WQ0044483_Application (FTSE)_20230606

NC; bep( of Filvironmelltat Quality
JUN — 2023
State of North Carolina
WR
Raleigh Regional Office Department of Environmental Quality
DDivision of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number t G� 6$ (tobecompletedbyDwR)
All items most be completed or the application will be returned
1. APPLICANT INFORMATION:
I. Applicant's name: Town of Clavton (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: Jonathan Jacobs, PE per 15A NCAC
02T .0106t Title: Assistant Engineering Director
4. Applicant's mailing address: I I I E. Second Street
City: Clavton State: NC Zip: 27520-
5. Applicant's contact information:
Phone number: [phone] Email Address: iiacobs&Ztownofclavtonnc.org
I1. PROJECT INFORMATION:
I . Project name: I_*cCuller's Qomer Sewer Extension
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 or the checklist.
If new construction, but part of a master plan, provide the existing permit number: WQ00
3. County where project is located: Johnston
4. Approximate Coordinates (Decimal Degrees): Latitude: 35 . 64931 'Longitude: - 78 . 46387
5. Parcel ID(if applicable): 165920-91-2780 (or Parcel ID to closest downstream sewer)
Ill. CONSULTANT INFORMATION -
I. Professional Engineer: Eva King, PE License Number: 039159
Firm: Adams & Hodge Engineering, PC
Mailing address: 314 E. Main Street
City: Clayton State: NC Zip: 27520-�
Phone number: [phone] Email Address: eva a adamsandhodge.com
IV. WASTEWATER TREATMENT FACILITY (W WTF) INFORMATION:
L Facility Name: LRnaC--F Permit Number:-0025453
Owner Name: T—of cuyion
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
I. Permit Number(s): WQ
2. Downstream (Receiving) Sewer Information: 8 inch ® Gravity 0 Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS 00110
Owner Name(s): Town of Clavton
FORM: FTA 06-21 Page I of 5

V1. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑ No S WA
2. If the Applicant is a Developer of lots to be sold, has a Developer's O erati nal Agreement I.ORM. DEV been attached?
❑ Yes ❑ No ® N'A
3. If the Applicant is a Home;'Property Owners' Association, has an HOA;POA Operational Agreement (FORM: I-IOA) and
supplementary documentation as required by 15A NCAC 02T.01 15(c) been attached?
4. Origin of wastewater: (check all that apply):
® Residential (individually Owned)
❑ Residential (Leased)
❑ School 1 preschool ? day care
❑ Food and drink facilities
❑ Businesses ' offices? factories
❑ Yes []No ® N?A
❑ Retail (stores, centers, malls)
❑ Retail with food preparation/service
❑ Medical ' dental r veterinary facilities
❑ Church
❑ Nursing Home
❑ Car Wash
❑ Hotel and/or Motels
❑ Swimming Pool. -Clubhouse
❑ Swimming PooVFilter Backwash
❑ Other (Explain in Attachment)
5. Nature of wastewater: 10 % Domestic 210 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 .01 14(f)? ® Yes ❑ No
> If yes, provide a copy of Row reduction approval letter with this annlication
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0I 14(f))
Daily Design Flow °b
No. or Units
Flow
Single Family Homes
250 gal. -day
3
750 GPD
gal;
GPD
gat'
GAD
84.
GPD
gal!
GPD
gal..'
GPD
Tofu!
750 GPD
a See 15A NCAC 02T .01 14(bl. (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 .01 14(c), design Flow rates for establishments not identified (in table 15A NCAC 02T.01 141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 1L0 GPD (per 15A NCAC 02T .01 la]
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 now,
❑ 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

