WQ0037203_Application (FTSE)_20140613

civilconsultants
LAND DEVELOPMENT CONSULTANTS
June 13, 2014 # 20040
Department of Environment and Natural Resources
Division of Water Resources, Water Quality Section
Washington Regional Office
943 Washington Square Mall
Washington, NC 27889
Re: Fast -Track Application
Wayne Preparatory Academy — Phase One
Goldsboro, NC
To Whom It May Concern,
Please find enclosed the necessary materials in support of a Fast -Track Gravity Sewer,
Pump Station, and Force Main application for the referenced project. Wayne
Preparatory Academy is a charter school that will begin operation in early August of
this year, with up to 578 Elementary students and 42 Pre -Kindergarten students.
Sanitary sewer service will be provided to the school via an onsite private collection
system, consisting of 6-inch diameter collection sewers with manholes, a duplex
pumping station, and a 4-inch diameter force main that will connect to an existing 6-
inch diameter public (City of Goldsboro) force main.
Future campus expansions are anticipated, and will occur in phases. Necessary peiiiiit
modifications will be requested at the appropriate times for these expansions. These
modifications will be largely for flow allocation purposes, since the Phase One
facilities have been designed to serve future expansions with simple service
connections and minor float switch adjustments in the pumping station.
Please let me know if you need any additional information for your review.
Regards,
Tony M. Whitaker, PE
Attachments
Cc: Rich Morley (w/a)
LAND PLANNERS + CIVIL ENGINEERS
3708 LYCKAN PARKWAY, SUITE 201 DURHAM, NC 27707, PHONE: [phone]
WWW.CIVIL-CONSULTANTS,COM
LIC. C-1030

DWR
Division of Water Resources
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
FAST -TRACK APPLICATION (FTA 08-13)
for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
General — When submitting this 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.
For more information, visit the Surface Water Section's Collection Systems website or;
contact the Regional Office serving your county
Unless otherwise noted, the Applicant shall submit one original and one copy of the application and supporting
documentation to the appropriate Regional Office (see page 3).
A. Cover Letter:
IX Include a brief project narrative describing the final design (i.e system and/or pump station to ultimately
serve 500 homes, but flow for only 100 homes being requested now). For modifications, clearly explain
the reason for the modification (i.e. adding another phase, changing line size, length, etc).
B. Application Form (FTA 08-13):
�( Submit the completed and appropriately executed Fast -Track (FTA 08-13) Application. Any unauthorized
content changes to this form shall result in the application being returned. If necessary for clarity or due
to space restrictions, attachment to the application may be made, as long as the attachments are
numbered to correspond to the section and item to which they refer. You do not need to submit detailed
plans and specifications unless you respond NO to item B(13).
to The Professional Engineer's Certification of the application shall be signed, sealed and dated by a North
Carolina licensed Professional Engineer.
07( The Applicant's Certification of the application shall be signed in accordance with 15A NCAC 02T
.0106(b). 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).
C. Application Fee:
z( Submit a check in the amount of $480 to: North Carolina Department of Environment and Natural
Resources (NCDENR).
➢ Checks shall be dated within 90 days of application submittal.
D. Certificate of Public Convenience and Necessity (For Privately -Owned Public Utilities Only):
NIA E Per 15A NCAC 02T .0115(a)(1), provide two copies of 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 served by the sewer extension, or
❑ Provide two copies of 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.
❑ The project name in the CPCN or letter must match that provided in Item A(2)a of this application.
E. Operational Agreements (For Home/Property Owners' Associations and Developers of lots to be sold):
Nip ➢ Home/Property Owners' Associations
❑ Per 15A NCAC 02T .0115(c), submit the properly executed Operational Agreement (HOA 08-13).
❑ 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 .0115(b), submit the properly executed Operational Agreement (DEV 08-13).
Even if the project may be turned over to a municipality upon completion, Form DEV 08-13 is required.
INSTRUCTIONS FOR APPLICATION FTA 08-13 & SUPPORTING DOCUMENTATION Page 1 of 6

