WQ0044131_Application (FTSE)_20230127

Wo()0qLf131
"OLIS ENGINEERING, PA
P.O. Box 15564 • New Bern, North Carolina 28561 252.633.0068 • License No. G-0706
RIMMMMCDETIRMWR
January 24, 2023
JAN 2 7 2023
Water Qualtty
NCDEQ Regional operations Section
Washington Regional Office Washington Reglonal Office
Water Quality Section
943 Washington Square Mall
Washington, NC 27889
RE: Goshen Medical Clinic
US Highway 17 South / Martin Luther King Jr. Boulevard, New Bern, North Carolina
AE Project No. 21053
Dear Sir/Madam:
Enclosed please find the Fast Track Sewer System Extension application package for your review
and approval consisting of the following:
• Form FTA 04-16 (Original and One Copy)
• $480 Application Fee
It is requested that you consider the submittal information, and if deemed appropriate, issue
the Sewer System Extension Permit for this project.
Your assistance with this matter is appreciated.
Sincerely,

PROJECT NARRATIVE
GOSHEN MEDICAL CLINIC
US HWY 17S/MLK BOULEVARD
NEW BERN, NC
This project proposes to construct 1483 linear feet of eight inch ductile iron pipe gravity sewer
main to serve a new proposed medical building. The medical building will have an average
wastewater flowrate of 2,000 gallons/day: --'
The sewer main extension will originate at the terminus of an eight inch gravity main serving a
residential subdivision. The sewer main will extend along a subdivision road that was closed by
the City of New Bern approximately 15 years ago. The main will then run along the US Highway
17 right-of-way to the proposed medical building site. Due to the sewer mains relatively deep
depth, more than 18 inches of vertical separation will be provided between the new sewer
main and the existing water main in the area in any locations where the 10 foot horizontal
separation cannot be achieved.
One ditch crossing is proposed and will be accomplished perpendicularly and will be below the
bottom of the ditch with a three foot cover.

D" ivlslon 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. D l,' i l `'I (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 New Bem (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: Foster Hughes per 15A NCAC 02T .0106(b)
Title: City Manager
4. Applicant's mailing address: PO Box 1129
City: New Bern State: NC Zip: 28563-
5. Applicant's contact information:
Phone number. 252 639-7527 Email Address: hughesf a ewbernnc.izov
H. PROJECT INFORMATION:
1. Project name: Goshen Medical Clinic
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: Craven
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.093610 Longitude:-77.12944'
5. Parcel ID (if applicable): 8-206-133 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Joseph C. Avolis, PE License Number. 15360
Firm: Avolis Engineering, PA
Mailing address: PO Box 15564
City: New Berri State: NC Zip: 28561-
Phone number: 252 33-0068 Email Address: joeAavohseng com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: City of New Bern Permit Number: NC 0025348
Owner Name: City of New Bern
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ
2. Downstream (Receiving) Sewer Information: 8 inch ® Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS-0
Owner Name(s): City of New Bern
FORM: FTA 06-21 Page 1 of 5

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
[:]Yes Z 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: HOA) 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: % Domestic 100 % Commercial % 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 copy 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
Medical Office
250 gal/practioner/shift
8
2000 GPD
gall
GPD
gal/
GPD
gall
GPD
gal/
GPD
gall
GPD
Total
2000 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 shallbe
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 2000 GPD (per 15ANCAC 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

VH. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 1483 DIP
➢ Section H & 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
VIM 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: 0Longitude: - °
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 2.01C. Lb. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NCAC 02T .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 15A NCACO2T.0305(h)(1)(C):
0 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 separations/alternatives found in 15A NCAC 02T.0305(f) & (g)? ® Yes [-]No
15A NGAC Q2T.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 H 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(f) or W, see Section X.1 of this application
*15A NCAC 02T.0305(a) 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 webyaQe
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? 0 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 ❑ 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 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 tines that are deemed "high -priority?" ❑ Yes 0 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 permtttee or its representative at least once every six -months and
inspections documented per 15A NCAC 02T.0403(a)(5) or the permittee's individual System -Wide Collection permit.
FORM: FTA 06-21 Page 4 of 5

x CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T. the Minimum Design Criteria.for the Permittm o� Stations
and Force Mains (latest version), and the QrqD�y Sewer Minimum Design Criteria (latest version) as applicable?
Yes 0 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
review.times. For protects requiring two .or more variances or where the variance is determined by the Division: to be a
denificant portion of the proiect; the full technical review Is required.
2. Professional Engineer's Certification:
I, Jo h "C. Aeolis P , attest that this application for G shen Medical Clinic
(Professional Engineer's name from Application Item 111.1.) (Project Name from Application Item ILL)
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 Gravy 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 he consistent with the proposed design.
NOTE In accordance: with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation. Misrepresentation of the application
information, including failure to disclose any design non-compliance with the applicable Rules and design criteria, may subject
the North Carolina -licensed Professional Engineer to referral to the licensing boar
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I, Foster Hujzhes . attest that this application for Goshen Medical Clinic
(Signature Authority Name from Application Item L3.) (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 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: Date:
FORM: FTA 06-21 Page 5 of 5

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State of North Carolina
. DWR
Department of Environmental Quality
Division of Water Resources
Division of Witter Resources Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: City of New Bern
Project Name for which flow is being requested: Goshen Medical Clinic
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: City of New Bern
b. WWTP Facility Permit #: NCO025348
All flows are in MGD
c. WWTP facility's permitted flow 6.500 —
d. Estimated obligated flow not yet tributary to the WWTP 0.630 N
e. WWTP facility's actual avg. flow 3.759
f. Total flow for this specific request 0.002
g. Total actual and obligated flows to the facility 4.391
h. Percent of permitted flow used 67.55%
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:
(A)
(B) (C) (D)=(B+C)
(E)�(A-D)
Design
Obligated,
Pump Average Daily
Approx. Not Yet Total Current
Station Firm Flow*"
Current Avg. Tributary Flow Plus
(Name or Capacity, * (Firm / pf),
Daily Flow, Daily Flow, Obligated
Available
Number) MGD MGD
MGD MGD Flow
Capacity***
LS 26 0.216 0.086
0.018 0.002 0.020
0.066
LS 111 1.498 0.600 0.312 0.069 0.381 0.219
* The Firm Capacity 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.
*** 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): New Bern WWTP
Downstream Permit Number: NCO025348
Page 1 of 6
FTSE 04-16

III. Certification Statement:
I Foster Hughes, City Manager 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 indicates acceptance of this wastewater flow.
qK-
Signing Wicial Signature
-1 -
Date
Page 2 of 6
FTSE 04-16

Average Yearly Flow for:
Jan.2022
Feb.2022
Mar.2022
Apr.2022
May2022
Jun2022
Ju12022
Aug2022
Sept2022
Oct2022
Nov2022
Dec2022
Facility name, Permit #
Permitted Flow:
3.952258
3.619286
3.732258
4.105667
3.936774
3.642
4.145806
3.719355
3.829333
3.613226
City of New Bern
NCO025348
OUTFALL 2 Effluent
3.469667
3.593548
3.7799315 Avg. Flow
2022 % of Permitted Flow:
6.5
0.581527923
(< 80% / 90% 0K)