WQ0044584_Application (FTSE)_20230621

5410 Trinity Road
TIMMONS GROUP Suite 102
YOUR VISION ACHIEVED THROUGH OURS. Raleiqh, NC 27607
TRANSMITTAL
Washington Regional Office
TO: Water Quality Regional
Operations Section
State of North Carolina DEQ
943 Washington Square
Washington, NC 27899
P 919.866.4951
F 919.359.5663
w .timmons.com
RECEIVED/NCDENR/DWR
JUN 21 2023
Water quality
Regional Operations Section
Washington Regional Office
Date: 06/19/2023 Job#: 58060
Project: Grace Drive Pump Station
Reference:
Copies Sent To:
COPIES
DATE
NUMBER
DESCRIPTION
2
06/16/2023
Cover Letter
2
06/16/2023
CK#93191
Application Fee $480.00
2
06/16/2023
FTSE 06-21
Fast -Track Sewer System Extension
Application
2
06/16/2023
Pro'ected Future Flows Calculations
2
06/16/2023
US Topographic Ma
2
06/16/2023
Ariel Ma
2
06/16/2023
WQCS00082
Existing System -Wide Collection System Permit - Redlined
THESE ITEMS ARE TRANSMITTED:
If enclosures are not as noted, please notify us at once.
COMMENTS:
Thank you for your time in reviewing this application requesting a modification to the Grace Drive pump
station in Elizabeth City, NC. If you find there is any missing information or if you have any questions,
please do not hesitate to contact me at:
Ashley Kabat
[phone]
[e-mail]
ENGINEERING I DESIGN I TECHNOLOGY

V[G00q1q9N
004r,
5 410 Trinity Road P 919.366.4951
T I M M O N S GROUP Suite 102 F 919.859.5663
YOUR VISION ACHIEVED THROUGH OURS. Raleigh, NC 27607 www.timmons.com
5/26/2023
David May, WRWQROS Regional Supervisor
State of North Carolina Department of Environmental Quality
Washington Regional Office Water Quality Section
943 Washington Square Mall
Washington, NC 27889
Fast Track Sewer Extension Application — Grace Drive Pump Station Upgrades
Mr. May,
Timmons Group is pleased to submit the following Fast Track Sewer Extension Application on behalf of the City of
Elizabeth City. This application is being submitted to request expansion of the Elizabeth City pump station located at
Grace Drive. This project includes the replacement of the existing two (2) dry -well pumps with three (3) suction -lift
pumps. The new proposed pumping capacity is 2,600 GPM at 175' TDH with two pumps pumping and one pump for
redundancy.
The sewer upgrades are in support of the eventual expansion of Elizabeth City Regional Airport, the USCG base of
Elizabeth City, and Elizabeth City State University. The pump station located at Grace Drive is currently pumping
approximately 800 GPM and is reliant on a permanent diesel pump for redundancy.
The existing pump station structure (wet well and pump/control building) will be reused. The existing permanent
diesel backup pump on site will be replaced with a new permanent diesel backup pump capable of pumping 2,600
GPM at 176' TDH to ensure full capacity pump station reliability. The existing 12" cast iron pump station site piping
will be replaced with 14" ductile iron piping. The existing force main from Grace Drive Pump Station manifolds with
the Main Street Pump Station force main and will be reused in this design, therefore no force main additions or
modifications are included in this application. The existing force main is approximately 7,500 linear feet of 14" cast
iron pipe and approximately 2,100 linear feet of 24" ductile iron pipe.
The existing system -wide collection system permit for the City of Elizabeth City is included in this application and has
been marked -up to reflect the requested modifications for this pump station expansion.
We look forward to hearing from you regarding this review. If you have any questions or need any additional
information, please don't hesitate to contact me at 919.532.3290 or ash ley. kabat(abtimmons.com at your
convenience.
Sincerely,
'A 749J
Ashley Ka , PE
Project ager
919.532.3290
CIVIL ENGINEERING I ENVIRONMENTAL I SURVEYING I G1S I LANDSCAPE ARCHITECTURE I CONSTRUCTION SERVICES

RECEIVEDMCDEN
R/DM
State of North Carolina
Department of Environmental Quality
W----- ____
JUN 2 2023 Division of Water Resources
Water Qu FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Dlvislon of Water Resources �j � FORM: FTA 06-21 & SUPPORTING DOCUMENTATION
n9ton ReolonE,, QM M
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 (Gravily 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 be 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):
® 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 H.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 Engineer.
® 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 Page 1 of 3

