WQ0021989_Application (FTSE)_20221202

WithersRavenel
our People. Yaw srlccess.
November 29, 2022
-_ Noth Carolina Department of Environmental Quality
_ Department of Water Resources
Attn: Water Quality Section
Washington Reginal Office
943 Washington Square Mall
Washington, North Carolina 27889
DEC —.2 2022
Water cry
offeq
Goldsboro Collection System Improvements - Phase I - Ash Street Pump Station Improvements
Fast Track Application
WithersRavenel Project No. 09220030
To whom it may concern:
On behalf of the City of Goldsboro and the Wayne County Economic Development Alliance,
WithersRavenel is submitting the attached application to your office for approval of a Fast Track
Sewer Permit for Phase I of the Goldsboro Collection System Improvements project.
The City of Goldsboro owns and operates the Ash Steet pump station located at 1040 Jeffery's
Lane Goldsboro, NC, near the intersection of Ash Street and Jeffery's Lane in Goldsboro, NC
(35023'25.02"N 78°0'52.98"W). The pump station currently conveys wastewater to a manhole on
West Mulberry Street. The West Mulberry Street gravity sewer line frequently backs up due to
flows from other pump stations entering the same line further downstream. The purpose of the
proposed project is to accommodate additional flow from industry expansion while avoiding
- adding additional flow to West Mulberry Street by installing a new 6-inch force main running
parallel to Jeffery's Lane. The pump station will be upgraded to a 0.756 MGD finn capacity pump
station and pump the wastewater to a new manhole located in the NCDOT right-of-way off of
Jeffrey's Lane. Under Phase I, new gravity sewer will be also be extended north from existing
gravity sewer along Jeffrey's Lane and an existing 8-inch gravity sewer line will be replaced with a
new 12-inch gravity sewer line. A 12-inch force main will also be installed in the same trench as
the 6-inch force main and will be connected to a new pump station in the future. The 12-inch force
main will be temporarily capped on both ends until Phase II is completed. A separate application
will be submitted for Phase II and will include the flow for the 12-inch force main.
The proposed project will increase the Ash Steet Pump Station's firm capacity from 0.32 MGD to
0.756 MGD. Currently the Ash Steet Pump Station does not have any additional capacity available,
hence the negative available capacity of -0.052 MGD shown in the FTSE and the planning
assessment addendum. The proposed upgrades mentioned in the previous paragraph make it
possible for the available capacity to increase to 0.1224 MGD.
Downstream of the Ash Street Pump Station is the Highway (HWY) 117 Pump Station. The
available capacity at the HWY 117 Pump Station depends on the wet weather flow for the
previous year. In 2019 and 2020 the HWY 117 Pump Station had additional available capacity.
However, using 2021 data the HWY 117 Pump Station does not have any additional capacity
available as shown in the FTSE and the planning assessment addendum. To resolve this issue, the
115 MacKenan Drive I Cary, NC 27511
t: 919.469.3340 1 f: 919.467.6008 1 www.withersravenel.com I License No. F-1479
Asheville I Cary I Charlotte I Greensboro I Pittsboro I Raleigh I Southern Pines I Wilmington

WithersRavenel
NOCher PtcoU YOU! Success.
existing 20" force main at the HWY 117 Pump Station will be replaced with a new 24" force main
to increase the firm capacity from 11.25 MGD to 15.97 MGD under Phase III of the project This
will increase the available capacity to 1.071 MGD.
The force main route will require encroachment on one NCDOT controlled access right-of-way
and one NCDOT non -controlled access road right-of-way. Applications have been submitted for
these encroachments. An erosion control permit application has also been submitted to the
NCDEQ Department of Energy, Mineral, and Land Resources.
The application package includes the following:
1. Fast Track Sewer Extension Application Form (FTA 06-21)
2. Flow Tracking/Acceptance for Sewer Extension Applications (FTSE 04-16) & Planning
Assessment Addendum
3. USGS and aerial location maps
4. Check for WO.00 application fee
Please do not hesitate to contact me should you have any questions or concerns. We look forward
to working with you on this project
Sincerely,
WithersRavenel
Clark Maness, P.E.
919-535-5213
[e-mail]
1 CC: Robert Sherman, Public Utilities Director for the City of Goldsboro
Page 2 of 2

