WQ0044359_Application (FTSE)_20230809

State of North Carolina
DWR Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources INSTRUCTIONS FOR FORM: FTA 06-21 & SUPPORTING DOCUMENTATION
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 (Gravity 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 S480.00, 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 1.2 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 11.1 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

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.
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.
H. Power Reliability Plan (Required if portable reliability option utilized for Pump Station):
❑ Per 15A NCAC 02T .0305(h)(I), 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)
1. 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 be 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 .01 15(b), submit the properly executed Operational 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 Regional Office
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 Regional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Harnett, 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
Raleigh 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
Washington 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, Pitt, Tyrrell, Washington, Wayne
Wilmington Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
Water Quality Section
Wilmington, North Carolina 28405
Hanover, Onslow, Pander
[phone]
[phone] Fax
Winston-Salem Regional Office
450 W. Hanes Mill Road
Alamance, Alleghany, Ashe, Caswell, Davidson,
Water Quality Section
Suite 300
Davie, Forsyth, Guilford, Rockingham, Randolph,
Winston-Salem, North Carolina 27105
Stokes, Surry, Watauga, Wilkes, Yadkin
[phone]
[phone] Fax
INSTRUCTIONS FOR FORM: FTA 05-21 & SUPPORTING DOCUMENTATION Page 3 of 3

Sewer Project Narrative
For
Mission Field — Phase One
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Mission Field Phase One in Rocky Mount is a Park that consists of a playground and
baseball field and will be located on a 33.17 Ac. parcel.The wastewater generated by this
residential area was calculated using the daily flow of 250 gal/plumbing fixtures. The
flow allocated for 2 bathrooms with 3 fixtures each which totals a daily flow for the
project of 1,500 GPD. It will consist of 100% Domestic flow. The sewer system will be
constructed of approximately 107 LF of Private 4-inch SDR-35 PVC, 257 LF of
Private 8-inch PVC and 686 LF of public 8-inch PVC gravity sewer line including 7
new manholes. The wastewater treatment plant facility that will be handling this flow is
the Rocky Mount W W'fF (Permit # NC 0030317). The permitted flow for the W WTF is
21.0 MGD and after the allocation of the Mission Field •-- Phase One flow the W WTF
will be allocated at _% of its total capacity.

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SN2.3 State of North Carolina
nA 1 110 Department of Environmental Quality
"W W A Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Wetter Resources FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number: W? 0 }" 1 (to he completed by OWR)
All items must be completed or the anplication will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: City of Rocky Mount (company. municipality. HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Fcderal ❑ State�County ® Municipal ❑ Other
3. Signature authority's name: hlq, ¢ Kfrr p,): per 15.A XCAC 02T ,a I 06ib}
Title: Public Works Director
4. Applicant's mailing address. Q Box 1 180
City: Rocky Mount State: NC Zip: 27802-
5. Applicant's contact information-
Phone number: (252) 972-13=5 Email Address: �
H. PROJECT INFORMATION:
I. Project name: Mission Field - Phase One
2. Application.Troject status: ® Proposed (Nem Permit) ❑ Existing PermirProject
If modification. provide the existing permit number: WQ00_. and issued date:..
For modifications, also attach a detailed narrative description as described in Item C of the checklist.
If new construction. but part of a master plan. provide the existing permit number: WQ00 _
3. County where project is located: Nash
4. Approximate Coordinates (Decimal Degrees): latitude: 35-94598 Longitude.-77,84826
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5. Parcel ID (if applicable): 3840 1701 7286 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
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I. Professional Engineer: J. Michael Stocks License Number: 19843
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Mailing address: 80[ f. Washington St.
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IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
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I. I-acility Name: RDeky Mount W WTP Permit Number: 1VC0030317
Owner Name; City of Rocky Mount
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V. RECEIVING DOWNSTREAM SEWER INFORMATION:
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1. Permit Number(s): WQ
2. Downstream (Receiving) Sewer Information: inch 0 Gravity 0 Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s):
FORM: F1 A 06-21 Page I of 5

