WQ0037854_Application (FTSE)_20150612

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BE MORE DO MORE SEYMOUR
City of GoCdsdoro
P.O. Drawer A
North CaroCina
27533-97D1
June 12, 2015
NCDENR
Washington Regional Office
943 Washington Square Mall
Washington, NC 27889
RE: Balsam Place Sanitary Sewer Improvements Project
Fast -Track Application
Dear Sir/Madam:
[phone]
RECEIVED/NCDENR/DWR
JUN 15 2015
Water Quality Regional
Operations Section
Washington Regional Office
The above referenced project consists of approximately 708 linear feet of 8-inch PVC gravity
sewer to serve eleven (11) residences. The proposed flow is calculated assuming each residence
consists of three (3) bedrooms. The proposed sewer line is sized using the minimum pipe size and
minimum grade per current NCDENR gravity sewer guidelines.
I am enclosing the following items concerning the referenced project:
• One original and one copy of the completed Fast -Track Application for Gravity
Sewers, Pump Stations, and Force Mains (FTA 10-14);
• One original and one copy of the Flow Tracking/Acceptance for Sewer Extension
Permit Application (FTSE 8-13);
• One original each of the USGS Topographic Map and Street Level Map identifying
the entire project area and closest surface waters. Maps also shows the location of
the downstream connection point;
• City of Goldsboro Check No. 121111 in the amount of $480.00 for the application
fee.
Your review and approval of this project is respectfully requested. If you have any questions,
please contact me at [phone].
Guy M. Anderson, PE, CFM
City Engineer
/jdm
Enclosures

DWR
Division of Water Resources
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
FAST -TRACK APPLICATION (FTA 10-14)
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 Water Quality Permitting Section's 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 10-14):
• Submit the completed and appropriately executed Fast -Track (FTA 10-14) 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 .01 06(b).
C. Application Fee:
CO 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 ETA 10-14 & 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)
E Include a street level map showing all relevant project areas.
H. Stream Classification (WSCAS 01-15)
❑ Submit the completed and appropriately executed Watershed Classification Attachment form
(WSCAS 01-15) 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(1 b). The PE should NOT certify the application if he/she is unfamiliar with 15A NCAC Chapter
2I-, 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 10-14 & 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, Bartle, 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
450 W. Hanes Mill Road
Suite 300
Winston-Salem, North Carolina 27105
[phone]
Alamance, Alleghany, Ashe, Caswell, Davidson,
Davie, Forsyth, Guilford, Rockingham, Randolph,
Stokes, Surry, Watauga, Wilkes, Yadkin
INSTRUCTIONS FOR APPLICATION FTA 10-14 & SUPPORTING DOCUMENTATION Page 3 of 6

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USE THE TAB KEY TO MOVE FROM FIELD TO FIELD Application Number: ��1 c 3-
24.
(to be completed by DWR) v (p
1. Owner/Permittee:
1 a. City of Goldsboro
Full Legal Name (company, municipality, HOA, utility, etc.)
lb. Scott A. 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 ■ Federal ►.A Municipality ■ State/County ■ Private Partnership ■ Corporation ■ Other (specify):
1 d. 200 North Center Street 1 e. Goldsboro
Mailing Address City
1 f. NC 1 g. 27530
State Zip Code
lh. [phone] 1i. [phone] 1j. [e-mail]
Telephone Facsimile E-mail
2. Project (Facility) Information:
2a. Balsam Place Sanitary Sewer Improvements 2b. Wayne
Brief Project Name (permit will refer to this name) County Where Project is Located
3. Contact Person:
3a. Guy M. Anderson, PE, CFM, City Engineer, City of Goldsboro
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. [phone] 3c. [e-mail]
Phone Number E-mail
1. Project is ►i4 New ■ Modification (of an existing permit) If Modification, Permit No.:
2. Owner is 0 Public (skip to Item B(3)) ■ Private (go to Item 2(a))
2a. If be: 2b. If sold, facilities owned by a (must choose one)
private, applicant will
• 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))
3. City of Goldsboro
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
4a. City of Goldsboro Wastewater Treatment Plant 4b. NC0023949
Name of WWTF WWTF Permit No.
5a. City of Goldsboro ,5b. 10 inch 0 Gravity 5c. W00031218
Owner of Downstream Sewer 1Receiving Sewer Size • Force Main Permit # of Downstream Sewer (Instruction F)
6. The origin of this wastewater is (check all that apply):
►i1 Residential Subdivision • Retail (Stores, shopping centers) 100% Domestic/Commercial
• Apartments/Condominiums • Institution 0% Industrial
IIMobile Home Park ■ Hospital —
• School ■ Church (Attach Description)
• Restaurant • Nursing Home 0% Other
• Office ■ Other (specify): —
(Attach Description)
7. Volume of wastewater to be allocated or permitted for this particular project: 3,960 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.
• Rehabilitation or replacement of existing sewer with no new flow expected
(see 15A NCAC 02T .0303 to determine if a permit is required)
FTA 10-14 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).
Assume 3 bedroom per dwelling = 3 x 120 GPD = 360 GPD
11 dwellings = 11 x 360 GPD = 3,960 GPD
Permitted Flow = 3,960 GPD
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches)
8
Length (feet)
708
New Gravity or Additional
Force Main
Gravity
11. Summary of Pump Stations w/ associated Force Mains to be Permitted (attach additional sheets as necessary)
Pump Station Location ID: (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 plans/map for reference)
Longitude: Latitude:
Design Flow Operational Point Power Reliability Option
(MGD) GPM @TDH 1 - permanent generator w/ATS; Force Main Size Force Main Length
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, complete and submit the Variance/Alternative Design Request (VADC 10-141 application and supporting
documents for review. Approval of the request is required prior to submittal of the Fast Track Application and
supporting documents.
FTA 10-14 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 401 Certification? ❑ Yes ❑ No ®N/A
Sedimentation and Erosion Control Plan? ❑ Yes ❑ No ® N/A
Trout Buffer Waiver?
Stormwater?
❑ Yes ❑ No
❑ Yes ❑ No
® N/A
® 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: ❑ and provide details:
1.
1 a.
Owner/Permittee's Certification: (Signature of Signing Official and Project Name)
1, Scott A. Stevens, attest that this application for Balsam Place Sanitary Sewer Improvements 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. 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 2misdemeanor, which may include a fine not to exceed $10,000 as well as civil penalties up to
$25,000 per violation.
Wing 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)
I, Guy M. Anderson, PE, CFM ,attest that this application for Balsam Place Sanitary Sewer Improvements 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. 1 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 143-215.6B, 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. Guy M. Anderson
Professional Engineer Name
2b. City of Goldsboro Engineering Department
Engineering Firm
2c. P.O. Drawer A
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NC PE Seal, Signature & Date
Mailing Address
2d. Goldsboro
City
2g. [phone] 2h. [phone]
Telephone Facsimile
2e. NC 2f. 27533-9701
State Zip
2i. [e-mail]
E-mail
FTA 10-14 APPLICATION Page 6 of 6

