WQ0045226_Modification_20240709 (2)

State of North Carolina
�4_ 0 J t f , Department of Environmental Quality
W, R? t""'jhJli:lk7ltR�p�� Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources JuN 2 6U14 FTA 10-23 & SUPPORTING DOCUMENTATION
A4tt wgt?o��2Z� mop
(�t�i oh #gl6r (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 Wilson, North Carolina (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: W.T. Bass, IV, P.E. per 15A NCAC 02T .0.106(b)
Title: Public Works Director
4. Applicant's mailing address: 1800 Herring. Avenue E.-P.O. Box 10
City: Wilson State: North Carolina Zip: 27894-0010
5. Applicant's contact information:
Phone number: ('252) 399-2467 Email Address: bbass a,wilsonnc.pM
I1. PROJECT INFORMATION:
1. Project name: City of Wilson - 51 14 Packhouse Road Sewer Force Main Extension
2. Application/Project status: ❑ Proposed (New Permit) ® Existing Pen-nit/Project
If a modification, provide the existing permit number: WQ0045226 and issued date: April 25, 2024,
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: Wilson
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.4658' Longitude:-77.5750
5. Parcel ID (if applicable): 3704-62-3075.000 (or Parcel ID to closest downstream sewer)
Ill. CONSULTANT INFORMATION:
1. Professional Engineer: W. Landon Younce License Number: 030003
Firm: Green En ing eering, PLLC
Mailing address: 303 Goldsboro St. E. / P.O. Box 609
City: Wilson State: North Carolina Zip: 27893-
Phone number: [phone] Email Address:. I.younce a,>reenene.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Hominy Creek Water Reclamation Facility Permit Number: NCO023906
Owner Name: City of Wilson, North Carolina
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
I. Permit Number(s): WQ
2. Downstream (Receiving) Sewer Information: 8 inch X Gravity O Force Main
3, System Wide Collection System Permit Number(s) (if applicable). WQCS
Owner Name(s): City of Wilson
FORM: FTA 10-23 Pagel of 5

V1. 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;'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 ® NIA
3. If the Applicant is a Home?Property Owners' Association, has an HOA?'POA Operational Agreement (FORM: HOA) and
supplementary documentation as required by 15A NCAC 02T.0115(c) been attached?
❑ 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 f preschool.," day care ❑ Medical , dental I veterinary facilities ❑ Swimming Pool/Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
❑ Businesses!' offices I 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 .0l 14(f)? ❑ Yes ® No
➢ If yes, provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow' b
No. of Units
Flow
Single -Family Private Residence (3 bed.)
75 gal. -Bedroom
3
225 GPD
gall
GPD
gal.'
GPD
gall
GPD
gal?
GPD
gall
GPD
Total
225 GPD
a See 15A NCAC 02T .0114(b). (d). (e)(l) 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 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: 225 GPD (per 15A NCAC 02T _01 14 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/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 10-23 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) Material
➢ Section 11 & 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
VII1. 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: _ 5114 Packhouse Road Pump Station
2. Approximate Coordinates (Decimal Degrees): Latitude: 35.7831 Longitude:-77.9654
3. Total number of pumps at the pump station: 1
3. Design flow of the pump station: 0.0144_.._ 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): 10 gallons per minute (GPM) at 200 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (forth is Pump Station):
Size (inches)
Length (feet)
Material
3"
895,
DIP
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. Lb. ® 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 10-23 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separationsialternatives found in 15A NCAC 02T .0305(f) & list)? ® Yes [:]No
15A NCAC 02T.0305 contains minimum separations that shall be provided for sewers stems:
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-1 waters of Class I or
Class 1I 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)
36 inches
➢ If noncompliance with 02T.0305(f) or (gJ, see Section X. l of this application
*I 5A NCAC 02T.0305(ai contains alternatives where separations in 02T.0305 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 webortt?e
2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ NSA
➢ 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: Neuse ❑ 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 coverageiauthorization under a 404 Nationwide/individual permits ❑ Yes ® No
or 401 Water Quality Certifications?
➢ Please provide the permit numberipermitting status in the cover letter if coverageiauthorization is required.
6. Does project comply with 15A NCAC 02T.0105(c)(6) (additional pen-nits/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 155A NCAC L22T_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 10-23 Page 4 of 5

