WQ0045699_Ogles_Creek_Pump_Station_and_Force_Main_FTSEE_Permit_Final_App_20240816

INC Department of
tnvironn-ierltai Quality
Received State of North Carolina
Department of Environmental Quality
AUGDWR 16, 2024 Division of Water Resources
Winston-Salem FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources Regional OfficeFTA 10-23 & SUPPORTING DOCUMENTATION
Application Number: WQ0045699 (to be completed by DWR)
All items must be completed or the application will be returned
1. APPLICANT INFORMATION:
1. Applicant's name: Town of Franklinville (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: Arnold Allred per 15A NCAC 02T .0106(b)
Title: Public Works Director
4. Applicant's mailing address: P.O. Box 277
City: Franklinville State: NC Zip: 27248-
5. Applicant's contact information:
Phone number: [phone] Email Address: arnold.allredAtofville.com
II. PROJECT INFORMATION:
1. Project name: Ogles Creek Pump Station and Force Main
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project ® ARPA funded
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: Randolph
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.73545 V Longitude:-79.684326'
5. Parcel ID (if applicable): 7792648068 (or Parcel ID to closest downstream sewer)
I1I. CONSULTANT INFORMATION:
1. Professional Engineer: Bill Lester, Jr. License Number: 17651
Firm: LKC Engineering, PLLC
Mailing address: 140 Aqua Shed Court
City: Aberdeen State: NC Zip: 28315-
Phone number: [phone] Email Address: billglkcen ing eerin,g com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Franklinville Wastewater Treatment Plant Permit Number: NC0007820
Owner Name: Town of Franklinville
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ
2. Downstream (Receiving) Sewer Information: N/A inch ❑ Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCSDO081
Owner Name(s): Town of Franklinville
FORM: FTA 10-23 Pagel of 5

of
Envir� quality
VI. GENERAL REQUIREMENTS AU 2024
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Conveni we and Necessity been attached?
it for em
El Yes ❑ No ® N/A
hegior1:I ; if
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been -attached?
❑ Yes ❑ No ®N/A
3. If the Applicant is a Home/Property Owners' Association, has an 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 / preschool / day care ❑ Medical / dental / veterinary facilities ❑ Swimming Pool/Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
® Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: 90 % Domestic 10 % Commercial % Industrial (See 15A NCAC 02T .0103(20))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(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','
No. of Units
Flow
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
GPD
a See 15A NCAC 02T .0114(b), (d), (e)(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 in G.S. 42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.01141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: _ GPD (per 15A NCAC 02T .0114 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

VIL GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8-inch 220 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: Ogles Creek Pump Station
2. Approximate Coordinates (Decimal Degrees): Latitude: 35.735395' Longitude:-79.684263'
3. Total number of pumps at the pump station: 2
3. Design flow of the pump station: 0.4608 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): 320 gallons per minute (GPM) at 41 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
8-inch
1,050
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 2.01C.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 10-23 Page 3 of 5

I cceiVE'
IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(t)): , � I nt -1
1. Does the project comply with all separations/alternatives found in 15A NCAC 02Tr A30,5(fl (P�? ®Yes El No
+TfTSLUf` -j a I P F1
15A NCAC 02T.0305(f) contains minimum separations that shall be vrQyidad, for,sewer systems:
Setback Parameter*
eparation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
'Water mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
'Water mains (horizontal)
10 feet
Reclaimed water lines (vertical - reclaimed over sewer)
18 inches
Reclaimed water lines (horizontal - reclaimed over sewer)
2 feet
**Any private or public water supply source, including any wells, WS-I waters of Class I or
Class II impounded reservoirs used as a source of drinking water, and associated wetlands.
100 feet
**Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal
high water (or tide elevation) and wetlands associated with these waters (see item IX.2)
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches, as well as wetlands associated with these waters or classified as WL.
10 feet
Any building foundation (horizontal)
5 feet
Any basement (horizontal)
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
➢ If noncompliance with 02T.0305(f) or (g), see Section X.1 of this application
*I 5A NCAC 02T.0305(a) 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 Surface Water Classifications webpaae
2. Does this project comply with the minimum separation requirements for water mains? [—]Yes ❑ No ® N/A
➢ If no, please refer to 15A NCAC 18C.0906(f) for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? ❑ Yes [:]No ® N/A
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ See the Division's draft separation requirements for situations where separation cannot be met.
➢ No variance is required if the alternative design criteria specified is utilized in design and construction.
4. Is the project located in a river basin subject to any State buffer rules? ® Yes Basin name: Cape Fear ❑ No
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ® Yes ❑ No
➢ This includes Trout Buffered Streams per 15A NCAC 2B.0202
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ❑ Yes ® No
or 401 Water Quality Certifications?
➢ Please provide the permit number/permitting status in the cover letter if coverage/authorization is required.
6. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? ®Yes ❑ No
Per 15A NCAC 02T.0 I 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 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 10-23 Page 4 of 5

