WQ0031807_Application (FTSE)_20070531

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• '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: 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. This form may be photocopied for use as an original.
rzf 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 13(12).
M II. 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.
❑ 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, outparceis, 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.
❑ 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 VVWTF, ff 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/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.
14.
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.
❑ Vil. 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 htto://h2o.enr.state.nc.us/reres or by contacting the appropriate regional
office.
'CrA A' /nR D l /lA II1c

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE2
❑ VIII. Environmental Assessments — If this project is subject to an Environmental Assessment (EA) [15A NCAC
01C], this application can not be used. Send the project application on Form PSFMGSA 10/99 to the PERCS
Unit, 1617 Mail Service Center, Raleigh, NC 27699-1617. Applications can not 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.
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(1 b). 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.
Downstream Sewer & Wastewater Treatment Plant Capacity
The applicant has assured downstream pipe, pump station and treatment plant capacity. The addition of new
sources of wastewater from this project has been evaluated along the route to the receiving treatment plant. 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. If the applicant is not the owner of the
downstream sewer or receiving treatment plant, submittal of flow acceptance letter(s) indicates that owner has
adequate capacity and will not violate G.S. 143-215.67(a).
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, Bladen, Cumberland, Hamett,
Hoke, Montgomery, Moore, Robeson,
Richmond, Sampson, Scotland
Mooresville Regional Office
610 E. Center Avenue, Suite 301
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, Berne, 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, Duplin,
New Hanover, Onsiow, 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, visit our web site at: http://h2o.enr.state.nc.us/peres/
VT n?mq - PA.r . rains

'FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE 3
ao 3 Or)
Iication Number: :=;;'-; ti ,. _,,,'. ,; -,---
USE THE TAB KEY TO MOVE FROM FIELD TO FIELD! 1 APp ._ .. ;;
(to be completed by DWQ)' , --
A. APPLICATION INFORMATION
1. Owner:
'Q•;'=-�-1
'1 a. County of Wayne i L007
Full Legal Name (company, municipality, HOA, utility, etc.)
1 b. Brant Brown, Buildings and Grounds Superintendent :1_' ,(�';;
Signing Official Name and Title (Please review 15A NCAC 2H .0206(b) for authorized signing officials!)
lc.
The
•
legal entiy who will
Individual DI Federal
own
■
this system
Municipality
is:
0 State/County
■
Private Partnershi
_■
Corporation
•
Other (specify):
1 d. P.O. Box 227
le. Goldsboro
Mailing Address
City
1f. North Carolina
1g. 27533
State
Zip Code
1 h. 919-731-1435
11. 919-731-1436
1].
Telephone
Facsimile
E-mail
,2. Project (Facility) Information:
a. Genoa Crossing
b. Wayne
Brief Project Name (permit will refer to this name)
County Where Project is Located
. Contact Person:
a. Jeffrey L. Komegay, PE, PLS - Project Engineer
Name and Affiliation of Someone Who Can Answer Questions About
this Application
b. 919-735-5886
3c. komsep©bellsouth.net
Phone Number
E-mail
B. PERMIT INFORMATION
1. Project is ►Il New
■
Modification (of an existing permit) If Modification, Permit No.:
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 this permit application - do not
duplicate protect Information In B(7) and B(10-11) that has already been Included In the original permit
Owner is
►�0
Public (skip 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 8(3))
Selling units (lots, townhomes, etc. - go to Item B(2b))
•
IN
Public Utlllty (Instruction III)
Homeowner Assoc./Developer (Instruction IV)
3. County of Wayne
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
4a. County of Wayne 4b. 23949
Name of WWTF
WWTF Permit No.
5a. County of Wayne
5b. 81n
Gravity
5c. 23949
Owner of Downstream Sewer
Receiving Sewer Size
Force Main
Permit Number of Downstream Sewer (If known)
6. The origin of this wastewater is (check all that apply):
•
•
•
■
Residential Subdivision
Apartments/Condominiums
Mobile Home Park
School
■
•
•
•
Car Wash
Institution
Hospital
Church
100 % Domestic/Commercial
% Industrial
@
Restaurant
•
Nursing Home
% Other (specify):
►i1
Office
■
Other (specify):
7.
Volume
of wastewater to be allocated for this particular project: 3,200 gallons per day
*Do
not Include previously.permltted allocations •
8.
If the
•
•
permitted flow is zero, indicate why:
Interceptor Line - Flow will be permitted in subsequent permits that connect to this line
Flow has already been allocated In Pemmit No.
•
Rehabilitation or replacement of existing sewer with no new flow expected
TVA A")/A') 7),._. '1 AA/AG

