WQ0034507_Application (FTSE)_20091204

MCDAVID ASSOCIATES' INC.
Engineers • Planners • Land Surveyors
CORPORATE OFFICE
[phone] • Fax [phone]
E-mail: [e-mail]
3714 N. Main Street • P.O. Drawer 49
Farmville, NC 27828
December 2, 2009
Mr. Al Hodge
Environmental Regional Supervisor
Washington Regional Office
Division .of Water Quality
943 Washington Square Mall
Washington, North Carolina 27889
GOLDSBORO OFFICE
[phone] • Fax [phone]
E-mail: [e-mail]
109 E. Walnut Street • P.O. Box 1776
Goldsboro, NC 27533
DEC 0 4 2009
Subject: Fast Track Application
Fork Township Sanitary District
Kangaroo Pump Station & Force Main
Wayne County, North Carolina
Dear Mr. Hodge:
The Fork Township Sanitary District requires a permit to construct a pump station and force main. Please
find attached two copies of the following items supporting their request:
1. Fast -Track Application (EFTA 12/07 ver5)
2. Check in the amount of $480.00 from The Pantry (Check No. 594698, dated 08/13/09)
3. FTSE Form completed by Fork Township Sanitary District to address their downstream pump station
4. FTSD Form completed by City of Goldsboro to address their downstream pump stations and their
acceptance of the flow at the WWTP
5. USGS Topographic Map
6. Watershed Classification Form
7. Variance Request Letter from Fork Township Sanitary District
8. Plans and Specifications
9. Design Notes
We look forward to a permit in the near future. Should you have any questions, do not hesitate to call me.
Sincerely,
McDAVID ASSOCIATES, INC.
Cecil G. adden, Jr., P.E.
Goldsboro Office
Attachments
Cc: Fork Township Sanitary District
Mr. Todd Grinolds, The Pantry, Inc.
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DWQ.DOC

Fork Township Sanitary District
P.O. Box 1515
Goldsboro, North Carolina 27533
[phone]
December 1, 2009
Mr. Adrian Eaton
Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
Subject: Variance Request
Pump Station Design Criteria
Kangaroo Pump Station
Fork Township Sanitary District
Wayne County, NC
Dear Mr. Eaton,
The purpose of this letter is to request a variance. 15A NCAC 02T .0305 (h) (4) states, "The
Public shall be restricted access to the site and equipment." In this case the Kangaroo Convenience Store
is currently served by two septic tanks piped in series with a single grinder pump placed in the final
chamber of the second tank. The pump then doses a nitrification field. Access to the single pump is
simply by removing a manhole lid. We propose to replace the simplex pump with dual grinder pumps, in
the same pump chamber; and direct the flow to an existing force main owned and operated by the District.
Controls will be inside a locked stainless steel NEMA 4X control panel. Access to the pumps will
continue to be made by removing a manhole lid.
The tanks are located in the store's parking lot under 6-inches of concrete. It is not appropriate to
fence in the area. Providing a locking mechanism could result in a hazard to customers' tires. The
existing facility has been in existence for greater than 12 years with no incidents of vandalism. We
propose to drill and tap the lid and rim directly above the pump chamber to restrict access. A picture is
attached to show you the existing situation.
Your approval of this request for variance will be appreciated. If you have any questions
concerning this, please do not hesitate to contact me, or our engineers.
Sincerely,
FORK TOWNSHIPS ITARY DISTRICT
AAA)
enry Braswell
Chairman
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FOR VARIANCE.DOC

osewbod
EXISTING
8
eade5w.
PROPOSED
FTSD KANGAROO
PUMP STATION AND
2" FORCE MAIN
WAYNE COUNTY
SN• NOVEMBER 2009
uth
Center •

