WQ0031242_Application (FTSE)_20000116

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FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PALA 1
OF�1F9 State of North Carolina
S>G Department of Environment and Natural Resources
r Division of Water Quality
FAST -TRACK APPLICATION
for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
(Pressure sewers systems are not to be included as part of this application per)
INSTRUCTIONS: Indicate that you have included the following list of required application package items by checking the
space provided next to each item. Failure to submit all required items will lead to your application being returned as
incomplete or additional processing and review time. This form may be photocopied for use as an original.
IZI 1. Application Form - Submit one original and one copy of the completed and appropriately executed application
form. 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(12).
® I1. Application Fee - Submit a check in the amount of $400 made payable to: North Carolina Department of
Environment and Natural Resources (NCDENR). Checks shall be dated within 90 days of application submittal.
❑ III. 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(2a) of this application.
Operational Agreements — Submit one original and two copies of a properly executed operational agreement if
the sewer extension is permitted 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
homeowners' association, use Form HOA 02/03. If the applicant Is a developer, use Form DEV 02/03. EVEN IF
THE PROJECT WILL BE TURNED OVER TO A MUNICIPALITY, FORM DEV 02/03 IS REQUIRED.
❑ IV.
❑ V. Flow Acceptance Letters — If the owner of the downstream sewers and/or WWTF is different from the applicant,
submit two copies of a flow acceptance letter from the owner of the downstream sewers and WWTF, if different
Flow acceptance letters must contain the following minimum information: applicant and project name, amount of
flow accepted, and name and permit number of the receiving sewers/1NVVTF. The flow acceptance must not
expire prior to permit issuance and must be dated Less than a year prior to the application date.
Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific flow acceptance
letter.
® VI. Map — Submit an 8.5-inch by 11-inch COLOR copy of the portion of a 7.5-minute USGS Topographic Map along
with this form. The map should identify the entire project area location as well as the closest downslope surface
waters as dearly as possible. Each map portion must be labeled with the map name and number, the identified
location of the sewer line and pump stations, and be of clear and reproducible quality. For instance, if the project
involves 4 miles of interceptor sewer that traverses over or near several different waterbodies (or counties,
basins, etc.), the map should have location ID's shown for each different waterbody (where the sewer line is within
100 feet of such waterbody - see Instruction VII). This location ID is self chosen and used to cross reference the
location in Section C of the permit application. ti
❑ Vfl. Stream Classifications — Section C
• If any portion of the project is within 100 feet of any down slope surface water, Section C must be completed
for the pertinent sections.
• If the entire project area is a minimum of 100 feet away from any down slope surface waters BUT there is a
pump station involved where a history of power outage is to be used to provide adequate design storage
FTA 02/03 - Rev. 3 04/05

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE 3
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, visit our web site at htipi/h2o.err.state.nc.us/ndpu/ REC I C)
IAkl1
ICaUOrI IY lHr1 UC'r: i• •,• ••
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD! i (to be Ip by DWQ) W be 319,'-I 2
A. APPLICATION INFORMATION
DWG W
O
la. City of
"'
Full Legal Name (company, municipality, HOA, utility, etc.)
1b. Joseph R. Huffman, City Manager
Signing Official Name and Title (Please review 15A NCAC 2H .0206(b) for authorized signing officials!)
lc.
The
•
legal entity who will own this system is:
Individual ❑ Federal 0 Municipality ■ State/County ❑ Private Partnership
■
Corporation
■
Other (specify):
1 d. 214 N. Center St, P.O. Drawer A
1 e. Goldsboro
Mailing Address
City
1 f. NC
1 g. 27533-9701
State
Zip Code
1 h. 919-580-4330
11. 919-580-4344
1 j. Jhuffman©ci.goldsboro.nc.us
Telephone
Facsimile E-mail
2. Project (Facility) Information:
2a. Kingston Place — Phase 2 2b. Wayne
Brief Project Name (permit will refer to this name) + County Where Project is Located
3. Contact Person:
3a. E. Scoft Edwards, PE (project engineer)
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b. 919-751-5100 13c. [e-mail]
Phone Number 1 E-mail
1. Project is ® New
■
Modification (of an existing permit) If Modification, Permit No.:
Z
0
1--,
For modifications, attach a separate sheet clearly explaining the reason for the modification (i.e. adding another
phase, changing line size/length, etc.). Only include the modified information In thls permit application - do not
duplicate project Information in B(7) and B(10-11) that has already been Included in the original permit
gI2.
Owner is
0
Public (s/dp to Item B(3))
IIIPrivate
(go to Item 2(a))
c
. If private, applicant will be:
2b. If sold, facilities owned by a (must choose one)
LL•
Z
•
■
Retaining Ownership (Le. store, church, single office, etc.) or
Leasing units (lots, townhomes, etc. - slip to Item B(3))
Selling units (lots, townhomes, etc. - go to Item B(2b))
•
•
Public Utility (Instruction III)
Homeowner Assoc./Developer (Instruction IV)
2
3. City of Goldsboro
re W '
W
Owner of Wastewater Treatment Facility (WTF) Treating Wastewater From This Project
0. 14a. Goldsboro Reclamation Facility 4b. NC0023949
Name of WWTF
WWTF Permit No.
m
5a. City of Goldsboro
5b. 8"
Gravity
5c. WQ0024847
Owner of Downstream Sewer
Receiving Sewer Size
Force Main
Permit Number of Downstream Sewer (if known)
FTA 02103 - Rev. 3 04/05