X. CERTIFICATIONS:
I. Does the submitted system comply with 15A.NC'AC 02 , the Mi€rimigg Design Criteria for the Permitting of Purnnp Stations
and Force Mains [latest version), and the 6r,,kyity Sewer Mii �Ini 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 reauest will be issued
concurrently with the approval of the permit. and imiects requiring a variance approval may be subiect to longer
review times. For ro'ects renuirinLy two or more variances or where the variance is determined by the Division to be a
aignificant portion of the protect, the full technical review is required,
2. Professional Engineer's Certification:
1, W. 61,000 Y001,4Cle , attest that this application for CKq OF Wll -Q q
(Professions Engineer's name from Application Item III 1 ) (Project Name from Application Item I1.1)
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
Ur Pump Stations and Fnrez Mains (fatcst version . Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that I have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE - In accordance with General Statutes 143-215.6A and 143-215.613, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a tine 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 S(LQ701)
p ' \A '
North Carolina Professional Engineer's seal, signature, and date: (
- tSSI /
+) p
AL
3 ;3
Ui
st �•`lN�
3. Applicant's Certification per 15A NCAC 02T .0106(b):
1, ��(� Q� _, attest that this application for CAW OF W 1vea-
(Signature Authority Name 66m Allplication Item 13 ) (Project Name from Application Item I1,1) 040M
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. 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: W. T. Bass V ,;,;;;, :_ Date:
FORM: FTA 10-23 Page 5 of 5

Silver' Lake
133
3ofifi a LD u �`'fr ~ ..
u I 1
f 1, o �.
r� I
•
Y �130
` i Bllia
`+ a
S4 • * /
W635-6
— - --
��
WIL.SON AIRPORT
r
y t
k�1Sx �r f � k til 5f.
I
inch l r 4
,nun oo rIr
A Jerusalem
Pine •'
1 � �
gyp. i k
c y _
'29 2 300 000 FEET 2.5 wrCSON COURr MI. 0 A, 57'Ar
a a ar:
j tpped, edited, and published by the Geological Survey
�l by USGS, NOSINOAA, and North Carolina Geodetic Survey ti
anhv by DhotoRrammetric mPthndq from aerial mI

Nub MaA
r R'7
GoA
DPA fa
# ' k We t t
MaA
MaA Ca Maq ~
� F
MaB� " MaB
Z u
+ MaA its F Erv.A\ [;ro
lip [ Uti MaA , Co y
QU R.i
GOA
CioS aOw d t DpA
MaA
W 3ir7 4} .
`fS CSR{ t • • �• �{
Ma's t}pA
a
Ida N'A t,Y MaR
Ra rl
GoA J;
G x yG+
oB a Bb ' F P.
1 h7o
T s}
�?" o w.6 Mod � r 6Ck
a No A
Nos a M) �—
Go
+ A NAB qK 16AaB
'ry � YJ
Co
Mae
Yr'i I>un 1
ud , �sr,s � Ma-
_t• h ry �� � �in �7 � {;uA
Ma
Ra Ma ' - A r .ir;i.
N;B Co
Ra Noll 4e N:pa
rl �B TO
Gf� R ss
+a
(� w CO
:J Thj. Z W Y nM
e oA
Z � � c Y;, _
V { C•�
L _
Ra r �" WiLSOM
�r
8b Noe j B xi of,
J R O_ 4F
o Nos
~3 R ,' • o� NoL+ MaA
Ma o GoA W PhOb
1
Ra Rb waB Co OQ .10B Ra
Nos Rra � doh r. o
NoB � ' � N
xt • Re Ra j rij M y NOA Ci
0
} ••c 41� No oA q �•
! Tt # Wa
Fih e
a i'n • Nob Ra G6AGtB2 Gtb2
78° •
This map is compiled on 1974 aerial photography by the U. S.
Department of Agriculture, Soil Conservation Service and
cooperat ng agencies. Coordinate grid ticks and land division
corners, f shown, are approximately positioned.

June 25, 2024
NCDEQ
Division of Water Resources
Raleigh Regional Office
3800 Barrett Drive
Raleigh, North Carolina 27609
Attention: Mr. Richard Simpson
Environmental Engineering
Office of Continuous Improvement (OCI)
NCDept.o Er,;.Irorrre„tat
Qualir,
f UN 2 6 2024
Raleigh Regiotla2 Of,, e
SUBJECT: MODIFICATION Fast -Track Sewer System Extension Application
5114 Packhouse Road Sewer Force Main Extension
City of Wilson, North Carolina
PN: 23-144
Dear Mr. Simpson:
On behalf of the City of Wilson, please find attached Request for Modification package for the
5114 Packhouse Road (SR 1382) project. The force main length and location has been extended by 455
linear feet, to allow discharge into a different manhole on Hunting Ridge Road. As before, the City will
operate and maintain this force main as part of their collection system.
Please find attached two (2) copies of each of the following documents for your review and
approval:
• Fast -Track Sewer Application Form — One (1) original and one (1) copy
• 8 1/2" x I I" copy of project location on USGS Quadrangle Maps
• 8 1/2" x I I" copy of project location on NRCS Soils Mapping
Please find attached check in the amount of $600.00 to cover the Request for Modification fee.
Also, if you should have any questions or require additional information, please call.
Respectfully,
W?andoeY;ounce, PE
Enclosures: As stated.
cc: Mr. W. T. Bass, IV, P.E. — Public Works Director, City of Wilson
W-1WILSO\2314410f iice\PEPMITSISewerVMichael Hall - NCD@Q - Fesi Track Sewer MODIFICATION iv (6-25-24).dac