WQ0041426_Application (FTSE)_20220224

II. PROJECT INFORMATION:
1. Project name: Henderson Vance Industrial Park Expansion
2. Application/Project status: ❑ Proposed (New Permit) ® Existing Permit/Project
If a modification, provide the existing permit number: WQ0041426 and issued date: 3/20/20,
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: Vance
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.273323 Longitude: -78.398103
5. Parcel ID (if applicable): 0453 05005 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Logan J. Parsons License Number: 50633
Firm: LKC Engineering, PLLC
Mailing address: 140 Aqua Shed Court
City: Aberdeen State: NC Zip: 28315-
Phone number: [phone] Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Henderson Water Reclamation Facility Permit Number: NC0020559
Owner Name: City of Henderson
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ
2. Downstream (Receiving) Sewer Information: 8 inch
® Gravity 0 Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS00055
Owner Name(s): City of Henderson
FORM: FTA 06-21
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: s-),1 (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 Henderson (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: E. Terrell Blackmon per ISA NCAC 02T ,0106(b)
Title: City Manager
4. Applicant's mailing address: P.O. Box 1434 NC Dept of Environmental Quality
City: Henderson State: NC Zip: 27536
F' 24 22
5. Applicant's contact information:
Phone number: [phone] Email Address: eblackmon@!ci.henderson.nc.us Raleigh Regional Office
Page I 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 Develuper'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 ❑ No ® N• A
4. Origin of wastewater: (check all that apply):
❑ Residential (Individually Owned) ❑ Retail (stores, centers, malls)
❑ Residential (Leased) ❑ Retail with food preparation/service
❑ School preschool t 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 : % Domestic 100 % Commercial 4{o Industrial (See 15A NCAC 02T .0103(20))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes❑ No
6. Has a flow reduction been approved under 15A NAC, 02T,1 l4 ? ❑ Yes ® No
> If ves, provide a co_pxof flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(0) Daily Design Flow 2'6
Henderson Vance Industrial Park Exp,
Phase III
880 gallacre
gall
gall
gal/
gal/
gal/
No. of Units
Flow
79
69,520 GPD
GPD
GPD
GPD
GPD
GPD
Total
69,520 GPD
a See 15A NCAC 02T .0114(b). Id}, {ell 1tand ej(21 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.0114) shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 69,520 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.
❑ 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 Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8
2,890
PVC & DIP
4
➢ Section II & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
Y 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: Industrial Park #2
2. Approximate Coordinates (Decimal Degrees): Latitude: 36.270355' Longitude: -78.398350
3. Total number of pumps at the pump station: 2
3. Design flow of the pump station: 0.950 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): 660 gallons per minute (GPM) at 79 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
8
3,565
PVC & DIP
6
1,320
PVC
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 2.01C.1.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(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 Iess 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(1)):
1. Does the project comply with all separations/alternatives found in 15A NCAC 02T .0305(f) & (};)?
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)
18 inches
Water 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 1 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 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 j,Q or (g), see Section X. 1 of this application
*15A NCAC 42T.0305 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 webna2e
2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ N A
➢ If no, please refer to l5A 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 -Pimlico
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B..0200?
➢ This includes Trout Buffered Streams per 15A NCAC 2B.0202
❑ No
®Yes El No
5. Does the project require coverage.authorization under a 404 Nationwiderindividual 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(e) 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 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:
Does the submitted system comply with 15A NCAC. 02T, the Mjnimym Design Criteria fur the Permittink of Pump Stations
and Force Mains (latest version), and the Gravity Sewei Mjn1pum D'esinn Criteria (laest 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 subiect to longer
review times. For proiects 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:
H Euoeascmi ^ VA.J E
I,L,o .) .�.PAR.5405 , attest that this application for TAO PA1ZP GXP.
(Professional Engineer's name from Application Item 111.1 ) (Project Name from Application Item 1t.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. I further
attest that to the best of my knowledge the proposed design has been prepared in accordance with the applicable regulations,
Minintunt.Dcsign Crngria for Gravity Sewers (latest version), and the Minimum Desie.n Criteria fur llte Fast -Track Per...mining
of Purim Slation 5 and Force Mlt.ins. (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 I43-215.6B, 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 Certificate per 15A NCAC 02T .0106(b):
I, *� r 1,4.4.4(
(Signature Authority Name from Application Item 1.3.)
at this application for a 1 0 a
(Project Name m pplication 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- 1 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_215.6B, 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:
Date: � a D a
FORM: FTA 06-21
Page 5 of 5

