WQ0029820_Application (FTSE)_20051109

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE 1
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
FAST -TRACK APPLICATION
for GRAVITY SEWERS, PUMP STATIONS, AND_FORCE MAINS
(Pt costae sewers systems are not to be included as pert oft is application package)
INSTRUCTIONS: Indicate that you have included/addressed the following list of required application package items by
checking the space provided next to each applicable item. Failure to submit all required Items will lead to your application
being returned as incomplete. This form may be photocopied for use as an original.
x I.
Application Form - Submit one original and one copy of the completed and appropriately executed application
form. Any changes to this form will result in the application being returned. The Division of Water Quality
(Division) will only accept application packages that have been fully completed with all applicable items
addressed. You do not need to submit detailed plans and specifications unless you respond NO to Item B(12).
0. II. Application Fee - Submit a check In the amount of $400 made payable to: North Carolina Department of
Environment and Natural Resources (NCDENR). Checks shall be dated within 90 days of application submittal.
❑ III. Certificates of Public Convenience arid Necessity — If the application Is being submitted in the name of a
privately -owned public utility, submit two copies of the Certificate of Public Convenience and Necessity (CPCN)
Which demonstrates that the public utility is authorized to hold the.utlllty franchise for the area to be'served by the
sewer extension. ' If aCPCN has not been issued, provide two copies of a letter from the North Carolina Utilities
Commission's Public Staff that states that an application for a franchise has been received, that the service area
is contiguous' to an existing franchised area, and/or that franchise approval Is expected. The project name in the.
CPCN or letter must match that provided in Item A(2a) of this application.
❑ IV.. Operational Agreements —Submit one original and two copies of a property executed operational agreement if
the sewer extension Is permitted by a private applicant and will be serving residentialor comrnercial lots. (e.g.,
houses, condominiums, townhomes, outparcels, etc.) that will be sold to another entity. if theapplicant is a
homeowners' association, use -Form HOA 02/03. If the applicant is a developer, use Form DEV 02/03. EVEN IF
THE PROJECT WILL BE TURNED OVER TO A MUNICIPALITY, FORM DEV 02/03 IS REQUIRED.
❑ V. Flow Acceptance Letters - if the owner of the downstream sewers and/or WWTF Is different "from the applicant -
submit two coplescf a flow acceptance letter from the owner of the downstream sewers and WWTF, If.different
Flow acceptance letters must contain the following minimum Information: applicant and project name, amount of
flow accepted, and.name and permit number of the receiving sewers/WWTF. The flow acceptance must not
expire prior 'to • permit Issuance and must be dated less than a year prior . to the application date.
Intergovernmental agteements or other contracts will not be accepted in Ileu of a project-specffic flow acceptance
letter.
VI.
VII.
Map — Submit an 8.5-Inch by 11-inch COLOR copy of the portionof a 7.5-minute USGS Topographic Map along
with this form. The map should. Identify the entire project area location as well as the closest downslope surface
waters as dearly as possible. Each map portion must be labeled with the mapname and number, the Identified
location of the sewer line and pump stations, and be of clear and reproducible quality. For Instance, if the: project
Involves 4 miles of interceptor sewer'that traverses over or near several different waterbodies (or counties,
basins, etc.), the map should have location ID's shown for each different waterbody (where the sewer line is within
100 feet of such waterbody = see Instruction VII). This location ID Is self chosen and used to cross reference the
location In Section C of the permit application.
Stream Classification - Section C
• If any portion of the project is within 100 feet of any down slope surface water, Section C must be completed
for the pertinent sections.
• If the entire project area is a minimum of 100 feet away from any down slope surface waters BUT there Is a
pump station involved where a history of power outage Is to be used to provide adequate design storage
Instead of dual feed or permanent or portable generator, Section C must be completed to demonstrate that
the closest down slope surface water Is Class C (see 15A NCAC 2H .0219(h)(3)(D)).
• Use the guidance document entitled, "Determining Watershed Classifications for Form FTA 02/03 (Fast -Track
Sewer Systems)" available from httw.//h2o.enr.state.nc.us/perce or by contacting the appropriate regional
office.
FT A m.inl - Rom, 104m5

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 2 •
.1:I VIII. Envirdnmental Assessments — If this project Is subject to an Environmental Assessment (EA) [15A NCAC
01C], this application can nOt be .used.-- Send the project application on Form PSFMGSA 10/99 to the PERCS
Unit, 1617 Mall Service Center, Raleigh, NC 27699-1617. Applications can not be accepted until. a Finding of No ,
Significant Impact (FONSI) or Environmental Impact Statement (EIS) has beenissued.'A'copy,is to be `submitted
With that.•.permit application.
