WQ0035251_Application (FTSE)_20110211

MCDAVID ASSOCIATES, INC.
Engineers • Planners • Land Surveyors
CORPORATE OFFICE
[phone]•F2x(252)753-7220
E-mail [e-mail]
3714N.Main Street •P.O.Drawer 49
Farmvilk, NC 27828
Mr. Robert Tankard
Washington Regional Office
Division of Water Quility
943 Washington Square Mall
Washington, NC 27889
SUBJECT:
Dear Mr. Tankard.
February 11 , 2011
GOLDSBORO OFFICE
[phone] • Fax [phone]
E-mail: [e-mail]
109 E. Walnut Street • P.O. Box 1776
Goldsboro, NC 27533
VVOS5ZSI
DWQ Sewer Permit Application
Contract No. 202-O'Reilly Sewer Service Extension
Fork Township Sanitary District
Wayne County, NC
Enclosed please find the following items:
1. Permit application fee in the amount of $480.00
2. Flow Tracking/Acceptance for Sewer Extension Permit for FTSD
3. Flow/Tracking/Acceptance for Sewer Extension Permit for owner of receiving WWTF (City
of Goldsboro)
4. Completed Permit Application (1 copy and 1 original)
5. Project narrative
6. USGS 8 1/2" x 11" project area map
7. Street level map illustrating the point of downstream connection to existing sewer
Please review and approve subject permit application. If you have any questions concerning this,
please do not hesitate to contact me.
Sincerely,
McDAVID ASSOCIATES, INC.
F. Tynda Lewis, P.E.
Goldsboro Office
TAL:
Enclosures
cc: FTSD
,;
2011
�f ivy
FEB 2 3
l/G-PC I/D 1005/TAL/2011 1
FTSD-CN202-DWQ-SEWER-PERMIT-APPLICATION-LTR.doc
110208

PROJECT NARRATIVE
Subject project involves the construction of approximately 177 LF 12"ductile iron gravity sewer
line to provide sanitary sewer services for a proposed O'Reilly Auto Parts store. Proposed sewer
improvements will connect to an existing manhole located at the southwest comer of the existing adjacent
shopping plaza The proposed sewer extension will flow into an existing 12" gravity sewer line and then
into existing Pump
Station No.1 located approximately 760 to the east from the point where the proposed sewer extension ties
into the existing sewer line along US Highway 70. The wastewater is then pumped from Pump Station No.
1 to Pump Station No. 2 via an 8" force main along US Highway 70 and NCSR 1243. The wastewater is
then conveyed approximately 700 LF east via force main along NC 581 where it is discharged into an
existing manhole. The aforementioned 12" gravity line, force mains, Pump Station No. 1, Pump Station
No. 2 are all owned, operated, and maintained by Fork Township Sanitary Distiict. All of the remaining
downstream sewer utilities to include the WWTF are owned, operated, and maintained by the City of
Goldsboro.
Fork Township Sanitary District will design, construct, own, operate, and maintain all such
proposed improvements. The calculated sewer flow in accordance with 15A NCAC 2T .0114 equates to
700 gallons per day giving consideration to stores and shopping centers without food service are calculated
at a rate of 100 gal/1000 sq.ft. per 2T specifications and the square footage of the building for the proposed
auto parts franchise is 7,000 square feet. A copy of an excerpt from the 2T rules is included as an
attachment that assigns the previously mentioned said design flow rate value.
//G-PC 1/D I005/I'AL'2011/I 1 SD-CN202-DWQ-NARRATIVE.doc 110208

