WQ0043591_Application (FTSE)_20220705

DWR
Division of Water Resources
NC Dept ofEnvironmental Quality
State of North Carolina
Department of Environmental Quality
Division of Water Resources
JUL 5 2arzisT TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 06-21 & SUPPORTING DOCUMENTATION
- --- •e.; nci Q l OMoe
Application Number: 4)4?A y5 5 / On he completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Town of Woodland (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ® Municipal ❑ Other
3. Signature authority's name: Randy L. Beale. Sr per 15A NCAC 02T .0106(b)
Title: Mayor
4. Applicant's mailing address: 123 East Main Street
City: Woodland State: NC Zip: 27897
5. Applicant's contact information:
Phone number: [phone] Email Address: woodlandnc dlmchsi.com
II. PROJECT INFORMATION:
1. Project name: Peachtree/Chestnut Street Sewer Replacement
2. Application/Project status:
® Proposed (New Permit)
If a modification, provide the existing permit number: WQ00_
❑ Existing Permit/Project
and issued date: ,
For modifications, also attach a detailed narrative description as described in Item G of the checklist.
If new construction, but part of a master plan, provide the existing permit number: WQ00
3. County where project is located: Northampton
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.334737738' Longitude:-77.2156856'
5. Parcel ID (if applicable): 5924-55-0666 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: M. Blaine Humphrey, P.E.
Firm: Rivers & Associates, Inc
Mailing address: P.O. Box 929
City: Greenville State: NC Zip: 27835
Phone number: [phone] Email Address: bhumphrev(a?,riversandassociates.com
License Number: 22987
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Town of Woodland WWTF Permit Number: WQ00049I0
Owner Name: Town of Woodland
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ0004910
2. Downstream (Receiving) Sewer Information: 10 inch El Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCSD0030
Owner Name(s): Town of Woodland
FORM: FTA 06-21
Page 1 of 5

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public 'Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑ No ® N,'A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DE\) been attached?
❑ Yes ❑ No ® NIA
3. If the Applicant is a Home/Property Owners' Association, has an HQA/POA Operational Agreement (FORM: FICA) and
supplementary documentation as required by 15A NCAC 02T.0115(c) been attached?
❑ Yes ❑ No ® N/A
4. Origin of wastewater: (check alI that apply):
® Residential (Individually Owned) ® Retail (stores, centers, malls)
® Residential (Leased) ® Retail with food preparation/service
® School / preschool 1 day care ® Medical / dental / veterinary facilities
® Food and drink facilities ® Church
® Businesses 1 offices factories ❑ Nursing Home
❑ Car Wash
❑ Hotel and/or Motels
❑ Swimming Pool/Clubhouse
❑ Swimming Pool/Filter Backwash
❑ Other (Explain in Attachment)
5. Nature of wastewater : ` ° ° Domestic 664 % Commercial 0 % Industrial (. S A NCAC 02T .0103(20))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 02T ,0l 14{t)? ❑ Yes ® No
➢ If ves, provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(t))
Daily Design Flow''e
No. of Units
Flow
N/A
0 gal/day
0
0 GPD
gal'
GPD
ga].
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
0 GPD
a See 15A NCAC 02T _0114a), (d), fe)(1) and (e)(2) for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use areas;
and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in G.S. 42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.0 I 14] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 0 GPD (per 15A NCAC2T .0114)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero, please indicate why:
❑ Pump Station/Force Main or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line.
Please provide supplementary information indicating the approximate timeframe for permitting upstream sewers with flow.
•
❑ Flow has already b .en allocated in Permit Number: Issuance Date:
® Rehabilitation or replacement of existing sewers with no new flow expected
❑ Other (Explain):
FORM: FTA 06-21
Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be perinitted:
Size (inches)
Length (feet)
Material
10
1510
PVC
10
2 I 0
DIP
➢ Section II & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
> Section III contains information related to minimum slopes for gravity sewer(s)
➢ Oversizing lines to meet minimum slope requirements is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) -. 02T .0305 & MDC (Pump Stations/Force Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: _
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: -
3. Total number of pumps at the pump station:
3. Design flow of the pump station: _. __ millions gallons per day (fun capacity)
> This should reflect the total GPM for the pump station with the largest pump out of service.
4. Operational point(s) per pump(s): gallons per minute (GPM) at __ __ feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.01C.1.b. ❑ Grinder Pump El Mechanical Bar Screen El Other (please specify)
6. Power reliability in accordance with 15A NCAC 02T .0305,b)(1):
❑ Standby power source or ❑ Standby pump
> Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(1)(B)_
> Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
> Must be permanent to facility and may not be portable
Or if the pump station has an average daily flow less than 15,000 gallons per day 15A NCACO2T.0305(h)(1)(C):
❑ Portable power source with manual activation, quick -connection receptacle and telemetry -
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry:
> Include documentation that the portable source is owned or contracted by the applicant and is compatible with the station.
