WQ0037617_Application (FTSE)_20150223

HEERY
Date: February 17, 2015
To:
Title:
Company: NCDENR Washington Regional Office
Water Quality Section
Address: 943 Washington Square Mall
Washington, NC 27889
Phone No. 252-946-6481
Fax No.
From:
Return Fax
Re
Project:
RECEIVED/NCDENR/D1NR
FEB 232015
Water Quality Regional
Operations Section
Washington Regional Office
TRANSMITTAL
Kevin Klueh, PE
FTA 08-13 Gravity Sewer Fast Track Permit
Seymour Johnson Air Force Base
Medical Clinic Replacement
4th Medical Group, NC
Project No: 0916515
Via. FedEx Next Day
Distribution:
File: (A01.01)
Qty. Descnphon
Email Address [e-mail]
Dated Action Required
2 One original and one copy of permit application FTA 08-13 2/15/15 For signature by City
2 One original and one copy of flow tracking FTSE-10/07 2/15/15 For your information
2 Project Narrative 2/15/15 For your information
1 $480 check for application fee 2/15/15 For your information
2 Plans: VF100, VF101, VF102, VF103, VF104, CS100, CU100, 2/15/15 For your information
CU101, CU102, CU103, CU104, CU503
Comments
A wastewater permit application is attached for the Seymour Johnson Air Force Base Medical Clinic
Replacement project. Please call if you have any questions 407-992-6331. Thank you.
Kevin Klueh
HEERY INTERNATIONAL, INC.
Millenia Lake I, 4700 Millenia Boulevard. Suite 550
Orlando, FL 32839
p 407.992.6300 f 407.992.6399
1 of 1
\Alav0002u,RJ3ws\H11-0916515\A ADMINIA01-00-CORRESPIA01-01-
ByHeery\Sewer Permit Transmitta11T001-0916515-NCDENR.docx

\f\I c),c-71.o
Q�
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
E 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

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)
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,
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.
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: ` „ r (, OO 3 `-7T (to be completed by DWR) N) �y 6
Z
Q
Z•
Q
LL
Z
Z
O
QTelephone
U
J
d
O. Q
< 3a.
3b.
1. Owner/Permittee:
la Seymour Johnson Air Force Base
Full Legal Name (company, municipality, HOA, utility, etc.)
lb. Dennis Goodson, PE
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 r Federal • Municipality ■ State/County IIIPrivate Partnership ■ Corporation IIIOther (specify):
ld. 1095 Peterson Avenue le. Seymour Johnson
Mailing Address City
If. NC lg. 27 31 1.1 31
State Zip Code
lh. 919-722-5142 li. 1j. [e-mail]
Facsimile E-mail
2. Project (Facility) Information:
2a. SJAFB Medical Clinic Replacement 2b. Wayne
Brief Project Name (permit will refer to this name) County Where Project is Located
3. Contact Person:
Kevin Klueh, PE
Name and Affiliation of Someone Who Can Answer Questions About this Application
407-992-6331 3c. [e-mail]
Phone Number E-mail
1. Project is New ■ Modification (of an existing permit) If Modification, Permit No.:
2. Owner is ■ Public (skip to Item B(3)) ►5 Private (go to Item 2(a))
2a. If private, applicant will be: 2b. If sold facilities owned by a (must choose one)
® Retaining Ownership (i.e. store, church, single office, etc.) or • Public Utility (Instruction D)
• Leasing units (lots, townhomes, etc. - skip to Item B(3)) ■ Homeowner Assoc./Developer (Instruction E)
■ Selling units (lots, townhomes, etc. - go to Item B(2b))
Z 3. City of Goldsboro
0 Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
H 4a. Goldsboro Waste Water Treatment Plant 4b. NC0023949
2 Name of VWVfF VWVfF Permit No.
Et
5b. 8 inch
@ Gravity
0 5a. City of Goldsboro
diamter
• Force Main
5c. NC0023949
LL Owner of Downstream Sewer
Z 6. The origin of this wastewater is
~ • Residential Subdivision
2 • Apartments/Condominiums
Receiving
(check
Sewer Size
all that apply):
III Retail
• Institution
(Stores, shopping
Permit # of
centers)
Downstream Sewer (Instruction F)
100% Domestic/Commercial
% Industrial
Ce • Mobile Home Park
W • School
CI. ■ Restaurant
• Hospital
■ Church
• Nursing Home
(Attach Description)
% Other
■ Office
CO
r Other (specify):
7. Volume of wastewater to be allocated
or permitted for this particular project: 0
(Attach Description)
gallons per day
8.
*Do not include future flows or previously permitted allocations
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.
►i4 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