State of North Carolina
Department of Environmental Quality
Division of Water Resources
r - FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources INSTRUCTIONS FOR FORM: FTA 06-21 & SUPPORTING DOCUMENTATION
This application is for sewer extensions involving gravity sewers, pump stations and force mains, or any combination that has been
certified by a professional engineer and the applicant that the project meets the requirements of 15A NCAC 02T and the Division's
Minimum Design Criteria (Gravity Sewer & Pump Stations/Force Mains) and that plans, specifications and supporting documents
have been prepared in accordance with 15A NCAC 02T, 15A NCAC 02T .0300, Division policies, and good engineering practices.
While no upfront engineering design documents are required for submittal, in accordance with 15A NCAC 02T .0305(b), design
documents must be prepared prior to submittal of a fast track permit application to the Division. This would include plans, design
calculations, and project specifications referenced in 15A NCAC 02T .0305 and the applicable minimum design criteria. These
documents shall be immediately available upon request by the Division.
Projects that are deemed permitted (do not require a permit from the Division) are explained in 15A NCAC 02T.0303.
Projects not eligible for review via the fast track process (must be submitted for full technical review):
➢ Projects that do not meet any part of the minimum design criteria (MDC) documents;
➢ Projects that involve more than one variance from the requirements of 15A NCAC 02T;
➢ Pressure sewer systems utilizing simplex septic tank -effluent pumps (STEPs) or simplex grinder pumps;
➢ Simplex STEP or simplex grinder pumps connecting to pressurized systems (e.g. force mains);
➢ Vacuum sewer systems.
General — When submitting an application, please use the following instructions as a checklist in order to ensure all required items are
submitted. Adherence to these instructions and checking the provided boxes will help produce a quicker review time and reduce the
amount of requested additional information. Failure to submit all required items will necessitate additional processing and review
time, and may result in return of the application. Unless otherwise noted, the Applicant shall submit one original and one copy of
the application and supporting documentation.
A. One Original and One Copy (second copy may he digital) of Application and Supporting Documents
® Required unless otherwise noted. Signatures on original must be "wet ink" or secure digital signatures.
Please do not submit engineering design plans with the application unless specifically requested.
B. Cover Letter/Narrative Description (Required for All Application Packages):
® List all items included in the application package, as well as a brief description of the requested permitting action.
➢ Be specific as to the system type, number of homes served, flow allocation required, etc.
➢ Include the permit number/status of any other required sewer permits (downstream/upstream)
➢ If necessary for clarity, include attachments to the application form.
C. Application Fee (All New and Modification Application Packages):
® Submit a check or money order in the amount of $480.00, dated no more than 90 days prior to application submittal.
➢ Payable to North Carolina Department of Environmental Quality (NCDEQ)
D. Fast Track Application (Required for All Application Packages, Form FTA 05-21):
E Submit the completed and appropriately executed application.
➢ If necessary for clarity or due to space restrictions, attachments to the application may be made.
❑ If the Applicant Type in Item I.2 is a corporation or company, provide documentation it is registered for business with the
North Carolina Secretary of State.
❑ If the Applicant Type in Item 1.2 is a partnership or d/b/a, enclose a copy of the certificate filed with the Register of Deeds in
the county of business.
® The Project Name in Item II.1 shall be consistent with the project name on the flow acceptance letters, agreements, etc.
® The Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a North Carolina
licensed Professional Engne rr.
® The Applicant's Certification on Page 5 of the application shall be signed in accordance with 15A NCAC 02T .0106(b). Per
15A NCAC 02T .0106(c), an alternate person may be designated as the signing official if a delegation letter is provided from
a person who meets the criteria in 15A NCAC 02T .0106(b).
INSTRUCTIONS FOR FORM: FTA 06-21 & SUPPORTING DOCUMENTATION Pagel of 3

E. Flow Tracking/Acceptance Form (Form: FTSE 04-16) (If Applicable):
® Submit the completed and executed FTSE form from the owners of the downstream sewers and treatment facility.
➢ Multiple forms maybe required where the downstream sewer owner and wastewater treatment facility are different.
➢ The flow acceptance indicated in form FTSE must not expire prior to permit issuance and must be dated less than one year
prior to the application date.
➢ Submittal of this application and form FTSE indicates that owner has adequate capacity and will not violate G,S. 143-215.67(a).
➢ Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific FTSE.
F. Site Maps (All Application Packages):
® Submit an 8.5-inch x 11-inch color copy of a USGS Topographic Map of sufficient scale to identify the entire project area,
including the closest surface waters.
➢ General location of the project components (gravity sewer, pump stations, & force main)
➢ Downstream connection points and permit number (if known) for the receiving sewer
® Include an aerial location map showing general project area (such as street names or latitude/longitude) so that Division staff
can easily locate it in the field.
G. Existing Permit (Application Packages for Modifications to an Existing Permit):
® Submit a copy of the most recently issued existing permit.
® Include a descriptive and clear narrative identifying the previously permitted items to remain in the permit, items to he
added, and/or items to be modified (the application form itself should include only include items to be added/modified). The
narrative should also include whether any previously permitted items have been certified.
® The narrative should clearly identify the requested permitting action and accurately describe the sewers to be listed in
the final permit.
H. Power Reliability Plan (Required if portable reliability option utilized for Pump Station):
❑ Per 15A NCAC 02T .0305(h)(1), submit documentation of power reliability for pumping stations.
➢ This alternative is only available for average daily flows less than 15,000 gallons per day
➢ It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant and is compatible with
the station. The Division will accept a letter signed by the applicant (see 15A NCAC 02T .0106(b)) or proposed contractor,
stating that "the portable power generation unit or portable, independently -powered pumping units, associated appurtenances
and personnel are available for distribution and operation of this pump 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 in the case of a multiple station power outage. (Required at time of certification)
I. Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per 15A NCAC 02T ,0115(a)(1) provide the Certificate of Public Convenience and Necessity from the North Carolina Utilities
Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served by the sewer
extension, or
❑ Provide a letter from the North Carolina Utilities Commission's Water and Sewer Division Public Staff stating an application
for a franchise has been received and that the service area is contiguous to an existing franchised area or that franchise approval
is expected.
J. Operational Agreements (Applications from HOA/POA and Developers for lots to be sold):
❑ Home/Propeity Owners' Associations
❑ Per 15A NCAC 02T ,0115(c), submit the properly executed Operational Agreement (FORM; HOA).
❑ Per 15A NCAC 02T .0115(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
❑ Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(b). submit the properly executed Operational Agreement (FORM; DEV).
For more information, visit the Division's collection systems website
INSTRUCTIONS FOR FORM: FTA 05-21 & SUPPORTING DOCUMENTATION Page 2 of 3

THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Realonal Office
2090 US Highway 70
Avery, Buncombe, Burke, Caldwell, Cherokee,
Water Quality Section
Swannanoa, North Carolina 28778-8211
Clay, Graham, Haywood, Henderson, Jackson,
[phone]
Macon, Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Fayetteville Realonal Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Harnett, Hoke,
Water Quality Section
Fayetteville, North Carolina 28301-5095
Montgomery, Moore, Robeson, Richmond,
[phone]
Sampson, Scotland
[phone] Fax
Mooresville Realonal Office
610 E. Center Avenue
Alexander, Cabarrus, Catawba, Cleveland,
Water Quality Section
Mooresville, North Carolina 28115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
Raleigh Regional Office
3800 Barrett Drive
Chatham, Durham, Edgecombe, Franklin,
Water Quality Section
Raleigh, North Carolina 27609
Granville, Halifax, Johnston, Lee, Nash,
[phone]
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
Warren, Wilson
Washinaton Realonal Office
943 Washington Square Mall
Beaufort, Bertle, Camden, Chowan, Craven,
Water Quality Section
Washington, North Carolina 27889
Currituck, Dare, Gates, Greene, Hertford, Hyde,
(252) 94&�Wl
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perqulmans, Pitt, Tyrrell, Washington, Wayne
Wilminaton Realonal Office
127 Cardinal Drive Extension
Carteret, Columbus, Duplln, New
Water Quality Section
Wllmington, North Carolina 28405
_Brunswick,
Hanover, Onslow, Pender
[phone]
[phone] Fax
Winstom-Salem Regional Office
450 W. Hanes Mill Road
Alamance, Alleghany, Ashe, Caswell, Davidson,
Water Quality Section
Suite 300
Davie, Forsyth, Guilford, Rockingham, Randolph,
Winston-Salem, North Carolina 27105
Stokes, Surry, Watauga, Wilkes, Yadkin
[phone]
[phone] Fax
INSTRUCTIONS FOR FORM: FTA 05-21 & SUPPORTING DOCUMENTATION Page 3 of 3

State of North Carolina
Department of Environmental Quality
Division of Water Resources
�,� FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Dhristoo of Water Resources FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number: (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: City of Goldsboro (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: Tim. Salmon per 15A NCAC 02T .0106(b)
Title: City Managcr
4. Applicant's mailing address: PO Drawer A
City: Goldsboro State: NC Zip: 72 530-3623
5. Applicant's contact information:
Phone number: (2& 5SQ-430 Email Address: tsalmon goldsboronc.Roy
II. PROJECT INFORMATION:
1. Project name: Goldsboro Collection System Improvements -Phase 1
2. Application/Project status: ❑ Proposed (New Permit) ® Existing Permit/Project
1. If a modification, provide the existing permit number: WQ0021989 and issued date: December 6, 2002
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: Wayne
4. ' Approximate Coordinates (Decimal Degrees): Latitude: 35,390272' Longitude:-78.014728'
5. Parcel ID (if applicable): 2599279914 (or Parcel ID to closest downstream sewer)
M. CONSULTANT INFORMATION:
1. Professional Engineer: J. Clark Maness License Number: 047235
Firm: WithersRavenel, Inc.
Mailing address: 115 Mackenan Dr
City: Caa State: NC Zip: 27511-7903
Phone number: (211 ) 535 - 5213 Email Address: cmanessng,withersravenel.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Goldsboro Wastewater Plant Permit Number: NCO023949
Owner Name: City of Goldsboro
V, RECEIVING DOWNSTREAM SEWER INFORMATION:
2. Permit Number(s): WQCS00023
3. Downstream (Receiving) Sewer Information: 12 inch ® Gravity ❑ Force Main
4. System Wide Collection System Permit Number(s) (if applicable): WQCS00023
Owner Name(s): City of Goldsboro
FORM: FTA 06-21 Pagel of 5