Car wash facilities (if recycling water see Rule .0235)
Sports centers
Bowling center
Fitness, exercise, karate or dance center
Tennis, racquet ball
Gymnasium
Golf course with only minimal food service
Country clubs
Mini golf, putt -putt
Go-kart, motocross
Batting cages, driving ranges
Marinas without bathhouse
Marinas with bathhouse
Video game arcades, pool halls
Stadiums, auditoriums, theaters, community centers
Stores, shopping centers, malls and flea markets
Auto, boat, recreational vehicle dealerships/showrooms
with restrooms
Convenience stores, with food preparation
Convenience stores, without food preparation
Flea markets
Shopping centers and malls with food service
s an ' s i oppm centers wi out ood service
Transportation terminals — air, bus, tram, erry, port and dock
1200 gal/bay
50 gaUlane
50 ga1/100 sq ft
50 gal/court
50 gal/100 sq ft
250 gaUplumbing fixture
60 gaUmember or patron
250 gal/plumbing fixture
250 gal/plumbing fixture
250 gal/plumbing fixture
10 gal/slip
30 gaUslip
250 gal/plumbing fixture
5 gal/seat
125 gal/plumbing fixture
60 gal/100 sq ft
250 gal/plumbing fixture
30 gal/stall
130 gal/1000 s
5—gal/passenger
(d) Design daily flow rates for proposed non-residential developments where the types of use and occupancy are not
known shall be designed for a minimum of 880 gallons per acre or the applicant shall specify an anticipated flow based
upon anticipated or potential uses.
(e) Conditions applicable to the use of the above design daily flow rates:
(1) For restaurants, convenience stores, service stations and public access restroom facilities, higher
design daily flow rates shall be required based on higher expected usage where use is increased
because of its proximity to highways, malls, beaches, or other similar high use areas.
(2) Residential property on barrier islands and similar communities located south or east of the Atlantic
Intracoastal Waterway used as vacation rental as defined in G.S. 42A-4 shall use 120 gallons per day
per habitable room. Habitable room shall mean a room or enclosed floor space used or intended to be
used for living or sleeping, excluding kitchens and dining areas, bathrooms, shower rooms, water
closet compartments, laundries, pantries, foyers, connecting corridors, closets, and storage spaces.
(f) An adjusted daily sewage flow design rate shall be granted for permitted but not yet tributary connections and future
connections tributary to the system upon showing that a sewage system is adequate to meet actual daily wastewater flows
from a facility included in Paragraph (b) or (c) of this Rule without causing flow violations at the receiving wastewater
treatment plant or capacity related sanitary sewer overflows within the collection system as follows:
(1) Documented, representative data from that facility or a comparable facility shall be submitted by an
authorized signing official in accordance with Rule .0106 of this Section to the Division as follows for
all flow reduction request:
(A) Dates of flow meter calibrations during the time frame evaluated and indication if any
adjustments were necessary.
A breakdown of the type of connections (e.g. two bedroom units, three bedroom units) and
number of customers for each month of submitted data as applicable. Identification of any
non-residential connections including subdivision clubhouses/pools, restaurants, schools,
churches and businesses. For each non-residential connection, information as identified in
Paragraph (c) of this Rule (e.g. 200 seat church, 40 seat restaurant, 35 person pool
bathhouse).
Owner of the collection system.
Age of the collection system.
Analysis of inflow and infiltration within the collection system or receiving treatment plant,
as applicable.
Where a dedicated wastewater treatment plant serves the specific area and is representative
of the residential wastewater usage, at least the 12 most recent consecutive monthly average
(B)
(C)
D)
(E)
(F)
NORTH CAROLINAADMEN'S I'RATIVE CODE Ef. January 1, 2009 12

/ )PR P
O'i I9Y,$ITEI
• PR PO •
12" GR
lk SEWER
EXIST!
GW.P;;VI TY
WER
"•-
%77:%O. •
NN•
USGS MAP
NORTHWEST GOLDSBORO
(N3522.5-w7800/7.5)
1" = 2000'
, Meaddw...
STG "••
,i0F GOLD
SYSTEM
ATTACHMENT "A"
PROPOSED O'REILLY
SEWER EXTENSION
WAYNE COUNTY
FEBRUARY .2011
Cen /), u th \\
5

II
STA. 1+77
PROPOSED
MANHOLE NO. 12
IiIM = 133.18
INV (E) = 121.46
INV (W) = 121.56
PROPOSED
12" DIP, CLASS 51
STUB -OUT
PROPOSEQ
12" DIP, CLASS 51
SANITARY SEWER
II
III
II O'Reilly Auto Pars
II'o II I�
/
III
II
133
BIbN CLL
133.1
J317
-134
3. L� - ` 4
,.�Jf
. l' . --_
,I. US:. HIGHWAY .70 1 _'t
I '
tuT
133.3 PVT
1"=40'
DOWNSTREAM PERMIT
# WQ0031074
3" WATER LINE
EXISTING
NATURAL
tl I GAS UNE
3
I; I
STA. 0+00
�I I EXISTING
d MANHOLE NO. 11
•
RIM = 133.95
;EXIST. INV (E) = 120.92
'PROP. INV (W) = 121.02
I(TO BE CORED & BOOTED
'IN THE FIELD)
"1 I SA
,1
f-
PROPOSED
POINT OF
CONNECTION
W
ATTACHMENT "B"
PROPOSED O'REILLY
GRAVITY SEWER EXTENSION
WAYNE COUNTY
FEBRUARY 2011