OF A7 State of North Carolina
Department of Environment and Natural Resources
7 Division of Water Quality
DEC 0 4 2009 FAST -TRACK APPLICATION
(FTA 12/07 ver5)
for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
(Pressure & Vacuum sewer systems are not to he included as part of this application package)
INSTRUCTIONS: Indicate that you have included/addressed the following list of required application package items by
checking the space provided next to each applicable item. Failure to submit all required items will lead to your application
being returned as incomplete. Forms are available from the web site or by calling the Regional Office serving your county:
http://h2o. enr. state. nc. us/percs/Collection%20Systems/CollectionSystemApplications. html
® A. Application Form - Submit one original and one copy of the completed and appropriately executed application
form. The application should include a project narrative describing the final build -out 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.). Only
include the modified information in this permit application - do not duplicate project information that has already
been included in the original permit.
Any changes to this form will result in the application being returned. The Division of Water Quality (Division) will
only accept application packages that have been fully completed with all applicable items addressed. You do not
need to submit detailed plans and specifications unless you respond NO to Item B(13).
Separate applications should be made for non-contiguous sewer systems.
® B. Application Fee - Submit a check in the amount of $480 made payable to: North Carolina Department of
Environment and Natural Resources (NCDENR). Checks shall be dated within 90 days of application submittal.
❑ C. Certificates of Public Convenience and Necessity — If the application is being submitted in the name of a
privately -owned public utility, submit two copies of the Certificate of Public Convenience and Necessity (CPCN)
which demonstrates that the public utility is authorized to hold the utility franchise for the area to be served by the
sewer extension. If a CPCN has not been issued, provide two copies of a letter from the North Carolina Utilities
Commission's Public Staff that states that an application for a franchise has been received, that the service area
is contiguous to an existing franchised area, and/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.
❑ D. Operational Agreements — Submit one original and two copies of a properly executed operational agreement, as
per 15A NCAC 02T .0115, if the application is submitted by a private applicant and will be serving residential or
commercial lots (e.g., houses, condominiums, townhomes, outparcels, etc.) that will be sold to another entity. If
the applicant is a home or property owner's association, use Form HOA 02/03. If the applicant is a developer,
use Form DEV 02/03. EVEN IF THE PROJECT MAY BE TURNED OVER TO A MUNICIPALITY UPON
COMPLETION, FORM DEV 02/03 IS REQUIRED.
® E. Downstream Sewer, WWTF Capacity and Flow Tracking/Acceptance — FORM FTSE 10/07 (Flow
Tracking/Acceptance for Sewer Extension Permit Applications) is required with every application. The applicant
(and owners of downstream sewers, pump stations and/or treatment facilities submitting FORM FTSE-10/07)
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 10/07
from the owner of the downstream sewer and owner of the WWTF, if different. The flow acceptance indicated in
FORM FTSE-10/07 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-10/07 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 project -specific FTSE 10/07.
F Map — Submit an 8.5-inch by 11-inch COLOR copy of a USGS Topographic Map of sufficient scale to identify the
entire project area and the closest surface waters. Each map or maps must show the location of the sewer line
and pump stations and be of reproducible quality. Include a street level map showing the downstream connection
point, and the permit number for the downstream sewer, if known.
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• • G. Stream Classifications — Watershed Classification Attachment (Form WSCAS-12/07) If any portion of the
sewer system project is within 100 feet of any surface water or wetlands, the Watershed Classification Attachment
may need to be completed. A variance must be requested for encroachment within required setbacks or buffers
pursuant to 2T .0305 (f) and be indicated in Item B-13 with supporting documentation/justification provided.
❑ H Environmental Assessments — If this project is subject to an Environmental Assessment (EA) [15A NCAC
O1C], this application cannot be used. Send the project application on the most current version of Form
PSFMGSA to the Design Management Unit, 1633 Mail Service Center, Raleigh, NC 27699-1633. Applications
cannot be accepted until a Finding of No Significant Impact (FONSI) or Environmental Impact Statement (EIS)
has been issued. A copy is to be submitted with that permit application.
❑ I. 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 this project, please indicate in B(12) and give the permit
number of the second treatment facility.
® J. 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 Fast -Track
Permitting of Pump Stations and Force Mains (most recent version), as applicable to the project.
THE COMPLETED FTA 12/07 APPLICATION PACKAGE, INCLUDING ALL SUPPORTING
DOCUMENTS AND $480 FEE, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional Office
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
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
610 E. Center Avenue
Mooresville, North Carolina 28115
[phone]
[phone] Fax
Alexander, Caban-us, Catawba, Cleveland,
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
Stanly, Union
Raleigh Regional Office
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
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
