WQ0045388_Application (FTSE)_20240624

DocuSign Envelope ID 80026AB9 1C98-4E69-8206-98837402429E
State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 10-23 &SUPPORTING DOCUMENTATION
Application Number:I✓Q400 fF.S3V g (to he completedby DWR)
Sir t �•2,S-2a.Z�
All items must be completed or the application will be rclurncd
I. APPLICANT INFORMATION:
1. Applicant's name: City of Wilson(company,nzunicipality,HOA,utility,etc.)
2. Applicant type: ❑ Individual ❑Corporation ❑General Partnership ❑Privately-Owned Public Utility
❑ Federal ❑State/County ®Municipal ❑Oiher
3. Signature authority's name: Kyle Manning per 15A NCAC 021 .0106(b)
Title:Assistant Director of Public Works
4. Applicant's mniling address: l Poox t o
City:Wilson State:NC Zip:-et a 7.v9 y yP./w yew
5. Applicant's contact information:
Phone number: [phone] Email Address:kmanning n wilsonnc.org
1I. PROJECT INFORMATION:
1. Project name:The Carolinian
2. Application/Project status: ®Proposed(New Permit) ❑Existing Perin it/Project ❑ARPA funded
If a modification,provide the existing permit number: WQOO and issued date: ,
Foe•modifications,also attach a detailed narrative description as described In Item G of the checklist.
if new construction,but part of a piaster plan,provide the existing perrnrl number WQOO
3. County where project is located: Wilson
4. Approximate Coordinates(Decitna.Degrees): Latitude:35-741 O, Longitude:—77.970'
S. Parcel ID(if applicable): 3702-56-5249(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engimer: Ricardo Cocconcelli License Number:052319
Finn: Wither:sRavenel
Mailing address: 115 Mackenan Dr.
City.Cary State:NC Zip.27511-
Phone number: [phone] Email Address: rcocconcelh a withetsravenel coin
IV. WASTEWATER TREATMEN'T FACILITY (WWTF)INFORMATION:
1. Facility Name:Hominy Creek Water Reclamation_Facility Permit Number:NCO023906
Owner Narnc:City-If Wilson
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Nurnber(s): WQCS00021
2 Downstream(Receiving)Sewer Information: 12 PVC inch ® Gravity O Force Main
3. System Wide Collection System Permit Numbers)(if applicable): WQCS00021
Owner Name(s): City of Wilson
FORM: FTA 10-23 Page [ of 5

DocuSign Envelope ID.80026AB9-1C984E69-8208-98837402429E
Vt. GENERAL REVUIREMENTS
1 If the Applicant is a Privately-Owned Public Utility,has a Certificate of PltbliC,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 Attreemcrit(FORM: DEV,)been attached?
❑Yes ❑No ®N/A
3. If the Applicant is a HomelProperty Owners'Association,has an NOA/POA Operational Agreement(FORM: HOA)and
supplementary documentation as required by 15A NCAC 02T 01 15(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 preparaton/service ❑ Hotel and/or Motels
❑ School/preschool/day care ❑ Medical/dental/veterinary facilities ❑Swimming Pool/Clubliousc
❑Food and drink facilities ❑Church ❑Swimming Pool/Filter Backwash
❑Businesses/offices/factories ❑ Nursing I lome ❑Other(Explain in Attachmait)
5. Nature of wastewater: 100%Domestic %Commercial %Industrial(age 15A NCAC 02T.0103(20))
If Industrial,is there a Pretreatment Program in effect?❑Yes❑No
6. Has a flow reduction been approved under I S/.NCAC Q2T.0 4(f? Yes ❑No
➢ If yes,provide a copy of flow reduction approval letter witit this application
7. Summarize wastewater generated by project:
Establishment Type(see 02T.0114(I)) Daily Design Flow i b No.of Units Flow
gal/ CPI)
gal/ GPD
gaU GPD
gaU GPD
gaU GPD
gal/ GPD
Tofal GPD
a Sec 15A NC-C 02T.0114(b),(d).(c)(1)and(e)(2) for caveats to wastewater design flow rates(i.e. 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 itt�S_42A_4}.
b Per 15A NCAC 02T.0114(c),design flow rates for establishments not identified(in table 15,& pC 02T.01 l41 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 and G S,.143-215.1)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero,please indicate why:
❑Pump Station/Forcc Main or Gravity Sewer where flow will be permitted in subsequentpermits that connect to this line.
Please provide supplementary information indicating the approximate timeframe for permitting upstream sewers with flog.
® Flow has already been allocated in Permit Number: Issuance Date: Feb 8,2024
❑Rehabilitation or replacement of existing sewers with no new flow expected
®Other(Explain): Private applicaton for The Carolinian has been approved under W00044900.in the naive of Heritage
Crossing Holdings LLC for 40,500 GPD.
FORM: FTA 10-23 Page 2 of 5