State of North Carolina
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 flaw is being requested: O'Reilly Sewer Service Extension
More than one 1,1 SE-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 #: NC0023949
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
0.2596
6.79
0.0007
7.0503
49.65%
H. 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 P.S. 0.65 0.003
Big Cherry PS 1.00 . 0.004
Highway 117 PS
.: Westbrook Road PS_
7.1 0.22
18.0 6.79
III. Certification Statement:.
I, Joseph R. Huffman , certify that, to the best of my knowledge, the addition_oftkie
volume of wastewater to be permitted in this project has been evaluated along the roi4e 'toj tleTteceipmg
wastewater treatment facility and that the flow from this project is not anticipated to cause anyre�pity
Il.;.
related sanitary sewer overflows or overburden any downstream pump station en route to the g
treatment plant under normal circumstances. This analysis has been perfornfeaan MordtrW,e wit j: a1
established policies and procedures using the best available data. This certification applies to ose i ms
listed above in Sections I and II for which I am the responsible P'y•Si nature of this -form in ts
accep :-� t 'stewater flow
g Official Signature
Date

State of North Carolina
`Q�" ` 4G Department of Environment and Natural Resources
Division of Water Quality
o -mac Flow Tracking/Acceptance for Sewer Extension Permit Applications
(F1 SE —10/07)
Project Applicant Name: Fork Township Sanitary District
Project Name for which flow is being requested: o' Reilly Sewer Service Extension
More than one 1i 1SE-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 #:
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 Approx. Capacity, MGD Approx. Current Avg.
(Firm/Design) Daily Flow, MGD
Pump Station No.1
Pump Station No. 2
0.460 MGD .00g
0.576 MGD ,0/2_
III. Certification Statement: r ' \ \'/
I, Henry Braswell , 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 r cel•.jj�g
wastewater treatment facility and that the flow from this project is not anticipated to caFtieBa4 gapfrLity
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 abcordance"wit} ao�cal F Ct
established policies and procedures using the best available data. This certification applies to.,those-items• - --y
listed above in Sections I and II for which I am the responsible party. Signatuhe=of tl i -(rm indicates
acceptance of this wastewater flow.
Signing Official Signature
/1 ICf lcle-g9 t`/ Z(.• !
Date

OF WATER State of North Carolina
`a, 4�G Department of Environment and Natural Resources
e 1 Y t . Division of Water Quality
-c FAST- '1'RACK APPLICATION
(FlA 12/07 ver5)
for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
(Pressure & Vacuum sewer systems are not to be 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 retumed as incomplete. Forms are available from the web site or by calling the Regional Office serving your county:
http✓/h2o. enr. state. nc. us/peres/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 retumed. The Division of Water Quality (Division) will
only accept application packages that have been fully completed with all applicable items addressed. You do not
nccd to submit detailed plans and specifications unless you respond NO to Item B(13).
Separate applications should be made for non-contiquous 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-12J07) 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 — tf this project is subject to an Environmental Assessment (EA) [15A NCAC
01C], 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(1 b). 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, Cabarrus, 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, Bete, 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/peres/Collection%20Systems/CollectlonSystemsHome.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)
Q O v 3 5-Z S
A.` APPLICATION,'INF'ORMATION
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!)
lc.
The legal en who will
• Individuals Federal
District
own this system
■ Municipality
is:
■ State/County
■ Private Partnership
■ Corporation
0
Other (specify): Sanitary
1 d. P.O. Box 1515
le. Goldsboro
Mailing Address
City
1 f. NC
lg. 27533
State
Zip Code
lh. [phone]
li. [phone]
1j. N/A
Telephone
Facsimile
E-mail
. Project (Facility) Information:
+a. O'Reilly Sewer Service Extension
2b. Wayne
Brief Project Name (permit will refer to this name)
County Where Project is Located
. Contact Person:
a. F. Tyndall Lewis, P.E.
Name and Affiliation of Someone Who Can Answer Questions About
this Application
b. [phone]
3c. [e-mail]
Phone Number
E-mail
1. Project is ►iI New
•
Modification (of an existing permit) If Modification, Permit No.:
r $ PERMIT INFORMATION
2. Owner is
►Z4
Public (skip to Item B(3))
IN
Private (go to Item 2(a))
a. 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
• Leasing units (lots, townhomes, etc. - skip to Item B(3))
■ Selling units (lots, townhomes, etc. - go to Item B(2b))
■
•
Public Utility (Instruction C)
Homeowner Assoc./Developer (Instruction D)
K. City of Goldsboro
Owner of Wastewater Treatment Facility (VWVTF) Treating Wastewater From This Project
• a. City of Goldsboro Water Reclamation Facility
4b. NC 0023949
Name of WWTF
VVWTF Permit No.
.a. Fork Township Sanitary
5b. 12"
Gravity
District
Receiving Sewer Size
■
Force Main
5c. WQ 0031074
Owner of Downstream Sewer
Permit # of Downstream Sewer (Instruction E)
•. The origin of this wastewater is (check all that apply):
100 % Domestic/Commercial
•
•
Residential Subdivision
Apartments/Condominiums
►4
•
Retail (Stores, shopping centers)
Institution
% Industrial (attach
■
■
IN
•
Mobile Home Park
School
Restaurant
Office
•
•
■Nursing
•
Hospital
Church
Home
Other(specify):Pretreatment
description.)
(RO: contact your Regional Office
staff
% Other (specify):
Volume
of wastewater to be allocated or permitted for this particular project: 700 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)
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110208

