 detached single-family units and the existing Nash County Middle School (644
current students, 670 students maximum). The new pumpstation will include the existing flows and projected sewer
flows from the Cardinal Woods Subdivision. We will utilize the existing 6" forcemain installed with the existing pump
station.
Town of Nashville was consulted and agreed to the number and types of units to reach an average daily flow that
could be accommodated. The flows, number of units and total daily flow are included on the application form as
required.
If you require additional information to complete the review and approval for this project, please contact me by phone
or email using the information below.
Kind Regards,
S. Shayne Leathers, PE
Civil Engineering & Land Development
P: 919.577.1080
[e-mail]

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B C S C
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BA"EMANt=MLSLiRVEYCOMPANY
2524 Re:'ance Avenue
Apex, North Carolina 27539
1O; NCDEQ-DWR
Raleigh Regional Office- WQS
3600 Barrett Drive
Raleigh, NC 27609
DATE: January 14, 2022
RE: Cardinal Woods — LETTER OF TRANSMITTAL
Town of Nashville
BCSC #200718
Phone. [phone]
[e-mail]
NC Dept ofEnvimnmcntal Quality
JAN 12 2022
COPIES
PAPER CD ELECTRONIC
1 1
SHEETS
1
DESCRIPTION
Cover Sheet
1
1
5
Application for Approval
1
1
1
USGS Topographical Map
1
1
1
Aerial Location Map
1I
Payment by Check for Application
THESE ARE TRANSMITTED AS INDICATED BELOW:
X For Approval
NOTES:
PREPARED BY:
SIGNE ,
DATE: January 14,
RECEIVED BY:
SIGNED:
DATE:
X For Submittal
As Requested by Client