WQ0044136_Application (FTSE)_20230215

DocuSign Envelope ID: 92CO3A8C-C9AB-48k P5RLjA t5' IFAF
r'enta! Quality
State of North Carolina
Department of Environmental Quality
FEBDWR 15 ?07.3 Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Dh►klon of Water Resources Raleigh Regional Office F1rA 06-21 & SUPPORTING DOCUMENTATION
Application Number: { V1 CtJ y`T (3(-' (to be completed 6y DwRj
All items must be completed or the applicatign will be returned
1. APPLICANT INFORMATION:
1. Applicant's name: City of Sanford. (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: Paul Weeks per 15A NCAC 02T _0106tb3
Title: Utilities & Engineering Director
4. Applicant's mailing address: PO Box 3729
City: Sanford - State: NC Zip: 27331-3729
5. Applicant's contact information:
Phone number: (2J9) 777-11 19 Email Address: [e-mail]
11. PROJECT INFORMATION:
1. Project name: Sheetz - Sanford
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ04 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; Lee
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.46006' Longitude:-79.14577~
5. Parcel ID (if applicable): 9652-62-4594,_9652-62-6406, 9652-62-6398 (or Parcel ID to closest downstream sewer)
Ill. CONSULTANT INFORMATION:
I. Professional Engineer: J. Dwight Vemelson License Number: 13055
Firm: Rivers & Associates. Inc.
Mailing address: 107 East_Second Street
City: Greenville State: NC Zip: 27858-
Phone number: 252 752-4135 Email Address: dvernelsonOriversandassociates.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Big, Buffalo W WTP Permit Number. NCO024147
Owner Name: City of Sanford
V, RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ
2. Downstream (Receiving) Sewer Information: 8 inch N Gravity 0 Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS 00047
Owner Name(s): City of Sanford
FORM: FTA 06-2 l Page 1 of 5

DocuS3gn Envelope ID- 92CO3A8C-C9A6-48BD-AB12-4B735A0206AC
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 HOAIPOA 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. Has a 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 wb
No. of Units
Flow
Convenience Store w/ food Preparation
60 gat/100 sq ft
4966 sf
2979.6 GPD
gall
GPD
gall
GPD
gall
GPD
gall
GPD
gall
GPD
7'61al
2979.6 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 15ANCAC 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: 2979.6 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

DocuSign Envelope ID: 92CO3A8C-C9AB48BD-AB12-48735A0206AC
VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC [Gravity Sewersle
I. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 161 DIP
D Section II & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
7 Section III contains information related to minimum slopes for gravity sewer(s)
fl Oversizing lines to meet minimum slope requirements is not allowed and a violation of the MDC
Vlll. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1 _ Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: -
3. Total number of pumps at the pump station:
3. Design flow of the pump station: millions gallons per day (fum 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.I.b. ❑ Grinder Pump ❑ Mechanical liar Screen ❑ Other (please specify) _ .
6. Power reliability in accordance with 15A NCAC 02T .0305 h( )(I ):
❑ Standby power source or ❑ Standby pump
D Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(1)(B)�.
D Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
D 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(hxl)(C).
❑ Portable power source with manual activation, quick -connection receptacle and telemetry -
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry:
A Include documentation that the portable source is owned or contracted by the applicant and is compatible with the station.
D 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 timefi-ames, shall be provided
as part of this permit application in the case of a multiple station power outage.
FORM: FTA 06-2I Page 3 of 5

DocuSign Envelope ID: 92CO3A8C-C9AB-48BD-AS124B735A0206AC
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) & ( ? ® Yes ❑ No
I SA 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 tI 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
D If noncompliance with 02T.0305(f) or r g), see Section X.I of this application
* 15A NCAC 02T.0305W 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 webste
2. Does this project comply with the minimum separation requirements for water mains? ®Yes ❑ No ❑ NIA
➢ If no, please refer to 15A NCAC 18C.0906(f) for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? ❑ Yes []No ® Nr'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: ®No
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ❑ Yes ❑ No
➢ This includes Trout Buffered Streams per 15A NCAC 2B.0202
5. Does the project require coverage/authorization under a 404 Nationwidelindividual permits ❑ Yes ® No
or 401 Water Quality Certifications?
➢ Please provide the permit number!permitting status in the cover letter if coveragetauthorization is required.
6. Does project comply with 15A NCAC 02T.0_l054c)(6) (additional permits/certifications)? []Yes ❑ No
Per 15A NCAC 02T.0105(t7€6l•, 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