_ P T
i y=B PERMIT{ INFORMATION (CONTINUED)t {
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).
(100gpd/1,000sgft)X7,000sgft=700gpd
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches)
Length (feet)
New Gravity or Additional
Force Main
12' DIP
177 LF 7 O
New Gravity
11. Summary of Pump Stations w/ associated Force Mains to be Permitted (attach additional sheets as necessary): N/A
Pump Station Location ID (self chosen - as shown on plans/map for reference)
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)
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)
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
12. Will
• Yes
the
0
wastewater flow in the proposed sewer lines or pump stations be able to be directed to another treatment facility?
No If Yes, permit number of 2nd treatment facility
(RO — if yes' to B,12 please contact the Central Office PERCS Unit)
13.
Does
Mains
applicable?
0
the
(latest
Yes
sewer system comply with the Minimum Design Criteria for the Fast Track Pemiitting of Pump Stations and Force
version), the Gravity Sewer Minimum Design Criteria (latest version) and 15A NCAC Chapter 2T as
■ 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
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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 401 Certification? ['Yes ❑ No ® N/A
Sedimentation and Erosion Control Plan? D Yes ❑ No ® N/A
Stormwater? ['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: Eland provide details : WA
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1. Owner/Permittee's Certification: (Signature of Signing Official and Project Name)
1, Henry Braswell, attest that this application for Fork Township Sanitary District -Contract No. 202-O'Reilly Sewer Service
Extension has been reviewed by me and is
accurate and complete to the best of my knowledge. i understand that if all
and that if all required supporting documentation and attachments
subject to being retumed as incomplete. Note: In accordance with North
any person who knowingly makes any false statement,
shall be guilty of a Class 2 misdemeanor, which may include a fine not
up to $25,000 per violation.
required parts of this application are not completed
are not included, this application package is
Carolina General Statutes 143-215.6A and 143-215.6B,
representation, or certification in any application
to exce d $10,000 as well civil penalties
j
1a. r . — �I- t
Si ni Official Sig atur Date
ENGINEERING DESIGN DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL OF THIS
PPLICATION. THESE DOCUMENTS MUST INCLUDE PLAN AND PROFILE OF SEWERS, THEIR PROXIMITY
O OTHER UTILITIES, DESIGN CALCULATIONS. ETC. REFER TO 15A NCAC 02T .0305
2. Professional Engineer's Certification: (Signature of Design Engineer and Project Name)
I, F. Tyndall Lewis, attest that this application for Fork Township Sanitary District -Contract No. 202-O'Reilly Sewer Service
Extension has been reviewed by me and is accurate,
complete and consistent with the information in the engineering
to the best of my knowledge. I further attest that to the best of
prepared in accordance with the applicable regulations, Gravity Sewer
February 12, 1996, and the Minimum Design Criteria for the Fast-
Mains adopted June 1, 2000 and the watershed classification in accordance
may have developed certain portions of this submittal package,
and seal signifies that I have reviewed this material and have judged it to
In accordance with NC General Statutes 143-215.6A and 143-215.6B, any
representation, or certification in any application shall be guilty of a
not exceed $10, 000 as well as civil penalties up to $25, 000 per violation.
plans, calculations, and all other supporting documentation
my knowledge the proposed design has been
Minimum Design Criteria for Gravity Sewers adopted
Track Permitting of Pump Stations and Force
with Division guidance. Although other professionals
inclusion of these materials under my signature
be consistent with the proposed design. Note:
person who knowingly makes any false statement,
Class 2 misdemeanor which may include a fine
a. F. Tyndall Lewis, P.E. GAL-7—
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NC PE Seal, Signature & Date
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Professional Engineer Name
r b . McDavid Associates, Inc.
Engineering Firm
rC. P.O. Box 1776
Mailing Address
rd. Goldsboro
f. 27533
City2e
State
Zip
2g. [phone] h. 919 735-7351
i. [e-mail]
Telephone I Facsimile
E-mail
W:\D10xc_gen\D100x msw\D1005_couca_msw\Tal\2011\FTSD-CN202-DWQ-PSFM-FTA-12-07-v5.doc
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