WQ0043936_Application (FTSE)_20221019

C State of North Carolina
Dept of Environmental Quality Department of Environmental Quality
y if ,, Division of Water Resources
D-WR .,,_
FASt'TRACK SEWER SYSTEM EXTENSION APPLICATION
Dfvlslon of Water Resources FTA 06-21 & SUPPORTING DOCUMENTATION
Ra[cih Rcdon;l!
Application Number:WQbO 454 41,6� (to be completed by DWR)
All items must be completed or the anolication will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Roanoke Rapids Sanitary District (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: Dan Brown per.1 �A NCAC 02T _0106tbt
Title: CEO
4. Applicant's mailing address: P.O. Box 308 I 1000 Jackson Street
City: Roanoke Rapids State. NC Zip: 27870-
5. Applicant's contact information:
Phone number: (ZL2) 537-9137 Email Address: dbrownnrrsd.org
II. PROJECT INFORMATION:
1. Project name: Roseburg Forest Products Sanitary Sewer Line Relocation
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ 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: Wes^
3. County where project is located: Halifax
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.439529'' Longitude:-77.622107'
5. Parcel ID (if applicable): 1203437 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
I . Professional Engineer: Leo Green, III License Number: 022594
Firm: Green Enp-ineerinR, PLLC
Mailing address: P.O. Box 609 / 303 Goldsboro St. E
City: Wilson State: NC Zip: 27893-
Phone number: 2( 52) 237-5365 Email Address: ela3(a)areenenp-.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Roanoke River Wastewater Treatment Plant Permit Number: NCO024201
Owner Name: Roanoke Rapids Sanitary District
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ
2. Downstream (Receiving) Sewer Information: 18 inch M Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS 00027
4. Owner Name(s): Roanoke Rapids Sanitary District
FORM: FTA 06-21 Page] 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: DEV) been attached?
[]Yes ❑ No ®N-A
3. If the Applicant is a Home/Property Owners' Association, has an HOA.:POA Operational A&reement (FORM: HOA3 and
supplementary documentation as required by 15A NCAC 02T.0115(c) been attached?
❑ Yes ❑ No ® N..'A
4. Origin of wastewater: (check all that apply): All Wastewater Flows Existing —No New Flow to be Permitted
® Residential (Individually Owned) ❑ Retail (stores, centers, malls) ® Car Wash
❑ Residential (Leased) ® Retail with food preparation/service ® Hotel and/or Motels
® School / preschool 1 day care ❑ Medical / dental / veterinary facilities ❑ Swimming Pool/Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
® Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: % Domestic % Commercial % Industrial (See I $A NCAC 02T .0103(2pl)
If Industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(f)? ❑ Yes ®No
➢ If yes, 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','
No. of Units
Flow
Wastewater Flows Existing — No New Flo
gal!
0 GPD
gaU
GPD
gall
GPD
gal/
GPD
gal/
GPD
gaU
GPD
Total
0 GPD
a See 15A NCAC 02T .01 14(b), (d), (e)(l) and (e)P) 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 .01 14(c), design flow rates for establishments not identified [in table 15A NCAC 02T.01 141 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 NCAC 02T .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 been allocated in Permit Number: Issuance Date:
❑ Rehabilitation or replacement of existing sewers with no new flow expected
® Other (Explain): Relocation of L018 LF of 12-inch gravity sewer and abandonment of 1,374 LF of 12-inch gravity
sewer. Relocation of approximately 374 LF of 18" g avitysewer and additional manhole to achieve greater slope.
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 permitted:
Size (inches)
Length (feet)
Material
12
1,018
PVC
18
374
PVC
➢ 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: N/A
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
If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.01 C. Lb. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NCAC 02T .0305{h)(] ):
❑ 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 06-21 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separationslalternatives found in .15A NCAC _02T .0305(0 & W? ® Yes ❑ No
15A NCAC 02T.0305 contains minimum separations that shall be provided for sewers stems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
'Water mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
'Water 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 WI,.
