WQ0040825_Application (FTSE)_20190425

r
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD!
Application Number:
(to be completed by DWQ)
V
V
°t 0 . 5
O1
Q
aNIndividual
0
Li-
Z
—
Z
0
QTelephone
o
J
0.
CL Q
Q
9. Owner!Permittee:
la. Adair Place, LP
Full Legal Name (company, municipality, HOA, utility, etc.)
b. Ms. Frankie Pendergraph, Registered Agent
Signing Official Name and Title
lc. The legal entity who will own this
(Please
system
review 15A NCAC 2T
is:
.0106
Private
(b) for authorized
signing
officials!)
IIFederal • Municipality
• State/County ►1
Partnership ■ Corporation
• Other (specify):
ld. 3924 Browning Place, Suite 1
1e. Raleigh
Mailing Address City
1f. North Carolina lg. 27609
State Zip Code
1 h. 919-669-0385 1 i. 919-754-8663 1j.CDFp
Facsimile
2. Project
E-mail �DINR
2b. Wayne ;tir PR,s 201,9
2a. Adair Place Apartm)entsOrmation:
Brief Project Name (permit will
3. ontact
refer to this name) County Where Project isIi ,
�rson:.�„i1 toad'Te 47 rcil of
-ice
3a. Bryan K Jones, PE
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. 919-221-5222 3c. [e-mail]
Phone Number
(of
an existing permit)
E-mail
If Modification, Permit No.:
1. Project is ►ZI New • Modification
Z
B(3))
(go to Item 2(a))
2. Owner is ■ Public (skip to Item
►:1 Private
2a. If private, applicant will be:
church, single office, etc.) or
etc. - skip to Item B(3))
etc. - go to Item B(2b))
2b. If sold, facilities
owned
(Instruction
Assoc./Developer
by a (must choose one)
C)
(Instruction D)
• Retaining Ownership (i.e. store,
• Public Utility
►:1 Leasing units (lots, townhomes,
• Homeowner
• Selling units (lots, townhomes,
3. City of Goldsboro
Owner of Wastewater Treatment Facility (WVVfF) Treating Wastewater From This Project
O
1'
Q
2
cc
Li-
Z
I—
M
LLl
C.
m
4a. City of Goldsboro Water Reclamation Facility 4b. NC0023949
Name of WWTF
5a. Fork Township Sanitary Dist.
5b. 8"
Main
shopping
WVVfF Permit No.
i1 Gravity
5c. WQ0031074
Owner of Downstream Sewer
6. The origin of this wastewater is
Receiving
(check
Sewer Size ■ Force
Permit # of
centers)
Downstream Sewer (Instruction E)
all that apply):
100 % Domestic/Commercial
• Residential Subdivision
• Retail (Stores,
% Industrial (attach
►1 Apartments/Condominiums
• Institution
• Hospital
• Mobile Home Park
description.)
(RO: contact your Regional Office
Pretreatment staff)
% Other (specify):
• School
• Church
■ Restaurant
■ Nursing Home
• Office
• Other (specify):
or permitted for this
particular
be permitted
project: 21,600
7. Volume of wastewater to be allocated
GPD gallons per day
*Do not include future flows
8. If the permitted flow is zero, indicate
or previously
why:
in
of existing
permitted allocations
Line where flow will
Permit No.
in subsequent
permits that connect to this line
NCAC 02T .0303 to determine if a
■ Pump Station, Outfall or Interceptor
■ Flow has already been allocated
• Rehabilitation or replacement
permit is required)
sewer with no new flow expected (see 15A
FTA 12/07

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).
Design flow = 120gpd x 180 Bed = 21,600gpd; 8" dia. max half full; S = 0.4%, N = 0.013
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches)
8
Length (feet)
463
New Gravity or Additional
Force Main
Gravity
0 11. Summary of Pump Stations w/ associated Force Mains to be Permitted (attach additional sheets as necessary)
W
Pump Station Location ID (self chosen - as shown on plans/map for reference)
De (MGDign )ow Operational Point
Z GPM @TDH
O
Power Reliability Option
1 - permanent generator w/ATS;
2 - portable generator w/MTS
Force Main Size Force Main Length
Pump Station Location ID
Design Flow
(MGD)
Operational Point
GPM @TDH
(self chosen - as shown on plans/map for reference)
Power Reliability Option
1 - permanent generator w/ATS; Force Main Size Force Main Length
2 - portable generator w/MTS
Pump Station Location ID
Design Flow
(MGD)
(self chosen - as shown on plans/map for reference)
Operational Point Power Reliability Option
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 6,12 please contact the Central Office PERCS Unit)
13. Does the sewer system comply with the Minimum Design Criteria for the Fast Track 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 0 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 12/07

