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HomeMy WebLinkAboutWQ0036155_Application (FTSE)_20120917MCDAVID ASSOCIATES, INC. l N C. Engineers • Planners • Land Surv�►ors CORPORATE OFFICE (252) 753-2139 • Fax (252) 753-7220 E-mail: maiemcdavid-incrnm 3714 N. Main Street • P.O. Drawer 49 Farmville, NC 27828 Mr. Al Hodge Environmental, Regional Supervisor Washington Regional Office Division of Water Quality 943 Washington Square Mall Washington, North Carolina 27889 Dear Mr. Hodge: September 12, 2012 GOLDSBORO OFFICE (919) 736-7630 • Fax (919) 735-7351 E-mail: malgoldOmcdavid-inc.cem 109 E. Walnut Street • P.O. Sax 1776 Goldsboro, NC 27533 RECEIVED SEP 1 7 2012 DWQ-WARO Subject Fast Track Application Fork Township Sanitary District Goldsboro Wellness Center Wayne County, North Carolina 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'I A 12/07 ver5) 2. Check in the amount of $480.00 from J Edwards Construction Co. Inc (Check No. 1794, dated 08/02/12) 3. 115E Form completed by Fork Township Sanitary District to address their downstream pump station 4. 1'1-SD 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 j,SSOCIATES, INC. Cecil G. Madden, Jr., P.E. Goldsboro Office Attachments Cc: Fork Township Sanitary District Mr. Trey Gurley, P.E. W:\D10XX_GEN\D100X MSW"D1005 CORRES MSW\CGM\2012\FTSD-DR.JIMENEZ OFFICE\TRANSMITTAL OF APPLICATION TO DWQ.DOC RECEIVED SEP ] 7 2012 FAST -TRACK APPLICATION (FTAW,� very) DWQ- SEWERS PUMP STATIONS, AND FORCE MAINS (Pressure & Vacuum sewer systems are not to be included as part of this application package) r=� State of North Carolina Department of Environment and Natural Resources Division of Water Quality 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. st ate. nc. us/percs/Collection%20Systems/CollectionSysternApplications. 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 (Le. 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. W:\D10XX GEN\D100X MSW\D1005 CORRES_MSW\CGM\2012\N1bD-DRJIMENEZOFFTCE\GOLDSBOROWELLNESSCENTERAPPLICATION FTA 12-07 VER5.DOC FTA12/07 ❑ 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 — Ff 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(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 (828) 296-4500 (828) 299-7043 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 (910) 433-3300 (910) 486-0707 Fax Anson, Bladen, Cumberland, Hamett, Hoke, Montgomery, Moore, Robeson, Richmond, Sampson, Scotland Mooresville Regional Office 610 E. Center Avenue Mooresville, North Carolina 28115 (704) 663-1699 (704) 663-6040 Fax Alexander, Cabarrus, Catawba, Geveland, Gaston, Iredell, Lincoln, Mecklenburg, Rowan, Stanly, Union Raleigh Regional Office 1628 Mail Service Center Raleigh, North Carolina 27699-1628 (919) 791-4200 (919) 788-7159 Fax Chatham, Durham, Edgecornbe, Franklin, Granville, Halifax, Johnston, Lee, Nash, Northampton, Orange, Person, Vance, Wake, Warren, Wilson Washington Regional Office 943 Washington Square Mall Washington, North Carolina 27889 (252) 946-6481 (252) 975-3716 Fax Beaufort, Bertie, Camden, Chowan, Craven, Curr[tuck, 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 (910) 796-7215 (910) 350-2004 Fax Brunswick, Carteret, Columbus, Duplin, New Hanover, Onslow, Pander Vlfinston-Salem Regional Office REC i{.•.•.`���D 585 Waughtown Street Winston-Salem, North Carolina 27107 (336) 771-5000 (336) 771-4630 Fax Alamance, Alleghany, Ashe, Caswell, Davidson, Davie, Forsyth, Guilford, Rockingham, Randolph, Stokes, Surry, Watauga, Wilkes, Yadkin S EP 1 7 2012 For more information, please visit our web site at: httpJ/h2o.enr.state.nc. us/perrs/Collection%20Systems/CollectlonSystemsHome.html or contact the Regional Office serving your county. Q� nw:MIAMI C_I W�IIW/5CORRES_MSW\CGM\2012\FTSD-DRJTMENEZ OFFICE\GOLDSBORO WELLNESS CENTER APPLICATION FTA 12-07 VER5.DOC FTA12/07 • USE THE TAB KEY TO MOVE FROM FIELD TO FIELD! Application Number: 0 (to be completed by DW Q) QC , A. APPLICATION INFORMATION 