WQ0036093_Application (FTSE)_20120813

MCDAVID ASSOCIATES, INC.
Engineers • Planners • Land Surveyors
CORPORATE OFFICE
[phone] • Fax [phone]
E-mail: mai#mcdavid-inc.com
3714 N. Main Street • P.O. Drawer 49
Farmville, NC 27828
August 2, 2012
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 maigold#mcdavid-inc.com
109 E. Walnut Street • P.O. Box 1776
Goldsboro, NC 27533
RECEIVED
AUG - 6 2012
DWQ-WARO
Subject: Fast Track Application
Fork Township Sanitary Disliict
Goshen Medical Center
Wayne County, North Carolina
Dear Mr. Hodge:
The Fork Township Sanitary District requires a permit to construct a gravity sewer extension. Please find
attached two copies of the following items supporting their request:
1. Fast -Track Application (1-"IA 12107 ver5)
2. Check in the amount of S480.00 from Adair, LLC (Check No. 779, dated 08/02/12)
3. 1-15E 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
We look forward to a permit in the near future. Should you have any questions, do not hesitate to call me.
Sincerely,
McDAVID ASSOCIA . , INC.
ecil G. Madden, J, P.E.
Goldsboro Office
Attachments
Cc: Fork Township Sanitary District
Mr. Steve Keen, Adair, LLC
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APPLICATION TO DWQ.DOC

RECEIVE
AUG -62012
DWQt-
State of North Carolina
D Department of Environment and Natural Resources
Division of Water Quality
FAST -TRACK APPLICATION
(FTA 12/07 ver5)
WERS, PUMP STATIONS, AND FORCE MAINS
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 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/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 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.
Z 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.
W:\DIOXX GEMD10OX MSWD1005 CORRES MSWCQM\2O12\FTSD-0OSHEN MEDICAL CENIFA\GOSHEN MEDICAL CENTER APPLICATION FTA 12-07 VERSDOC.

® '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 ProfRs-sional 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, Biaden, 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, 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, Allegheny, 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. ustperes/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: W�A
(to be completed by DW Q) 0� q J!. Q
A. APPLICATION INFORMATION
1. Owner/Permittee:
1 a. Fork Township Sanitary District
Full Legal Name (company, municipality, HOA, utility, etc.)
1b. Henry Braswell, Chairman
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): San. Di.
1 d. Fork Township Sanitary District, P.O. Box 1515
le. Goldsboro
Mailing Address
City
If. North Carolina
1g. 27533
State
Tip Code
lh. [phone]
11. [phone]
1 j.
Telephone
Facsimile
E-mail
2. Project (Facility) Information:
2a. Goshen Medical Center Sewer Extension
2b. Wayne County
Brief Project Name (permit will refer to this name)
County Where Protect Is Located
3. Contact Person:
3a. Tony McCabe
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
2. Owner is 0 Public (skit) to Item B(3))
■ Private (go to Item 2(a))
2a. If applicant will be:
2b. if sold, facilities owned by a (must choose one)
private,
• 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)
3. City of Goldsboro
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
4a. Goldsboro WWTP
4b. NC 0023949
Name of WWTF
WWTF Permit No.
5a. Fork Townshi• San. Dist.
5b 12-inch
Gravity
5c.
Owner of Downstream Sewer
Receiving Sewer Size
Force Main
Permit # of Downstream Sewer (Instruction E)
B. The origin of this wastewater is (check all that apply):
• Retail (Stores, shopping centers)
100 % Domestic/Commerclal
•
•
Residential Subdivision
Apartments/Condominiums
■Institution
II Hospital
% Industrial (attach
•
•
•
►_�
Mobile Horne Park
School
Restaurant
Office
• Church
• Nursing Home
El Other (specify): Dr's Office & Fitness
Center
description.)
(RO: contact your Regional Office
Pretreatment staff)
Other (specify):
7.
Volume
of wastewater to be allocated or permitted for this particular pro}ect 6,350 gallons per day
*Do
not include future flows or previously permitted allocations
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
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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B. PERMIT INFORMATION (CONTINUED}
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 dentists + 3 hygienists + 5 doctors x 250 GPD) + (7,200 sf wellness/fitness center x 50/100) = 8,350 gpd.
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (Inches)
Length (feet)
New Gravity or Additional
Force Main
12-Inches
512 feet .—)5 , % r- v,....;
, Gravity
11. Summary of Pump Stations w/ associated Force Mains to be Permitted (attach additional sheets as necessary)
Pump Station Location ID N/A (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
NA
(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 NA (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 2"d treatment facility
(RO — if 'yes" to B,12 please contact the Central Office PERCS Unit)
13.
1'
cry
Does
Mains
applicable?
0
the
(latest
Yes
�-t
r,.�t
sewer system comply with the Minimum Design Criteria for the Fast Track Permitting 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
4
lJ N
S ° I ......)1 Q r-, seJ/.lrJ oc.a--dyJio--,S, �jo t.�4Cl TL& telDC
as r� �+-- t'a ?cry..`w..0 1-i 11, 101%-a{ I:-•1-.
W:\D1OXX GEN\D1OOX MSW\D1005 CORRES MSW\CGM\20 LZFISD-GOSHEN MEDICAL CENTER \GOSHEN MEDICAL CENTER APPLICATION F A 12-07 VER5.DOC