U61 f620
X. CERTIFICATIONS: Winston -Sa!C-M
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Cr@20iftAlgJUWtling of Pump Stations
and Force Mains (latest version), and the Gravity Sewg 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 requirine 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:
-1, __ attest that this application liar
I'ro , sional Gn it ccri s natnc from hcauon Item 111. I . ( $ pP ►
Ogles Creek Pump Station and
Force Main Replacement
(Project Namc from Application Item II. I )
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 Sewcrs (latest versionl, and the Minimum Design Criteria for the Fast -Track Permitting
of Pump Stations and Force Mains (latest version). Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that I have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.613, 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 fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation. Misrepresentation of the application
information, including failure to disclose any design non-compliance with the applicable Rules and design criteria, may subject
the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NCAC 56.0701)
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(h):
1, / %/?.vaJ e, /lit • , attest that this application for
(Signature Authority Name fmm Applicatio item 1.3.)
Ogles Creek Pump Station and
Force Main Replacement
(Project Name from Application Item 11.1)
attest that this application has been reviewed by me and is accurate and complete to the best of my knowledge.
i understand that if all required parts of this application are not completed and that if all required supporting documentation
and.attachments are not included, this application package is suhjcct to being returned as incomplete. I understand that any
discharge of wastewater from this non -discharge system to surface waters or the land will result in an immediate enforcement
action that may include civil penalties, injunctive relief, and/or criminal prosecution. i will make no claim against the Division
of Water Resources should a condition of this permit be violated. I also understand that if all required parts of this application
package are not completed and that if all required supporting information and attachments are not included, this application
package will be returned to me as incomplete.
NOTE -- in accordance with General Statutes 143-215.6A and 143-215.6D, 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 tine not to exceed $10.000 any well as civil penalties up to $25,000 per violation.
Signature: _ Date: ` — --
FORM: FTA 10-23 I Page 5 of 5

�.i
Ogles Creek Pump Station and Force Main Replacement
`=o
O
Town of Franklinville, NC
Ln
High Priority Line Narrative — Fast Track Sewer Permit
Ogles Creek— Deep River Crossing
There is currently a 4-inch force main that runs under the Deep River from the current pump station in
vicinity to Ogles Creek Street to a trail on the other side of the river, before continuing to the Franklinville
Wastewater Treatment Plant. The 4-inch force main is PVC and has been in service since 1997. Please see
the Image 1 below for an overview of the current pump station and force main. Highway 64 is located to
the south and the Town of Franklinville is located to the north of the crossing. The current 4-inch force
main is deemed high priority based on the sub waterway crossing of the Deep River. The length of high
priority line crossing under the Deep River is approximately 440 feet.
Image 1: Existing Pump Station and Force Main Layout
The proposed project will construct a new pump station, and an associated 8-inch DIP force main that will
cross the Deep River in a similar manner to the existing 4-inch force main. Once the new pump station
and force main are certified and placed online, the existing pump station and associated 4-inch PVC force

'llI'C;F cCEf�'2 Y'
.1 F 6 2L124
VVi,-)ston-saiem
Re ionai v fCc,
main will be abandoned. The new 8-inch DIP force main wll� likewise become a high priority line once in
service, due to the sub waterway crossing of the Deep River. The length of the high priority line crossing
under the Deep River will be approximately 440 feet. Please see Image 2 below for a layout of the new 8-
inch force main and pump station, shown in relation to the existing pump station and 4-inch force main.
The new 8-inch DIP force main will also run to the Franklinville Wastewater Treatment Plant, as shown in
Image 2.
Image 2: Proposed Pump Station and Force Main Layout