> If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel timeframes, shall be provided
as part of this permit application in the case of a multiple station power outage.
FORM: FTA 06-2I Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations/alternatives found in 15A HCAC 1)2T .0305(f) & fg}?
15A NCAC 42T.0305(fl contains minimum separations that shall be provided for sewer systems:
® Yes ❑ No
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
2Water mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
zWater mains (horizontal)
10 feet
Reclaimed water lines (vertical - reclaimed over sewer)
18 inches
Reclaimed water lines (horizontal - reclaimed over sewer)
2 feet
**Any private or public water supply source, including any wells, WS-I waters of Class I or
Class II impounded reservoirs used as a source of drinking water, and associated wetlands.
100 feet
**Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal
high water (or tide elevation) and wetlands associated with these waters (see item IX.2)
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches, as well as wetlands associated with these waters or classified as WL.
10 feet
Any building foundation (horizontal)
5 feet
Any basement (horizontal)
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
> If noncompliance with 02T.0305( or (8), see Section X.1 of this application
*15A NCAC O T'.0305(g) contains alternatives where separations in 027113051(A cannot be achieved. Please check "yes"
above if these alternatives are used and provide narrative information to explain.
**Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ MA
> If na, please refer to 15A NCAC 18C.0906(f) for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? ® Yes ❑ No ❑ MA
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ See the Division's draft separation requirements for situations where separation cannot be met.
➢ No variance is required if the alternative design criteria specified is utilized in design and construction.
4. Is the project located in a river basin subject to any State buffer rules? ❑ Yes Basin name: ® No
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 028 .0200? ❑ Yes ❑ No
> This includes Trout Buffered Streams per 15A NCAC 2B.0202
5. Does the project require coverage/authorization under a 404 Nationwide:individual permits ❑ Yes ® No
or 401 Water Quality Certifications?
> PIease provide the permit number/permitting status in the cover letter if coverage/authorization is required.
6. Does project comply with 15A NCAC. 02T.0IO5(e)(6) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T.0105(c)(61, directly related environmental permits or certification applications must be being prepared,
have been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion
and sedimentation control plans, stormwater management plans, etc.).
7. Does this project include any sewer collection lines that are deemed "high -priority?" ❑ Yes ® No
Per 15A NCAC 02T,0402, "high -priority sewer" means any aerial sewer, sewer contacting surface waters,
siphon, or sewers positioned parallel to streambanks that are subject to erosion that undermines or deteriorates the sewer.
Siphons and sewers suspended through interference/conflict boxes require a variance approval.
> If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at least once every six -months and
inspections documented per 15A NCAC 02T.0403(a)(5) or the permittee's individual System -Wide Collection permit.
FORM: FTA 06-21 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A_NCAC 02T, the Minimum Design Criteria for the Permitting. of Pump Stations
and Force Mains (latest version), and the Gravity Sewtr Minimum Desii;n Criteria (latest version as applicable?
® Yes ❑ No
If no, for projects requiring a single variance, complete and submit the Variance/Alternative Design Request application
(VADC 10-14) and supporting documents for review to the Central Office. Approval of the request will be issued
concurrently with the approval of the permit, and projects requiring a variance approval may be subject to longer
review times. For projects requiring two or more variances or where the variance is determined by the Division to be a
significant portion of the project, the full technical review is required.
2. Professional Engineer's Certification: /
I, c41 _ }'i �7%, attest that this application for J��-# � %Sit 5/ )I tIdd`i
(Pro! ssional Engineer's name from Application Item INA.) (Project Name from Applicat is Item 11.1)
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans,
specifications, engineering 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,
Minimum Design Criteria for Gravity Sewers. latest version), and the Minimum Design Criteria for the Fast -Track Permitting
of Pump Stations and Force Mains (latest version). Although other professionals may have developed certain portions of this
submittal package, 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 General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation. or certification in any application package 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. Misrepresentation of the application
information, including failure to disclose any design non-compliance with the applicable Rules and design criteria, may subject
the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NCAC 56.0701)
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I, foray L. Merit , Sr. , attest that this application for Ppae% retie..Ittoc- nu-F S-1ge -. Sor! Qe. fileging
(Signature Authority Name from Application Item 1.3.) (Project Name from Application Item II.1)
attest that this application 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 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. I understand that any
discharge of wastewater from this non -discharge system to surface waters or the land will result in an immediate enforcement
action that may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division
of Water Resources should a condition of this permit be violated. I also understand that if all required parts of this application
package are not completed and that if all required supporting informationand attachments are not included, this application
package will be returned to me as incomplete.