F. Downstream Sewer, WWTF Capacity and Flow Tracking/Acceptance Form (FTSE 08-13)
Submit the completed and appropriately executed Flow Tracking/Acceptance for Sewer Extension Permit
(FTSE 08-13) Form for all applications.
• The applicant (and owners of downstream sewers, pump stations and/or treatment facilities submitting
form FTSE 08-13 certifies that the addition of the volume of wastewater to be permitted in this project
has been evaluated along the route to the receiving treatment plant, and that the flow from this project
will not cause capacity related sanitary sewer overflows or overburden any downstream pump station en
route to the receiving wastewater treatment plant.
Where the applicant is not the owner of the downstream sewer, submit two copies of form FTSE 08-13
from the owner of the downstream sewer and owner of the WWTF, if different.
• The flow acceptance indicated in form FTSE 08-13 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 08-13 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 08-13.
G. Site Map (All Application Packages):
igc Submit an 8.5-inch x 11-inch color copy of a USGS Topographic Map of sufficient scale to identify the
entire project area and closest surface waters. Each map must include at a minimum:
➢ The location of the sewer line and pump stations and be of reproducible quality.
Downstream connection points and the permit number for the receiving sewer (if known)
➢ Pump Station Locations and the longitude and latitude for each pump station (if applicable)
Include a street level map showing all relevant project areas.
H. Stream Classification (WSCAS 08-13)
Submit the completed and appropriately executed Watershed Classification Attachment form
(WSCAS 08-13) if any portion of the sewer system project is within 100 feet of any surface water or
wetlands.
y A variance must be requested for encroachment within required setbacks or buffers pursuant to 15A
NCAC 02T .0305(f)
I. Environmental Assessments (Projects subject to an Environmental Assessment (EA)):
N\ ➢ Projects involving an Environmental Assessment per 15A NCAC 01C .0408, must be submitted for a full
1 technical review and must be submitted to the PERCS Unit on application forms provided by the Division.
J. Alternative Sewer Systems
``�' • Projects involving low pressure sewer systems, vacuum sewer systems and other alternative sewer
I'i/11 systems must be submitted for a full technical review and must be submitted to the PERCS Unit on
application forms provided by the Division.
K. Flow Direction
y Many wastewater treatment systems are entering into agreements for regionalization efforts and
N/A emergency treatment capacity. Parts of the system are installed so that the wastewater flow can be
directed to more than one treatment facility. If this is the case with the project, please indicate in B(12)
and give the permit number of the second facility.
Certifications — Section C
• The application must be certified by both the applicant and the design engineer who is 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 Chapter
2T, The Gravity Sewer Minimum Design Criteria (most recent version) and the Minimum Design Criteria
for the Permitting of Pump Stations and Force Mains (most recent version), as applicable to the project.
INSTRUCTIONS FOR APPLICATION FTA 08-13 & SUPPORTING DOCUMENTATION Page 2 of 6

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
Water Quality Section
2090 US Highway 70
Swannanoa, North Carolina 28778
[phone]
[phone] Fax
Avery, Buncombe, Burke, Caldwell, Cherokee,
Clay, Graham, Haywood, Henderson, Jackson,
Macon, Madison, McDowell, Mitchell, Polk,
Rutherford, Swain, Transylvania, Yancey
Fayetteville Regional Office
Water Quality Section
225 Green Street Suite 714
Fayetteville, North Carolina 28301-5094
[phone]
[phone] Fax
Anson, Bladen, Cumberland, Harnett, Hoke,
Montgomery, Moore, Robeson, Richmond,
Sampson, Scotland
Mooresville Regional Office
Water Quality Section
610 E. Center Avenue
Mooresville, North Carolina 28115
[phone]
[phone] Fax
Alexander, Cabarrus, Catawba, Cleveland,
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
Stanly, Union
Raleigh Regional Office
Water Quality Section
1628 Mail Service Center
Raleigh, North Carolina 27699-1628
[phone]
[phone] Fax
Chatham, Durham, Edgecombe, Franklin,
Granville, Halifax, Johnston, Lee, Nash,
Northampton, Orange, Person, Vance, Wake,
Warren, Wilson
Washington Regional Office
Water Quality Section
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,
Perquimans, Pitt, Tyrrell, Washington, Wayne
Wilmington Regional Office
Water Quality Section
127 Cardinal Drive Extension
Wilmington, North Carolina 28405
[phone]
[phone] Fax
Brunswick, Carteret, Columbus, Duplin, New
Hanover, Onslow, Pender
Winston-Salem Regional Office
Water Quality Section
585 Waughtown Street
Winston-Salem, North Carolina 27107
[phone]
[phone] Fax
Alamance, Alleghany, Ashe, Caswell, Davidson,
Davie, Forsyth, Guilford, Rockingham, Randolph,
Stokes, Surry, Watauga, Wilkes, Yadkin
INSTRUCTIONS FOR APPLICATION FTA 08-13 & SUPPORTING DOCUMENTATION Page 3 of 6