❑. IX. Certlflcatlons- Section D
The application must be certified by both the- applicant and a North Carolina Registered Professional Engineer
(PE). , The applicant signature must match -the signing official listed in Item A(1 b). The PE should NOT certify the
application if he/she is unfamiliar with 15A NCAC 2H •.0200, the Gravity Sewer Minimum Design Criteria (most.
recent version) and the Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains
(most recent Version), as applicable to the project. Certificationby a PE Who Is unfamiliar with these documents
• is subject to NC Board referral: •
El X. Downstream Sewer & Wastewater Treatment Plant Capacity
• The applicant has assured downstream pipe, pump station and. treatment plant capacity. The addition of new
sources of Wastewater from 'this protect has been evaluated along the route- to the receiving treatment:plant. The
flow from this project will. not cause capacity related •sanitary sewer overflows or overburden any .downstream
pump station •on .route to the receiving wastewater treatment plant, • If the applicant is not the owner of the
downstream sewer or receiving treatment plant, submittal of flow'acceptance letter(s) indicates that owner has
adequate. capacity and will.not violate G.S. 1.43-215.67(a).
•:THE COMPLETED FTA 02/03.APPLICATION PACKAGE, INCLUDING ALL SUPPORTING DOCUMENTS AND $400
FEE, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional Office
2090 US Highway 70 •
Swannanoa, North Carolina 28778
(828).296-4500 • •.
(828) 299=7043 Fax :
,.. ..:.Sinraln,
Avery, Buncombe, Burke, Caldwell, .
Cherokee, Clay, Graham, Haywood,
Henderson, Jackson, Macon, Madison,
McDowell, Mitchell, PoIk,•Rutherford,-
Transylvanla,.Yancey. <:" ' •
Fayetteville Regional Office _
225 GreenSfreet Suite 714 •
.Fayetteville,.North Carolina 28301 •
• [phone] •Richmond,
[phone] Fax " •
Anson, Bladen, Cumberland, Harnett, .
•Hoke, Montgomery, Moore, Robeson,
Sampson, Scotland
_
Mooresville Regional Office .
.
• 61.0 E. Center Avenue, Suite 301 :
Mooresville, North Carolina 28115; •
[phone] .. •
[phone] Fax • ,.
Alexander, Cabamis, CatavVba,
Cleveland, Gaston, Iredell, Lincoln.
Mecidenburg, Rowan, Stanly, Union
Raleigh Regional Office.- - .
1628 Mall Service Center ..
• Raleigh, North Carolina 2769971628.... .
. [phone] •. •• •
[phone] Fa • .
Chatham, Durham, Edgecombe, Franklin,
Granville,. Halifax;Johrlston; Lee, Nash, .,
m Northapton,•Orange; Person,.Vance, .. _..
Wake, Warren; Wilson .. .
• Washington Regional Office : _
=.
943 Washington Square Moll .
Washington, North Carolina 27889
(252).946• 6.481••
[phone] Fax .. • .
Beaufort, Beriie, Camden, Cliowan, .
Craven, Currttudk, Dare; Gates, Greene, .
Hertford, Hyde, Jones, Lenolr,; Martin, •
Pamiice-, Pasquotank, Perquiman8,.Pitt,
:Tyrrell, Washington, Wayne .
Wilmington Regional Office
127 Cardinal Drive pension.
Wilmington, North Carolina 28405 . .
[phone]-•
[phone] Fax
Brunswick, Carteret, Columbus, Duplin,
New Hanover, Onslow, Pender .
•
Winston-Salem Regional Office'
.
. 585 Waughtown Street • •
Winston-Salem, North Carolina 27107 _.
. [phone] . ' .
[phone] Fax
Alamance, Allegheny, Ashe, Caswell,
� Davidson, Davie, Forsyth, Guilford,
. Rockingham, Randolph, Stokes, Surry,
.Watauga, Wilkes, Yadkin
For more information, visit our web site at•httpi/ii2o.enr.state.nc.us/peres✓
-PTA mml . - Reiv i (34/05

FAST-Tf2ACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE 3
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD!
Application Number.
(to be completed by DWQ) (.4) a a o a,9 g 2:p
. Owner:
a. Town of Mount Olive •
Full Legal Name (company, municipality, HOA, utility, etc.)
lb. B.R. Huggins, Mayor
Signing Official Name and Title (Please review 15A NCAC 2H .0206(b) for authorized signing offldalsl)
�:_lc.