DocuSign Envelope ID 80026A89 1C98-4E69.820B-98837402429E
VI1. GRAVITY SEWER DESIGN CRl'1 ERIA(It'Applicable)-02T.0305&MDC(Gravity Sewers):
1. Summarize gravity sewer lobe permitted
Size(inches) Length(feet) Material
8" 207 LF PVC
➢ Section II& III oft lie MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section Ill contains information related to minimum slopes fit gravity scwcr(s)
➢ Oversizing lines to meet minimum slope requirements is not allowed and a violation of the MDC
Vlll. 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
I. Pump station number or name:
2. Approximate Coordinates(Decimal Degrees):Latrlude: 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 t(re force main is less than 4 inches in diameter,please identify the method of solids reduction per
MDCPSFM Section 2.01 C.Lb.❑Grinder Pump ❑ Mechanical Bar Screen ❑ Other(please specify) _
6 Power reliability in accordance with 1 SA NCAC Q2T_0105(hk 1):
ElStandby power source or ElStandby pump
)- Must have automatic activation and telemetry- 15A NCAC 02T.0305(Ir)(1)(B):
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
➢ ,dust 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)(I)(C):
U 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 tinieframes,shall be provided
as part of this permit application in the case of a multiple station power outage.
FORM: FTA 10-23 Page 3 of

DocuSign Envelope 10 80026AB9-1C98-4E69-820B-98837402429E
IX. SE1 BACKS&SEPARAVONS—(0211.0200 & ISA NCAC 02'1 .0305(f)):
1 Does the project comply with all separations/alternatives found in I SA,NCAC'0 T 030 & '► ®Yee ❑No
ISA NCAC 02T.0305(f)contains inininhutn separations that shall be provided for sewer systems:
Setback Parameter* Separation Required
Storm sewers and other utilities not listed below(vertical) 18 inches
ZWater mains(vertical-water over sewer preferred,including in benched trenches) I inches
ZWater 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-1 or WS-V),B,SA,ORW, HQW,or SB from normal
high water(or tide elevation)and wetlands associated with these waters(see item 1X.2) 50 feet
**Any other stream,lake,impoundment,or ground water lowering and surface drainage
ditches,as well as wetlands associated with these waters or classified as WL. 10 feet
Any building foundation(horizontal) 5 feet
Any basement(horizontal) 10 feet
Top slope of embankment or cuts of 2 feet or more vertical height 10 feet
Drainage systems and interceptor drains 5 feet
Any swimming pools 10 feet
Final earth grade(vertical) 16 inches i
➢ If noncompliance with 02T.0305(t)Qr igh see Section X.1 of this application
*15A NCAC 02T.0305(g)contains alternatives where separations in 02T.0305(f)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 S%rf'Wc Water Classifications webriarte
2 Does this project comply with the minimum separation requirements for water mains? ® Yes ❑No ❑N/A
➢ if no,please reter to 15A NCAC 18C.0906(f)for documentation requirements and submit a separate doctuuent,
signed/sealed by on NC licensed PE,verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? ❑ Yes ❑No ®NIA
➢ 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 specifed is utilized in design and construction.
4. Is the project located in a river basin subject to any State buffer rules? ® Yes Basin name:Nws�-.—ire
If yes,does the project comply with setbacks found in die river basin rules per ISA Ng-AC 02B.0200 Yes ❑No
➢ This includes Trout Buffered Streams per SA NCAC 2B.0202
5. Does the project require coverage/authorization under a 404 Nationwideiindividual permits ❑ Yes ®No
or 401 Water Quality Certifications?
➢ Please provide the permit number/permitting status in the cover letter if coveragelauthorization is required.
6. Does project comply with 15A NCAC 02T 0105(cX6)(additional permitsicertifications)? ®Yes ❑No
Per 15A NCAC 02T.Oj;05(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 manage.-cent plans,etc.).
7. Does this project include any sewer collection lines that are deemed"high-priority?" [:]Yes ®No
Per 15A NCAC 02T,040�,"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 permtttee or its representative at least once every six-months and
inspections documented per ISA NCAC 02T.0403(a)(5)or the permittec's individual System-Wide Collection permit.
FORM: FTA 10-23 Page 4 of 5