DWR
Division of Water Resources
Application Number:
State of North Carolina
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 06-21 & SUPPORTING DOCUMENTATION
(to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
I. Applicant's name: City of Rocky Mount (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State/County ® Municipal
3. Signature authority's name: Brad Kerr, PE per 15A NCAC 02T .0106(b)
Title: Public Works Director
4. Applicant's mailing address: PO Box 1180
City: Rocky Mount State: NC Zip: 27802-
5. Applicant's contact information:
Phone number: [phone] Email Address:
II. PROJECT INFORMATION:
❑ Privately -Owned Public Utility
❑ Other
1. Project name: Mission Field - Phase One
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: Nash
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.94598° Longitude:-77.848260
5. Parcel ID (if applicable): 3840 1701 7286 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: J. Michael Stocks License Number: 19843
Firm: Stocks Engineering
Mailing address: 801 E Washington
City: Nashville State: NC Zip: 27856-
Phone number: [phone] Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Rocky Mount WWTP Permit Number: NCO030317
Owner Name: City of Rocky Mount
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ
2. Downstream (Receiving) Sewer Information: inch ❑ Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s):
FORM: FTA 06-21 Pa-e I of 5

VI. GENERAL REQUIREMENTS
I. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑ No N 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 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.0I 15(c) been attached?
❑ Yes ❑ No N 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 N Church ❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 % 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 .0114(t)? ❑ Yes N 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 I-'
No. of Units
Flow
Park with Restroom facilities
250 gal/plumbing fixtures
6
1500 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
1500 GPD
a See 15A NCAC 02T .01 14(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 .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: 1500 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

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) T
Material
8"(Public) 686' SDR 35 PVC
➢ Section II & 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)
➢ Oversizing 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:
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)
➢ 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.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) & M? ® 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 (e). see Section X.1 of this application
* 15A NCAC 02T.0305(s) 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 weboage
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 drat[ 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: Tar -Pamlico ❑ No
byes, 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. 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
significant portion of the project, the full technical review is required.
2. Professional Engineer's Certification:
I, J. Michael Stocks , attest that this application for Mission Field— Phase One
(Professional Engineer's name from Application Item 111.1.) (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 1 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. Applicant's Cer' tion per 15A NCAC 02T .0106(
61 AID �8
I, ��� attest that this application for
(S' nature i ority to from Application Item 1.3.)
MtsS'L(Li -n-ppc (Z /�4/, 1-
(Project Name from Application Item II.I )
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. 1 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. 1 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: �� Date: Zb Z5
FORM: FTA 06-21 Page 5 of 5