127 Cardinal Drive Extension
Wilmington, North Carolina 28405
[phone]
[phone] Fax
Brunswick, Carteret, Columbus, Duplin, New
Hanover, Onslow, Pender
Winston-Salem Regional Office
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
For more information, please visit our web site at:
http://h2o. enr. state. nc. us/peresJCollection % 20Systems/Col/ectionSystemsHome.html
or contact the Regional Office serving your county.
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USE THE TAB KEY TO MOVE FROM FIELD TO FIELD!
Application Number:
(to be completed by DWQ) -�
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1. Owner/Permittee:
la. Fork Township Sanitary District
Full Legal Name (company, municipality, HOA, utility, etc.)
lb. Henry Braswell, Chairman
Signing Official Name and Title (Please review 15A NCAC 2T .0106 (b) for authorized signing officials!)
1 c. The legal entity who will own this system is:
❑ Individual ❑ Federal ❑ Municipality ❑ State/County 0 Private Partnership 0 Corporation ® Other (specify): San. Di.
ld. Fork Township Sanitary District, P.O. Box 1515 le. Goldsboro
Mailing Address City
1f. North Carolina
State
lh. [phone]
li. [phone]
Telephone Facsimile
2. Project (Facility) Information:
2a. Kangaroo Pump Station & Force Main
Brief Project Name (permit will refer to this name)
3. Contact Person:
3a. Tony McCabe
lg. 27533
1j.
Zip Code
E-mail
2b. Wayne County
County Where Project is Located
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. [phone]
Phone Number
3c. [e-mail]
E-mail
1. Project is ® New 0 Modification (of an existing permit) If Modification, Permit No.:
2. Owner is ® Public (skip to Item B(3)) 0 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 C)
❑ Homeowner Assoc./Developer (Instruction D)
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
4a. Goldsboro WWTP 4b. NC 0023949
5a.
Name of WWTF
Fork Township San. Dist. 5b. 8-inch
Owner of Downstream Sewer Receiving Sewer Size
6. The origin of this wastewater is (check all that apply):
❑ Residential Subdivision
❑ Apartments/Condominiums
❑ Mobile Home Park
❑ School
❑ Restaurant
❑ Office
❑ Gravity
® Force Main
WWTF Permit No.
5c. WQ 0031A74
Permit # of Downstream Sewer (Instruction E)
❑ Retail (Stores, shopping centers)
❑ Institution
❑ Hospital
❑ Church
❑ Nursing Home
❑ Other (specify): Convenience Store
with food preparation.
100 % Domestic/Commercial
% Industrial (attach
description.)
(RO: contact your Regional Office
Pretreatment staff)
Other (specify):
7. Volume of wastewater to be allocated or permitted for this particular project: 2,185 gallons per day
*Do not include future flows or previously permitted allocations (60 gal/100 sf) x 3642 sf.
8. If the permitted flow is zero, indicate why: N/A
❑ Pump Station, Outfall or Interceptor Line where flow will be permitted in subsequent permits that connect to this line
0 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)
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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).
3,642 gal x (60 gal/100sf) = 2,185 gpd
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches)
2-inches
Length (feet) New Gravity or Additional
Force Main
1,490 feet T 2,$ A . % Force Main
in 11. Summary of Pump Stations wl associated Force Mains to be Permitted (attach additional sheets as necessary)
W
M Pump Station Location ID Kangaroo Pump Station (self chosen - as shown on plans/map for reference)
Design Flow Operational Point Power Reliability Option
Z (MGD) GPM @TDH 1 - permanent generator w/ATS; Force Main Size Force Main Length
0 2 - portable generator wIMTS
V .002185 mgd ADF Tributary 30 GPM @ 55.88' 2 — and 24 hours storage
2-inches 1.490 ft
Z
0
l Pump Station Location ID NA (self chosen - as shown on plans/map for reference)
Q
B. PERMIT
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
Pump Station Location ID NA (self chosen - as shown on planslmap for reference)
Design Flow
(MGD)
Operational Point
GPM @TDH
Power Reliability Option
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 2'd 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 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 ® 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
O k' h y PERTINENT TO THE VARIANCE WITH YOUR APPLICATION
rZ
4ccess to the wetwell is by a bolted down manhole cover. The wetwell is existing and is under 6" of paving in an existing
parking lot. Installing a locking cover may be hazardous to customer's tires. The facility has been in place
pi ILA 1.0
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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?
Sedimentation and Erosion Control Plan?
Stormwater?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
® N/A Directional Bore
® N/A Less than one acre.
® 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 N.A.
1. Owner/Permittee's Certification: (Signature of Signing Official and Project Name)
1, Henry Braswell, Chairman , attest that this application for the Kangaroo Pump Station & Force Main 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 /yell as civil penaltiM up to $25, 000 per violation.
gning Official Sighat re
i2-2-o5
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, _Cecil G. Madden, Jr., P.E. , attest that this application for Kangaroo Pump Station & 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 143-215.6B, 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. Cecil G. Madden, Jr., P.E.
Professional Engineer Name
2b. McDavid Associates, Inc.
Engineering Firm
2c. P.O. Box 1776
Mailing Address
2d. Goldsboro
City
2g. [phone] 2h. (919) 7335-7351 2i.
E-mail
Telephone Facsimile
= SEAV QU
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2e. NC 2f. 27533 .<2- °°� � �;���•`
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State Zip `P000�BG. wiAD0,0%)
[e-mail]
NC PE Seal, Signature & ate
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FILES\CONTENT.IE5\P3TQYOTO\KANGAROO_APPLICATION_PTA_12-07_VER5[ I ].000'