The legal enft who will own this system Is:
Qindividual Federatla Municipality ■ State/County ❑ Private Partnership • Corporation j]'Other (specify):
1d. P.O. Box939
le.
Mount Olive
Mailing Address
City
l
lf. NC
lg28365
State
Zip Code
l h. 919-658-5561
11.
919-658-5257
11.
Telephone
Facsimile
E-mail
Project (Facility) Information:
`;:'a.
Produce Park
2b.
Wayne
Brief Project Name (permit will refer to this name)
County Where Project is Located
::. . Contact Person:
:. Jeffrey L. Komegay, PE, PLS - Project Engineer
Name and Affiliation of Someone Who Can Answer Questions About this Application -
`{
;+
b. 9t9-735-5880 ' .
3c. jeffre : e s(i► bellsouth:net
Phone Number
E-mail
1. Project Is 0 New • ■ Modification (of an existing permit) if Modlflc:ation, Permit -.NO.:,
"For modlflcations, attach a separate sheet dearly explalning the reason'for the modification (i.e. adding another
phase, changing line slze/length, etc.). Only Include the modified Information In this permit application - do not•
duplicate •project Information In B(7) andB(10=11) that has already been Included Inthe orlglnal'pertnit. • ,
: Owner Is 0 Public (slip to Item B(3)) ■ Private (go to Item 2(a))
r a. If'private� applicant will be:.
■ Retaining 'Ownership (i.e. store, church, single office, etc.) or
=='`'•' ■ Leasing units (lots, townhomes, etc..- slip to Item B(3))
■ Selling units (kits, townhomes, etc. - go to Item B(2b))
2b. If sQl.d, facilities owned, by a (must choose
❑ Public Utility (Instruction 11I)
■ Homeowner AssocJDeveloper (Instruction IV) •
• To of Mount Olive .
• Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
'r
' �
. towof Mount Olve
n•Name
b: NC 0020575
of WWTF
WWTF Permit No.
,,.,«.;��:;
Town of Mount Olive
• .
y 0 r $
' ecelving Sewer Size
��� Gravity
• Force Mein
• Not of
Owner of Downstream Sewer
Permit' Number of Downstream Sewer (if known).
.. The origin of this wastewater Is (check all that apply):
• Residential Subdivision
■ Apartments/Condominiums
IN Mobile Home Park
'``'' `::' • ■ School
, i ►:: Restaurant
:: e
• Car Wash
0 Institution
■ Hospital
■ Church
■ Nursing.Honie
• Other (specify):
100 % Domestic/Commerclal
%•Industrial
%' Other (specify):
7. Volume of wastewater to be allocated
for this particular protect
allocations
2.900 gallons per day
*Do. not Include previously permitted
.. <
}:= _
8. lithe permitted flow is zero,
Indicate why:
be permitted
in
of existing
in subsequent
Permit No. '
permits that connect to this line •
new flow expected
■ Interceptor Line- Flow will
• Flow has already been allocated
• Rehabilitation or replacement
sewer with no
V A m./n - Rev 114m5

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE 4 -
x•=
9.
Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2H
.0219(1) for Item B(7) or the design flow for line or pump station sizing If zero flow in the space below. Values other than
that in 15A NCAC 2H .0219(IX1-2) must be supported with actual water or wastewater use data In accordance with 15A
NCAC 2H .0219(IX3).
%;;!'.
(An exact flow amount cannot be determined until all lots are sold and the proposed development is known.)
Assumed Flows:
1 food services x 50 seats x 40 GPD per seat = 2,000 GPD
6 offices x 25 GPD per person per shift x 1 shift x 6 persons = 900 GPD
2,000 GPD + 900 GPD = 2,900 GPD for the proposed site.
10.
Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
tr
Size (Inches)
Length (feet)
Gravity or Force Main
(use the pull down menu)
8
1001
Gravity
•
'`•
:'
ENTER TOTAL UNE LENGTH IN MILES
0.494 , I g 9 '
11.
Summary of Pump Stations to be Permitted (attach additional sheets as necessary)
'`
(self
plans
Location ID
chosen - as shown on
for cross-reference)
Design Flow
- (MGD)
Operational Point
GPM © TDH
Power Reliability Option
(1- dual line feed; 2- permanent generator w/ATS; 3-
portable generator wltelemetry; 4-wet well storage)
i•;z
} r
2.