NO NEW GENERATED FLOWS (INFLOW TO PUMP STATION) BEING PERMITTED AT THIS TIME
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.
SYSTEM -WIDE COLLECTION SYSTEM PERMIT INCLUDED. PUMP STATION PERMIT CANNOT BE FOUND
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 be
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.
N/A - PAD -MOUNTED DIESEL PUMP
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 he 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/Property 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 Qperational 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 Offtee
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 Renional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Hamett, Hoke,
Water Quality Section
Fayetteville, North Carolina 28301-5095
Montgomery, Moore, Robeson, Richmond,
[phone]
Sampson, Scotland
[phone] Fax
Mooresville Regional 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
Raleiah 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
Washlncrton Regional Office
943 Washington Square Mall
Beaufort, Bertie, Camden, Chowan, Craven,
Water Quality Section
Washington, North Carolina 27889
Currituck, Dare, Gates, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pltt, Tyrrell, Washington, Wayne
Wilmington Regional Offlce
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
Water Quality Section
Wilmington, North Carolina 28405
Hanover, Onslow, Pender
[phone]
[phone] Fax
Winston-Salem Realonal Office
450 W. Hanes MITI Road
Alamance, Alleghany, Ashe, Caswell, Davidson,
Water Quality Section
Suite 300
Davie, Forsyth, Guilford, Rockingham, Randolph,
Winston-Salem, North Carolina 27105
Stokes, Sury, Watauga, Wilkes, Yadkin
[phone]
[phone] Fax
INSTRUCTIONS FOR FORM: FTA 05-21 & SUPPORTING DOCUMENTATION Page 3 of 3

V\ j nor) j j, j <-Q-O State of North Carolina
Department of Environmental Quality
1XW_Division of Water Resources
��— J' FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number.
(to be completed by DWR)
All items must be completed or the application will he returned
L APPLICANT INFORMATION:
1. Applicant's name: City of Elizabeth City (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: Dwan A. Bell per 15A NCAC 02T .0106(b)
Title: Public Works Director
4. Applicant's mailing address: 410 Pritchard Street
City: Elizabeth City State: NC Zip: 27909-
5. Applicant's contact information:
Phone number. 252 337-6628 Email Address: dbell[a�elizabethciWjn .goy
H. PROJECT INFORMATION:
1. Project name: Grace Drive Pump Station
2. Application/Project status: ❑ Proposed (New Permit) ® Existing Permit/Project EXISTING W000 PERMIT
FOR THIS PUMP STATION
If a modification, provide the existing permit number. WQOC) and issued dater CANNOT BE FOUND.
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: Pasguotank
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.284711' Longitude: - 6.27 01065'
5. Parcel ID (if applicable): 8923-14- 480-28 (or Parcel ID to closest downstream sewer)
M. CONSULTANT INFORMATION: /
1. Professional Engineer. Ashley M Kabat License Number: 052736 (/
Firm: Timmons Group
Mailing address: 5410 Trinity Road Suite 102
City: Raleigh State: NC Zip: 2 60 -_
Phone number. 919 532-3290 Email Address: Ashley.KabatCd�timmons.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Elizabeth City WWTP Permit Number. NCO025011
Owner Name: City of Elizabeth City
V. RECEIVING DOWNSTREAM SEWER INFORMATION: EXISTING W000 PERMIT FOR "MAIN
1. PermitNumber(s): W� PUMP STATION" CANNOT BE FOUND.
2. Downstream (Receiving) Sewer Information: 24 inch ❑ Gravity M Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS00082
Owner Name(s): City of Elizabeth City
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 ❑ 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?
NO NEW FLOWS GENERATED . Y CRQ.)ECT - �XISTING FLOWS ONLY. EXPANDING PS FOR FUTURE PROJECTS
4.
Origin o wastewater: (c ec aril 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 % 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 .0I 14(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'b
No. of Units
Flow
gaU
GPD
gal/
GPD
gaU
GPD
gaU
GPD
gaU
GPD
gaU
GPD
Total 0 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: 0 GPD (per 15A NCAC 02T .0114)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero, please Indicate why:
® Pump Station/Force Main or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line.
Please provide supplementary information indicating the approximate timeframe for permitting upstream sewers with flow.
❑ Flow has already been allocated in Permit Number: Issuance Date:
❑ Rehabilitation or replacement of existing sewers with no new flow expected
❑ Other (Explain):
FORM: FTA 06-21 Page 2 of 5