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable)- 02T o305 & Al ❑,' [Gruvity .Se,4ers):
I. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8
169
DR-35
8
115
DIP
Section 11 & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
y Section III contains information related to minimum slopes for gravity sewer(s)
i Oversizing tines to meet minimum slope requirements is not allowed and a violation of the MDC
Vill. PUMP STATION DESIGN CRITERIA (If Applicable) —D2T .0305 & MD] (Pucnp Stations/Fgrce Mainsj:
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 (firm capacity)
z 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) I Length (feet) I 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 Bar Screen [:]Other (please specify)
6. Power reliability in accordance with 15A NCAC 02'D .0305(h)(1):
❑ Standby power source or ❑ Standby pump
Must have automatic activation and telemetry - ISA NCAC 02T.0305(h)(1)(B)'.
Required for all pump stations with an average daily now 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:
D Include documentation that the portable source is owned or contracted by the applicant and is compatible with the station.
i 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 titneframes, 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 & I5A NCAC 02T.0305(f)):
1. Does the project comply with all separationslalternatives found in 15A NCAC 02T .0305 t & e ? ® Yes ❑ No
15A NCAC 02T.0305fft contains minimum separations that shall ha nrn..id-i r— �
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-1 waters of Class 1 or
Class Ii impounded reservoirs used as a source of drinking water, and associated wetlands.
100 feet
"Waters classified WS (except WS-1 or WS-V), B, SA, QRW, HQW, or SB from normal
high water (or tide elevation) and wetlands associated with these waters (see item 1X.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
tr noncompliance wun o, l .u.iu3t tl orr tvt. see section X.1 of this application
#: A NUAC 02T.031)54,.) contains alternatives where separations in 02T.0305t f1 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 tiieb ave
2. Does this project comply with the minimum separation requirements for water mains? ®Yes []No ❑ N-A
> If no, please refer to ISA NCAC 18C.0906(t) for documentation requirements and submit a separate document,
signed/scaled 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 ❑ No
If yes, does the project comply with setbacks found in the river basin rules per I iA NCAC 02B .02002 ® Yes ❑ No
Y This includes Trout Buffered Streams per 15A NCAC 213.0202
5. Does the project require coverage.+authorization under a 404 Nation wide.,individual permits ❑ Yes ® No
or401 Water Quality Certifications?
Please provide the permit number.'pennitting status in the cover letter if coverage.:authorization is required.
6. Does project comply with 15A NCAC 02T.0105 6) (additional permitsrcertifications)? ® Yes ❑ No
Per 15A NCAC 02T.0105(c)f6, directly related environmental permits or certification applications must be being prepared.
have been applied for, or have been obtained. Issuance o€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 02'r.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/confliet boxes require a variance approval.
If yes, include an attachment with details Far 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.O403(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 02 r, the btinimt1m Design Criteria for die Rermittinc of Pump Suuions
and Force Mains tiatest version). and the Gakviev Sewer Mirk im t:Drsi0 Criteria Ilatest 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 or the permit. and Droiects requiring a variance approval may be subiect to Ioneer
review times. For oroiects reauirine two or more variances or where the variance is determined by the Division to be a
significant portion of the Droiect, the Tull technical review is required.
2. Professional Engineer's Certification:
1. Eva Kim. PE , attest that this application for McCuller's Corner Sewer Extension
tProressionat Engineer's name rmm Application Item Al I i (Proaecl Name from Application Item II.I1
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 or 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 Gra%ity Sewers (latest version), and the Mininnim :)r%i-,n C.'ri!eria Ft,rt=te fist -Track Permin:r:;
of Pump Stations and Force Mains (latest wersiam). Although other professionals may have developed certain portions of this
submittal package, inclusion of these materia�s 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 raise
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 pena'ties 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-1 icensed Professional Engineer to referral to the licensing board. (21 NCAC 56.0701)
North Carolina Professional Engineer's seal, signature, and dale: �.►'�`,�N rCARO'''%
o fs
A.V
039159
c ��A 1%to
���"",,1111WIN Q4119l2023
3, Applicant's Certification per 15A NCAC 02T .0106(b);
1 Jonathan Jacobs, PE , attest that this application for McCuller's Corner Sewer Extension
(Signature Authority Name from App'tcatton lien-. ; 3 ) IProjecl Name from Application Item 11.1)
attest that this application has been reviewed by me and is accurate and complete to the best or my knowledge.
1 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 not) -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 143-213.6A 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 S 10.000 as well as civil penalties up to $25,000 per violation.
Signature.
Dale: NM
FORM: F rA 06-21
Page 5 of 5

NC Dept of Environmental Qual'Ity
JUN Zfl23
State of North Carolina
Raleigh Regional 4filee Department of Environmental Quality
DWRDivision of Water Resources
Dlvislon of %Vater Resources Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: Town of Clayton
Project Name for which flow is being requested: McCullees Corner Sewer Extension
More than one FTSE may be required for a single project if floe 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: Little Creek
b. WWTP Facility Permit #: NC0025453
AU lows are in MGD
c.
WWTP facility's permitted flow
LCWRF 2.5 + 1oCo 1.4 +
Raleigh 1.75 = 5:65 MGD
d.
Estimated obligated flow not yet tributary to the WWTP
0.9549
e.
WWTP facility's actual avg. flow
2.803
f.
TotaI flow for this specific request
0,00075
g.
Total actual and obligated flows to the facility
3.7587
h.
Percent of permitted flow used
66.5° o
11. 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)
Design
Pump
Pump
Average
Appmx.
Station
Station
FLTM Daily Flow**
Current
(Name or
Permit
Capacity, * (Firm + pi).
Avg. Daily
Number)
No.
MGD MGD
Flow, MGD
(C)
(D)=(B+C) (E)=(A-D)
Obligated,
Nnt Yet
Total Current
Tributary
Flow Plus
Daily Flow,
Obligated Available
MGD
Flow Capacity***
* The Firm Capacity (design flow) of any pump station is defined as the maximum pumped flow
that can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor
(pf) not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer):
Downstream Permit Number:
Page l of 6
FTSE 10- I S

III. Certification Statement:
I " rO J 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 Il 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.
gsss "1-
Title of Signing Official
Page 2 of 6
FTSE 1b-18

ADAMS & HOD 'rnvlr«It,nel,ttil Quall
0 me ENGINEERING, PC
JUN —8 2023
June Sth, 2023 Raleigh Regional Office
Ted Cashion
NC DWQ
3800 Barrett Dr
Raleigh, North Carolina 27609
Subject: McCuller's Corner Hamby Sewer Extension
Town of Clayton
Attached is one original and one copy of complete Application for Gravity Sewers,
which includes the following:
I. Complete Fast Track Application for Gravity Sewers, Pump Stations, and Forcemains
(Form FTA 06-21). signed by the applicant.
2. Completed Flow Tracking for Sewer Extension Application (FTSE10-18)
3. One set of Construction Drawings
4. USGS Quad Map showing approximate site location
5. Street Level Map
6. $480.00 Check for Application Fee
This application is for +1-169 If of 8" SDR-35 gravity sewer and +1-1151f of DIP
gravity sewer to serve 3 single family home lots.
If you have any questions or comments, please give me a call at 919-480-0782 or email
to [e-mail].
Sincerely,
Justin Hodge
ADAMS & HODGE ENGINEERING, PC • 314 East Main Street, Clayton, NC 27520 • Office: 919-243-1332 • Firm License # C-4187

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