NC Department of
Environinental Quality
Received State of North Carolina
Department of Environmental Quality
AUGDWR Q 9 2024 Division of Water Resources
Winston-Salem FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources Regional Office FTA 10-23 & SUPPORTING DOCUMENTATION
Application Number: A&V # ., 41 `' (to be completed by DWR)
All items must be completed or the anolication will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Town of Franklinville (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: Arnold Alfred, per 15A NCAC 02T .0106(b)
Title: Public Works Director("
4. Applicant's mailing ad ess: P.O. Box /
City: Franklinville State: NC` Zip: 2724$-
5. Applicant's contact information:
Phone number: [phone] Email Address: amold.allredgtofville.com
II. PROJECT INFORMATION:
1. Project name: Ogles Creek Pump Station and Force Main
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project ® ARPA funded
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: Randolph
i
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.735451°/ Longitude:-79.684326'
5. Parcel ID (if applicable): 7792648068 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Bill Lester, Jr. License Number: 17651
Firm: LKC En ing eerieg PLLC
Mailing address: 140 Aqua Shed Corfrt
City: Aberdeen ` State: NC Zip: 28315
i
Phone number: [phone]" Email Address: billg1kcengineering com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
t
1. Facility Name: Franklinville Wastewater Treatment Plant Permit Number: NC0007820
Owner Name: Town of Franklinville -
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ
2. Downstream (Receiving) Sewer Information: N/A inch ❑ Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCSDO081
Owner Name(s): Town of Franklinville "
FORM: FTA 10-23 Pagel of 5

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑ No ® N/A .-
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached?
❑ Yes ❑ No ®N/A
3. If the Applicant is a Home/Property Owners' Association, has an HOA/POA Operational Agreement (FORM: HOA) and
supplementary documentation as required by 15A NCAC 02T.0115(c) been attached?
❑ Yes ❑ No ® N/Al'
4. Origin of wastewater: (check all that apply):
❑ Residential (Individually Owned) ❑ Retail (stores, centers, malls) ❑ Car Wash
® Residential (Leased) ' ❑ Retail with food preparation/service ❑ Hotel and/or Motels
❑ School / preschool / day care ❑ Medical / dental / veterinary facilities ❑ Swimming Pool/Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: % Domestic % Commercial % Industrial (See 15A NCAC 02T .0103(20))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(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 ab
No. of Units
Flow
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
GPD
a See 15A NCAC 02T .0114(b), (d), (e)(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 in G.S. 42A-41.
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.0114] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: _ GPD (per 15A NCAC 02T .0114 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,O'
❑ Other (Explain):
FORM: FTA 10-23 Page 2 of 5

GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
VIII
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8-inch /
220
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
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: Ogles Creek Pump Station"
2. Approximate Coordinates (Decimal Degrees): Latitude: 35.735395'f Longitude:-79.684263°
3. Total number of pumps at the pumpstation: 2
3. Design flow of the pump station: C0_1�84)illions 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): 320 gallons per minute (GPM) at 41 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
8-inch '
1,050 l
DIP .,
V
5
v�
i
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 r ❑ 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 separations/alternatives found in 15A NCAC 02T .0305(fl & (a)? ® Yes ❑ No
15A NCAC 02T.0305(f) contains minimum separations that shall he provided for sewer zv-tPmc-
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)
18 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 1I 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
y It noncompliance with 02T.0305(t) or (g), see Section X.1 of this application
* 15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(1) 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 web patre
i
2. Does this project comply with the minimum separation requirements for water mains? ❑ Yes ❑ No ® N/A
➢ If no, please refer to 15A NCAC 18C.0906(f) for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? ❑ Yes ❑ No ®N/A
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ See the Division's draft separation requirements for situations where separation cannot be met.
➢ No variance is required if the alternative design criteria specified is utilized in design and construction.
i
4. Is the project located in a river basin subject to any State buffer rules? ® Yes Basin name: ❑ Now
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 213.0202
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.
1
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.prep d,
have been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosio
and sedimentation control plans, stormwater management plans, etc.). 1
7. Does this project include any sewer collection lines that are deemed "high -priority?" EfYes ❑
Per 15A NCAC 02T.0402, "high -priority sewer" means any aerial sewer, sewer contacting surface water, ,
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.
CERTIFI TIONS:
1. Does the sub nitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permittingof Pump Stations
and Force M ins latest version and the Gravity Sewer Minimum Design Criteria (latest version) as applicable?
r
® Yes ❑ No
If no, for pr jects requiring a single variance, complete and submit the Variance/Alternative Design Request application
(VADC 10- 4) and supporting documents for review to the Central Office. ApRroval of the _request will be issued
2. Professional ngineer's Certification:
L Ogles Creek Pump Station and
attest that this application for Force Main Replacement
(Professional Ey gineer's name from Applicati n Item III.I ) (Project Name from Application Item IL 1)
3.
has been re iiewed by me and is accurate, complete and consistent with the information supplied in the plans,
specification , engineering calculations, and all other supporting documentation to the best of my knowledge. I further
attest that to me best of my knowledge the proposed design has been prepared in accordance with the applicable regulations,
Minimum De;iiin Criteria for Gravity Sewers latest version), and the Minimum Design Criteria for the Fast -Track Permittin
of Pump Stat ns and Force Mains latest version). Although other professionals may have developed certain portions of this
submittal pa c age, inclusion of these materials under my signature and seal signifies that I have reviewed this material and
have judged i to be consistent with the proposed design.
NOTE — In ecordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, rel resentation, 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, ' icluding failure to disclose any design non-compliance with the applicable Rules and design criteria, may subject
the North Car Aina-licensed Professional Engineer to referral to the licensing board. (21 NCAC 56.0701)
N
Carolina Professional Engineer's seal, signature, and date:
. got -
�.'ii
s
FHg1NE�` ,�� • �.
Ogles Creek Pump Station and/
I , attest that this application for Force Main Replacement
ignaturc Au ority Name f m Application Item I.3.) (Project Name from Application Item 11.1)
` \
attest that t is application has,betsn reviewed by me and is accurate and complete to the best of my knowledge.
I understand I lat ifall-parts of this application are not completed and that if all required supporting documentation
and attachme is 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 ma y include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division
of Water Resc urces should a condition of this permit be violated. I also understand that if all required parts of this application
package are n cot completed and that if all required supporting information and attachments are not included, this application
package will tic 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 penalt. s up to $25,000 per violation.
Signature:
on per 15�, NCAC 02T .0I06(b):
i
Date:
FORM: FTA 10-23
Page 5 of 5