,•
FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE 4
6. The origin of this wastewater is (check all that apply):
j
@
■
Residential Subdivision
Apartments/Condominiums
■
•
Car Wash
Institution
100 % Domestic/Commercial
•
•
•
Mobile Home Park
School
•
■
Hospital
Church
% Industrial
•
Restaurant
•
Nursing Horne
% Other (specify):
•
Office
•
Other (specify):
7.
Volume
of wastewater to be allocated for this particular project: 12,960 gallons per day
*Do
not include previously permitted allocations
8.
If the
■
■
permitted flow is zero, indicate why:
Interceptor Line - Flow will be permitted insubsequent 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
B. PERMIT INFORMATION (CONTINUED)
9. Provide the wastewater flow calculations used in determining the permitted flow hi accordance with 15A NCAC 2H
.0219(1) for Item B(7) or the design flow for line or pump station sizing if zero flow in the space below. Values other than
that in 15A NCAC 2H .0219(1)(1-2) must be supported with actual water or wastewater use data in accordance with 15A
NCAC 2H .0219(1).
36 units x 3 bedrooms x 120 gallons/day = 12,960 gallons per day
10. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (Inches)
Length (feet)
Gravity or Force Main
(use the pull down menu)
8'
1365
Gravity Main
ENTER TOTAL LINE LENGTH IN MILES
028f
11. Summary of Pump Stations to be Permitted (attach additional sheets as necessary)
Location ID
(self chosen - as shown on
plans for cross-reference)
Design Flow
(MGD)
Operational Point
GPM @ TDH
Power Reliability Option
(1- dual Tine feed; 2- permanent generator w/ATS; 3-
portable generator w/telemetry; 4-wet well storagel_
FTA 02/03 - Rev. 3 04/05

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 5
12. 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 2H .0200 as applicable?
® Yes ❑ No tf 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
13. Have the following permits/certifications been submitted for approval?
Wetfand/Stream Crossings - General Permit or 401 Certification? ® Yes ❑ No El N/A
Sedimentation and Erosion Control Plan? ® Yes ❑ No ❑ N/A
Stormwater? ® Yes ❑ No ❑ N/A
14. Does this project involve aerial lines or siphons? No
These lines will be considered high priority and must be checked once every six months
C. STREAM CLASSIFICATION
1. Use the Division's guidance document entitled,
(FAST -TRACK SEWER SYSTEMS)" to collect
necessary). This document is available from
regional office (see Instructions for addresses)
STREAM CLASSIFICATIONS
FOR FORM FTA 02/03
data below (attach additional sheets as
Division of Water Quality
"DETERMINING
and record the stream
our web site or by contacting
OR indicate the following:
classification
the appropriate
is not needed because all parts of the project are at least 100 feet away from any down slope
@ A Stream Classification
waterbody-, AND.
0 A Stream Classification
is not needed because the design does not depend on wet well storage as a power reliability
station near a Class C down slope waterbody.
option for any pump
Location ID on Map
(self chosen - as shown on
map for cross-reference)
Name of
Waterbody
County
River Basin
Waterbody Stream
Index
Waterbody
Classification
Submit
the 8.5" x 11" COLOR
topographic map as required In Instruction VI
whether a classification is provided!
regardless of
FTA 02/03 - Rev. 3 04/05

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS PAGE 6
1. Applicant's Certification:
1, Joseph R. Huffman, attest that this application for Kingston Place Subdivision - Phase 2 has been reviewed by
me and is accurate and complete to die best of my knowledge. I understand that if all required parts of this application
am 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 well as civil
penalties up to $25,000 per violation.
ignature
ional Engineer's Certification:
I attest that this application for KMgston Place Subdivision - Phase 2 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 certain portions of this submittal
package may have been developed by other professionals, 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. Edwln Scott Edwards
Professional Engineer Name
.2b. Cox -Edwards Company, Inc.
Engineering Firm
:2c. 1205 Parkway Drive
Mailing Address
2d. Goldsboro '2e. NC 2f. 27534
City State Zip
2g. 919-751-5100 '2h. 919-751-17.44 2i. [e-mail]
Telephone Facsimile � E-mail
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FTA 02/03 - Rev. 3 04/05

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