NOTE — In accordance with General Statutes 143-215,6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package 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.
Signature:
Date: `lc: I )11
FORM: FTA 06-21
Page 5 of 5

I44ivers
8 ASSOCIATES, INC
ENGINEERS
PLANNERS
MEMORANDUM
TO: DWR Raleigh Regional Office
CC: Raymond Eaton, Public Works Director
Stephen Reece, E.I., Rivers
and Associates
FROM: M. Blaine Humphrey, P.E.
Raleigh Regional Office
DATE: June 21, 2022
SURVEYORS LANDSCAPE ARCHITECTS
NC Dept of Environmental QaiIity
JUL 5 la22
SUBJECT: Fast -Track Application Narrative
Town of Woodland — Peachtree/Chestnut Street Sewer Replacement
File 2021032 D
The purpose of this memorandum is to provide a narrative of the Town of Woodland's proposed
Sanitary Sewer Replacement project to accompany the project's Fast -Track Application.
The major items of work for this project submitted for review under the Fast Track permitting
program include laying approximately 1.510 LF of 10'' PVC pipe, 210 LF of 10" DIP pipe,
installing four (4) new manholes, abandoning three (3) manholes, and rehabbing two (2) manholes.
This project is intended to provide improvements to the Woodland Sanitary Sewer System by
laying new pipe, replacing services, rehabbing manholes, etc. An improvement of this project
includes grouting and abandoning a 10" vitrified clay gravity line that passes underneath an
occupied residence. New 10" gravity sewer will reroute existing gravity sewage to be installed in
Town controlled roadway right-of-way along East Peachtree Street. All of the sewer lines and
manholes proposed for replacement in this project are greater than 40 years in age. The purpose of
this project is to reduce infiltration and inflow in the Town of Woodland's sanitary sewer collection
system by replacing vitrified clay gravity sewer pipes and brick manholes exhibiting inflow and
infiltration (III).
No new flow is anticipated, and no new flow is being requested, with this permit application.
107 E. Second Street, Greenville, NC 27858 • PO Box 929, Greenville, NC 27835 • Phone: [phone] • Fax: [phone]
NCBELS Lic. No. F-0334 www.riversandassociates.com NCBOLA Lic. No. C-312

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(414ivers
& ASSOCIATES, INC.
ENGINEERS
Mr. Jason Robinson, P.E.
NCDEQ — Division of Water Resources
Raleigh Regional Office
3800 Barrett Drive
Raleigh, North Carolina 27609
PLANNERS
July 1, 2022
SURVEYORS
LANDSCAPE ARCHITECTS
NC Dept of Environmental Quality
JUL 5 2022
Raleigh Regional Office
SUBJECT: Town of Woodland — Peachtree/Chestnut Streets Sanitary Sewer Replacement
Fast Track Application and Permitting
Rivers File 2021032-D
Dear Mr. Robinson:
On behalf of the Town of Woodland, we are submitting a Fast Track application for the Peachtree and
Chestnut Streets Sanitary Sewer Replacement. This project will include the installation of new 10" gravity
sewer, four (4) new manholes, and abandonment of three (3) manholes and a 10" vitrified clay gravity
sewer line passing underneath a residence. Specifics for the improvements are including in the Application
Narrative.
Enclosed are the following required documents:
• One (1) check in the amount of $480.00 for the application fee
• Two (2) copies of the project narrative
• One (1) original and one (1) copy of the executed application form
• One (1) map showing the location of the proposed facilities to be constructed
• One (1) original and one (1) copy of a USGS Topographic Map identifying the entire project
associated with this Application.
Please note that a Variance Request is being submitted to Charlie Miller P.E., Municipal Permitting Unit
due to two interference/ conflict boxes required for the project.
Should you have any questions or if we can provide any additional information that will provide a favorable
review, please do not hesitate to contact our office at [phone].
Respectfully,
M. Blaine Humphrey, P.E
Project Manager
cc: Mr. Raymond Eaton, Town of Woodland
Mr. Stephen Reece, Rivers and Associates
File 2021032-D
P,-WMunil,Woodland-Peachtree Chestnut St Swr Rep1-20210324ADMIND-Permitttn '.FastTrack.Fast Track Cover Letter.docx
107 E. Second Street, Greenville, NC 27858 • PO Box 929, Greenville, NC 27835 • Phone: [phone] • Fax; 252-752-3974
NCBELS Lic. No. F-0334 www,riversandassociates,com NCBOLA Lic. No- C-312