USE THE TAB KEY TO MOVE FROM FIELD TO FIELD
A. APPLICATION INFORMATION
NFORMATION
B. PERMIT
Owner of Downstream Sewer Receiving Sewer Size ® Force Main
6. The origin of this wastewater is (check all that apply):
❑ Residential Subdivision
❑ Apartments/Condominiums
❑ Mobile Home Park
❑ School
❑ Restaurant
❑ Office
1. Owner/Permittee:
la. Provo Land Exchange III, L.C.
Full Legal Name (company, municipality, HOA, utility, etc.)
1b. .Kevin Pinder, Managing Member
Application Number:
(to be completed by DWR)
0 0 33- 2 Q:
Signing Official Name and Title (Please review 15A NCAC 2T .0106 (b) for authorized signing officials)
lc. The legal entity who will own this system is:
❑ Individual ❑ Federal ❑ Municipality ❑ State/County ❑ Private Partnership ® Corporation ❑ Other (specify):
ld. 130 W. Center St.
le. Orem
Mailing Address City
1 f. UT 1 g. 84057
State
lh. 801-225-1924 1 i. None
Telephone Facsimile
2. Project (Facility) Information:
2a. Wayne Preparatory Academy - Phase 1
Brief Project Name (permit will refer to this name)
3. Contact Person:
3a. Tony M. Whitaker, PE
Zip Code
1j. [e-mail]
E-mail
2b. Wayne
County Where Project is Located
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. 919-490-1645 or 919-943-8418 3c. [e-mail]
Phone Number E-mail
Project is ® New ❑ Modification (of an existing permit) If Modification, Permit No.:
2. Owner is ❑ Public (skip to Item B(3)) ® Private (go to Item 2(a))
2a. If private, applicant will be:
® Retaining Ownership (i.e. store, church, single office, etc.) or
❑ Leasing units (lots, townhomes, etc. - skip to Item B(3))
❑ Selling units (lots, townhomes, etc. - go to Item B(2b))
3. City of Goldsboro
2b. If sold, facilities owned by a (must choose one)
❑ Public Utility (Instruction D)
❑ Homeowner Assoc./Developer (Instruction E)
Owner of Wastewater Treatment Facility (WVIITF) Treating Wastewater From This Project
4a. C'ay Ga(Asbore. IJ4ef Reclamd,4 r\ f c I;-ty
Name of WWTF WWTF Permit No.
4b. N00023`iqll
5a. City of Goldsboro 5b. 6" ❑ Gravity 5c. Lln%hacan
Permit # of Downstream Sewer (Instruction F)
❑ Retail (Stores, shopping centers)
❑ Institution
❑ Hospital
❑ Church
❑ Nursing Home
❑ Other (specify):
100% Domestic/Commercial
% Industrial
(Attach Description)
Other
(Attach Description)
7. Volume of wastewater to be allocated or permitted for this particular project: 6,955 gallons per day
*Do not include future flows or previously permitted allocations
8. If the permitted flow is zero, indicate why:
❑ Pump Station, Outfall or Interceptor Line where flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit No.
0 Rehabilitation or replacement of existing sewer with no new flow expected
(see 15A NCAC 02T .0303 to determine if a permit is required)
FTA 08-13 APPLICATION Page 4 of 6

