WQ0043629_Application (FTSE)_20220719

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number: W 00 113 (0 a [i he cnn,pleled by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
I, Applicant's name: City of Henderson (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual
❑ Federal
El Corporation
❑ Stater County
❑ General Partnership ❑ Privately -Owned Public Utility
Municipal ❑ Other
3. Signature authority's name: Terrell Blackmon per I5A NCAC 02T .0106(b)
Title: City Manager
4. Applicant's mailing address: P.O. Box 1434
City: Henderson State: NC Zip: 27536-
5. Applicant's contact information:
Phone number: [phone] Email Address: TerrellBlackmon a,henderson.nc.gov
11. PROJECT INFORMATION:
I. Project name: RED OAK APARTMENTS — Put b (i (--
2. Application±Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ00 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: Vance
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.3386 Longitude:-78.4482 ezj
5. Parcel ID (if applicable): 0408 02012 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:--
--t r i
1. Professional Engineer: Steve M. Causey License Number: 19701 �.° r .s e
Firm: Allied Design, Inc.
Mailing address: 4720 Kester Mill Roadsvr +
City: Winston-Salem State: NC Zip: 27103- r
Phone number: [phone] Email Address: scausevRallied-engsurv.com
r
s
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Henderson Water Reclamation Facility Permit Number: NC0020559
Owner Name: City of Henderson
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ0014291
2. Downstream (Receiving) Sewer Information: 8 inch XX Gravity O Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s): City of Henderson
FORM: FTA 06-21
Page 1 of 5

VI.
GENERAL REQUIREMENTS
i. lithe Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑ No ® NA
2. If the Applicant is a Developer of lots to be sold, has a De‘elol er s (1lxeratittnal Agreement (FORM- DEN` ( been attached?
❑ Yes ❑No ZNIA
3. If the Applicant is a Home/Property Owners' Association, has an HOA. PQA.t yeral ional Agreement (FORM: HOA) and
supplementary documentation as required by 15A NCAC 02T.01 15(c) been attached?
❑ Yes ❑ No ® N/A
4. Origin of wastewater: (check all that apply):
❑ Residential (Individually Owned) ❑ Retail (stores, centers, malls)
® Residential (Leased) ❑ Retail with food preparation/service
❑ School 1 preschool / day care ❑ Medical / dental / veterinary facilities
❑ Food and drink facilities ❑ Church
❑ Businesses; offices 1 factories ❑ Nursing Home
❑ Car Wash
❑ Hotel and/or Motels
❑ Swimming Pool?Clubhouse
❑ Swimming Pool/Filter Backwash
0 Other (Explain in Attachment)
5. Nature of wastewater : 100 % Domestic % Commercial % Industrial (See 1.5A NCAC 02T .0103(20))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes❑ No
6. Has a flow reduction been approved under l5A NCAC 02T .01 14(0? ❑ 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(f))
Daily Design Flow e•b
No. of Units
Flow
1 Bedroom Apartment
240 gal, day
13
3,120 GPD
2 Bedroom Apartment
240 gal/day
35
8,400 GPD
3 Bedroom Apartment
360 gallday
24
8,640 GPD
gall
GPD
gal/
GPD
gall
GPD
Total
20,160 GPD
a See 15A NCAC 02T .01141K (dl, (ell 1) and 1el( 21 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 i 5A NCAC 02T.01 14] shall
be determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 20,160 GPD (per I5A NCAC 02T,01 I4)
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 been allocated in Permit Number: Issuance Date:
0 Rehabilitation or replacement of existing sewers with no new flow expected
O Other (Explain):
FORM: FTA 06-21
Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & NI DC (Gra%its Sewers):
1.
Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8
285
SDR 35 PVC
Section I1 & 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 & tit DC (Pump StationsiForce Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
I. 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 (firm 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)
Length (feet)
Material
3
1,305
SDR 21 PVC
If any portion of the force main is less than 4-inches in diameter, please identify the me hod of solids reduction per
MDCPSFM Section 2.01C.1.b. ® Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with I5A NCAC 02'I .0305(h)(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 I5A NCACO2T.0305(h)(1)(C):
❑ Portable power source with manual activation, quick -connection receptacle and telemetry -
or
FORM: FTA 06-21 Page 3 of 5

