WQ0044590_Application (FTSE)_20230621

CONSULTING
GROUP, PLLC
kpR, ENGINEERS & PLANNERS
June 15, 2023
W ao o qqSq o
Washington Regional Office Water Quality Section
943 Washinton Square Mall /�vcoENwowR
Washington, North Carolina 27889 '
JUN 212023
Subject: Main Extension Application
Roanoke-Chowan Community Health Center�b1�C. R W
Town of Aulander, Bertie County, North Carolina 11'� w �n
Bahl on
To whom it may concern,
Attached are the forms for the permitting of sewer extension for Roanoke-Chowan Community Health Center located
along S. Pine Drive in the Town of Aulander, Bertie County, North Carolina.
The proposed project consists of constructing a new medical office. In order to serve the medical office, the proposed
project will extend approximately 1,130 LF of 2" HDPE force -main sewer pipe from existing town utilities located on Early
Drive in Aulander. The main will extend eastward totheproperty and terminate with a valve serving as the service
connection. The new main will be owned and maintained by the Town of Aulander. As calculated using 15A NCAC 2T
.0114, the new flow generated by the proposed project is 1,500 gpd:
• 6 practitioners at 250 gpd/practitioner
Enclosed for your use is the application fee ($480.00) along with two copies of the documents listed below:
• Fast -Track Application for Gravity Sewers, Pump Stations and Force Mains (FTA 06-21)
• USGS Topo Quad Site Map
• Street Level Map
Thank you for your assistance with this project. Should you have any questions or require additional information, please
do not hesitate to contact our office.
Respectfully submitted,
Ark Consulting Group, PLLC
Nicholas Fitzgerald, P.E.
Project Engineer
1/55-B Charles Boulevarri, Greenville. NC 27858 252-55S-0888 w�..w..rrkconr.ultingpl,mup.eOm

CONSULTING
GROUP, PLLC
To:
NCDEQ - Div. of Water Resources
Washington Regional Office
943 Washington Square Mall
Washington, NC 27889
RECEIVED/NCDENR/DWR
JUN 21 2023
TRANSMITTAL LETTER
DATE: PROJECT NO.
June 16, 2023 20068
ATTENTION:
Water Quality SUBJECT:
Regional Operations Section Roanoke Chowan Community Health Clinic
Washington Regional Office
Fast Track Application -Sanitary Sewer Main -Public
Town of Aulander, Bertie County, North Carolina
WE ARE SENDING YOU:
® Attached El Under Separate Cover Via: [Type text here] the following items:
❑ Copy of Letter ❑ Plans ❑ Specifications ® Other:
❑ Shop Drawings ❑ Prints ® Permits
❑ Change Order ❑ Reproducible ❑ Samples
COPIES
DATE
DWG. #
DESCRIPTION
1
6/15/2023
Cover Letter for Fast Track Applications (Public)
2
6/9/2023
Fast -Track Permit Application - (Public)
2
5/18/2023
Flow Tracking /Acceptance Form (Public)
2
USGS Topo Quad Site Map (Public)
2
Street Level Map (Public)
1
6/16/2023
Application Fees ($480.00 for Public)
THESE ITEMS ARE TRANSMITTED AS CHECKED BELOW:
®
For Approval
❑
Approved as Submitted
❑
Submit copies for approval
❑
For Your Use
❑
Approved as Noted
❑
Submit copies for distribution
❑
As Requested
❑
Returned for Corrections
❑
Return corrected prints
®
For Review & Comment
❑
Disapproved
❑
other:
COMMENTS:
You can reach me at 919.475.0430 or [e-mail]. Thank youl
COPY TO:
NCchalcLk FP.E.
Signature
2755-B Charles Blvd. I Greenville, NC 27858 252-558-0888 www.arkconsultinggroup.com