9. Provide the wastewater flow calculations used in determining the permitted flow in accordance with 15A NCAC 2T .0114 for
the value in Item B(7) AND/OR the design flow for line or pump station sizing if a reduced or zero flow is being requested in
Item B(7). Values other than that in 15A NCAC 2T .0114 (b) and (c) must be supported with actual water or wastewater use
data in accordance with 15A NCAC 2T .0114 (f).
School with no gym or cafeteria: 578 students x 10 gpd/student +
Pre -Kindergarten facility: 47 persons x 25 gpd/person = 6955 gpd
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches) Length (feet) New Gravity or Additional
Force Main
6" gravity sewer 1243 1243
4" force main 320 320
Cl
LU
D
I, 11. Summary of Pump Stations w! associated Force Mains to be Permitted (attach additional sheets as necessary)
0 Pump Station Location ID: Wayne Prep Station (self chosen - as shown on plans/map for reference)
0
Longitude: 35 deg-25'-23.5" N Latitude: 77 deg-57'-45.3" W
Z
0
P Design Flow Operational Point Power Reliability Option
Q (MGD) GPM @TDH 1 - permanent generator w/ATS; Force Main Size Force Main Length
2 2 - portable generator w/MTS
Q0.0069 190 @ 29.2 1 4" 330'
LL
Z Pump Station Location ID: (self chosen - as shown on plans/map for reference)
H
2 Longitude: Latitude:
lid
LU Design Flow Power Reliability Option
0- (MGD) Operational Point 1 - permanent generator w/ATS; Force Main Size Force Main Length
GPM @TDH 2 - portable generator w/MTS
12. Will the wastewater flow in the proposed sewer lines or pump stations be able to be directed to another treatment facility?
❑ Yes ® No If Yes, permit number of 2nd treatment facility :
(RO - if "yes" to B,12 please contact the Central Office PERCS Unit)
13. Does the sewer system comply with the Minimum Design Criteria for the Permitting of Pump Stations and Force Mains
(latest version), the Gravity Sewer Minimum Design Criteria (latest version) and 15A NCAC Chapter 2T as applicable?
® Yes ❑ 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
FTA 08-13 APPLICATION Page 5 of 6

14. Have the following permits/certifications been submitted for approval for the system or project to be served?
C. CERTIFICATIONS
Wetland/Stream Crossings - General Permit or 401 Certification?
Sedimentation and Erosion Control Plan?
Trout Buffer Waiver?
Stormwater?
❑ Yes
® Yes
❑ Yes
® Yes
❑ No
❑ No
❑ No
❑ No
® N/A
❑ N/A
® N/A
❑ N/A
15. Does this project include any high priority lines (15A NCAC 02T .0402 (21) involve aerial lines, siphons, or interference
manholes)? These lines will be considered high priority and must be checked once every six months
Check if Yes: ❑ and provide details:
1. Owner/Permittee's Certification: (Signature of Signing Official and Project Name)
1, Kevin Pinder, attest that this application forWayne Preparatory Academy gravity sewer, pump station, and force
main has been reviewed by me and is accurate and complete to the best of my knowledge. ! 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 retumed 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 all be guilty of a Class 2 misdemeanor, which may include a fine not to exceed $10, 000 as
well as/civil-penalties u' o 000 per violation.
1 a.
Signing Official Sig ature
6—/2 7A,
Date
ENGINEERING DESIGN DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL OF THIS
APPLICATION. THESE DOCUMENTS MUST INCLUDE PLAN AND PROFILE OF SEWERS, THEIR PROXIMITY
TO OTHER UTILITIES, DESIGN CALCULATIONS, ETC. REFER TO 15A NCAC 02T .0305
2. Professional Engineer's Certification: (Signature of Design Engineer and Project Name)
1, Tony M. Whitaker ,attest that this application forWayne Preparatory Academy gravity sewer, pump station, and
force main has been reviewed by me and is accurate, complete and consistent with the information in the engineering
plans, 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, Gravity Sewer
Minimum Design Criteria for Gravity Sewers adopted February 12, 1996, and the Minimum Design Criteria for the Fast -
Track Permitting of Pump Stations and Force Mains adopted June 1, 2000 and the watershed classification in accordance
with Division guidance. 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 NC 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 misdemeanor which may include a fine not to exceed $10,000 as well as civil penalties up to $25, 000 per violation.
2a. Tony M. Whitaker
Professional Engineer Name
2b. Civil Consultants, Inc.
Engineering Firm
2c. 3708 Lyckan Pkwy. Suite 201
Mailing Address
2d. Durham
City
2g. 919-490-1645 2h. None
Telephone Facsimile
2e. NC 2f. 27707
State Zip
2i. tony.whitaker@civil-
consultants.com
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FTA 08-13 APPLICATION Page 6 of 6

Onsite features are
not jurisdictional
see DWR letter)

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