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 entity • Individual who will ■ Federal own this system is: ■ Municipality ■ 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 lg. 27533 State Zip Code lh. (919) 736-2551 li. (919) 735-6565 1 J. Telephone Facsimile E-mail 2. Project (Facility) Information: 2a. Goldsboro Wellness Center 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. (919) 736-2551 3c. ftsd2@bellsouth.net Phone Number E-mail 1. Project is @ New • Modification (of an existing permit) If Modification, Permit No.: B. PERMIT INFORMATION 2. Owner is ►i Public (skip to Item B(3)) • Private (go to Item 2(a)) 2a. 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) 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, ForkTownshl• San. Dist. 5b. 8-inch Gravity 5c. Owner of Downstream Sewer Receiving Sewer Size Force Main Permit # of Downstream Sewer (Instruction E) 6. The origin of this wastewater is (check all that apply): Subdivision • Retail (Stores, shopping centers) 100 % Domestic/Commerclal • Residential • Apartments/Condominiums • institution • Hospital % Industrial (attach • Mobile Home Park ■ School ■ Restaurant @ Office • Church • Nursing Home ■ Other (specify): Convenience Store with food preparation. description.) (RO: contact your Regional Office Pretreatment staff) % Other s ( pec►fy): 7. Volume of wastewater to be allocated or permitted for this particular project: 1,500 gallons per day *Do not Include future flows or previously permitted allocations 6 practitioners @ 250 gpd ea. = 1,500 gpd 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) W:\D 1 OXX GEN\D 100X_MSW\D 1005_CORRES_MSW\CGM\2012\FI'SD-DR]IMENEZ OFFICE\GOLDSBORO WELLNESS CENTER APPLICATION FTA 12-07 VU 5.DOC FTA12/07 Z 1-- Z 0 U Z 0 H ce 0 LL H ce LLI m 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). 6 Practitioners x 250 gpd each = 1,500 gpd 3 Practitioners initially with a build -out to 6 Practitioners 10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary) 1 Size (inches) 1.25-inches Length (feet) 575 feet .1 . New Gravity or Additional Force Main Force Main Summary of Pump Stations w/ associated Force Mains to be Permitted (attach additional shots as necessary) ump Station Location ID N/A Design Flow (MGD) Operational Point GPM @TDH 12GPM @70' (self chosen - as shown on plans/map for reference) Power Reliability Option 1 - permanent generator w/ATS; Force Main Slze 2 - portable generator w/MTS 2 — and 24 hours storage 1.25-inches Force Main Length 575 ft Pump Station Location ID NA Design Flow (MGD) Operational Point GPM @TDH (self chosen - as shown on plans/map for reference) Power Reliability Option 1 - permanent generator w/ATS; 2 - portable generator w/MTS Force Maln Slze Force Main Length Pump Station Location ID NA Design Flow (MGD) Operational Point GPM @TDH (self chosen - as shown on plans/map for reference) Power Reliability Option 1 - permanent generator w/ATS; 2 - portable generator w/MTS Force Main Slze Force Main Length 12. Will the wastewater flow in the proposed sewer lines or pump stations be able to be directed to another treatment facility? ❑ Yes ® No If Yes, permit number of 2nd treatment facility (RO — if "yes" to B,12 please contact the Central Office PERCS Unit) 13. Does the sewer system comply with the lAnimum 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 W:\D10XX GEN\D 100X MSW\D1005 CORRES_MSW\CGM\2012\11SDDRJIMENEZOFFICE\GOLDSBOROWELLNESSCENTERAPPLICATION FrA 12-07 VER5.DOC FTA12/07 14. Have the following permits/certifications been submitted for approval for the system or project to be served? Wetland/Stream Crossings - General Permit or 401 Certification? Sedimentation and Erosion Control Plan? Stormwater? ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ® N/A No Stream Crossing ® 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. co Z 0 H IIL H cL W V V Owner/Permittee's Certification: (Signature of Signing Official and Protect Name) 1, Henry Braswell, Chairman , attest that this applccation 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 alrequted parts of this application are not completed and that if all required supporting documentation and attachments are not included, this application package Is subject to being returned as incomplete. Note: In accordance with North Carolina General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false statement, representation, or certification in any application shall be guilty of a Class 2 misdemeanor, which may include a fine not to exceed $10,000 as w l as civil penalties to $25,000 per violaatttiionn.. rj Igning Official Sig ature Date NGINEERING DESIGN DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL OF THIS PPLICATION. THESE DOCUMENTS MUST INCLUDE PLAN AND PROFILE OF SEWERS, THEIR PROXIMITY 0 OTHER UTILITIES, DESIGN CALCULATIONS. ETC. REFER TO 15A NCAC 02T .0305 Professional Engineer's Certification: (Signature of Design Engineer and Protect Name) 1, Cecf G. Madden, Jr., P.E. , attest that this application for Goldsboro Wellness Center Pump Station and 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 Minknum 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, l►clusion 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. a. Cecil G. Madden, Jr., P.E. Professional Engineer Name b. McDavid Associates, Inc. Engineering Firm c. P.O. Box 1776 Mailing Address 2d. Goldsboro 2e. NC City 2f. 27533 State Zip 2g. (919) 736-7630 2h. (919) 7335-7351 Telephone Facsimile 2i. cgm@mcdavid-inc.com E-mail ``4. ( SEAL. �E 16359 , ''F� pZ7 54�; ` 7/5 !2_ 4datattottty NC PE Seal, Signature & Date W:\D10XX GEN\D100X MSW\D1005 CORRES MSW\CGM\2012\FTSD-DR.TIMENEZOFFICE\GOLDSBOROWELLNESSCENTERAPPLICATION FTA_12-07_VER5.DOC FTA12/07 FORM WSCAS-12/07 WATERSHED CLASSIFICATION ATTACHMENT FOR SEWER SYSTEMS Applicant Name Project Name Fork Township Sanitary District Goldsboro Wellness 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 1 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 correct to the best Of my knowledge and belief. PE Seal, Signature and Date ► END OF FORM WSCAS-12/07 *** RECEIVED SEP 17 2012 FORM: WSCAS-12/07 DWQ-WARD Page 1 of 1 State of North Carolina Department of Environment and Natural Resources Division of Water Quality Flow Tracking/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: Goldsboro Wellness Center More than one N 1 ME-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 Approx. Current Avg. (Firm/Design) Daily Flow, MGD Pump Station No. 2 0.576 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 for whici I am the responsible party. Signature of this form indicates acceptance of this wastewater flow. RECEIVED SEP172012 DWQ-WARO Signing Official Signature Date State of North Carolina Department of Environment and Natural Resources Division of Water Quality Flow Tracking/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: Goldsboro Wellness Center More than one F'1 E-10/07 may be required for a single project if'the owner of the WW1P 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 £ 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 MGD 9 i5-IMIGD 0.41 ati I 8.35 MGD _ 0.0015 MGD 8.83775 MGD g l 1 41 _62.24% j Q. /' 7„ 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 Hi. iwa 117 7.1 MGD/firm 0.22 Westbrook 18 MGD/firm 6.79 III. Certification Stgtement: I, _Scott Stevens, Te.4 Manager , 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 Sec ns I and II for which I am the responsible party. Signature of this form indicates accep s ..- ihis - Signing jzcial Signature Date W:\DIOXX_GEN\D100X_MSW\D I005_CORRES_MSWCGM\2012\FISD-DRJIMENEZ OFFICE GOLDSBORO - GOLDSBORO WELLNESS CENTER- PS & FM FISE 10 07 FINALDOC -,r . ‘\\•„. ) Cem fr USGS MAP NORTHWEST GOLDSBORO (N3522.5-W7800/7.5) = 2000' UNNAMED TRIBUTARY TO LITTLE RIVER POSITIVE DISPLACEMENT DUPLEX GRINDER PUMP STATION A FORK TOWNSHIP SANITARY DISTRICT PROPOSED PUMP STATION AND FORCE MAIN TO SERVE GOLDSBORO WELLNESS CENTER SCALE: 1" = 2000' "e• r