WQ0031336_Application (FTSE)_20070214

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE 1
State of North Carolina
Department of Environment and Natural Resources
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 package)
INSTRUCTIONS: Indicatethat you. have Includedthe following Ilst 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 firm may be photocopied for use as an original.
131 I. 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).
® 11. Application Fee - Submit a check In the amount of $400 made payable to: North Carolina Department of
Environment and Natural Resources (NCDENR).
❑ III. Certificates of PublicT 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
iscontiguous 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.
❑ IV. 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 02103. 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.
O V. Flow Acceptance Letters —.If theowner of the downstream sewers and/or WWTF is different from the applicant,
submit twocopies of: a flowacceptanceletter from the owner of the downstream. sewers and WWTF, if different.
Flow acceptanceletters must .contain the following minimum information: applicant and project name, amount of
flow accepted, and. name and permit number of the receiving sewers/WWTF. 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 clearly 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.
XVII. 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'
instead of dual feed or permanent or portable generator, Section C must be completed to demonstrate that
the closest down slope surface water is Class C (see 15A NCAC 2H .0219(h)(3)(D)).
• Use the guidance document entitled, "Determining Watershed Classifications for Form FTA 02/03 (Fast -Track
Sewer Systems)" available from . http://h2o.enr.state.nc.us/ndpu or by contacting the appropriate regional
office.

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINSPAGE 2
❑ VIII: Environmental Assessments — If this protect is subject to an Environmental Assessment (EA) [15A NCAC
01C .0500], this application can not be used. Send the project application on Form PSFMGSA 10/99 to the
Non -Discharge Permitting Unit, 1617 Mail Service Center, Raleigh, NC 27699-1617. Applications can not be
processed 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.
g IX. Certifications — Section D
The application must be certified by both the applicant and 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 2H .0200, 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.. Certification by a PE who is unfamiliar with these documents
is subject to NC Board referral.
THE COMPLETED FTA 02/03 APPLICATION PACKAGE, INCLUDING ALL SUPPORTING DOCUMENTS AND $400
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
[phone]
[phone] Fax
Anson, Blader�, Cumberland, Harnett,
Hoke, Montgomery, Moore, Robeson,
Richmond, Sampson, Scotland
Mooresville Regional Office
919 N Main Street,
Mooresville, North Carolina 28115
(704) 663-16gg
[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,
Perquimans, Pitt, Tyrrell, Washington, •
Wayne
Wilmington Regional Office
•
127 Cardinal Drive Extension
Wilmington, North Carolina 28405
[phone]
[phone] Fax
Brunswick, Carteret, Columbus,
Duplln, New Hanover, Onslow,
Ponder
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, visit our web site at http✓/h2o.enr.state.nc.us/ndpu/
i+'r+. /fin --- /1 nA In

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE 3
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD!
Application Number. tGe
(to be completed by DWQ) Lua a4 3133
ifft
w
:1. Owner: FEB 1
la. City of Goldsboro
- Full Legal Name (company, municipality, HOA, utility, etc.)
::1 b. 'Joseph R. Huffman, City Manager
ARO
+....:-
° s
Slgning Official Name and Tnle (Please review 15A NCAC 2H .0208(b) for authorized signing officals!)
`'1c. The legal en' who will own this system Is:
■' Individual ■ Federal ►1! Munlci •.:1 • State/Coun - ■ Pavate Partnershi • i Co • •ration ■ Other : j aFD
1 d. P.O. Drawer A
le. Goldsboro
Street Address
L City_
1f. NC
1g. 27533
State
Zlp Code
1 h. [phone]
11. [phone]
1 j.
Telephone
Facsimile
F-mall
• Project (Facility) Information:
a. Southeast Commercial Park . _ ...
2b. Wayne. .. .. .. .. .
Brief Protect Name (permit will refer to this name)
County Where Protect Is Located
3. Contact Person:
'..
tea. Jeffry L. Komegay, PE, PL$ - Protect Engineer
Name andAfflliation of Someone Who Can Answer Questions About
this Application
b: (919) 735,5886
3c. [e-mail]
Phone Number
E-mail
°.`•,'?'
1. Protect is
►P
New
•
Modification (of an existing permit)
If Modification, Permit No.:
For modifications, attach a separate sheet clearly explaining the
phase, changing line size/length, etc.). Only Include the modified
duplicate project information In B(7) and B(10-11) that has already
reason for the modification i.e. adding another
-Information In•thls permit application - do not
been Included In the original permit.
�+. Owner Is
0
Public (skip to Item B(3))
■
Private (go
to Item 2(e))
k
a.
-
If
IN
•
•
private, applicant will be:, -
Retaining Ownership (i.e. store, church, single office, etc.) or
Leasing units (lots, townhomes, etc.-.sldpto Item B(3))
Selling units (lots, townhomes, etc. -'go to item B(2b))
2b.
If
•
IN
sold, facilities owned by a (must choose -one)
Public Utility (Instruction Ill) '
Homeowner As8ocJDeveloper (Instruction IV)
City'of Goldsboro
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Protect
- -
• a. City of Goldsboro
4b. 23949
WWTF Permit No.
Name of WWTF
' `"`•
. N/A
5b.
5c.
Permit Number of Downstream Sewer (if known)
Receiving Sewer Size
Owner of Downstream Sewer
. Theorigin of this wastewater is (check all that apply):
.'"''
`--"-
■
■
■
•School
Residential Subdivision
Apartments/Condominiums
Mobile. Home Park
■
■
•
II
Gar Wash
Institution
Hospital
�
100 % Domestic/Commercial
% Industrial
.._.*-
::��-'�
�:
0Restaurant
■
Nursing Home
"% Other (specify):
:0
Office
•
Other (specify);
7..
Volume
of wastewater tole jmnlitgi in this protect 7,650' gallons per day
,..
8.
If the
•
■
permitted flow Is zero, indicate why:
Interceptor Line - Flow will be, permitted Is subsequent permits that connect to this Ilne
Flow has already been allocated - in Permit No.
•
Rehabilitation or replacement of existing sewer with no new flow expected
FT 119m1 - Pev 9 f14/f14