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2-1-23 TRC COMMENTS
3-23-23 TRC COMMENTS
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FILE NO. 2019-028
HORZ. SCALE:
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VERT. SCALE:
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OUR MISSION IS TO CREATE A CHRIST-CENTERED COMMUNITY OF CARING THAT MINISTERS TO THE SPIRITUAL, PHYSICAL, EDUCATIONAL, EMOTIONAL, OR REHABILITATIVE NEEDS OF INDIVIDUALS AND FAMILIES
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........................................................................ / ..................... I i a ii
BEFORE YOU DIG, C//q/n,
CALL �F V
0 ) SCE It
N/F
NORTH CAROLINA IN 38 �Mps� %I \\\\\ \\\\ \ _-- //// ///
ONE CALL CENTER DB 4o N / / J /� PRO. MH#7
www.ncocc.org ,49 1�/ ti` / // —' v ou $iio 50
50 R/W
7' 1 _ 35' BB
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24 1 4" S9.56 ASPHALT 3
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REPORT.
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NOT TO SCALE
LANDSCAPE TABLE
QUANTITY
LATIN
COMMON
I SIZE Cam? PLANTING
5J
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RED MAPLE
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6' HIGH
'gioA
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CERTIFICATION BY THE DEPARTMENT OF DEVELOPMENT SERVICES THAT THIS CONSTRUCTION
PLAT WAS APPROVED BY THE CITY PLANNING -
BOARD ON DAY OF 20
DIRECTOR OF DEVELOPMENT SERVICES
CERTIFICATION BY THE CITY ENGINEERING DEPARTMENT THAT THIS CONSTRUCTION PLAT AND
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REQUIRED IMPROVEMENT DRAWINGS MEET THE APPROPRIATE CITY STANDARDS. ��� \� \ �\ _ \� _ __:!� - \\\ "-U�' • ,� O \\
DIRECTOR OF ENGINEERING
HLL901V QI210 DIVVAT .1741
-
1 \ I \
\\ 11I
SCALE: 1 " = 40'
0 40 80 160 120
REVISIONS
2-1-23 TRC COMMENTS
3-23-23 TRC COMMENTS
5-31-23 DEQ COMMENTS
FILE NO. 2019-028
HORZ. SCALE:
1"=40'
VERT. SCALE:
NONE
OUR MISSION IS TO CREATE A CHRIST-CENTERED COMMUNITY OF CARING THAT MINISTERS TO THE SPIRITUAL, PHYSICAL, EDUCATIONAL, EMOTIONAL, OR REHABILITATIVE NEEDS OF INDIVIDUALS AND FAMILIES
CE-02

Wilson, Susan A
From: Kevin Varnell <[e-mail]>
Sent: Wednesday, August 9, 2023 12:01 PM
To: Wilson, Susan A
Subject: RE: [External] Re: Fast Track Application for Mission Field - Phase One
Attachments: FTA Mission Field Ph 1 - signed.pdf
CAUTION: External email. Do not click links or open attachments unless verified. Report suspicious emails with the Report Message
button located on your Outlook menu bar on the Home tab.
Susan,
City (Public) Sewer Permit attached. As soon as I can get the church to sign, I will send over the Private side.
Sincerely,
�euict �/a�ure�
•
ENGINEERING
PO Box 1108 Phone: [phone]
Nashville, NC 27856
For I am convinced that neither death nor life, neither angels nor demons, neither the present nor the future, nor any powers, neither
height nor depth, nor anything else in all creation, will be able to separate us from the love of God that is in Christ Jesus our
Lord. Romans 8:38-39
From: Wilson, Susan A <[e-mail]>
Sent: Wednesday, August 9, 2023 11:03 AM
To: Kevin Varnell <[e-mail]>
Subject: RE: [External] Re: Fast Track Application for Mission Field - Phase One
Hi Kevin —just have a couple of questions in follow up. I'm in the office until 1pm if you get back by then (your admin
said you were out in the field). Otherwise I'll try you later. Sometimes just easier to actually speak over the phone!
I'm just puzzled over the "private" line aspect of this. And maybe you're saying it is private since it will not have other
lines connected to it? But it will be owned and maintained by Rocky Mount?
And since this is essentially one building — does it comply with other aspects to be deemed permitted (so the 4 inch line
does not have to be permitted through this office?).
From: Kevin Varnell <[e-mail]>
Sent: Monday, August 7, 2023 1:54 PM
To: Wilson, Susan A <[e-mail]>; Scott Miles <[e-mail]>; Isaac Hardison