11,9
CIS".'•7
February 215t, 2022
Mr. Jason Robinson, P.E.
NCDEQ Raleigh Regional Office
3800 Barrett Drive
Raleigh, NC 27609
Re: City of Henderson
Henderson Vance Industrial Park Expansion
NO Dept of Environmental Quality
Raleigh Regional
Office
Wastewater Collection System Extension Permit (WQ0041426)
Permit Modification — change in pump capacity
Mr. Robinson,
Regarding the above referenced project, please find enclosed:
1. One original and one copy of the Fast Track Application Package (Permit Modification)
2. One application fee check for $480.00
The subject application package and request for permit modification is required as a result of the
constructed pump station capacity exceeding the 5% allowance per existing approved permit.
The items associated with the existing permit and permit modification as listed herein.
Existing (current) Permit includes:
• 2,890 linear feet of 8-inch gravity sewer.
• 510-gallon per minute pump station with duplex pumps, on -site audible and visual high
water alarms, telemetry, and a standby power source or pump with automatic activation
and telemetry.
• 1,300 linear feet of 6-inch force main
• 3,565 linear feet of 8-inch force main
Permit Modification to include (modified items are bold and underlined):
• 2,890 linear feet of 8-inch gravity sewer.
• 660-gallon per minute pump station with duplex pumps, on -site audible and visual high
water alarms, telemetry, and a standby power source or pump with automatic activation
and telemetry.
• 1320 linear feet of 6-inch force main
• 3,565 linear feet of 8-inch force main
LKC Engineering, PLLC, 140 Aqua Shed Court, Aberdeen, North Carolina 28315
PH: 910/420-1437 * FAX: [phone] * License No. P-1095

If you have any questions, please do not hesitate to contact me at [phone] or by email at
[e-mail].
Sincerely,
LKC Engineering, PLLC
).-eir-- P0,--ii----'-
Logan J. Parsons, P.E.

C . 1'1CRiA4 S.AN'piT MAP
2,890 Linear Feet of
8-inch Gravity Sewer
New Industrial Park
Pump Station
IN
�y-
777
11-1111-141
0 250 500
mita
_ 000
Feet
Discharge 8-inch Force Main
to Exisitng Manhole
4.
Industrail Park
Expansion Property
New 3,565 LF of
8-inch Force Main
New 1,300 LF of 6-inch Force Main
to Divert Flow to New Pump Station
LEGEND
El PUMP STATION
• MANHOLES
^/ GRAVITY SEWER
8-IN FORCE MAIN
•, 6-IN FORCE MAIN
^V Roads
Parcels
0 Industrial Park Expansion Property
LKC ENGINEERING, PLLC
VANCE COUNTY INDUSTRIAL PARK EXPANSION
VANCE COUNTY, NC
GENERAL PROJECT LAYOUT MAP

2.890 Linear Feet of
r 8-inch Gravity Sewer
New 1,300 LF of 6-inch Force Main
to Divert Flow to New Pump Station
LKC ENGINEERING, PLLC
V. j v ,?1q-3 r%nr
Discharge Location of
New 8-inch Force Main
rf
; IP/
Industrail Park
Expansion Property
LEGEND
El PUMP STATION
Al GRAVITY SEWER
8-IN FORCE MAIN
6-IN FORCE MAIN
/N/ Roads
Industrial Park Expansion Property
VANCE COUNTY INDUSTRIAL PARK EXPANSION
VANCE COUNTY, NC
USGS TOPOGRAPHIC MAP