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?
Stormwater?
® Yes ❑ No ❑ N/A
® Yes ❑ No ❑ N/A
15. Does this project include any high priority lines, [see 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
C. CERTIFICATIONS
1. Owner/Permittee's Certification: (Signature of Signing Official and Project Name)
1 a.
1, Frankie Penderqraph , attest that this application for Adair Place Apt. Sewer Ext. 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 sh be guilty of a Class 2 misdemeanor, which may include a fine not to exceed $10,000
as well as civil penalties up 25,000 per violation.
Signing cial Si
4/—/7-/9
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 Adair Place Apt Sewer Ext. 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 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 143-215.6B, 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
2g. 919-221-5222 2h.
Telephone
2e. NC 2f. 27532
State Zip
2i. [e-mail]
Facsimile E-mail
•
•, `
�
a23
q
�
/'/��;';y`\�
NC PE Seal, Signature & Date
FTA 12/07

IRIDG
,rth
✓ I

Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: Fork Township Sanitary District
Project Name for which flow is -being requested: Adair Apartments Water and Swer Imp.
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 Water Reclamation Facility
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 1.680689
e. WWTP facility's actual avg. flow 8.05
f. Total flow for this specific request .0216
g. Total actual and obligated flows to the facility 9.752289
h. Percent of permitted flow used 68.68 %
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 Firm
(Name or Capacity, *
Number) MGD
Westbrook 40
Hwv 117 7.1
BigCherry 1.0-
(A)
Design
Average Daily
Flow**
(Firm / pf),
MGD
16
2.84
0.4
LittleCherry 0.65 0.26
(B) (C) (D)=(B+C) (E)=(A-D)
Obligated,
Approx. Not Yet Total Current
Current Avg. Tributary Flow Plus
Daily Flow, Daily Flow, Obligated
MGD MGD Flow
Available
Capacity* * *
7.8 1.68 9.48 6.52
4.07 0.0216 4.091-6-1.2516
0.13 0.0216 0.1516 0.2484
0.117 0.0216 .01386 0.2816
* 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 (pt) 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.
Downstream Facility Name (Sewer): City of Goldsboro
Downstream Permit Number: NC0023949
Page 1 of 6
PTCF

sanctions for Flow Tracking/Acceptance form (FTSE) and Planning Assessment Addendum (PAA)
S ction I
WWTP Facility Name: Enter the name of the WWTP that will receive the wastewater flow.
b WWTP Facility Permit #: Enter the NPDES or Non -Discharge number for the WWTP receiving the
wastewater flow.
WWTP facility's permitted flow, MGD: From WWTP owner's NPDES or Non -Discharge permit.
c.
d. Estimated obligated flow not yet tributary to the WWTP, MGD: This includes flows allocated to other
construction projects not yet contributing flow to the collection system. Flows allocated through
interlocal agreements or other contracts not yet contributing flow to the collection system are also
included. For POTWs that implement a pretreatment program, include flows allocated to industrial
users who may not be using all of their flow allocation. Please contact your Pretreatment Coordinator
for information on industrial flow tributary to your WWTP.
As of January 15, 2008 the POTW should have reviewed flow allocations made over the last two years
and reconciled their flow records, to the best of their ability, so it is known how much flow has been
obligated and is not yet been made tributary to the WWTP, in accordance with local policies and
procedures employed by the reporting entity.
e. WWTP facility's actual avg. flow, MGD: Previous 12 month average.
f. Total flow for this specific request, MGD: Enter the requested flow volume.
g. Total actual and obligated flows to the facility, MGD Equals [d + e + f]
h. Percent of permitted flow used: Equals [(g / c)* 100]
For example:
On January 15 a POTW with a permitted flow of 6.0 MGD, reported to the Regional Office that there
is 0.5 MGD of flow that is obligated but not yet tributary. The annual average flow for 2007 is 2.7
MGD. There is a proposed flow expansion of 0.015 MGD.
The first Form FTSE submitted after January 15, 2008 may have numbers like this:
c. = 6.0 MGD
d. = 0.5 MGD
e. = 2.7 MGD
f. = 0.015 MGD
g. = 3.215 MGD
h. = 53.6 %
The next Form FTSE may be updated like this with a proposed flow expansion of 0.102 MGD:
c. = 6.0 MGD
d. = 0.515 MGD
e. = 2.73 MGD
f. = 0.102 MGD
g. = 3.349 MGD
h. = 55.8%
Each subsequent FTSE form will be updated in the same manner.
1
Page 4 of 6
FTSE 04-16