14. Have the following permfts/certiflcadons been submitted for approval for the system or project to be served?
Wetland/Stream Crossings - General Permit or 401 Certification? ❑ Yes ❑ No ® N/A WQC No. 3884 Exempt
Sedimentation and Erosion Control Plan? ❑ Yes ❑ No ® N/A Less than one acre.
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: ❑ and provide details N.A.
C. CERTIFICATIONS
1. Owner/Permittee's Certification: (Signature of
1, Henry Braswell, Chairman , attest
Signing Official
that this application
best of my knowledge.
documentation
Note:
makes
which
and Project Name)
for the Goshen Medical Center has been reviewed
by me and is accurate and complete to the
are not completed and that if all requred supporting
package is subject to being returned as incomplete.
215.6A and 143-215.6B, any person who knowingly
application shal be guilty of a Class 2 misdemeanor,
penalties up t. '. 25, 000 per violat'
I understand that if all required parts of this application
and attachments are not included, this application
In accordance with North Carolina General Statutes 143-
any false statement, representation, or certification in any
may include a fine not to exceed $10,000 as well as civil
!� /��
�7
1a. -0�/ /% L)wei / O/1?
Signing • "dal Signature (/Date
ENGINEERING DESIGN DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL OF THIS
APPLICATION. THESE DOCUMENTS MUST INCLUDE PLAN AND PROFILE OF SEWERS, THEIR PROXIMITY
TO OTHER UTILITIES, DESIGN CALCULATIONS. ETC. REFER TO 15A NCAC 02T .0305
+. Professional Engineer's Certification: (Signature
I, Cecil G. Madden, Jr., P.E. , attest
of Design
that this application
with the information
I further
the applicable
the Minimum
and the watershed
certain portions
reviewed this
General Statutes
certification In
as well as civil
Engineer and Project Name)
for the Goshen Medical Center has been reviewed
by me and Is accurate, complete and consistent
supporting documentation to the best of my knowledge.
design has been prepared in accordance with
Gravity Sewers adopted February 12, 1996, and
Stations and Force Mains adopted June 1, 2000
Although other professionals may have developed
under my signature and seal signifies that I have
proposed design. Note: In accordance with NC
makes any false statement, representation, or
which may include a fine not to exceed $10,000
in the engineering plans, calculations, and all other
attest that to the best of my knowledge the proposed
regulations, Gravity Sewer Minimum Design Criteria for
Design Criteria for the Fast -Track Permitting of Pump
classification in accordance with Division guidance.
of this submittal package, inclusion of these materials
material and have Judged It to be consistent with the
143-215.6A and 143-215.6B, any person who knowingly
any application shall be guilty of a Class 2 misdemeanor
penalties up to $25,000 per violation.
a. Cecil G. Madden, Jr., P.E.
;':�
k; AR
l �E. apt 4 "
1,4),.
SEAL 1
16359 e,
ar
��C ��^j�E�t►+_`\�� //7-
4
ieaio G m gOv „,,,
NC PEttlieltAlgoilattire & Date
Professional Engineer Name
b. McDavid Associates, Inc.
Engineering Firm
+c. P.O. Box 1776
Mailing Address
od Goldsboro
e. NC
. 27533
City
state
ZP
- - -
g. [phone]
--
2h. (919) 7335 7351
1. cgm@mcdav�d �nc.com
Telephone
Facsimile
E-mail
W:\DIOXX GEN\D100X MSWD1005 CORRES MSWCGM\2012\FTSD-GOSHENMEDICAL CENTER \OOSHENMEDICALCENTERAPPLICATIONFFA 12-07 VERSDOC