<ihardison@stocksenginee ring.com>
Subject: RE: [External] Re: Fast Track Application for Mission Field - Phase One
CAUTION: External email. Do not click links or open attachments unless verified. Report suspicious emails with the Report Message
button located on your Outlook menu bar on the Home tab.
Susan,
I just wanted to follow up to make sure you have everything you needed.
Sincerely,
•
ENGINEERING
PO Box 1108 Phone: [phone]
Nashville, NC 27856
For I am convinced that neither death nor life, neither angels nor demons, neither the present nor the future, nor any powers, neither
height nor depth, nor anything else in all creation, will be able to separate us from the love of God that is in Christ Jesus our
Lord. Romans 8:38-39
From: Wilson, Susan A <[e-mail]>
Sent: Monday, July 31, 2023 12:31 PM
To: Scott Miles <[e-mail]>; Isaac Hardison <[e-mail]>
Cc: Kevin Varnell <[e-mail]>
Subject: RE: [External] Re: Fast Track Application for Mission Field - Phase One
Just wanted to let you folks know I received your information and I'll be taking a look at it soon (and getting back with
you if I have questions).
Thanks!
From: Scott Miles <[e-mail]>
Sent: Friday, July 28, 2023 11:31 AM
To: Isaac Hardison <[e-mail]>; Wilson, Susan A <[e-mail]>
Cc: Kevin Varnell <[e-mail]>
Subject: [External] Re: Fast Track Application for Mission Field - Phase One
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Ms. Wilson,

The City of Rocky Mount is trying to upgrade the pump station and force main. The design is complete, but the
original bid for the project came in at double the engineer's estimate. We are currently seeking alternative
funding (SRF and bonds) to cover the cost and hope to have construction started by the spring of 2024.
fi
(` 1
Flo KYMOUNT,
THE CENTER OF It ALL
From: Isaac Hardison<[e-mail]>
Sent: Friday, July 28, 2023 10:38 AM
To: [e-mail] <[e-mail]>
Cc: Kevin Varnell<[e-mail]>; Scott Miles <[e-mail]>
Subject: Fast Track Application for Mission Field - Phase One
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Susan,
Our comment response package to your comments from July 215Y is attached. A copy of the comments and the
responses are below. Please let me know if you need anything else.

We can't permit gravity sewer lines (even if they're private) less than 6 inches if they serve more than one
building. You have 107 LF of 4 inch line in the application. However— please review 15A NCAC 2T .0303 (a) (1) and
(2). From your description it sounds like it's serving 2 bathroom buildings so probably would not qualify for
deemed permitted. This gets a bit confusing with regard to permitting — so after I get your sewer flow diagram we
may need to talk.
For this project our sewer line will only serve (1) building. This Building has (2) bathrooms. This could have been
clearer in the narrative. Please see CE-02.
Would you please submit a sewer flow diagram for this project (it can be very basic). I need to see basically how
the sewer flow is coming from the buildings — are they 4 inch lines from the buildings and then combine to a 6
inch line?
Our 4" line will connect to Pro. MH#6 at a minimum slope of 2.04%. Please see CE-02.
As noted on the flow tracking sheet (FTSE 04-16), it appears that the Old Mill Road PS will have zero capacity after
completion of this project. Any future projects to this pump station will have to provide information regarding
upgrades — fyi. Also — I have not been able to find a permit issued for this pump station — I assume it is very old?
Any idea what year it may have been built or possibly permitted? I'll try to track it down again if you folks think it
may have been permitted.
We were unable to find any permits for this Pump Station as well. Scott Miles from the City of Rocky Mount has
assured us that this Pump Station has plans to be upgraded to meet the demands of future developments as soon
as the city acquires adequate funding. Please email him at [e-mail] or call him at 252-972-
1122 for more information.
Thank you for your time,
Isaac Hardison
Project Specialist
(252)-217-7821 (cell)
9ENTG1N?EER1N!Gq1F
801 East Washington Street 252.459.8196 (voice)
P.O. Box 1108 252.459.8197 (fax)
Nashville, NC 27856
www.stocksengineering.com
Our Competitive Advantage
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by being Creative, Personable, Accessible, Responsive,
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From: Kevin Varnell <[e-mail]>
Sent: Wednesday, July 26, 2023 2:04 PM
To: Isaac Hardison<[e-mail]>
Subject: FW: Fast Track Application for Mission Field - Phase One
Sincerely,
P 5! as W 1/aute&
STOOCKS
ENGINEERING AL
PO Box 1108 Phone: [phone]
Nashville, NC 27856
For I am convinced that neither death nor life, neither angels nor demons, neither the present nor the future, nor any powers, neither
height nor depth, nor anything else in all creation, will be able to separate us from the love of God that is in Christ Jesus our
Lord. Romans 8:38-39
From: Mike Stocks <[e-mail]>
Sent: Friday, July 21, 2023 10:57 AM
To: Kevin Varnell <[e-mail]>
Subject: Fwd: Fast Track Application for Mission Field - Phase One
Stocks Engineering, PA
J. Michael Stocks
252.903.6891
Begin forwarded message:
From: "Wilson, Susan A" <[e-mail]>
Date: July 21, 2023 at 10:46:31 AM EDT
To: Mike Stocks <[e-mail]>
Cc: [e-mail]
Subject: Fast Track Application for Mission Field - Phase One
HI Michael —
Just wanted to let you know I inherited this project from a coworker (sorry for the delay) and have given
it a preliminary review. A couple of comments/questions for you:
1. We can't permit gravity sewer lines (even if they're private) less than 6 inches if they serve more
than one building. You have 107 LF of 4 inch line in the application. However — please review
15A NCAC 2T .0303 (a) (1) and (2). From your description it sounds like it's serving 2 bathroom