DocuSign Envelope 115 80026AB9-1 C98 4E69-8208 98837402429E
X. CERTIFICATIONS:
1 Does the submined system comply with i AVEAC Q71, the MisirnrgQesim Criteria for the Permittingof Pumip Stations
and Force Mains(latest version),and the Gr#vAy Sewer Minimum I>esign 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 yernnit, and projects requiring a variance approval may be subject to lonzet
review(lines.For protects reguh•Ing two or more variances or where the vat-lance Is determined by the Division to be a
significant portion of the project,the full technical review is required.
2. Professional Engineer's Certification:
Ricardo A. cocconcel l i The Carolinian
1, ,quest that this application for
(Professional Engineer's uiuuc from Applicatiun Ilan Ill.1.) (Project Name from Application ILCIII II.I)
has been reviewed by nne and is accurate, complete and consistent wilh 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 GravjX&%y (latest version),and the Minimum Ugs1L). riletia fbi the Fa*Tfask F miiltinit
of Pump Stations and-QM;Mains(latest version). Although other professionals nnay have developed certain portions of this
submittal package, Inclusion of these materials under my signature and seat 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 143-215.6D, 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)
_ a.... ..........
North Carolina Professional Engineer's seal,signature,and date: °°°°°-t He CA R O 0041
° fcSS/p 0.
o za 1z:o ky e�
4 a r e
SEAL
a o e
052319
e y�°•FN/,j N 00 o
[DocuSigned by: oOpO Q °O°°e eeee°°°Q�oe
ta��e 5/30/2024
1-D75B79Da419948D
3. Appllicanes Certification per 15A NCAC 02T.0106(b):
1, 9V}t° 7. ,attest that this application for The Carolinian
(Signature Autharity Name from Aoplicafion Item 11.3.) (Project Name tom Application Item I1.1)
attest that this application has been reviewed by rile and is accurate and complete to the best of my knowledge.
I understand that if all required parts of(his 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 sys(enn to surface waters or tine land will result in an immediate enforcement
action that inay 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 lh.s 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 rtay
include a fine not to exceed$10,000 as well as civil penalties up to$25,000 per violation.
Signature: Date:
FORM: FTA 10-23 Page 5 of 5

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WithersRavenel
Our people Your Success M- Ucp!of L'.T;viroi-Mc.-tal Q;lahLl 7r
April 24, 2024
APR 2 5 2024
NCDEQ
3800 Barrett Dr.
Raleigh NC 27609
RE: The Carolinian -
Sewer Extension Application
Dear NCDEQ,
On behalf of Heritage Crossing LLC, WithersRavenel is submitting a Sewer Extension Application
for in Wilson, Wilson County, North Carolina. Please find the attached documentation in
support of a revision to approved Fast Track Application (FTA 06-21) for WQ0044900 issued on
February 8, 2024. As noted in the application, this revision is to designate a portion of the
proposed sewer as public and retain the rest of the approved as private. All flows are collected as
part of the private portion of the sewer. The proposed public segment(new permit) will have no
additional flow. The sewer proposed within this application will service 288 apartment units
inclusive of 540 bedrooms in the Heritage Crossing of City of Wilson and connects to sewer
constructed and permitted under WQCS00021.
Establishment Type(see 02T.01 14(f)) Daily Design Flow Ib No.of Units Flow
Apartments w/ 1 Bed 75 gaVbed 72 5,400 GPD
Apartments w/2 150 gal bed 180 27.000 GPD
Apartments w/3 225 gal/bed 36 8,100 GPD
Apartment Club House 25 gal employeershift 40 1000 GPD
Apartment Pool House 250 gal Plumbing Fixture 8 2000 GPD
gal/ GPD
Total 43,500 GPD
The proposed project will meet all of DWR's minimum design criteria for sanitary sewer
extensions as well as DWR's minimum design criteria for gravity sewers. The projected flow for
this sewer extension is 43,500 GPD. The proposed sanitary sewer lines are more than adequate
to convey the design flow rates.
The proposed project schedule is to begin as soon as the project permits have been approved.
Below is a list of items included in the application package:
1. Email with Comments
2. Sewer Extension Fast Track Application ( 5 Pages)
3. Flow Tracking for Sewer Extension Form (6 Pages)
137 South Wilmington Street, Suite 200 1 Raleigh, NC 27601
t: 919.469.3340 1 f: 919.467.6008 1 wtivw.withersravenel.com License No. F-1479
Asheville I Cary I Charlotte I Greensboro I Pittsboro I Raleigh 1 Southern Pines Wilmington

1% WithersRavenet
Our People You,Success
4. Site Maps
a. US Topo Map (1 Page)
b. Aerial Site Map (1 Page)
Thank you for your time and efforts on this project and look forward to hearing back from you.
Please do not hesitate to contact me should you have any questions or concerns.
Sincerely,
Ricardo Cocconcelli, PE
WithersRavenel
137 South Wilmington Street, Suite 200 1 Raleigh. NC 27601
t: 919,469.33401 €: 919.467.6008 1 www,withersravenel.com I License No. F-1479
Asheville I Cary I Charlotte I Greensboro I Pittsboro Raleigh Southern Pines Wilmington