FAST -TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE 4 •
B. PERMIT INFORMATION (CONTINUED)
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(1)(1-2) must be supported with actual water or wastewater use data in accordance with 15A
NCAC 2H .0219(1)(3).
An exact flow amount cannot b determined until all lots are sold and the proposed development is known.
Assumed flows:
1 food service x 50 seats x 40 GPD per seat = 2,000 GPD
8 offlni -s x 25 GPD per person per shift x 1 shift x 6 persons = 1,200 GPD
2,000 GPD + 1,200 GPD = 3,200 GPD for the proposed site.
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
951
Gravity
7
ENTER TOTAL LINE LENGTH IN MILES 0.18
11. Summary of Pump Stations to be Permitted (attach additional sheets as necessary)
Location ID
(self chosen - as shown on
p!ans for cross-reference)
Design Flow
(MGD)
Operational Point
GPM Q TDH
Power Reliability Option
(1- dual line feed; 2- permanent generator w/ATS; 3-
generator w/telemetry; 4-wet well storage)
N/A
_portable
12.
Does the
Mains (latest
0 Yes
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 2H .0200 as applicable?
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
13. Have the following permits/certifications been submitted for approval?
Wetland/Stream Crossings - General Permit or 401 Certification?
Sedimentation and Erosion Control Plan?
Stormwater?
IN
0
►Il
Yes
Yes
Yes
■
•
■
No
No
No
0
■
•
N/A
N/A
N/A
14. Does this project Involve aerial lines or siphons? Check if yes: •
Titese_Ilaes_alltbe_c o ece t high orloritv_and mustbe checked once even, alxmonths
15. Does this project have gravity sewer lines designed at minimum slopes?
Be aware that the Division will not accept installed lines more than 1096 flatter than the minimum
corrected prior to submitting the final engineering certification..
►:1
slope. Lines installed outside this tolerance should be
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'FASST-TRACK APPLICATION for GRAVITY SEWERS, PUMP STATIONS, AND FORCE MAINS
PAGE 5
C. STREAM CLASSIFICATION
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:
►ii A Stream Classification is not needed because all parts of the project are at least 100 feet away from any down slope
waterbody; AND,
►'4
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
ma for cross-reference)
Name of
Waterbody
County
River Basin
Waterbody Stream
Index
Waterbody
Classification
N/A
Submit the 8.5" x 11" COLOR topographic map as required in Instruction VI
regardless of whether a classification Is provided!
D. CERTIFICATIONS
1. Applicant's Certification:
1, print Drown Dulldings and Grounds Superintendent, attest that this application for Genoa Crossing has been
reviewed by me and Is accurate and complete to the 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, thls
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 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.
t M
1�'\\
1 a.
Signing Official Signature Date
2. Professional Engineers Certification:
I attest that this application for Genoa Crossing 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 thls submittal package may have been
developed by other professionals, inclusion of these materials under my signature and seal signifies that 1 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 143-215.68, 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. Jeffrey L. Komegay
s' -61
`%%%%i" ,,
Professional Engineer Name
`
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'
2b. B.R. Komegay, Inc.
,2oP.• 1 SSloy• V/
Engineering Firm
;QQ
2c. P.O. Drawer 1435
- S
Mailing Address
16813
.
2d. Goldsboro
2e. NC f. 27533
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City
State Tip
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2g. 919-735-5886 �2h. 919-580-9053
2i. [e-mail]
);;;''''''
Telephone
Facsimile
E-mail
Seal, Signature & Date
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db/05/2007 11;53
9195809053
B.R. KORNEGAY, INC. PAGE 02
iiue 4, 2007 •
'N.. C. Department of Environrnent
and Natural 'Reso cts
Washington Regional 4ffiCe
943 Washingto
RE: Non-Dlsoharge:Ferniit,App1ication
Genoa Cro swig - Genoa'Place (Street.Additior►j
Crap . of ii5otbsboto
Igrabper
VivoUna
27533-9701
To Whom It•May C oneern: .
The City of Qrotdsboro,wi1l accept approximately 3,200 G?D •of wastewater generated by
the referenced project as 'shown n plans prepared by kiTrey. L. ily.orAtgay, P. E., dated .
September 11, 20.06 and revised October 2.6,'2006.. The sewer 4i.e that serves this project
will be privately owned and. tri i tamed• • •
Lf you have any p estinns err need additiozral inforui4`clon; pleaacr. call me at
[phone], • •
Sincerely,
Terry H. Callimore; P.
C'�1r T.11 It L'.cr
idyl
Enclosure
c:. Jeffrey L. Kprneaay
•