WQ0037260_Application (FTSE)_20140714

rdropri
B.K.
JONES CONSULTING ENGINEERS, P.A.
7a1fri
Post Office Box 10882
Goldsboro, NC 27532 Lic#: C-3065
Phone: [phone]
Email: [e-mail]
TRANSMITTAL SHEET
TO: FROM:
NCDENR
Bryan Jones, PE
COMPANY: DATE:
Div. of Water Qual. 7/14/2014
PHONE NUMBER: TOTAL NO. OF PAGES INCLUDING COVER:
252.946.6481
FAX NUMBER: SENDER'S REFERENCE NUMBER:
252.975.3716
RE:
Seymour Village Subdivision
NOTES! COMMENTS:
Project Narrative:
Seymour Village Subdivision consists of one phase with 40 lots within
the City of Goldsboro. The subdivision will proposes approximately
2058 +/- ft of 8" gravity sanitary sewer, within the dedicated City
street right-of-way and tying into the existing sanitary sewer in
Corbett St.
JUL 18 2014
jkAl Q P 01‘ ri$ (1)

���0633-2io0
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:
❑ 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).
❑ The Professional Engineer's Certification of the application shall be signed, sealed and dated by a
North Carolina licensed Professional Engineer.
❑ 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:
❑ 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):
❑ 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):
➢ 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):
❑ 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.
➢ 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)):
➢ Projects involving an Environmental Assessment per 15A NCAC 01 C .0408, must be submitted for a
full 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
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
➢ Many wastewater treatment systems are entering into agreements for regionalization efforts and
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.
L. 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(1b). 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
Application Number: ‘,1
(to be completed by DWR) vV QQ 3 . 2 (0 0
NFORMATION
Z
0
F-
Q
0
—J
a.
1. Owner/Permittee:
1 a. City of Goldsboro
Full Legal Name (company, municipality, HOA, utility, etc.)
lb. Mr. Scott Stevens, City Manager
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 0 Federal ® Municipality 0 State/County 0 Private Partnership 0 Corporation ❑ Other (specify):
ld. PO Drawer A le. Goldsboro
Mailing Address
1f. NC
State
lh. 919-580-4330
1 i. 919-580-4344
City
1 g. 27533
Zip Code
1j. sst
Telephone Facsimile E-mail
2. Project (Facility) Information:
2a. 5Q\I T O\Ax ' "\\\ % 1K-; 5 k•\ 151 1 2b. Wayne
County Where Project is Located
Brief Project Name (permit wYl refer to this name)
3. Contact Person:
N me an Affiliation of Someone Who'Can Answer Questions About this Application
Pho a NurAber E-mail
1. Project is 0 New 0 Modification (of an existing permit) If Modification, Permit No.:
?. Owner is ® Public (skip to Item B(3)) ❑ Private (go to Item 2(a))
2a. If private, applicant will be:
0 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 (WWTF) Treating Wastewater From This Project
4a. Goldsboro Wastewater Treatment Plant 4b. NC0023949
Name of WWTF
5a. City of Goldsboro 5b. 8" ® Gravity 5c. WQ0031218
Owner of Downstream Sewer Receiving Sewer Size '❑ Force Main
6. The origin of this wastewater is (check all that apply):
® Residential Subdivision
El Apartments/Condominiums
❑ Mobile Home Park
❑ School
O Restaurant
0 Office
WWTF Permit No.
Permit # of Downstream Sewer (Instruction F)
❑ Retail (Stores, shopping centers)
O Institution
O Hospital
❑ Church
❑ Nursing Home
O Other (specify):
100% Domestic/Commercial
°A) Industrial
(Attach Description)
°A° Other
(Attach Description)
7. Volume of wastewater to be allocated or permitted for this particular project: 19,200 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
O Flow has already been allocated in Permit No.
❑ 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).
Seymour Village Subdivision Design Flow = 40 Lots x 4 bedrooms x 120gpd = 19,200 gpd;
8" dia. max half full, S(min) = 0.4%, N-0.013
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches) Length (feet)
8
New Gravity or Additional
Force Main
2058' +/- New Gravity
LLI
11. Summary of Pump Stations wl associated Force Mains to be Permitted (attach additional sheets as necessary)
0 Pump Station Location ID: (self chosen - as shown on plans/map for reference)
V Longitude: Latitude:
Z
0
Design Flow Operational Point Power Reliability Option
(MGD) GPM @TDH 1 - permanent generator w/ATS; Force Main Size Force Main Length
2 2 - portable generator w/MTS
cc
0
LL
Pump Station Location ID: (self chosen - as shown on plans/map for reference)
H
Longitude: Latitude:
cc
L11 Design Flow Power Reliability Option
(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 6,12 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 ❑ No ®N/A
® Yes ❑ No ❑ N/A
❑ Yes ❑ No ®N/A
® Yes ❑ No ❑ N/A
15. Does this project include any high priority lines (15A NCAC 02T .0402 (2)) 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: Eland provide details:
1. Owner/Permittee's Certification: (Signature of Signing Official and Project Name)
1 a.
1,
, attest that this application for Seymour Village 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 retumed as incomplete. Note: In accordance with North Carolina 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 penajties up to $25,000 per violation.
Sigrfirfg Official Signature
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, Bryan K Jones, PE ,attest that this application for Seymour Village 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 1 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.
2a. Bryan K Jones, PE
Professional Engineer Name
2b. Bryan K Jones Consulting Engineers, PA
Engineering Firm
2c. PO Box 10882
Mailing Address
2d. Goldsboro
City State Zip
2g. 919-221-5222 2h. 2i. [e-mail]
Telephone
Facsimile E-mail
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FTA 08-13 APPLICATION Page 6 of 6