VL 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 Agreement (FORM: HOAI 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):
❑ Residential (Individually Owned) ❑ Retail (stores, centers, malls) ❑ Car Wash
❑ Residential (Leased) ❑ Retail with food preparation/service ❑ Hotel and/or Motels
❑ School / preschool / 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: 5 % Domestic % Commercial 2 % Industrial (See 15A NCAC 02T .0103(20))
If Industrial, is there a Pretreatment Program in effect? ® Yes❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(fl? ❑ Yes ®No
➢ If yes, provide a cony of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow 'b
No. of Units
Flow
Factories, excluding industrial waste
25 gal/employee/shift
100
2,500 GPD
Industrial Waste not covered by 15A CAC
02T.0114
150,000 gal/day
1
150,000 GPD
gal/
GPD
gal/
GPD
gaU
GPD
gaU
GPD
Total
152,500 GPD
a See 15A NCAC 02T .0114(b),(d), (e)(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.01141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 152,500 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):
FORM: FTA 06-21 Page 2 of 5

VIL GRAVITY SERER DESIGN CRITERIA (If Applicable) - 02T,0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
12 706 C900 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 (Puma Stations/Force Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: Ash Street Pump Station
2. Approximate Coordinates (Decimal Degrees): Latitude: 35.390272' Longitude: -78,Q147280
3. Total number of pumps at the pump station: 2
3. Design flow of the pump station: 0.756 million 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): 525 gallons per minute (GPM) at 911 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
6
2130
C900 PVC
12*
2130
C900 PVC
* The 12-inch force main will be capped temporarily on
both ends until Phase II is completed. A separate
application will be submitted for Phase II and will
include the flow for the 12-inch force main .
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.l.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(1):
® Standby power sourceor ❑ 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.
FORM: FTA 06-21 Page 3 of 5

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 O6-21 Page 4 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T.0305(f)):
1. Does the project comply with all separations/alternatives found in 15A NCAC 02T .0305(f) & (g)? ® Yes ❑ No
15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
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
'-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 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(fl or (g). see Section X.1 of this application
*15A NCAC, 02T.0305(Q) 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 webnage
2. Does this project comply with the minimum separation requirements for water mains? ® Yes [:]No ❑ N/A
➢ 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 ❑ N/A
➢ 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: Neuse River ❑ No
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 0213 .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 coverage/authorization is required.
6. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T.0105(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 interferencelconflict 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 5 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 Sewer Minimum Design Criteria (latest version) as applicable?
If no, for projects requiring a single variance, complete and submit the Variance/Altemadve 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 proiects requiring a variance approval may be subiect to longer
review times, For proiects requiring two or more variances or where the variance is determined by the Division to be a
significant portion of the proicet. the full technical review is required.
2. Professional Engineer's Certification:
I, J. Clark Maness, attest that this application for Goldsboro Collection System Improvements — Phase 1
(Professional Engineer's name from Application Item M.1.) (Project Name from Application Item LLI)
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 143-215.613, 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)
��1111111!/�
North Carolina Professional Engineer's seal, signature, and date: f \\ N CA
SEAL r'; -
r= 04 235 _
GINS 5 ���
ARK._MN�N�..._..._
�T�I I 1111�
Applicant's Certification per 15A NCAC 02T .0106(b):
I, Tim Salmon, attest that this application for Goldsboro Collection System Improvements — Phase 1
(Signature Authority Name from Application Item I.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 143-215.6A and 143-215.613 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: ll% � - 2- 2-
FORM: FTA 06-21 Page 6 of 5

4OWiffieFsRavenet
Our People. Your Success.
Planning Assessment Addendum - Ash Street Pump Station Supplemental Narrative
The proportion of Available Capacity that is Obligated, Not Yet Tributary Daily Flow cannot be
calculated for the Ash Street Pump Station. Currently the Ash Steet Pump Station does not have
any additional capacity available, hence the negative available capacity of -0.052 MGD shown in
the FTSE and the planning assessment addendum. The proposed project will increase the Ash
Steet Pump Station's firm capacity from 0.32 MGD to 0.756 MGD. The proposed project will
increase the available capacity to increase to 0.1224 MGD.
115 MacKenan Drive I Cary, NC 27511
t 919.469.3340 1 f: 919.467.6008 1 www.withersravenel.com I License No. F-1479
Asheville I Cary I Charlotte I Greensboro I Pittsboro I Raleigh I Southern Pines I Wilmington

%0 WithersRavenel
Our People. Your Success.
- Planning Assessment Addendum - HWY 117 Pump Station Supplemental Narrative
The proportion of Available Capacity that is Obligated, Not Yet Tributary Daily Flow cannot be
calculated for the HWY 117 Pump Station. The available capacity at the HWY 117 Pump Station
depends on the wet weather flow for the previous year. In 2019 and 2020 the HWY 117 Pump
Station had additional available capacity. However, using 2021 data the HWY 117 Pump Station
does not have any additional capacity available, hence the -0.817 MGD shown in the FTSE and
the planning assessment addendum. To resolve this issue, the existing 20" force main at the HWY
117 Pump Station will be replaced with a new 24" force main to increase the firm capacity from
11.25 MGD to 15.97 MGD. This will increase the available capacity to 1.071 MGD.
115 MacKenan Drive I Cary, NC 27511
t: 919.469.3340 1 f: 919.467.6008 1 www.withersravenel.com I License No. F-1479
Asheville I Cary I Charlotte I Greensboro I Pittsboro I Raleigh I Southern Pines I Wilmington