NFORMATION (CONTINUED)
B. PERMIT
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).
No new flow. The project will construct a medical clinic to replace the existing medical clinic which will be demolished after
construction. There will be no new flow because the clinic will serve the same population as the existing clinic.
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches) Length (feet)
New Gravity or Additional
Force Main
4
6
8
34 New gravity
106 New gravity
1,181 New gravity
11. Summary of Pump Stations w/ associated Force Mains to be Permitted (attach additional sheets as necessary)
Pump Station Location ID: No new pump stations (self chosen - as shown on plans/map for reference)
Longitude: Latitude:
Design Flow
(MGD)
Operational Point
GPM @TDH
Power Reliability Option
1 - permanent generator w/ATS;
2 - portable generator w/MTS
Force Main Size
Force Main Length
Pump Station Location ID: (self chosen - as shown on planslmap for reference)
Longitude: Latitude:
Design Flow
(MGD)
Operational Point Power Reliability Option
GPM @TDH 1 - permanent generator w/ATS;
2 - portable generator w/MTS
Force Main Size
Force Main Length
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 8,12 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
Pipe slope varies between 0.35% and 0.4% for 8" diameter mains which means that some mains have less than 0.4%
slope. Increasing the slope is not possible because of the high downstream connecting invert elevation and the lack of
gradient on the property. The downstream sanitary sewer to which the project connects has a slope of 0.26% while the
slope of other existing sewers on site vary from 0.25% to 0.32%.. The proposed slopes therefore exceed the existin4.
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?
Wetland/Stream Crossings - General Permit or 401Certification? ❑ Yes ❑ No ® N/A
Sedimentation and Erosion Control Plan? ® Yes ❑ No ❑ N/A
Trout Buffer Waiver? El Yes ❑ No ® N/A
Stormwater? ❑ Yes ❑ No ® N/A
15. Does this project include any high priority lines (15A NCAC 02T .0402 (2j) 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:
C. CERTIFICATIONS
1. Owner/Permittee's Certification: (Signature of Signing Official and Project Name)
1, Dennis Goodson, PE, attest that this application for SJAFB Medical Clinic Replacement has been reviewed by
me and is accurate and complete to the best of my knowledge. 1 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. 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
pen!ties up to $25,000 per violation.
la.
Signing Official Signature
z9�Date
is
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)
!, Linda Bennett, PE ,attest that this application for SJAFB Medical Clinic Replacement 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 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 143-215.68, 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 line not to exceed $10,000 as well as civil penalties up to $25,000 per ".latio
2a. Linda F. Bennett, PE
Professional Engineer Name
2b. Heery International
Engineering Firm
2c. 4700 Millenia Blvd., Suite 550
Mailing Address
2d. Orlando 2e. FL 2f. 32837
City State Zip
2g. 407-992-6300 2h. 2i. [e-mail]
Telephone Facsimile E-mail
1
FTA 08-13 APPLICATION Page 6 of 6

GFW1F,9 State of North Carolina
c) State
Department of Environment and Natural Resources
r Division of Water Quality
H
-c Flow Tracking/Acceptance for Sewer Extension Permit Applications
(FTSE —10/07)
Project Applicant Name: Seymour Johnson Air Force Base
Project Name for which flow is being requested: SJAFB Medical Clinic Replacement
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
1.583843
8:804—a , k•e1
0.000
10.387843b^
'73.15
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 MGD
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 Sections d II for which I am the responsible party. Signature of this form indicates
acceptan9e of this west ater flow.
Signing Official Signature City Manager
i GIs
Date

Project Narrative
The Seymour Johnson Air Force Base Medical Clinic Replacement project involves the construction of a
new 105,000 +/- square foot medical clinic building to replace the existing 100,000+/- square foot
medical clinic that is located at the Seymour Johnson Air Force Base in Goldsboro, North Carolina. The
new clinic is not anticipated to increase wastewater outflow to the City of Goldsboro waste water
treatment plant because the number of people using the clinic and the number of services will not
increase. Instead, it is anticipated that the wastewater outflow will decrease due to the use of more
modern low flow plumbing fixtures.
The new clinic is located approximately 100 feet north of the existing clinic and will discharge to the
same sanitary sewer system. Both clinics will not be operational at the same time. Instead, the existing
clinic will be demolished immediately following construction of the new clinic. All wastewater flow at
the existing and new clinic is by gravity. No pumping stations will be constructed. In summary, this
project is anticipated to have no impact to the water and sewer services at the Seymour Johnson AFB or
the City of Goldsboro.
The project is not located within 100 feet of any surface water or wetlands. The project is not subject to
an environmental assessment and does not utilize an alternative sewer system.

dig
USGS
science for a changing world
/5 UU
35.77 10
^180°0iN
"17
'16
1115
r213f40 E
Mallow v
Dar (en,
a,Na IM
WV. aYr
STADIUM DR
Mawtroal DR
cpl
U.S. DEPARTMENT OF THE INTERIOR
U. S. GEOLOGICAI. SURVEY
uNDR
Webtown
WGYrR DR
a,"
Airboro
4.
Seymour Johnson Homes Is
1
1-7 S`T 3
57 30-
'31_.
y
44
Halcrest Faun or
ff
E ELM lr
!he National Map
Itp US Topo
'32
.Harr PROJECT :�
LOCfION
=,J D sew04 =
: Berkeley «f#
`y,w a{ Village Oak
*• ', „4' or
# Forest
�f'*af �� yy*,t•. ♦ .`-noel 17 <o `uCa =ff
a`
mt(0,1 LINr RD
-
Seymour Johnson
rM« rare
Green
Meadows
34
Wrryy5
44