WQ0044869_ASEA_20231027

DWIR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — ALTERNATIVE SEWER EXTENSION APPLICATION
ASEA 04-16 & SUPPORTING DOCUMENTATION
Application Number:
I. APPLICANT INFORMATION:
(to be completed by DWR)
1. Applicant's name: Brunswick Regional Water and Sewer (H2G0) (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State ® Municipal ❑ County
3. Signature authority's name: Bob Walker per 15A NCAC 02T .0106(b)
Title: Executive Director
4. _Applicant's mailing address: P.O. Box 2230
City: Leland State: NC Zip: 28451-
5. Applicant's contact information:
Phone number: 910) 371-9949 Email Address: bwalkergh2goonline.com
H. PROJECT INFORMATION:
1. Project name: Grayson Park Phase 3C Section 2
2. Application/Project status: ® Proposed (New Permit) ❑ Existing PermitlPrcject
If a modification, provide the existing permit number: WQ00 and issued date:
If new construction but part of a master plan, provide the existing permit number: WQ00
3. County where project is located: Brunswick
4. Approximate Coordinates (Decimal Degrees): Latitude: 34.19463' Longitude:-78.10173'
III. CONSULTANT INFORMATION:
1. Professional Engineer: Mason Manhertz License Number: 052739
Firm: Cape Fear Engineering, Inc.
Mailing address: 151 Poole Rd., Ste. 100
City: Leland State: NC Zip: 28451-
Phone number: [phone] Email Address: mason.manhertz@capefearen ing eerie
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Belville Wastewater Treatment Facility Permit Number: NCO075540
Owner Name: H2GO Brunswick Regional Water and Sewer
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): W00029667
System Wide Collection System Permit Number(s): WQCS00202
Owner Name(s): H2GO Brunswick Regional Water and Sewer
FORM: ASEA 04-16 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 submitted?
❑ 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 submitted?
❑ Yes ❑No ®N/A
3. If the Applicant is a Home/Property Owners' Association, has an Operational Agreement (FORM: HOA) been submitted?
❑ Yes ❑No ®N/A
4. Origin of wastewater: (check all that apply):
® Residential Owned ❑ Retail (stores, centers, malls)
❑ Residential Leased ❑ Retail with food preparation/service
❑ School / preschool / day care ❑ Medical / dental / veterinary facilities
❑ Food and drink facilities ❑ Church
❑ Businesses / offices / factories ❑ Nursing Home
5. Is/was an Environmental Assessment required under 15A NCAC 01 C? ❑ Yes ❑ No
If yes, submit the appropriate final environmental document (FONSI, ROD, etc.)
6. Nature of wastewater: 100 % Domestic/Commercial % Other waste — specify:
Industrial (See 15A NCAC 02T .0103(20))
7. Wastewater generated by project: 7,770 GPD (per 15A NCAC 02T .0114)
Hasa flow reduction been approved under 15A NCAC 02T .0114(f)? ®Yes ❑ No
If yes, provide a copy of approval
8. Summarize wastewater generated by project:
❑ Car Wash
❑ Hotel and/or Motels
❑ Swimming Pool /Clubhouse
❑ Swimming Pool/Filter Backwash
❑ Other (Explain in Attachment)
Establishment Type
Daily Design Flow'
No. of Units
Flow
Residential- 3 Bedroom
210 gal/day-unit
37
7,770 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
7,770 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 below shall be determined using available
flow data, water using fixtures, occupancy or operation patterns, and other measured data.
FORM: ASEA 04-16 Page 2 of 5