State of North Carolina
Division of Water Resources
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: City of Goldsboro
Project Name for which flow is being requested: ..Goldsboro Collection System - Phase 1
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: . Goldsboro Wastewater.Plant
b. WWTP Facility Permit #: NCO023949
Allflows are in MGD
c. WWTP facility's permitted flow
14.2
d. Estimated obligated flow not yet tributary to the WWTP
0.2130
e. WWTP facility's actual avg. flow
11.3958
f. Total flow for this specific request
0.1525- .
g. Total actual and obligated flows to the facility
11.7513
h. Percent of permitted flow used
82.76%
Il. 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:
(A) (B)
(C)
(D)=(B+C)
(E)=(A-D)
Design
Average Approx.
Obligated,
Total
Pump Pump Daily Current
Not Yet
Current Flow
Station Station Firm Flow** Avg. Daily Tributary
Plus
(Name or Permit Capacity, * (Firm / p fl, Flow,
Daily Flow,
Obligated
Available
Number) No. MGD MGD MGD
MGD
Flow
Capacity***
Ash St 0.32 0.128 0.03
0.1525
0.1825
-0.05.5
Hwy 117 11.25 4.5 5.13
0.1895
5.3195
-0.8195
Westbrook 40 16. - 10.62
0.3655
10.986
5.014
* The Firm Capacity (design flow) of any pump station is defined as the malaimum pumped flow
that can he 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): Goldsboro Water Reclamation Facility.
Downstream Permit Number: NCO021644
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I fi'�.�.,,► 7Gi certify to the best of my knowledge that the addition of
the volume of w6stewater 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 H plus all attached planning assessment addendum s 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.
Signing Qrj�cial Signature
Title of Sigr�Ag Official
///7/ZdZ
Page 2 of 6
FTSE 10-18

PLANNING ASSESSMENT ADDENDUM (PAA)
Submit a planning assessment addendum for each pump station listed in Section Il where Available Capacity is <
0.
Pump Station (Name or Number): Ash S+(-e-& Ply rv,� S.}Ql, o,
Given that:
a. The proportion and amount of Obli ated, Not Yet Tributary Daily Flow (C) accounts for
S ez n4 rra-f � yP - % and 5 MGD of the Available Capacity (E) in Pump Station
h �t Ash iNs . Sf"u4,o, ; and that
b. The rate of activation of this obligated, not yet tributary capacity is currently approximately
0, 1 S 2 5 MGD per year; and that
c. A funded Ca ital Project that will provide the required planned capacity, namely
l��Itl i 6" (d �� ��w �,,ti, - Q}1 1 is in design or under construction with
planned completion in Mate Z 0 2 3 ; and/or
d. The following applies:
The proportion of Available Capacity that is Obligated, Not Yet Tributary Daily Flow
cannot be calculated for the Ash Street Pump Station. Currently the Ash Steet Pump
Station does not have any additional capacity available, hence the negative. availabl
capacity of -0.055 MGD shown in the FTSE and the planning assessment addendum. The
proposed project will increase the Ash Steet Pump Station's firm capacity from 0.32 MGD
to 0.756 MGD. The proposed project will increase the available capacity to increase to
0.1224 MGD.
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 OfJicidl Signature
/z v Z
Page 3 of 6
FTSE 10-18

PLANNING ASSESSMENT ADDENDUM (PAA)
Submit a planning assessment addendum for each pump station listed in Section H where Available Capacity is <
0.
Pump Station (Name or Number): H W y 0 Nr�'n
Given that:
a. The proportion and amount of Obligated, Not Yet Tributary Daily Flow (C) accounts for
Vc % and 0,) 5- 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
S zz r' ea rM+"y MGD per year; and that
c. A funded Capital Project that will provide the required planned capacity, namely
6oIJ56c, C0jlw-;4- , Sys l !,, . — PK � is in design or under construction with
planned completion in JkAL4a& and/or
d. The following applies:
The proportion of Available Capacity that is Obligated, Not Yet Tributary Daily Flow
cannot be calculated for the HWY 117 Pump Station. The available capacity at the
HWY 117 Pump Station depends on the wet weather flow for the previous year. In
2019 and 2020 the HWY 117 Pump Station had additional available capacity. However,
using 2021 data the HWY 117 pump Station does not have any additional capacity,
available, hence the-0.8195 MGD shown in the FTSE and the planning assessment
addendum. To resolve this issue, the existing 20" force main at the HWY 117 Pump
Station will be replaced with a new 24" force main to increase the firm capacity from
11.25 MGD to 15.97 MGD. This will increase the available capacity to 1.071 MGD. T
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
Page 3 of 6
FTSE 10-18