❑ 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 06-21 Page 4 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(I)):
1. Does the project comply with all separationsialternatives found in 1.SA NCA ` Q2T D34511) & (1,1r ® Yes ❑ No
15A NCAC 02T.0305(f1 contains minimum separations that shall be provided for sewer systems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
24 inches
2Water mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
2Water 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 1I 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(11 or{g)+ see Section X.I of this application
*15A NCAC 02T.0305 contains alternatives where separations in 02T.0305(f) 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 ti+ eboage
2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ NIA
> If no, 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 ❑ NIA
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: Tar -Pamlico River ❑ No
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ® Yes ❑ No
This includes Trout Buffered Streams per 15A NCAC 2B 4M.
5. Does the project require coveragelauthorization under a 404 Nationwide; individual permits
or 401 Water Quality Certifications?
❑ Yes ® No
Please provide the permit numberlpermitting status in the cover letter if coveragelauthorization is required.
FORM: FTA 06-21 Page 5 of 5

6. Does project comply with I5A NCAC 02T.0105(c)(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 6 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with I5A NCAC 02T, the Minimum Design Criteria for the Permitting of Pump Stations
and Force Mains (latest version), and the Gravity Sewer Minimum Design 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 he issued
concurrently with the approval of the permit. and projects requiring a variance approval may be subject to longer
review times. For protects 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, Steve M. Causev , attest that this application for
(Professional Engineer's name from Application Item 111.I.)
Red Oak Apartments
(Project Name from Application 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. 1 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 1 have reviewed this
material and have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes I43-215.6A 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: (t� CAP?"
3. Applicant's Certification per I5A NCAC 02T .0106(b):
I, Tarr 41 lit cl4 Q_r , attest that this application for Red Oak Apartments
(Signature Authority Name from Application Item 1.3 )
(Project Name from Application Item 11.I)
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. 1 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 Wall required parts of this
application package are not completed and that if all required supporting information and attachments are not included, this
application package will be returned to me as incomplete.
NOTE — In accordance with General Statutes I43-215.6A and I43-215.6B, 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:
FORM: FTA 06-21
Date: C1 ;
jj// Page 7 of 5

Division of Water Resources
State of North Carolina
NG bept of Environmental Quaid Department of Environmental Quality
Division of Water Resources
GCT212022
Flow Tracking for Sewer Extension Applications
Raleigh Regional Office (FTSE 10-18)
Entity Requesting Allocation: City of Henderson
Project Name for which flow is being requested: Red Oak Apartments (Public)
More than one FTSE 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: Henderson Water Reclamation Facility
b. WWTP Facility Permit #: NC0020559
All flows are in MGD
c. WWTP facility's permitted flow 4.14
d. Estimated obligated flow not yet tributary to the WWTP 0.1364
e. WWTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
1.95
0.020160
2.0356
49.17 %
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 or
Number)
RedBud
Pump
Station
Permit
No.
Zeb
Firm
Capacity, *
MGD
(A)
Design
Average
Daily Flow**
(Firm ! pf),
MGD
(B) (C)
Obligated,
Approx. Not Yet
Current Tributary
Avg. Daily Daily Flow,
Flow, MGD MGD
2.952 1.181 0.65 0.07412
0.18 0.072 0.021 0.02208
(D)=(B+C) (E)-(A-D)
Total Current
Flow Plus
Obligated
Flow
0.72412
0.04308
Available
Capacity***
0.4568
0.137
* The Firm Capacity (design flow) of any pump station is defined as the maximum pumped flow
that can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor
(pf) not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): Henderson Water Reclamation Facility
Downstream Permit Number: NC 0020559
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I E , T A cgirn,en certify to the best of my knowledge that 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, given the implementation of the planned
improvements identified in the planning assessment where applicable. 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 plus all attached planning assessment
addendums for which I am the responsible party. Signature of this form certifies that the receiving
collection system or treatment works has adequate capacity to transport and treat the proposed new
wastewater.
(P/4/.
Signing Official Signature Ate
CA- .�
Title of Signing Official
Page 2 of 6
FTSE 10-18