FORM WSCAS-12/07
WATERSHED CLASSIFICATION ATTACHMENT
FOR SEWER SYSTEMS
Applicant Name
Project Name
Fork Township Sanitary District (FTSD)
Kangaroo Pump Station & FM
Professional Engineer Name
Engineering Firm Name
Cecil G. Madden, Jr.
McDavid Associates, Inc.
Goldsboro Office
Location
ID
Name of Waterbody'
County
River
Basin
Waterbody
Stream Index No.
Waterbody
Classification
1
Unnamed Tributary to
Cogdell's Pond which is
Tributary to "The Canal"
Wayne
NEUSE
27-57-21.3
C; NSW
DEC 0 4 20G9
If unnamed, indicate "unnamed tributary to X", where Xis the named waterbody to which the unnamed tributary joins.
1 certify that as a Registered Professional Engineer in the State of
North Carolina that I have diligently followed the Division's
instructions for classifying waterbodies and that the above
classifications are inclusive of the stated project, complete and
correct to the best of my knowledge and belief.
PE Seal, Signature and Date
*** END OF FORM WSCAS-12/07 ***
©?
FORM: WSCAS-12/07
Page 1 of 1

•
NC DENR - DIVISON OF WATER QUALITY
.0315 NEUSE RIVER BASIN
2B .0300
Name of Stream
Class
Description Class Date Index No.
Dennis Branch
Mill Creek
Buck Swamp
Peacock Branch
Smith Mill Run
Little River
Little River
The Canal
Little River
Little River
From source to Little River WS-IV;NSW 08/03/92 27-57-20.5
From source to Little River WS-IV;NSW 08/03/92 27-57-20.7
From source to Mill Creek WS-IV;NSW 08/03/92 27-57-20.7-1
From source to Buck Swamp WS-IV;NSW 08/03/92 27-57-20.7-1-1
From source to Little River WS-IV;NSW 08/03/92 27-57-21
From a point 0.6 mile WS-IV;NSW,CA 08/03/92 27-57-(21.1)
downstream of Smith Mill
Run to City of Goldsboro
water supply intake
From City of Goldsboro C;NSW 08/03/92 27-57-(21.2)
water supply intake to U.S.
Hwy. 70
From source to Little River C;NSW
From U. S. Highway 70 to a B;NSW
point 1.0 mile downstream
from U. S. Highway 70
08/03/92 27-57-21.3
08/03/92 27-57-(21.4)
From a point 1.0 mile C;NSW 08/03/92 27-57-(22)
downstream from U.S. 70 to
Neuse River
Borden Field Ditch From source to Little River C;NSW 05/01/88 27-57-23
Big Ditch From source to Neuse River C;NSW 05/01/88 27-58
Neuse River Cut -Off From source to Neuse River C;NSW 05/01/88 27-59
Poplar Branch From source to dam at Gold B;NSW 05/01/88 27-60-(1)
Park lake
Poplar Branch
From dam at Gold Park Lake C;NSW 05/01/88 27-60-(2)
to Neuse River
Caraway Creek From source to Neuse River C;NSW
Unnamed Tributary at Camp From source to dam at Camp B;NSW
Traillee Traillee Lake
05/01/88 27-61 '
05/01/88 27-61-1-(1)
Unnamed Tributary at Camp From dam at Camp Traillee C;NSW 05/01/88 27-61-1-(2)
Traillee Lake to Caraway Creek
Stoney Creek From source to Neuse River C;NSW 05/01/88 27-62
Stoney Run From source to Stoney Creek C;NSW 05/01/88 27-62-0.5
Howell Creek From source to Stoney Creek C;NSW 05/01/88 27-62-1
Reedy Branch From source to Stoney Creek C;NSW 05/01/88 27-62-2
Billy Branch From source to Stoney Creek C;NSW 05/01/88 27-62-3
Fellows Branch From source to Neuse River C;NSW 05/01/88 27-63
Green Branch From source to Neuse River C;NSW 05/01/88 27-64
Pine Level Branch From source to Neuse River C;NSW 05/01/88 27-65
Cabin Branch From source to Neuse River C;NSW 05/01/88 27-66
Sleepy Creek From source to lower dam at B;NSW 05/01/88 27-67-(1)
Camp Carver Lake
Sleepy Creek
Burnt Mill Branch
Burnt Mill Branch
From lower dam at Camp C;NSW 05/01/88 27-67-(2)
Carver Lake to Neuse River
From source to dam at Camp B;NSW 05/01/88 27-67-3-(1)
Tuscarora Lake
From dam at Camp Tuscarora C;NSW 05/01/88 27-67-3-(2)
Lake to Sleepy Creek
Page 20 of 43 2009-10-31 06:22:20

