WQ0036050_Application (FTSE)_20120628

MCDAVID ASSOCIATES, INC.
N C. Engineers • Planners • Land Surveyors
CORPORATE OFFICE
[phone] • Fax [phone]
E-mail: maitbmcdavid-inc.com
3714 N. Main Street • P.O. Drawer 49
Farmville, NC 27828
Al Hodge, Supervisor
Washington Regional Office
943 Washington Square Mall
Washington, NC 27889
SUBJECT:
Dear Mr. Hodge:
June 28, 2012
GOLDSBORO OFFICE
[phone] • Fax [phone]
E maiL [e-mail]
109 E. Walnut Street • P.O. Box 1776
Goldsboro, NC 27533
v41 00s0050
Fast Track Application
Wayne Water Districts Office Building Sewer Extension
City of Goldsboro
Wayne County, NC
Enclosed please find the following items:
1. Check in the amount of $480.00
2. Fast Track Application (1 original, 1 copy)
3. Flow Tracking Form (1 original, 1 copy)
4. Color USGS Topographic Map (2 copies)
5. Street Level Connection Point Map (2 copies)
RECEIVED
JUL -22012
DWQ-WARO
If you have any questions concerning this, please do not hesitate to contact me.
Sincerely,
McDAVID ASSOCIATES, INC.
7i'‘6.-,er
Ivey P. Cauley, EI
Goldsboro Office
IPC:
Enclosures
cc: Rama Chittilla
EWSD
\'G-PC 1\D 1005\FFL\2012 1 120628
EWSD-CN153-WWD OFFICE-DWQ FAST-TRACK-LTRdoc