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 08-13)
Project Applicant Name: City of Goldsboro
Project Name for which flow is being requested: Balsam Place Sanitary Sewer Imprvmnts
More than one FTSE 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 Wastewater Treatment Plant
b. WWTP Facility Permit #: NC0023949
All, flows are in MGD
c. WWTP facility's permitted flow 14.2
d. Estimated obligated flow not yet tributary to the WWTP 1.586
e. WWTP facility's actual avg. flow 9.67
f. Total flow for this specific request 0.004
g. Total actual and obligated flows to the facility 11.26
h. Percent of permitted flow used 79.30
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:
(A) (B) (C) (D)=B+C) (E)=(A-D)
Design Obligated,
Pump Average Daily Approx. Not Yet Total Current
Station Firm Flow** Current Avg. Tributary Flow Plus
(Name or Capacity,* (Firm / pf), Daily Flow, Daily Flow, Obligated Available
Number) MGD MGD MGD MGD Flow Capacity***
New H
Road PS 0.83 0.332 0.493 0.004 0.497 -0.165
Westbrook
Road PS 18 7.2 9.12 1.59 10.71 -3.51
* The Firm Capacity of any pump station is defined as the maximum pumped flow that
can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking
factor (pf) not less than 2.5.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < 0.
Page 1 of 6
FTSE 08-13

III. Certification Statement:
I Scott A. Stevens certify to the best of my knowledge that 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, given the implementation of
the planned improvements identified in the planning assessment where applicable. 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 I and II plus all
attached planning assessment addendums for which I am the responsible party. Signature of this
form indicates acceptance of this wastewater flow.
S gning Official Signature Date
Page 2of6
FTSE 08-13

FTSE PLANNING ASSESSMENT ADDENDUM (PAA)
Submit a planning assessment addendum for each pump station listed in Section 11 where Available
Capacity is < 0.
Pump Station (Name or Number):
Given that:
a. The proportion and amount of Obligated, Not Yet Tributary Daily Flow (C) accounts for
2.42 % and 0.004 MGD of the Available Capacity (E) in Pump Station
New Hope Road PS ; and that
b. The rate of activation of this obligated, not yet tributary capacity is currently approximately
0.002 MGD per year; and that
c. A funded Capital Project that will provide the required planned capacity, namely
2015 Priority Sewer Rehabilitation - Phases is in design or under construction with
1-3
planned completion in 1 year ; and/or
d. The following applies:
Significant inflow/infiltration is contributing to the current average daily flow. The 2015
Priority Sewer Rehabilitation Phases 1-3 project will significantly reduce the inflow/
infiltration and thus reduce the current average daily flow.
Therefore:
Given reasonably expected conditions and planning information, there is sufficient justification to
allow this flow to be permitted, without a significant likelihood of over -allocating capacity in the
system infrastructure.
1 understand that this does not relieve the collection system owner from complying with G.S. 143-
215.67(a) which prohibits the introduction of any waste in excess of the capacity of the waste
disposal system.
igning Official Signature
Date
Page 3 of 6
FTSE 08-13

Balsam Place
Sanitary Sewer
100 Improvements Project
4-434
Legend
Sewer Manholes
► Sewer Gravity Mains
75 150 300
Fe