VII. PRESSURE SEWER DESIGN CRITERIA —15A NCAC 02T .0305:
1. Number of simplex pump stations (STEP tanks/effluent pumps, vacuum pits, etc.) provided: 37
2. What is the nearest 100-year flood elevation to the facility? 66 feet mean sea level.
Is any of the proposed project located within the 100-year flood plain? ❑ Yes ®No
3. If Yes, are the following items provided per 15A NCAC 02T .0305(e):
Water -tight seals on all station hatches and manholes; and
Control panels vents extend two feet above the 100-year flood plain elevation? ❑ Yes ❑ No ❑ N/A
If No, what measures are being taken to protect them against flooding?
4. Volume of storage in wet well above pump on elevation: 367.2 Gallons (include calculations)
5. How power reliability will be provided in accordance with 15A NCAC 02T .0305(h)(D:
® Wet well storage provides 24 hours worth of wastewater storage; or
❑ Wet well storage provides wastewater storage based on power reliability and response times
(See "Policy for Meeting Reliability Requirements")
➢ Provide 3 years of power history date in the area.
➢ Provide response time to replace a failed pump. This would include travel time, time to replace pump, etc.
➢ Wet well storage would be based on whichever is greater.
All other pump stations meet the reliability requirements of 15A NCAC 02T .0305(h)(1): ❑ Yes ❑ No ❑ N/A
6. Summarize simplex pump station design elements:
Design Element
Plan Sheet
Reference
Specification
Reference
Emergency Contact Placard or Sticker
D-5
Screened Wet Well Vent
D-5
Restricted Access Details
D-5
Control Panel
D-5
High Water Alarms (Audible & Visual)
D-5
Valves (Check, Gate, etc)
D-5
Air Relief Valves
N/A
7. Summarize the pipe length by diameter to be permitted. Lines from a building to the septic or pump tank should be excluded.
(provide attachments if necessary)
Zone
From Node
To Node
Diameter (in)
Length (feet)
# Pumps in Zone
Pump Model
Specified for Zone
1.5
350
2
1,210
8. Air release valve station locations per 15A NCAC 02T .0305(i) (provide attachments if necessary)
Air Release Valve # Station Plan Sheet Reference
N/A
FORM: ASEA 04-16 Page 3 of 5

VUL SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations found in 15A NCAC 02T .0305(f) & (g)
➢ 15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
I►=41MMEre
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below vertical
24 inches
Water mains vertical -water over sewer 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
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 see item IX.2
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches
10 feet
Any building foundation
5 feet
Any basement
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
➢ 15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(o cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
➢ If noncompliance with 02T.0305(�) or (g), see Section IX of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ® Yes ❑ No ❑ N/A
➢ See the Division's draft separation requirements for situations where separation cannot be meet
➢ No variance is required if the alternative design criteria specified is utilized in design and construction
➢ As built documents should reference the location of areas effected
3. Does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ❑ Yes ❑ No ® N/A
➢ This would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Does the project require coverage/authorization under a 404 Nationwide or ® Yes ❑ No
individual permits or 401 Water Quality Certifications?
➢ Information can be obtained from the 401 & Buffer Permitting Branch
5. 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 are 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.).
6. Does this project include any sewer collection lines that are deemed "high -priority?"
Per 15A NCAC 02T.0402, "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes ® No
➢ 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 permitee's individual System -Wide Collection permit.
FORM: ASEA 04-16 Page 4 of 5

IX. 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?
N Yes ❑ No
If No, complete and submit the Variance/Alternative Design Request application (VADC 10-14) and supporting documents for
review. Approval of the request is required prior to submittal of the Fast Track Application and supporting documents.
2. Professional Engineer's Certification:
I,
M as 6n k a%V e. C- k-2-
(Professional Engineer's name from Application Item III.1.)
p `^ A
(Facility name from Application Item II.1.)
attest that this application for
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 this application package and its instructions, as
well as all applicable regulations and statutes. 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 $25,000 per violation.
.........................................................................................
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North Carolina Professional Engineer's seal, signature, and date: ��`,�K CARO
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3. Applicant's Certification per 15A NCAC 02T .0106(b):
I, � Ot w�-1 K�=� I)1 attest that this application for
(Signature Authority's name & title from Application Item I.3.)
�r►,nsu.« t2aa;u�►.,,� 8t!",$c✓ S"w, H 2.6-0
(Facility name from Application Item II.1.)
has been reviewed by me and is accurate and complete to the best of my knowledge. 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. As the permittee for the pressure sewer system, I understand I will be required to
own, maintain, and operate all individual pump stations.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature:
Date: �0 --! d ' z3
FORM: ASEA 04-16 Page 5 of 5