'ANiECEIVE
State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
JUL - 2 2012 FAST-'1'KACK APPLICATION
(PIA 12/07 )
D, A Q—W /� s e & Vac SEWERS, PUMP STATIONS, AND FORCE MAINS
�(V V V f'1 ssure & Vacuum sewer systems are not to be included as part of this application package)
INSTRUCTIONS: Indicate that you have induded/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/Collection SystemApplications. 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,
dearly 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 02J03. 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.
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 WACAS-12/07) If any portion of the
project boundary is within 100 feet of any surface water or wetlands, the Watershed Classification Attachment
must be completed.
H Environmental Assessments — If this protect 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]
(704)4)�663-6040 Fax
Alexander, Cabarrus, Catawba, Cleveland,
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
Stanly, Union
Raleigh RegionaeCEIv_rulail
YY ��"��
l 11 _ 2
Service Center
Raleigh, North Carolina 27699-1628
[phone]
919) 788-7159 Fax
Chatham, Durham, Edgecombe, Franklin,
Granville, Halifax, Johnston, Lee, Nash,
Northampton, Orange, Person, Vance, Wake,
Warren, Wilson
Washington Regional Office
�., ..
1 � `I ;A(2
943 Washington Square Mall
(2 ) n, North Carolina 27889
)��4 gg481
[phone] Fax
Beaufort, Bertie, Camden, Chowan, Craven,
Currituck Dare, Gates, Greene, Hertford, Hyde,
Jones, Lenoir, Martin, Pamlico, Pasquotank,
Perqulmans, 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/
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 DW Q) Q 003 ba S 0
A. APPLICATION INFORMATION
1. Owner/Permittee:
1 a. City of Goldsboro
Full Legal Name (company, municipality, HOA, utility, etc.)
1 b. Scott A Stevens, City Manager
Signing Official Name and Title (Please review 15A NCAC 2T .0106 (b) for authorized signing officials!)
1 c.
The legal entity
• Individual
who will
■ Federal
own this system
@ Municipality
is:
■
State/County ■ Private Partnership ■ Corporation ■ Other (specify):
1 d. PO Drawer A
le. Goldsboro
Mailing Address
City
lf. North Carolina
lg. 27533
RECEIVED
State
Zlp Code
1h. [phone]
1i. N/A
•
1j. N/A
2 2012
Telephone
Facsimile
E-mail JUL
2. Project (Facility) Information:
2a. Wayne Water Districts Office Building Sewer Extension
2b. Wayne n
Brief Project Name (permit will refer to this name)
County Where ProjbelI
3. Contact Person:
3a. Rama Chittilla
Name and Affiliation of Someone Who Can Answer Questions About
this Application
3b. [phone]
3c. [e-mail]
Phone Number
E-mail
1. Project is
■ New
•
Modification (of an existing permit) If Modification, Permit No.:
B. PERMIT INFORMATION
Owner Is @ Public (sk(o to Item B(3)) • 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))
ri Qnllinn .,niio /Inh, 1,umh.,n-, non run f, lfe.., Q/9h11
M
•
Public Utility (Instruction C)
Homeowner Assoc./Developer (Instruction D)
3. City of Goldsboro
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
4a. City of Goldsboro WWTP
4b. NC0023949
Name of WWTF
WWTF Permit No.
5a. City of Goldsboro
5b. 12"
El Gravity
5c.
Owner of Downstream Sewer
Receiving Sewer Size
LI Force Main
Permit # of Downstream Sewer (Instruction E)
8. The origin of this wastewater is (check all that apply):
IIResidential Subdivision
•
Retail
100 % Domestic/Commercial
■ Apartments/Condominiums
•
(Stores, shopping centers)
Institution
0.0 % Industrial (attach
•
•
•
@
Mobile Home Park
School
Restaurant
Office
•
•
■
•
Hospital
Church
Nursing Home
Other (specify):
description.)
(RO: contact your Regional Office
Pretreatment staff)
% Other (specify):
7.
Volume of wastewater to be allocated or permitted for this particular project 625 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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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).
25 employees in a single shift/day office 25 x 25 gpd = 625 gpd
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches)
8" Gravity Sewer
12" Gravity Sewer
Length (feet)
New Gravity or Additional
Force Main
340 New Gravity
- 605 --- ---- New Gravity
11. Summary of Pump Stations w/ associated Force Mains to be Permitted (attach additional sheets as necessary)
W
Pump Station Location ID
Z — -
Design Flow
Z (MGD)
0
Z
0
H
2
0
LL
Z
1--
g
re
W
a
m
N/A
Operational Point
GPM @TDH
(self chosen - as shown on plans/map for reference)
Power Reliability Option
1 - permanent generator w/ATS;
2 - portable generator wIMTS
Force Main Slze
Force Main Length
Pump Station Location ID
Design Flow
(MGD)
N/A
Operational Point
GPM @TDH
(self chosen - as shown on plans/map for reference)
Power Reliability Option
1 - permanent generator w/ATS; Force Main Slze Force Main Length
2 - portable generator w/MTS
Pump Station Location ID
Design Flow
(MGD)
N/A (self chosen - as shown on plans/map for reference)
Operational Point
GPM @TDH
Power Reliability Option
1 - permanent generator w/ATS;
2 - portable generator w/MTS
Force Main Slze
Force Main Length
2. 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
PERTINENT TO THE VARIANCE WITH YOUR APPLICATION
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4. Have the following permits/certifications been submitted for approval for the system or project to be served?
Wetiand/Stneam Crossings - General Permit or 401 Certification?
Sedimentation and Erosion Control Plan?
Stormwater? (Goldsboro)
❑ Yes ❑ No
® Yes ❑ No
® Yes ❑ No
Z N/A
❑ N/A
❑ N/A
5. 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
if Yes: ❑ and provide details
Owner/Pemmittee's Certification: (Signature of Signing Official and Protect Name)
1, Scott Stevens, attest that this application for the Wayne Water Districts Office Sewer Extension has been reviewed by
me and Is accurate and complete to the best of my knowledge. I understand that if all requked parts of this application
are not completed and that if all requred supporting documentation and attachments are not Included, this application
package is subject to being returned as incomplete. Note: In accordance wffh North Carolina General Statutes 143-
215.6A and 143-215.6B, any person who knowingly makes any faise 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
penalt u• to $25,000 violation.
C PA G -V-iz.
Si • ng Official Signature
Date
NGINEERING DESIGN DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL OF THIS
,APPLICATION. THESE DOCUMENTS MUST INCLUDE PLAN AND PROFILE OF SEWERS, THEIR PROXIMITY
lTO OTHER UTILITIES, DESIGN CALCULATIONS. ETC. REFER TO 15A NCAC 02T .0305
Professional Engineer's Certification: (Signature of Design Engineer and Protect Name)
1, F Tyndall Lewis, P.E., attest that this application for the Wayne Water Districts Office Sewer Extension 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. F. Tyndall Lewis, P.E.
Professional Engineer Name
b. McDavld Associates, Inc.
Engineering Fimi
c. PO Box 1776
Mailing Address
d. Goldsboro
City
g. 919-736-7630 2h.919-735-7351
Telephone
Facsimile
E-mail
A. \�
g 7.469 to k
-
4
NC PE Sea , gnature & Date
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�F W A7- 9 State of North Carolina
PG Department of Environment and Natural Resources
Division of Water Quality
Flow Tracking/Acceptance for Sewer Extension Permit Applications
(FI SE —10/07)
Project Applicant Name: City of Goldsboro
Project Name for which flow is being requested:Wayne water Districts Office,Commercial Drive
More than one 1, 15E-10/O7 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
WWTP Facility Permit #: NC 0023949
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
f_ Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
All flows are in MGD
14.2
0.47865
8.35
0.000625
8.829275
62.18 %
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
Piedmont Lift Station 0.40 0.002
Westbrook Road 18.0
6.7RECEIVED
JUL - 2 2012
DWQ-WARO
IIL Certification Statement:
I, Scott A Stevens , certify that, to the best of my knowledge, the addition of the
volume of wastewater to be permitted in this project has been evaluated along the route to the receiving
w stewater 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 . • ve in Sections and II for which I am the responsible party. Signature of this form indicates
accep ce;
gning Official Signature Date

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PROPOSED SANITARY SEWER
PROJECT LOCATION MAP
EASTERN WAYNE SANITARY DISTRICT
JUNE 2012