Future FM Extension for
New Cherry Pump Station
Ex. Ash Street Pump Station
upgraded with larger pumps.
.. N'W ,.
Ex. 6" FM
a Proposed 12" FM for Gay;,
future Cherry Pump
® Ex. Sewer Manhole Station and 6" FM for;
tT Ash Street Pump Station
® Ilk
Proposed Manhole r
® Ex. Sewer Pump Station
Ex. Gravity Sewer
Proposed Gravity SewerJ��
Ex. Sewer FM
Proposed FM Sizes � �{ , � �A`• i .�
4�2 irvcH Proposed MHs
INCH P
Goldsboro Collection
System Improvement=
Phase I Proposed 12" fi�li
.'� Gravity Sewer
140 10 WithersRavenel
B r. - I Pii ,i.I „reyors r,+
our People. Your success. Replace exisiting 8" Gravity Sewer ^ .
IIC 2 -51 1 with 12" Gravity Sewer a ^'
,. a r
• $f i
1 inch = 400 f, ■
b.
n
PatF U\22'.22 0030`.220036-Project Butter' Geo,a[ics', GISProject Butter Phase I Aerials—H Printed

Future FM Extension for
New Cherry Pump Station
Legend
® Ex. Sewer Manhole
® Proposed Manhole
Ex. Sewer Pump Station
Ex. Gravity Sewer
Proposed Gravity Sewer
Ex. Sewer FM
Proposed FM Sizes
� 12 INCH
� 6INCH
Goldsboro Collection
System Improvements
Phase I
1% WithersRavenel
Engineers I Planners) Surveyors
Our People. Your Success.
115MarKenan Dr' Ca,
vNC27511
t 919 e69.3340
Ilcense # r+1479
m�,xnelo,in
200 400 800
Feet
Ex. Ash Street Pump Station
upgraded with larger pumps.
�x.6...
1
Proposed 12" FM for \
future Cherry Pump
Station and 6" FM for
Ash Street Pump Station
u
_z
111
Proposed MHs
Proposed 12"
Gravity Sewer.
Replace exisiting 8" Gravity Sewer
with 12" Gravity Sewer
t• .
1 inch - 400 feet
iU 22 .22-0030`.2:

%0 WithersRavene(
40 Our People. Your Success.
Modifications to the Existing Permit Supplemental Narrative
The current existing permit for the Ash Street pump station (WQ0021989) includes the
construction and operation of approximately 1,303 linear feet of 10-inch gravity sewer; a 180-
gallon per minute pump station with duplex pumps, on -site audible and visual high water alarms,
manual transfer switch, portable generator quick -connect receptacle and telemetry system; as well
as approximately 1,024 linear feet of 6-inch force main.
The modified permit will continue operation of the approximately 1,303 linear feet of 10-inch
gravity sewer. The modified permit will also include the construction and operation of a 525-
gallon per minute pump station with duplex pumps, automatic transfer switch, on -site audible and
visual high water alarms, manual transfer switch, automatic generator, quick -connect receptacle,
telemetry system, approximately 2,130 linear feet of 6-inch sewer force main, and approximately
706 linear feet of 12-inch gravity sewer.
115 MacKenan Drive I Cary, NC 27511
t: 919.469.3340 1 f: 919.467.6008 1 www.withersravenel.com I License No. F-1479
Asheville I Cary I Charlotte I Greensboro I Pittsboro I Raleigh I Southern Pines I Wilmington