State of North Carolina
PG Department of Environment and Natural Resources
7 Division of Water Quality
Flow Tracking/Acceptance for Sewer Extension Permit Applications
(FTSE —10/07)
Project Applicant Name: Fork Township Sanitary District
Project Name for which flow is being requested: Kangaroo Pump Station & Force Main
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:
b. WWTP Facility Permit #: DEC 0 4, 2009
All flows are in MGD
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
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
Pump Station No. 2
Approx. Capacity, MGD Approx. Current Avg.
(Firm/Design) Daily Flow, MGD
0.576 MGD . O 1 2-
III. Certification Statement:
I, I4 IJi2 j, ajsz eJ ( , certify that, to the best of my knowledge, the addition of the
volume of watewater 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 I and II for which 1 am the responsible party. Signature of this form indicates
acce nce of this astewater flow.
L L4 /Z-2_09
Date
Signing Of_ficibl Signa re

TF9 State of North Carolina
OG Department of Environment and Natural Resources
Division of Water Quality
Flow Tracking/Acceptance for Sewer Extension Permit Applications
(FTSE —10/07)
Project Applicant Name: Fork Township Sanitary District
Project Name for which flow is being requested: Kangaroo Pump Station & Force Main
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 #: NC0023494
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
DEC 0 4 2009
All flows are in MGD
14.2
0.0424
6.79
0.0022
6.8346
48.1%
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
Little Cherry 0.65 MGD
Big Cherry 1.0 MGD
Highway 117 7.1 MGD
Westbrook 18 MGD
0.003 MGD
0.004 MGD
0.22 MGD
6.79 MGD
III. Certification Statement:
I, Joseph R. Huffman, 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 I and II for which I am the responsible party. Signature of this form indicates acceptance of
this wastewate fl w.
IC�ICII J
/ 2 -o 2 -og
Si. ' ' g ignature Date

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