DocuSign Envelope ID: 92CO3ABC-C9AB-46BD-AB12-4B735A0206AC
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 flatcst version, and the Gravity Sewer Minimum Design Criteria (latest version as applicable?
® Yes ❑ No
If no, for projects requiring a single variance, complete and submit the Variance/Alternative Design Request application
(VADC 10-14) and supporting documents for review to the Central Office. Approval of the request will be issued
concurrently with the approval of the Permit, and projects requiring a variance approval maybe subject to longer
review times. For projects requiring two or more variances or where the variance is determined by the Division to be a
significant portion of the proiect, the full technical review is required.
2. Professional Engineer's Certification:
1, 0ewf- �r ELSoI►I , attest that this application for Sheetz - Sanford
(Professional Engineer's name from Application Item 1II.1.) (Project Name from Application Item II.1)
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans,
specifications, engineering calculations, and all other supporting documentation to the best of my knowledge. I further
attest that to the best of my knowledge the proposed design has been prepared in accordance with the applicable regulations,
Minimum Design Criteria for Graviiy Sewers (latest versions. and the Minimum Design Criteria for the Fast -Track Permitting
of Pump Stations and Force Mains (latest version). Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that I have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation. Misrepresentation of the application
information, including failure to disclose any design non-compliance with the applicable Rules and design criteria, may subject
the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NCAC 56.0701)
North Carolina Professional Engineer's seal, signature, and date:
'3
3. Applicant's Certification per 15A NCAC 02T .0106(b).
Paul M. weeks Jr. P.E.
1, , attest that this application for Sheetz - Sanford
(Signature Authority Name from Application llem I.3.) (Project Name from Application Item 11.1)
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: T
OccuSigned by:
�ALcI* h. wt,t,IcS Y. P.f,. 2/9/2023
BBC39E66678"B9.., Date:
FORM: FTA 06-2 1 Page 5 of 5

DocuSign Envelope ID: 9EB4DCBA-88F1-49E4-B390-05415FOB3D48
NC Dept of Environmental Quality State of North Carolina
Department of Environmental Quality
DWRFEB 15 2023 Division of Water Resources
Raleigh Regional Qffi� w Tracking for Sewer Extension Applications
Division of Water Resources (FTSE 10-18)
Application Number: FT-350
Entity Requesting Allocation: City of Sanford
Project Name for which flow is being requested: Sheetz - Horner Blvd.
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
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility name: Big Buffalo Wastewater Treatment Plant
b. WWTP Facility Permit #: NC0024i47
All flows are in MGD
c.
WWTP facility permitted flow:
12.0000
d.
Estimated obligated flow not yet tributary to the WWTP:
1.9720
e.
WWTP facility's actual average flow:
4.1390
f.
Total flow for this specific request:
0.00298
g.
Total actual and obligated flows to the facility.
6.1140
h.
Percent of permitted flow used:
51 %
II. Complete this section for each pump station you are responsible for along the route of this proposed
List pump stations located between the project connection point and the WWTP.
(A) (B) (C) (D) - (B+C)
(E)=(A-D)
Pump
Pump Firm Design Approx. Obligated. Total Current
Avadablc
Station
Station Capact4}1 Average Current Not Yet Flow Plus
Capaci(y3
(Name or
Permit Daily Flow2 Avg. DaiRy Tributary Obligated
Number)
'.dumber [Firm.nf). Flow. Daily FioH. Flow
MGD MGD MGD MGD MGD
NIGD
Little —Buffalo
MW00040295 6.3W 2.5459 1.3046 0.6552 1.9599
0.3861
zBig_Buffalo
#N:A PN;'A #N+A 9WA alk;h
#N-A
x
#N.,A #N-A FN-A xN-A #NrA
PIN -A
x
#N.A NMA #N-A 9N,A vN:A
#N-A
x
#N,A #N+A #N:'A #N+A #N'A
#N1A
x
#N-A ON -A #K!A #N,A ARt'A
aN-A
1. The Firm Capacity (design flow) of any pump station is defined as the maximum pumped flow that
can be achieved with the largest pump taken out of service.
2. Design Average Flow is the firm capacity of the pump station dii tided by the peaking factor (pf) not
less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
3. 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 9 0.
Downstream Facility Name (Sewer)
Downstream Permit Number:
City of Sanford Collection System
WQCS00047
Page 1 of 6 FTSE 10-18