yn(�� State of North Carolina
V �+ Department of Environmental Quality
nWR Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
` Dlvislon of Water Resources FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number:
(to be completed by DWR)
All items must he completed or the application will be returned
I. APPLICANT INFORMATION:
ToNh a'F
1. Applicant's name: Aulander (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: Kevin Smith per 15A NCAC 02T .0106(b)
Title: Water/Wastewater Superintendent
4. Applicant's mailing address: P.O, Box 100
City: Au ender State: IBC Zip: 27805-
5. Applicant's contact information:
Phone number: 252 345-3541 Email Address: I4 i✓c% R CJ���
H. PROJECT INFORMATION:
{
1. Project name: Roanoke-Chowan Community Health Center — �u�l1C
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: Bertie
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.13.86' Longitude:-77.5.99'
5. Parcel ID (if applicable): 5950-98-7727 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Nicholas Fitzgerald, P,E, License Number: 047645
Firm: Ark Counsulting, PLLC
Mailing address: 2755B Charles Blvd,
City: Greenville State: NC Zip: 27858-
Phone number: 19 475-0430 Email Address: nicholas.fi erald(&arkconsultinggroup,corn
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Aulander WWTP Permit Number: W00000777
Owner Name: Aulander
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ S D OZ6'9
2. Downstream (Receiving) Sewer Information: S inch 0 Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS 0 0 r7
Owner Name(s): % &0x✓ o-'
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 HO Overational Agreement : 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: 1% Domestic 1-00 % Commercial 0 % 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
➢ Jf 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'''
No. of Units
Flow
gaL/
GPD
laU
GPD
gaU
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
GPD
a See 15A NCAC 02T .0114(b), (d), (e 1 and (e)(22) 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: 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 ct to this line.
Please provide supplementary information indicating the approximate timeframers with flow.
❑ Flow has already been allocated in Permit Number:
Issuance Date:
PH s I ]AP
❑ Rehabilitation or replacement of existing sewers with no new flow expected
® Other (Explain): Private line is flow carrier for project
HMGMN3a0waM3038
FORM: FTA 06-21 Page 2 of 5

I .,
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 11 & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section 111 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
VIH. 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: 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
2
1,130
PVC
If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.01 C.l.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).
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
➢ Must be permanent to facility and may not be portable
Or if the pump station has an average daily flow less than 15,000 gallons per day 15A NCACO2T.0305(h)(1)(C):
❑ Portable power source with manual activation, quick -connection receptacle and telemetry -
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry:
➢ Include documentation that the portable source is owned or contracted by the applicant and is compatible with the station.
➢ 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 NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
'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 II impounded reservoirs used as a source of drinking water, and associated wetlands.
100 feet
**Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal
high water (or tide elevation) and wetlands associated with these waters (see item IX.2)
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches, as well as wetlands associated with these waters or classified as WL.
10 feet
Any building foundation (horizontal)
5 feet
Any basement (horizontal)
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
➢ If noncompliance with 02T.0305(f) 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 webnage
2. Does this project comply with the minimum separation requirements for water mains? ® Yes [:]No ❑ N/A
➢ If no, please refer to 15A NCAC 18C.0906(f) for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? ❑ Yes ❑ No ® N/A
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ See the Division's draft separation requirements for situations where separation cannot be met.
➢ No variance is required if the alternative design criteria specified is utilized in design and construction.
4. Is the project located in a river basin subject to any State buffer rules? ® Yes Basin name: Roanoke ❑ 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 021, the Minimum Design Criteria for the Permittins of Pumpi$tatjons
and Force Mains I latest version), and the Gravity Sewer Minimum Desiten 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 may be subject to longer
review times. For projects requiring two or more variances or where the variance is determined by the Division to be a
signit3cant portion of the project, the full technical review is required.
2. Professional Engineer's Certification:
1, Nicholas Fitzgerald, P.E, , attest that this application for Roanoke Chown Community Health Center
(Professional Engineer's name front Application Item M.1.) (Project Name from Application Item 11.1)
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 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 143-215.68, 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. Applicant's Certification per 15A NCAC 02T .0106(b):
I, keV I yi 6m iif , attest that this application for 1Zonnol,-C CV►o,u4n (,>MrWn► v \r-aNh CLM<S
(signature Authority Name from Application Item 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 143-215,68, 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: S"' � — a
FORM: FTA 06-21 Page 5 of 5

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Project Mgr.: BCF Project No.: 20068 NC License. P-1199 SITE LOCATION PLAN EXHIBIT
Drawn By: TGN scale: ISFIONIN��CONSULTING
Checked BY: Date. GROUP,ruC ROANOKE COWAN COMMUNITY
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2755-B Charles Blvd. I Greenville, NC 27858 BERTIE COUNTY, NORTH CAROLINA

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