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(f) or (g), see Section X.1 of this application
* 15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305if) 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 webpac.e
2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ N{A
D 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 ❑ NSA
➢ PIease 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: Roanoke ❑ 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 213.0202
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ❑ Yes ® No
or 401 Water Quality Certifications?
➢ Please provide the permit number/permitting status in the cover letter if coveragelauthorization is required.
6. Does project comply with 15A NCAC 02T.0105&Jjo) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T.0 I 05(c)(6), 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 I5A NCAC 02L the Minimum DesiW Criteria far the, PcrmittinR_of Pump Stations
and Force Main latest ve and the Gravity Sewer Minimum Design Criteria flatest 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 protects reoulring a variance approval may be subject to loneer
reviely times. For prolects reguiring two or more variances orwhere the variance is determined by the Division to be a
slanificant portion of the prolect, the full technical review is required.
2. Professional Engineer's Certification:
I, Leo Green. Ill. PE , attest that this application for Roseburg_Fomt Products Sanitary Sever Line Relocation
(Professional Engineers name from Application Item 111.1.) (Project Name from Application Item It. 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,
iatmuni Dasi n Qrlte ' r QrRvity Sewers (Inlest. version), and the Minimum Design Criteria for the Fast -Track Permittin
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 S 10,000, as well as civil penalties up to $25,000 per violation. Misrepresentation of the application
information, including failure to disclose any design non-compliance with the applicable Rules and design criteria, may subject
the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NC
61Q]Q))
North Carolina Professional Engineer's seal, signature, and date: E$S/d �'I'
;4 SEAL r .
• 022594
11G I NI% NIN
3. Applicant's Certification per 15A NCAC 02T .0106(b): J V ` l" 1 — Zo'Z."Z
i, Dan Brown , attest that this application for RosebuEg Forest Products Sanitary Sewer Line Relocation
(Signature Authority Name from Application Item 1.3.) (Project Name From Application Item IL 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 information and attachments are not included, this application
package will be returned to me as incomplete.
NOTE — In accordance with General Statutes 1 3-215.6A 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 S 10,000 as well as civil penalties up to $25,000 per violation.
Signature: Date: %0 *'Z
FORM: FTA 06-21 Page 5 of 5

October 17, 2022
NCDEQ
Water Resources
Raleigh Regional Office
3800 Barrett Drive
Raleigh, North Carolina 27609
NCDeptofBnvironmental Qualit}
�4r<
Attention: Mr. Scott Vinson Raleigh Rc
Regional Supervisor g ona1 Offloo
Water Quality Regional Operations
SUBJECT: Fast -Track Sewer System Extension Application
Roseburg Forest Products Sanitary Sewer Line Relocation
Halifax County, North Carolina
PN: 21-138
Dear Mr. Vinson:
The Roanoke Rapids Sanitary District has proposed relocation of 1,018 LF of 12-inch gravity
sewer to tie into an existing 18-inch gravity sewer line and abandonment of 1,374 LF an 12-inch gravity
sewer line that currently crosses Roseburg Forest Products property east of the intersection of the I-95 /
U.S. Highway 158 interchange at Roanoke Rapids and at the end of Watkins Drive. Also, approximately
374 LF of the existing 18-inch gravity sewer line will be reinstalled with the addition of a manhole to
increase the slope of the two sections.
Please find attached two (2) copies of each of the following documents for your review and
approval:
• Fast -Track Sewer System Extension Application Form
• 8'V2" x 11" copy of project location on USGS Quadrangle Map
• Street Level Photography
Also, please find attached check in the amount of $480.00 to cover the application review fee. If
you should have any questions or require additional information, please call or email
I.Youncekg reeneng.com.
Respectfully,
Lan n Younce, P.E.
Enclosures: As stated.
cc: Mr. Dan Brown — CEO, Roanoke Rapids Sanitary District, Roanoke Rapids, N.C.
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