tion
List the pump station name or number and approximate pump station firm capacity, approximate design
average daily flow (A) approximate current average daily flow (B), and the obligated, not yet tributary flow
through the pump station (C) for each pump station that will be impacted by the proposed sewer extension
project. Calculate the total current flow plus obligated flow (D=B+C) and the available capacity (E=A-D).
Include the proposed flow for this project with other obligated flows that have been approved for the pump
station but are not yet tributary (C).
Firm capacity is the maximum pumped flow that can be achieved with the largest pump out of service as
per the Minimum Design Criteria.
Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor (pf) of not
less than 2.5.
If the available capacity (E) for any pump station is < 0, then prepare a planning assessment for that pump
station if the system has future specific plans related to capacity that should be considered in the permitting
process.
(A) (B) (C) (D)=(B+C) (E)=(A-D)
Design
Firm Average
Pump Station Capacity Daily Flow
(Name or Number) MGD (Firm / pf)
Kaw Creek PS 0.800 0.320
Approx.
Current Avg.
Daily Flow,
MGD
Obligated,
Not Yet
Tributary
Daily Flow,
MGD
0.252 0.080
Valley Road PS 1.895 0.758 0.472
0.135
Total Current
Flow Plus
Obligated Available
Flow Capacity*
0.332 -0.012
0.607 0.151
Page 5 of 6
FTSE 04-16

Planning Assessment Addendum Instructions
Submit a planning assessment addendum for each pump station listed in Section II where available capacity
is <0.
A planning assessment for Kaw Creek PS (see example data above) may be performed to evaluate whether
there is significant likelihood that needed improvements or reductions in obligated flows will be in place
prior to activating the flows from the proposed sewer extension project.
If the system decides to accept the flow based on a planning assessment addendum, it is responsible to
manage the flow without capacity related sanitary overflows and must take all steps necessary to complete
the project or control the rate of flow to prevent sanitary sewer overflows.
The planning assessment may identify a funded project currently in design or construction, or a planned
project in the future not yet funded but in a formal plan adopted by the system. The system should carefully
weigh the certainty of successful timely project completion for any expansion, flow management diversion
or infiltration and inflow elimination projects that are the foundation of a planned solution to capacity
tracking and acceptance compliance.
For example:
Given that:
a. The proportion and amount of obligated, not yet tributary flow accounts for 24 % and 0.080
MGD of the committed flow in Pump Station Kaw Creek; and that
b. The rate of activation of this obligated, not yet tributary capacity is currently approximately 0.01
MGD per year; and that
c. A funded capital project that will provide the required planned capacity, namely
is in design or under construction with
planned completion in ; and/or
d. The following applies:
The master plan and ten year capital plan contain recommended scope and funding for a capital project
entitled Kaw Creek Pump Station upgrade with funding planned in July 2014. This project is planned to
add 0.100 MGD to the firm capacity of the pump station by October 2015. Inclusion of this proposed
capital project as a condition of this Flow Tracking/Acceptance for Sewer Extension Permit Application
elevates this project's priority for funding and construction to be implemented ahead of the activation of
obligated, not yet tributary flows in amounts that exceed the firm pump station capacities identified in
Section II above.
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.
Page 6 of 6