OF W ATF9 Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E., Director
`rw- Division of Water Quality
December 6, 2002
RICHARD SLOZAK, CITY MANAGER
CITY OF GOLDSBORO
POST OFFICE DRAWER A
GOLDSBORO, NC 27533
Subject: Permit No. WQ0021980
City of Goldsboro
- NCDOT Project R-1030 AA Pump Station Relocation
Wastewater Collection System Extension
Wayne County
Dear Mr. Slozak:
In accordance with your application received October 25, 2002, we are forwarding herewith
Permit No. WQ0021989, dated December 6, 2002, to the City of Goldsboro for the construction and
operation of the subject wastewater collection system extension. This permit shall be effective from the
date of issuance until rescinded- and shall be subject to the conditions and limitations as specified
therein. This cover letter shall be considered a part of this permit and is therefore incorporated therein
by reference.
Please pay particular attention to Permit Condition 3 which requires that the wastewater
collection facilities be properly operated and maintained in accordance with 15A NCAC 2H .0227 or any
individual system -wide collection system permit issued to the Permttee.
Permitting of this project does not constitute an acceptance of any part of the project that does
not meet 15A NCAC 2H .0200; the Division of Water Quality's (Division) Gravity Sewer Minimum
Design Criteria adopted February 12, 1996 as applicable; and the Division's Minimum Design Criteria
for the Fast -Track Permitting of Pump Stations and Force Mains adopted June 1, 2000 as applicable,
unless specifically mentioned herein. Division approval is based on acceptance of the certification
provided by a North Carolina -licensed Professional Engineer in the application. It shall be the
Permittee's responsibility to ensure that the as -constructed project meets the appropriate design criteria
and rules. Failure to comply may result in penalties in accordance with North Carolina General Statute
§143-215.6A through §143-215.6C, construction of additional or replacement wastewater collection
facilities, and/or referral of the North Carolina -licensed Professional Engineer to the licensing board.
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North
Carolina as amended, and other applicable Laws, Rules, and Regulations, permission is hereby
granted to the City of Goldsboro for the construction and operation of approximately 1,303 linear feet of
10-inch gravity sewer, a 180—gallon .per minute pump station with duplex pumps, on -site audible and
visual high water alarms, manual transfer switch, portable generator quick -connect receptacle and
telemetry system; as well as approximately 1,024 linear feet of 6-inch force main to serve an existing
industrial user as part of the NCDOT Project R-1030 AA Pump Station Relocation project, with no
additional discharge of collected domestic wastewater into the City of Goldsboro's existing sewerage
Non -Discharge Permitting Unit Intemet httpJ/h2o.enr.state.ne.us/ndpu
1617 Mall Service Center, Ralelgh, NC 27699-1617 Telephone [phone] Fax [phone]
DENR Customer Service Center Telephone [phone]
An Equal Opportunity Action Employer 50% recycled/10% post -consumer paper

system, pursuant to the application received October 25, 2002 and in conformity with 15A NCAC 2H
.0200; the Division's Gravity Sewer Minimum Design Criteria adopted February 12, 1996 as applicable;
the Division's Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains
adopted June 1, 2000 as applicable; and other supporting data subsequently filed and approved by the
Department of Environment and Natural Resources and considered a part of this permit.
The sewage and wastewater collected by this system shall be treated in the City of Goldsboro
Wastewater Treatment Facility (Permit No. NC0023949) prior to being discharged into the receiving
stream.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the
right to request an adjudicatory hearing upon written request within 30 days following receipt of this
permit. This request must be in the form of a written petition, conforming to Chapter 150E of North
Carolina General Statutes, and filed with the Office of Administrative Hearings, 6714 Mail Service
Center, Raleigh, NC 27699-6714. Unless such demands are made, this permit shall be final and
binding.
If you. need additional information concerning this matter, please contact Kristin E. Miguez at
[phone] extension 524.
Sincerely,
for Alan W. Klimek, P.E.
cc: Wayne County Health Department
Washington Regional Office, Water Quality Section (WWTF Permit No. NC0023949)
Barbara H. Mulkey Engineering, Inc.
Central Files
NPDU Files

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH
WASTEWATER COLLECTION SYSTEM EXTENSION PERMIT
This permit shall be effective from the date of issuance until rescinded and shall be subject to the
following specified conditions and limitations:
1. This permit shall become voidable unless the wastewater collection facilities are constructed In
accordance with the conditions of this permit; 15A NCAC 2H .0200; the Division of Water Quality's
(Division) Gravity Sewer Minimum Design Criteria adopted February 12, 1996 as applicable; the
Division's Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force
Mains adopted June 1, 2000 as applicable; and other supporting materials unless specifically
mentioned herein.
2. This permit shall be effective only with respect to the nature and volume of wastes described in the
application and other supporting data.
3. The wastewater collection facilities shall be properly maintained and operated at all times. The
Permittee shall maintain compliance with an individual system -wide collection system permit for the
operation and maintenance of these facilities as required by 15A NCAC 2H .0227. If an individual
permit is not required; the following performance crfteria shall be met as provided in 15A NCAC 2H
.0227:
~ a. The sewer system shall be effectively maintained and operated at all times to prevent
discharge to land or surface waters, and any contravention of the groundwater standards in
15A NCAC 2L .0200 or the surface water standards in 15A NCAC 2B .0200.
b. A map of the sewer system shall be developed prior to January 1, 2004 and shall be actively
maintained.
c. An operation and maintenance plan shall be developed and implemented.
d. Pump stations that are not connected to a telemetry system shall be inspected every day (i.e.
365 days per year)., Pump stations that are. connected to a telemetry system shall be
inspected at least once per week.
e. High -priority sewer lines shall be inspected at least once per every six-month period of time.
f. A general observation of the entire sewer system shall be conducted at least once per year.
g. Inspection and maintenance records shall be maintained for a period of at least three years.
h. Overflows and bypasses shall be reported to the appropriate Division regional office in
- accordance with 15A NCAC 2B .G506(a), and public notice shall be provided as required by
North Carolina General Statute §143-215.1C.
1