FORCE MAIN TO CONNECT TO
SPUTTER BOX AT INFLUENT OF THE
WASTEWATER TREATMENT PLANT
EXISTING PUMP STATION
TO BE DEMLOSIHED
Legend
• Proposed Manholes
Ps Existing Pump Station
Ps Proposed Pump Station
Proposed Gravity Sewer
8-inch
Proposed Force Main
,®v 8-inch
0 Existing Manholes
Existing Gravity Sewer
.�'�'•�►�' 8-inch
Ogles Creek Pump Station and
Force Main Replacement
Aerial Overview Map
Randolph County, NC
' x
♦ l tt,`
♦♦ �4i
♦♦♦
0\1 I - - , -
f 5 -.Z
PS
r'r
4U
U
0
OGLES CREEK
PUMP STATION
75 150
300 111
m Feet

Legend
Proposed Manholes
Ps Existing Pump Station
Ps Proposed Pump Station
Proposed Gravity Sewer
8-inch
Proposed Force Main
~ 8-inch
Existing Manholes
Existing Gravity Sewer
.�'�'•�►�� 8-inch
Ogles Creek Pump Station and
Force Main Replacement
USGS Topographic Map
Randolph County, NC
)00
i r%
R OCef .
0
ARROW ST
0 150 300
ft
III
600
m Feet

August 8, 2024
Mr. Collin Day, Regional Supervisor
NCDEQ—Winston-Salem Regional Office
450 West Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
Re: Randolph County
Ogles Creek Pump Station and Force Main Replacement
Fast -Track Sewer Application
Mr. Day,
NC Department of
Environmental Quality
Received
Regarding the above referenced project, please find the following items:
AUG 0 9 2024
Winston-Salem
Regional Office
1. Two Copies of the Fast Track Application Package and supporting documents
2. One application fee check for $600.00
The proposed project includes the installation of approximately: 220 If of 8-inch PVC gravity
sewer, 1,050 If of 8-inch RJ DIP force main, a new pump station, and associated appurtenances.
The gravity sewer infrastructure will be installed to direct flow to the new pump station. The
proposed pump station will pump the flow to the northeast under the Deep River and discharge
into a splitter box at the Franklinville Wastewater Treatment Plant via an 8-inch force main. The
pump station will be situated on a small portion of a parcel (Randolph County Parcel Number
7792720160) north of Highway 64 in a mobile home park.
If you have any questions, please do not hesitate to contact me at [phone] or by email at
[e-mail].
Sincerely,
LKC Engineering, PLLC
Jae_r, S C"A9Zw—
Marc Schaefer, E.I.
LKC Engineering, I'L LC, 140 Aqua Shed Court,
Aberdeen, North Carolina 28315
I'll: 910/420-1437 * PAX: 910/420-1438 * License No. P-1095