PLANNING ASSESSMENT ADDENDUM (PAA)
Submit a planning assessment addendum for each pump station listed in Section 11 where Available Capacity is t=
0.
Pump Station (Name or Number):
Given that:
a. The proportion and amount of Obligated, Not Yet Tributary Daily Flow (C) accounts for
% and MGD of the Available Capacity (E) in Pump Station
; and that
b. The rate of activation of this obligated, not yet tributary capacity is currently approximately
MGD per year; and that
c. A funded Capital Project that will provide the required planned capacity, namely
is in design or under construction with
planned completion in ; andior
d. The following applies:
Therefore:
Given reasonably expected conditions and planning information, there is sufficient justification to allow
this flow to be permitted, without a significant likelihood of over -allocating capacity in the system
infrastructure.
I understand that this does not relieve the collection system owner from complying with G.S. 143-
215.67(a) which prohibits the introduction of any waste in excess of the capacity of the waste disposal
system.
Signing Official Signature
Page 3 of 6
0,A ?-
Date
FTSE 10-18

October 19, 2022
Cassidy Kurtz
NCDEQ - Water Quality Section
Raleigh Regional Office
3800 Barrett Drive
Raleigh, North Carolina 27609
[phone]
Allied Design, Inc.
CIVIL ENGINEERING ❖ LAND SURVEYING
Firm License No.: C-1891
NC Dept of Snvirnnmentel @unlit)
GCT 2 1 1012
Leigh Regional. Office
SUBJECT: GRAVITY SEWER CONSTRUCTION PERMIT — RE -SUBMITTAL
PUBLIC SANITARY SEWER LINE EXTENSION
RED OAK APARTMENTS
HENDERSON, NC, VANCE COUNTY
AIM PROJECT: 20-040
Cassidy:
On behalf of Red Oak Apartments, LLC, and based on your email comments dated September 14,
2022, we are pleased to re -submit the enclosed information for permitting of the Public sanitary
sewer line extensions to serve the subject project.
The proposed public sewer extension will serve a 72-unit apartment community. Approximately
285 linear feet of 8" PVC gravity sewer will be constructed to serve the project. Additionally, 1305
linear feet of 3" PVC force main will be constructed to convey wastewater from a private pump
station, along a public right-of-way to the point of connection to an existing public sewer line. The
lines will be dedicated to the City of Henderson for maintenance. The required flow allocation is
based on 240 gallons per day for the one- and two -bedroom units (48) and 360 gallons per day for
the three -bedroom units (24) for a total flow of 20,160 gallons per day.
Please find enclosed:
1. This cover letter with the project description in the paragraph above;
2. Two copies of a completed and executed "Fast Track Sewer System Extension
Application FTA 06-21", for gravity sewers, pump stations and force mains, for the
PUBLIC sewer extension;
3. Two copies of a completed and executed "Flow Tracking for Sewer Extension
Applications" Form FTSE—10-18, for the PUBLIC sewer extension;
4. One color copy of the USGS topographic map of this area;
5. A street level map showing the general project area.
A check in the amount of $480.00, as payment of the application review fee for the PUBLIC portion
of the sewer extension, was submitted with our initial submittal dated July 15, 2022. Please review
the enclosed information and notify our office of permit approval. Should you require any revisions
or additional information, please email (scausey a. allied-engsurv.com) or call the office at (336)
765-2377.
Sincerely,
Steve M. Causey, P.E.
4720 KESTER MILL ROAD WINSTON-SALEM, NORTH CAROLINA 27103
Phone: [phone] + Fax: [phone]

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