DocuSign Envelope ID: 9EB4DCBA-88F1-49E4-B390-05415FOB3D48
III. Certification Statement
I, Paul Weeks, Jr. PE, certify to the best of my knowledge that the addition of the volume of
wastewater to be permitted in this project has been evaluated along the route to the receiving wastewater
treatment facility and that the flow from this project is not anticipated to cause any capacity related
sanitary sewer overflows or overburden any downstream pump station en route to the receiving treatment
plant under normal circumstances, given the implementation of the planned improvements identified in
the planning assessment where applicable. This analysis has been performed in accordance with local
established policies and procedures using the best available data. This certification applies to those items
listed above in Sections I and II plus all attached planning assessment addendums for which I am the
responsible party. Signature of this form certifies that the receiving collection system or treatment works
has adequate capacity to transport and treat the proposed new wastewater.
—DDcuftned by:
PAa At kAs Jr. P.f.
Signing Official Signature
Utilities & Engineering Director
Title of'Signing Official
02;'07::23
Date
Page 2 of 6 FTSE 10-18

'V�]'s ENGINEERS
P, 8 ASSOCIATES, INC.
Jason Robinson
NCDEQ — Raleigh Regional Office
Water Quality Section
3800 Barrett Drive
Raleigh, NC 27609
Phone: [phone]
PLANNERS
February 10, 2023
SURVEYORS LANDSCAPE ARCHITECTS
NC Dept of Environmental Quality
FEB 15 U
Subject: Sheetz — NE Cor of S. Horner Blvd.: US 421 Bus.
Sanford, NC
Dear Mr. Robinson:
Sheetz, Inc. is seeking to develop a new store at the corner of S. Horner Boulevard and E.
Main Street in Sanford, NC. This store would require the construction of approximately 161 LF
of 8" DIP gravity sewer main in addition to 3 sanitary sewer manholes and 110 LF of 16" steel
encasement pipe to cross under S. Horner Boulevard. The proposed sanitary sewer will tie into
an existing manhole located in S. Horner Boulevard.
On behalf of Sheetz, Inc. we would like to request approval of the sewer permit for the
entire store. The submittal package is attached.
Please contact me with any questions or comments. Thanks for your help.
With best
Dwight Vemelson, PE
vers & Associates, Inc.
P - 1-andDevlSheetz-Sanford-2022-46/Adm in/D-PermittinglSanSewer+DW R RFas[TrackSewerPermitApp. 12-21-221
CvrUrShecuSanford 02-10-23
107 E. Second Street, Greenville, NC 27858 * PO Box 929, Greenville, NC 27835 ■ Phone: [phone] - Fax: [phone]&
NCBELS Lic. No. F-0334 www.riversandassociates.com NCBOLA Lic. No. C-312

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ivej- ENGINEERS
I, ASSOCIATES 'NC.
TO: NCDEQ - Raleigh Regional Office
Water Quality Section
3800 Barrett Drive
Raleigh, NC 27609
Phone: [phone]
GENTLEMEN:
WE ARE SENDING YOU
❑ Shop Drawings
❑ Copy of Letter
PLANNERS SURVEYORS LANDSCAPE ARCHITECTS
LETTER OF TRANSMITTAL
Date IJob No. 2022046
February10, 2023
ATTENTION:
Jason Robinson 1!
Sheetz - S. Horner Blvd. & E. Main Street
Fast Track Sewer Permit
Sanford. NC
❑� Attached ❑ Under Separate Cover Via Courier the following items:
❑ Prints ❑ Plans ❑ Samples ❑ Specifications
❑ Change Order ❑ Other
COPIES DATE No.
1
1
1
1
1
1
1
DESCRIPTION
Cover Letter
Fast Track Sewer System Extension Application (FTA 06-21)
- Signed & Sealed by Engineer and Owner 1 Applicant
Flow Tracking Acceptance Form (FTSE 10-18)
Fast Track Application Fee: Rivers CV 6110416 in the
amount of $480.00, dated 2-10-23 ept of Environmental Quality
USGS Topo Map
Aerial Site Map
FEB 15 Z, l 3
CD containing all items listed above Raleigh Regional Office
THESE ARE TRANSMITTED as checked below
Q For Approval ❑ Approved ❑ Resubmit copies for approval
❑ For Your Use ❑ Approved as Noted ❑ Submit copies for distribution
❑ As requested ❑ Disapproved ❑ Return copies for approval
❑ For Review and Comment ❑ Other
REMARKS Hello Jason: Attached please find the Fast Track Sewer Permit Application for your
approval. Please let me know if I can be of further assistance.
Thanks for your help and please call with any questions.
With best regards,
RIVERS & ASSOCIATES, INC.
Cck"hy TO SIGNED.
_
enjamin D. Engstro I
email: [e-mail]
If enclosures are not as noted, kindly notify us at once
107 E. Second Street, Greenville, NC 27858 - PO Box 929, Greenville, NC 27835 ■ Phone: [phone] + Fax: [phone]
NCBELS Lic, No. F-0334 www.riversandassociates.com NCBOLA Lic. No. C-312