buildings so probably would not qualify for deemed permitted. This gets a bit confusing with
regard to permitting — so after I get your sewer flow diagram we may need to talk.
15A tiCAC 42,f .U.10 rl;"1FFHNG BY I+Rr(AILATIOti
(a) The following systems shall be dccnlcd permitted pursuant to Rule A 113 of this Subchapter if the systcm meets
the criteria in RuIc .01 13 of this Subchapter and all criteria rcquircd for that systcrn in this Rule.
(1) a building scAvT dncumcmai by the local huilding inapcctcar to be in campliancc with the North
Carolina Stan Plumbing Code and that scrx-cs a single building ailh the sole purp❑sc ofrorvcying
wast ev`-ater from that building into a pmvity sewer Thal £attends onto or is adjacent r❑ the building's
property. A building sewer tbat ovntributcs rrwre than five percenl of the existing wartrumier
Oealrnertt facility's design .rapacity or 50,0W gallons per day of ttow as calculated using the
wastcwater design floe- rates in Ruh .0114 of this Subchapter shall not eminicnoe operations until
a letter of agreement, meeting the requiremcnis of 15A NCAC 0 T .0304(V} has been submitted
to and apluo+cd by the regional office:
(2) a gravity sewer KT-%*Pg a single building with lo a thin 6W gal lone per day of flow as calculated
using rates in 15 N-'AC 02T _01 14 that crosses arwthcr prop'crty or parallels a right-oFway,
provided that:
(A) an "aCtne`nt feu eny&% ag ar utltcr property is obtained, a nyap is cfealed, and bath am
recorded at the Register of Ike& office in the tawny of residence for bath propeny
owners and runs with the land or, in the case of a building sewer traveling along a right-
of-way, documented permission from t he ded icated righr-of--way owner to use such right-
of-way;
Would you please submit a sewer flow diagram for this project (it can be very basic). I need to
see basically how the sewer flow is coming from the buildings — are they 4 inch lines from the
buildings and then combine to a 6 inch line?
As noted on the flow tracking sheet (FTSE 04-16), it appears that the Old Mill Road PS will have
zero capacity after completion of this project. Any future projects to this pump station will have
to provide information regarding upgrades — fyi. Also — I have not been able to find a permit
issued for this pump station — I assume it is very old? Any idea what year it may have been built
or possibly permitted? I'll try to track it down again if you folks think it may have been
permitted.
Thanks much,
Susan Wilson
Environmental Engineer (Part Time, Temporary)
Water Quality Regional Operations — Raleigh Regional Office
NC Department of Environmental Quality
Office: 919-791-4240
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