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
-mac Flow Tracking/Acceptance for Sewer Extension Permit Applications
(FTSE —10/07)
Project Applicant Name: City of Goldsboro
Project Name for which flow is being requested: Seymour Village subdivision, Corbett Street
extension
More than one FTSE-10/07 may be required for a single project if the owner of the WWTP is not responsible for all
pump stations along the route of the proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: City of Goldsboro Water Reclamation Facility
b. WWTP Facility Permit #: NC 0023949
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
All flows are in MGD
14.2
1.563311
8.804
0.0192
10.386511
73.14 %
II. Complete this section for each pump station you are responsible for along the route of this
proposed wastewater flow.
List pump stations located between the project connection point and the WWTP
Pump Station Name Approx. Capacity, MGD Approx. Current Avg.
(Firm/Design) Daily Flow, MGD
Westbrook Pump Station
18 mgd/firm 8.81
III. Certification Statement:
I, Scott A. Stevens , certify that, to the best of my knowledge, the addition of the
volume of wastewater to be permitted in this project has been evaluated along the route to the receiving
wastewater treatment facility and that the flow from this project is not anticipated to cause any capacity
related sanitary sewer overflows or overburden any downstream pump station en route to the receiving
treatment plant under normal circumstances. This analysis has been performed in accordance with local
established policies and procedures using the best available data. This certification applies to those items
listed above in Sect :ns I and II for which I am the responsible party. Signature of this form indicates
accep % water flow. 7-I -1 i
Si ing Official Signature City Manager 1)uir

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SANITARY SEWER EXHIBIT
PROPERTY DATA:
OWNER LANBRANCH DEVELOPMENt LLC
STREET ADDRESS: CORBETT MEET. GOLDSBORO, NC
ZONING: R12 SF
PROPOSED ZONING: 89 - SF
TRACT ACREAGE 13.763 acre
3519832458
TAX PARCEL 1194: 12 3519 83 2458
DEED REFERENCE DEED BOON 2834, PAGE 226
EXISTING USE: FALLOW FIELD
FLOODPLAIN ZONE X • AREA DETERMINED TO BE OUTSIDE
THE 0.2% ANNUAL CHANCE FLOODNAIN
FIRM HAP NUMBER 3720351900J
EFFECTIVE DECEMBER 2. 2005
OR 110
ens, I• • ET
ONES CONSUL
ENGINEERS, P.A.
Pest Offlor fax 10882
Goldsboro. NC 27532
W 221 5222
bloortes.en cf.
LC t C.3065
PROJECT 11096
P.M STATES' PREOWEART
EERIER OH
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