4. This permit shall not be transferable. In the event there is a desire for the wastewater collection
facilities to change ownership, or there is a name change of the Permittee, a formal permit request
shall be submitted to the Division accompanied by documentation from the parties involved, and
other supporting materials as may be appropriate. The approval of this request shall be
considered on its merits and may or may not be approved.
5. Construction of the gravity sewers, pump stations, and force mains shall be scheduled so as not to
interrupt service by the existing utilities nor result in an overflow or bypass discharge of wastewater
to the surface waters of the State.
6. Upon completion of construction and prior to operation of these permitted facilities, a certification, a
copy of the construction record drawings, as well as supporting design calculations for any pump
stations permitted as part of this project shall be received from a North Carolina -licensed
Professional Engineer certifying that the facilities have been installed in accordance with this
permit; 15A NCAC 2H .0200; the Division's Gravity Sewer Design Criteria adopted February 12,
1996 as applicable; the Division's Minimum Design Criteria for the Fast -Track Permitting of Pump
Station and Force Main adopted June 1, 2000 as applicable; and other supporting materials. If this
project is to be completed in phases and partially certified, you shall retain the responsibility to
track further construction approved under the same permit, and shall provide a final certificate of
completion once the entire project has been completed. A copy of the constriction record
drawings, indicating the facilities constructed in the phase being certified, shall be submitted with
each partial certification. Mail the Engineer's Certification, one copy of the "Construction Record
Drawings", and one copy of the supporting design calculations to the Non -Discharge Permitting
Unit, 1617 Mail Service Center, Raleigh, NC 27699-1617.
7. A copy of the construction record drawings shall be maintained on file by the Permittee for the life
of the wastewater collection facilities.
8. Failure to abide by the conditions and limitations contained in this permit; 15A NCAC 2H .0200; the
Division's Gravity Sewer Design Criteria adopted February 12, 1996 as applicable; the Division's
Minimum Design Criteria for the Fast -Track Permitting of Pump Station and Force Mains adopted
June 1, 2000 as applicable; and other supporting materials may subject the Permittee to an
enforcement action by the Division, in accordance with North Carolina General Statutes §143-
215.6A through §143-215.6C.
9. In the event that the wastewater collection facilities fail to perform satisfactorily, including the
creation of nuisance conditions, the Permittee shall take immediate corrective action, including
those as may be required by this Division, such as the construction of additional or replacement
facilities.
10. The issuance of this permit shall not exempt the Permittee from complying with any and all
statutes, rules, regulations, or ordinances that may be imposed by other government agencies
(local, state and federal) which have jurisdiction, including but not limited to applicable river buffer
rules in 15A NCAC 2B .0200, erosion and sedimentation control requirements in 15A NCAC Ch. 4
and under the Division's General Permit NCG010000, and any requirements pertaining to wetlands
under 15A NCAC 2B .0200 and 15A NCAC 2H .0500.
11. Noncompliance Notification:
The Permittee shall report by telephone to the Washington Regional Office, telephone number
[phone], as soon as possible, but in no case more than 24 hours or on the next working
day, following the occurrence or first knowledge of the occurrence of either of the following:
a. Any process unit failure, due to known or unknown reasons, that renders the facility incapable
of adequate wastewater transport, such as mechanical or electrical failures of pumps, line
blockage or breakage, etc.; or

b. Any failure of a pumping station or sewer line resulting in a by-pass directly to receiving waters
without treatment of all or any portion of the influent to such station or facility.
Persons reporting such occurrences by telephone shall also file a written report in letter form within
five days following first knowledge of the occurrence. This report must outline the actions taken or
proposed to be taken to ensure that the problem does not recur.
Permit issued this the sixth day of December, 2002
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
for Alan W. Klimek, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission
Permit Number W00021989

Permit No. WQ0021989
December 6, 2002
ENGINEER'S CERTIFICATION
Partial Final
I, , as a duly registered Professional Engineer in the State of North
Carolina, having been authorized to observe (periodically, weekly, full time) the construction of the
for the
Project Name Location and County
Permittee hereby state that, to the best of my abilities, due care and diligence was used in the
observation of the construction such that the construction was observed to be built within substantial
compliance of this permit; 15A NCAC 2H .0200; the Division of Water Quality's (Division) Gravity Sewer
Minimum Design Criteria adopted February 12, 1996 as applicable; the Division's Minimum Design
Criteria for the Fast -Track Permitting of Pump Stations and Force Mains adopted June 1, 2000 as
applicable; and other supporting materials.
North Carolina Professional Engineer's seal, signature, and date:
The above Engineer's Certification shall be completed and submitted to the address below with one
copy of the "Construction Record Drawings" of the wastewater collection system extension as well as
supporting design calculations for any pump stations permitted as part of this project. This project shall
not be considered complete nor allowed to operate until this Engineer's Certification and all required
supporting documentation have been received by the Division. Any wastewater flow made tributary to
the wastewater collection system extension prior to completion of this Engineer's Certification shall be
considered a violation of the permit and shall subject the Permittee to appropriate enforcement actions.
NORTH CAROLINA.DIVISION OF WATER QUALITY
WATER QUALITY SECTION
NON -DISCHARGE PERMITTING UNIT
1617 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1617
4