NO NEW GRAVITY SEWER TO BE PERMITTED
VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
➢ 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)
➢ Overaizing lines to meet minimum slope requirements is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: Grace Drive Pump Station
2. Approximate Coordinates (Decimal Degrees): Latitude: 36.284711' Longitude:-76.201065°
3. Total number of pumps at the pump stazti n: 3
3. Design flow of the pump station: 3.74 fnillions 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): 2,600 gallons per minute (GPM) at 175 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
UTILIZING EXISTING 14" CAST
IRON 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.1.b. ❑ 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)i
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
➢ Must he permanent to facility and may not be portable
Or if the pump station has an average daily flow less than 15,000 gallons per day 15A NCACO2T.0305(h)(1)(C):
❑ Portable power source with manual activation, quick -connection receptacle and telemetry -
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry:
➢ Include documentation that the portable source is owned or contracted by the applicant and is compatible with the station.
➢ If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel timeframes, shal I 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(fl & (g)? ® Yes ❑ No
15A NCAC 02T.0305(I) contains minimum senarations 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
2Water 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 11 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(I) or (g), see Section X.1 of this application
* 15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(fl 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 webpage
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: ® 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 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 interference/conflict boxes require a variance approval.
➢ If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at least once every six -months and
inspections documented per 15A NCAC 02T.0403(a)(5) or the permittee's individual System -Wide Collection permit.
FORM: FTA 06-21 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 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?
® 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. Apuroval of the retraest wM be issued
concurrently with the approval of the permit, and projects requiring a variance approval may be subject to longer
review times. For protects 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, Ashley M. Kabat , attest that this application for Grace Drive Pump Station
(Professional Engineer's name ftom Application Item ILL 1.) (Project Name ltom Application Item H.1)
has been reviewed by me and is accurate, complete and consistent with the information suppkied 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 $25,000 per violation. Misrepresentation of the application
information, including failure to disclose any design non-compliance with the applicable Rules and design criteria, may subject
the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NCAC 56; 0701)
North Carolina Professional Engineer's seal, signature, and date: O..........
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27
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3. Applicant's Certification per 15A NCAC 02T .0106(b): "11iiijjjjnl01"
1, D Wave A attest that this application for CTYOIC& -DylV& W M P (%l O Vl
(Signature Authority Nate from Applieation Item 1.3.) (Project Name from Application Item n.l)
attest that this application has been reviewed by me and is accurate and complete to the best of my knowledge.
I understand that if all required parts of this application are not completed and that if all required supporting documentation
and attachments are not included, this application package is subject to being returned as incomplete. I understand that any
discharge of wastewater from this non -discharge system to surface waters or the land will result in an immediate enforcement
action that may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division
of Water Resources should a condition of this permit be violated. I also understand that if all required parts of this application
package are not completed and that if all required supporting information and attachments are not included, this application
package will be returned to me as incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6$, 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.
Date
Signature: Wart
FORM: FTA 06-21 Page 5 of 5

• Io
14 1
GRACE DRIVE PUMP STATION
36.2847110
-76.2010650
DT
;?ochello

Projected
Description
02T Establishment
02T Flow 02T Units
# of Units
Value
Units
Year
Airport Expansion
24.48
gpm
Phase 1: 110,000 SF Hangar
5.99
gpm
2024
Phase 2: 110,000 SF Hangar
5.99
gpm
2025
Phase 3: 110,000 SF Hangar
5.99
gpm
2028
5,000 SF Terminal
General business and 1
25 gal/employee/shift
50
2.17
gpm
2024 Assumed
16,000 5F Hangar
General business and 1
25 gal/employee/shift
100
4.34
gpm
2024 Assumed
ECSU Expansion
173.96
gpm
400-Person Residence Hall
Hotels and motels, wit
175 gal/room
400
121.53
gpm
2025
22,000 SF Dining Hall
Caterers
50 gal/100 sq it floor space
220
19.10
gpm
2025
50,000 SF Avitation Center
Schools without cafete
10 gal/student
500
8.68
gpm
2026 Assumed
55,0D0 SF Library
Schools without cafetf
10 gal/student
2,000
34.72
gpm
2026 Assumed
Butler Residence Hall
Hotels and motels, wit
175 gal/room
200
60.76
gpm
2026 Assumed
15-Acre Tract at Airport
Unknown land
880 gal/acre
15
22.92
gpm
2026 Assumed
9o-SR Residence Hall (Wornak)
HotcIs and motels, wit
I /5 gol/room
; T.:?-.
up�r
>DU
130-BR Residence Hall (Mitchell-LtHotels
and motels, wit
175 ya!/room
25,000 SF Old Ridley
Schools without cafete
10 gat/stodew
; 47
Ia,m
Caterers
50 govloosgf;
Coast Gourd Expansion
Plane Washing
Childcare Facility
Day care and preschoc 25 gal/person (child+employee)
9.98 gpm
3.47 gpm 2024 Assumed
150 6.51 gpm 2024 Assumed