Does
Mains
0
the
(latest
Yes
sewer
•
system comply with the Minimum Design Criteria for the. Fast Track Permitting of Pump Stations and Force
verslon),`the Gravity. Sewer Minimum Design Criteria (latest version) and 15A NCAC 2H .0200 as applicable?
No If no, please reference the pertinent minimum design criteria or regulation and Indicate why a
variance Is requested. SUBMIT TWO COPIES OF PLANS, SPECIFICATIONS OR CALCULATIONS
PERTINENT TO THE VARIANCE WITH YOUR APPLICATION
13.
'Wetland/Stream
:
Have the following permlts/certiflcations been submitted for approval?
Crossings - General Permit or 401 Certification?
Sedimentation and Erosion Control Plan?
Stormwat@r?
■
0
0
Yes
Yes
Yes
•
■.No
•
No
No
0
■
•
N/A
N/A
N/A
,;
'<'
4.011.1N
14.
_ _'-
Does this project ect Involve aerial lines or siphons? Check if •
lines wlfl be oorsidered hloh orlortty and must be checked once every ebc month
aK':
' 15.
Does this protect have gravity sewer lines designed at minimum slopes? El
Be aware that the Division will not accept Installed Ones more than 10% flatter than the minimum slope. Lines Installed outside this tolerance should be
corrected prior to submitting the final engineering certification_
PTA 09/03 - RPv 3 04/05

1-FAST-TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 5
1.
• Use the Division's guidance document entitled, "DETERMINING STREAM CLASSIFICATIONS FOR FORM FTA 02/03
(FAST-TRACK SEWER SYSTEMS)' to collect and record the stream classification data below (attach additional sheets as
necessary). This document Is available from our web site or by contacting the appropriate Division of Water Quality
regional office (see instructions for addresses) OR indicate the following:
•-'r•�'=
0 A Stream Classiflcatfon is not needed because all parts of the project are at least 100 feet away from any downslope
waterbOdy; M12,
►: A Stream Classification is not needed because the design does not depend on wet well storage as a power rellabiliiy.
option for any pump station near a Class C down slope waterbody.
t?`:="'>`..•.WaterbodyStream
(sett
Location "ID on Map
chosen - as shown on
map for cross-reference)
Name of
Waterbody
County
River Basin
Index
Waterbody
Classification
A
Si:xF
��e.
Submit the 8.5" x.11" COLOR topographic map as required in Instruction VI
regardless of whether a classification Is provided!
1.
Applicants Certification:
4 P.R..�Huf ilns,, attest that this for produce Park hasbeenbeen reviewed by me and Is accurate and complete to
• -±�f-?:�;>�.,-
;"� �
J pa�ppplicatio„�
the bed( of my kno. ie ge. 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
' retuned as Incomplete. Note: In accordance with North Carolina General Statutes 143-215.6A and 143-215.68, any
person who knowingly makes any false 'statement representation, or certification in any application shall be guilty of a
Class 2 rsdemeanor which may include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per
violet on. •_
1a
b - �. - • %SIN '
�/-'
{-�' '•°
✓
• .'! rW l / • Date
Signing • al Slgnatu
Professlorial Engineer's Certification:
`._.
.
/ attest that thls'applk atlon for produce Park has been reviewed by me and Is accurate, complete and consistent with the
k::==:
,<r.'
Jnfonnation In the engineering plans, calculations, and all other supporting documentation Al 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, Gravity Sewer Minimum Design Criteria for Gravity Sewers adopted February 12, 1996, and the Minimum
Design Criteria for the Fast -Track Perrriltting of Pump Stations and Force Mains adopted June 1, 2000 and the watershed
classification In accordance with Division guidance. Although certain portions of this submittal package may have been'.
developed by other professionals, Inclusion of these materials under my signature and seal signifies that l have reviewed
this material and have judged It to be consistent with the proposed design. Note: In accordance with NC General Statutes
143-215.6A and 143-215.6B, any person who knowingly makes any false statement, representation, or certification In any
. application 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.
. Jeffrey L. Komegay
- `• --(Y, CAR
.� ,,, --i/„
,'s 0•49- �/
((tJ < '
Ct•'
=`:y am •'tiGINE� •'C.� ',
Seal, Signature & Date
Professional Engineer Name
b.
B.R. Komegay, Inc.
Engineering Firm
`tom
c.
P.O. Drawer 1435
"A.
Mailing Address
d.
Goldsboro
2e. NC
Rf. 27533
City
State
Zip
g.
919-735-5886
2h. 919-580-9053
21. ieffreykseAbellsouth.net
Telephone
ep
Facsimile
E-mail
vrA (MIA 7 Rev 04/05

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