Check if this project is ARPA-funded
FINANCIAL RESPONSIBILITY/OWNERSHIP FORM
SEDIMENTATION POLLUTION CONTROL ACT
No person may initiate any land-disturbing activity on one or more acres as covered by the Act, including any
activity under a common plan of development of this size as covered by the NCG01 permit, before this form
and an acceptable erosion and sedimentation control plan have been completed arid`6�proved by the Land
Quality Section, N.C. Department of Environmental Quality. Submit the completed form to the appropriate
Regional Office. (Please type or print and, if the question is not applicable or the e-mail address or phone
number is unavailable, place N/A in the blank.) APR 2 5 20�4
Part A.
1. Project Name Leonard Shaffer Subdivision Phase 1
'if this project involves American Rescue Plan Act (ARPA) funds, list the Project Name below
under which you applied for funding through the Division of Water Infrastructure (DWI)
2. Location of land-disturbing activity: County NaSh City or Township alley
Old Smithfield Rd. 35 785255 -78.099
Highway/Street Latltude(decimal degrees) Longltude�de�lmai degrees)
3. Approximate date land-disturbing activity will commence: May 2023
4. Purpose of development (residential, commercial, industrial, institutional, etc.): Residential
5. Total acreage disturbed or uncovered (including off-site borrow and waste areas): 14.25
6. Amount of fee enclosed: $ 1 ,500 . The application fee of$100.00 per acre (rounded
up to the next acre) is assessed without a ceiling amount (Example: 8.10-acre application fee is $900).
Checks should be addressed to NCDEQ.
7. Has an erosion and sediment control plan been filed? Yes ❑ Enclosed m No ❑
8. Person to contact should erosion and sediment control issues arise during land-disturbing activity:
Name David M. Williams E-mail Address [e-mail]
Phone: Office# Mobile # [phone]
9. Landowner(s)of Record (attach accompanied page to list additional owners):
Williams Builders of Rocky Mount, LLC 252.205.0860
Name Phone: Office# Mobile#
8820 Thomas Road 8820 Thomas Road
Current Mailing Address Current Street Address
Rocky Mount NC 27803 Rocky Mount NC 27803
City State Zip City State Zip
10. Deed Book No. 3334 Page No.460-463 Provide a copy of the most current deed.

Part B.
1. Company(ies)who are financially responsible for the land-disturbing activity(Provide a comprehensive list
of all responsible parties on accompanied page.)If the company is a sole proprietorship or if the landowner(s)is
an individual(s), the name(s)of the owner(s)may be listed as the financially responsible party(ies).
Williams Builders of Rocky Mount, LLC [e-mail]
Company Name E-mail Address
8820 Thomas Road 8820 Thomas Road
Current Mailing Address Current Street Address
Rocky Mount NC 27803 Rocky Mount NC 27803
City State Zip City State Zip
Phone: Office# Mobile# [phone]
Note: If the Financially Responsible Party is not the owner of the land to be disturbed, include with this form
the landowner's signed and dated written consent for the applicant to submit a draft erosion and sedimentation
control plan and to conduct the anticipated land disturbing activity.
2. (a) If the Financially Responsible Party is a domestic company registered on the NC Secretary of State
business registry, give name and street address of the Registered Agent:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office# Mobile# [phone]
Name of Individual to Contact(if Registered Agent is a company)
(b) If the Financially Responsible Party is not a resident of North Carolina, give name and street address
of the designated North Carolina agent who is registered on the NC Secretary of State business registry:
Name of Registered Agent E-mail Address
Current Mailing Address Current Street Address
City State Zip City State Zip
Phone: Office # Mobile #
Name of Individual to Contact(if Registered Agent is a company)

(c)If the Financially Responsible Party Is engaging In business under an assumed name, give name under
which the company is Doing Business As. If the Financially Responsible Party is an individual, General
Partnership, or other company not registered and doing business under an assumed name, attach a copy
of the Certificate of Assumed Name.
Company DBA Name
The above information is true and correct to the best of my knowledge and belief and was provided
by me under oath. (This form must be signed by the Financially Responsible Person if an individual(s)
or his attorney-in-fact, or if not an individual, by an officer, director, partner, or registered agent with
the authority to execute instruments for the Financially Responsible Party). I agree to provide
corrected information should there be any change in the information provided herein.
David M. Williams Manager
Type or print name Title or Authority
Signature Date
----------------------------�--------------------------------------------------------------------------------------------------------
I, ���( c V" V of vim-(, , , a Notary Public of the County of
State of North Carolina, hereby certify that t Av i CA L-U, L 0.u.c S appeared personally
before me this day and being duly sworn acknowledged that the above form was executed by him/her.
Witness my hand and notarial seal, this 25-day of , 20-2-4—
J. KEVIN VARNELL
Notary Public Nota
North �aroline
Edgecgmbe county My commission expires. . /Z