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE 4' -
' 9. Provide the wastewater flow calculations used in determining the permitted flow in 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(IX1-2) must be approved prior to submittal of this application. Submit a separate request to
the Division of Water Quality,Non-Discharge Permitting Unit, 1617 Mall Service Center, Raleigh, NC 27699-1617 in
accordance with 15A NCAC 2H .0219(I)(3):
..<:�
..:'•
'
.gyp
(An exact flow amount cannot be determined until all lots are sold and the proposed development Is know.)
M.S
Assumed flows:
_ 3 food services x 50 seats x 40 GPD per seat = 6,000 GPD
->-person per shift x 1 shift x 6 persons = 1;650 GPD
11. offices x 25 GPD per
6,000 GPD + 1,650 GPD = 7,650 GPD for the proposed site.
. "
�iii
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)
?`r
8
924
Gravity
1255
Force Main
t11.
-
-
ENTER TOTAL LINE LENGTH IN MILES
0.41
Summaryof PumpStations to be Permitted(attach additional sheets as necessary)
i"`
Location ID
(self chosen - as shown on
• fans for cross-reference
Design Flow
MGD
Operational Point
GPM 61 TDH
Power Reliability Option
(1- dual line feed; 2= permanent generator w/ATS; 3-
• • rtable r: nerator w/teleme 4-wet well store! :
A
0.26
178 GPM r_m 21' TDH
:-*
:
f�-y�yl
:,4. t' y13.
'' ° *
,
12. Does the sewer system comply
Mains (latest version), the
with the Minimum Design Criteria for the Fast Track Permitting of Pump Stations and Force
Gravity Sewer Minimum Design Criteria (latest version) and 15A NCAC 2H .0200 as applicable?
reference the pertinent minimum design criteria or regulation and Indicate why a
Is requested:
SPECIFICATIONS OR CALCULATIONS PERTINENT TO THE VARIANCE WITH YOUR APPLICATION
0 Yes • No If no, please
variance
SUBMIT TWO COPIES OF PLANS,
Have the following permits/certifications been submitted for approval?
Wetland/Stream Crossings - General Permit or 401 Certification?
Sedimentation and Erosion Control Plan?
Stormwater?
• Yes ■ No 0 N/A
0 Yes • No ■ N/A
0 Yes • No • N/A
VT' A m inz -_ u PIXY ') 111.11121.

BAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE 5
`>- :
" '''`'
1. Use the Division's -guidance document entitled, "DETERMINING STREAM CLASSIFICATIONS FOR FORM FTA 02/03
(FAST -TRACK SEWER. SYSTEMS)" to collect and record the stream classification data below (attach additional sheets as
necessary). This document is available from our web site or by contacting the appropriate Division of Water Quality
regional office (see instructions for addresses) OR indicate the following;
►�� A Stream Classification is not needed because allparts of the project are at (east 100 feet awayfrom an down slope
Prof Y
waterbody Ada, .
►:
A Stream Classification Is not needed because the design does not depend on wet well storage as a power reliability
option for any pump station near a Class C down slope waterbody.
Location ID on Map
(self chosen - as shown on
map for cross-reference]
Name of
Waterbody
County
River Basin
Waterbody Stream
Index
Waterbody
Classification
A
unnammed tribute ry
to Walnut Creek
Wayne
Wa a
Meuse
27-68
C;NSW
Submit the 8.5" x 11" COLOR topographic map as required In Instruction VI
regardless of whether a classification Is provided!
1. Applicant's Certification:
1, -Joseph R: Huffman. City Mananer, attest that this application for Southeast Commercial Park has been reviewed
ti:•;.. ;,:, by me and is accurate and complete to the best of my knowledge. I understand that If all required 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 143-215.68, any person who knowingly makes any false statement, representation, or
• certification in any application shall begulity of a Class 2 misdemeanor which may include a fine not to exceed $10,000
as well as • !penalties up to $25,000 per violation.
1a. q `
..� g Official Signal re Date
i .fesslonal Engineer's Certification:
1 attest that this application for Southeast Commercial Park has been reviewed by me and Is accurate, complete and
, • consistent with the Information lathe englneering plans, calculations, and all other supporting documentation to the best of
r` <"' - ,'. my knowledge:./ 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 Mans adopted June 1, 2000
and the watershed classification in accordance with Division guidance. Although certain portions of this submittal package
mayhave been dewsl byother professionals, inclusion of these materials under mysignature and seal signifies that I
�d � �'
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
kw r well as dull penalties up to $25,000 per violation.
:==-+a. Jeffrey L. Komegay
`, \ �, t 1 r r E r; ;
• - '. O ,--
., cif'- `�
�� A- �C:. N
4
— 16813
f'�.,N �4;.,'' .a,,
fix` GIN
�ti�
r r t b 1 E E E
Seal, Signature & Date
Professional Engineer Name
b. B.R. Komegay, Inc.
Engineering Firm
•+c. P.O. Drawer 1435
_ = :
Address
d. Goldsboro
+e. NC
+ . 27533
::..;::,
State
Zip
g. [phone]
2h. 919 580-9053
+I. [e-mail]
Telephone
Facsimile
E-mail
r-re 111irn - u/xi (Id Ind

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