FORM WSCAS-12/07
WATERSHED CLASSIFICATION ATTACHMENT
FOR SEWER SYSTEMS
Applicant Name
Project Name
Fork Township Sanitary District
Goshen Medical Center
Professional Engineer Name
Engineering Firm Name
Cecil G. Madden, Jr. P.E.
McDavid Associates, Inc.
Location
ID
Name of Waterbody'
County
River
Basin
Waterbody
Stream Index No.
Waterbody
Classification
1.
.Unnamed Trib. To Little Riv.
Wayne
Neuse
27-57-(20.2)
WS-IV NSW
If unnamed, Indicate "unnamed tributary to X", where X Is the named waterbody to which the unnamed tributary Joins.
I 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
con-ect to the best of my knowledge and belief.
PE Seal, Signature and Date ►
*** END OF FORM WSCAS-12J07 ***
FORM: WSCAS-12/07
Page 1 of 1

W A 1 State of North Carolina
�14 Department of Environment and Natural Resources
7 Division of Water Quality
Flow Tracldng/Acceptance for Sewer Extension Permit Applications
(FT SE —10/07)
Project Applicant Name: _Fork Township Sanitary District
Project Name for which flow is being requested: Goshen Medical Center
More than one P1SE-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 #:
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
€ 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
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
(Fii in/Design)
_ Pump Station No. 1 0.4608 MGD
_ Pump Station No. 2 0.576 MGD
Approx. Current Avg.
Daily Flow, MGD
_0.006 MGD
0.015 MGD
III. Certification Statement:
I, Henry Braswell, Chairman , 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 ,r which I amresponsible party. Signature of this form indicates
acceptance of this wastewater.
/'44
Signing Official Signatu e
7//0//
Date

7-lZ-Q
Signing Official Signature ' City Manager Date
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 Town Ship Sanitary District
Project Name for which flow is being requested: Goshen Medical Center, US 70 West
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 #: 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
0.479275
8.35
0.000635
8.82991
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
Little Cherry 0.65 mgd 0.003
Big Cherry 1.0 mgd 0.004
Highway 117 Pump Station 7.1 mgd/firm 0.22
Westbrook Pump Station 18 mgd/firm 6.79
III. 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
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 wastewater flow. /

Name
Index Number
Neuse River Basin
Classification Class Date
Description
Special Designation
Burnt Stocking Branch 27-57-19-1 C;NSW
From source to Little Creek
Spring Branch 27-57-20 C;NSW
(From source to Little River
Little River 27-57-(20.2) WS-IV;NSW
From Spring Branch to a point 0.6 mile downstream of Smith Mill Run
Dennis Branch 27-57-20.5 WS-IV;NSW
(From source to Little River
Mill Creek 27-57-20.7 WS-IV;NSW
From source to Little River
Buck Swamp 27-57-20.7-1 WS-IV;NSW
From source to Mill Creek
Peacock Branch 27-57-20.7-1-1 WS-IV;NSW
From source to Buck Swamp
Smith Mill Run 27-57-21 WS-IV;NSW
From source to Little River
Little River
27-57-(21.1) WS-IV;NSW,CA
From a point 0.6 mile downstream of Smith Mill Run to City of Goldsboro water supply intake
27-57-(21.2) C;NSW
Little River
From City of Goldsboro water supply intake to U.S. Hwy. 70
The Canal
27-57-21.3 C;NSW
From source to Little River
Little River
27-57-(21.4) B;NSW
!From U. S Highway 70 to a point 1.0 mile downstream from U. S. Highway 70
Little River
27-57-(22) C;NSW
-ir
From a point 1.0 mile downstream from U.S. 70 to Neuse River
Borden Field Ditch
From source to Little River
Big Ditch
From source to Neuse River
Neuse River Cut -Off
From source to Neuse River
27-57-23 C;NSW
27-58 C;NSW
27-59 C;NSW
1L
05/01/88
05/01/88
08/03/92
08/03/92
08/03/92
08/03/92
08/03/92
08/03/92
08/03/92
08/03/92
08/03/92
08/03/92
08/03/92
05/01/88
05/01/88
05/01/88
Tuesday, February 14, 2012
Based on Classifications as of 20120208 Page 27 of 72

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FTSD - CONTRACT NO. 200 ,
PROPOSED SEWER
EXTENSION TO SERVE
GOSHEN MEDICAL CENTER