WQ0045846_Application (FTSE)_20240906

August 29th, 2024
Washington Regional Office- WQS
Attn: Fredric Oelrich
943 Washington Square Mall
Washington, NC 27609
RECEIVED/NCDENR/DWR \`\`
SEP -6 2024
Water Quality
Regional Operations Section
Washington Regional Office
RE: NCDOT R-5777C UC Plans For the City of New Bern Forcemain Upsizing
Fast Track Sewer System Extension Application
Attached are the permit application, permit application fee, USGS Map, Aerial Map with
project area, and the Utility Construction plans and specifications for the NCDOT R-
5777C UC Plans for the City of New Bern Forcemain Upsizing project.
The City of New Bern has requested upsizing approximately 8,1551.LF' of 6" forcemain to
8" forcemain. This segment of forcemain has 11 direct service cMnections and will
allow for removal of a second smaller line in this section of the project. This upsizing will
occur between Fisher Ave and Camp Kiro Rd. The forcemain sewer for this project will
be relocated along U.S. 70 from the Havelock Bypass to East of S.R. 1116 (Thurman
Rd).
If you have any questions or concerns, please do not hesitate to give me a call at 252-
242-1187 or on my cell phone at 252-945-2983 or email at mpeedin(a)imt.com.
Respectfully submitted,
JMT - Johnson, Mirmiran & Thompson, Inc.
An Employee -Owned Company
Marie U. Peedin, PE
Section Head — Water/Wastewater

E(The Applicant's Certification on Page 5 of the application shall be signed in accordance with 15A NCAC 02T .0I061b1. 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).
E. Floyf Tracking/Acceptance Form (Form: FTSE 10-23) (If Applicable):
R1 CEIVED/NCDENR/DWR V v G 00
Lfsgt1 tate of North Carolina
Department of Environmental Quality
DWR
Division of Water Resources
- ` SEP — G 2024 FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
DMsion of Water Resources INSTRUCTIONS FOR FORM: FTA 10-23 & SUPPORTING DOCUMENTATION
Water Quality
Washington Regional Office
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 02'1 and the Division's
Minimum Design Criteria (Gravny Sewer & Pump Stations!_Fgrce 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;
D 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 inshuctions 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.
a. Co r 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 requited sewer permits (downstream/upstream)
➢ If necessary for clarity, include attachments to the application form.
➢ If the project is funded by American Rescue Plan Act (ARPA) funds, please include the ARPA project number in the cover
letter and in parentheses under Project Name (Section H.1. of the application).
C. Application Fee (All New and Modification Application Packages):
❑ Submit a check or money order in the amount of S600.00, dated no more than 90 days prior to application submittal.
➢ Payable to North Carolina Department of Environmental Quality (NCDEQ)
D. Track Application (Required for All Application Packages, Form FTA 10-23):
Fas
Submit the completed and appropriately executed application.
➢ if necessary for clarity or due to space restrictions, attachment-, 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
Nonh Carolina Secretan of Sratc.
❑ 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
/ be county of business.
[9' 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.
INSTRUCTIONS FOR FORM: FTA 10-23 & SUPPORTING DOCUMENTATION Page 1 of 3

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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 Qu& ty Section
Swannanoa, North Carolina 28778-8211 Clay, Graham, Haywood, Henderson, Jackson,
(828) 2964500
Macon, Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Fayetteville Redonal 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
1 Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
$sleigh 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
Wilmington Regional Office
Water Quality Section
Winston-Salem Regional Office
Water Quality Section
943 Washington Square Mall
Washington, North Carolina 27889
[phone]
[phone] Fax
127 Cardinal Drive Extension
Wilmington, North Carolina 28405
[phone]
[phone] Fax
Beaufort, Bertie, Camden,n, Chowan, Craven,
Currituck, Dare, Gates, Greene, Hertford, Hyde,
Jones, Lenoir, Martin, Pamllco, Pasquotank,
Perquimans, Pitt, Tyrrell, Washington, Wayne
Brunswick, Carteret, Columbus, Duplin, New
Hanover, Onslow, Pander
450 W. Hanes Mill Road Alamance, Alleghany, Ashe, Caswell, Davidson,
Suite 300 Davie, Forsyth, Guilford. Rockingham, Randolph,
Winston-Salem, North Carolina 27105 Stokes, Surry, Watauga, Wilkes, Yadkin
[phone]
[phone] Fax
INSTRUCTIONS FOR FORM: FTA 10-23 & SUPPORTING DOCUMENTATION Page 3 of 3

State of North Carolina
Del Department of Environmental Quality
Division of Water Resources
�DWklon of Water Resources FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
VIA 10-23 & SUPPORTING DOCUMENTATION
Application Number: __..__.. Ito be completed be r M k i
All items must be completed or the application will he returned
I. APPLICANT INFORMATION:
1. Applicant's name: City of New Bern (company, municipality, HOA, utility, etc.)
2. Applicant type: ;j Individual ❑ Corporation ❑ General Partnership
❑Privately-Owned Public Utility
❑ Federal ❑ State/County ® Municipal ❑ Other
3. Signature authority's Warne: Foster Hughes per 15A NCAC 02T .0106tbt
Title: City Manager
4. Applicant's mailing address: P.O Box 1129
City: New State: NC Zip: 28563-.
5. Applicant's contact information:
Phone number: 252 639-7527 Email Address: hughesf(anewbetnnc.gov
11. PROJECT INFORMATION:
1. Project name: NCDOT R-5777C UC Plans for the City of New Bern Forcemain Upsizing
2. Application/Project status: ® Proposed (New Permit) ❑ Existing PermiuProject ❑ ARPA funded
If a modification, provide the existing permit number: W000_ 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: WQOO_
3. County where project is located: Craven
4. Approximate Coordinates (Decimal Degrees): Latitude: N.34.954° Longitude:-W.76.948°
5. Parcel ID (if applicable): _ (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION: /
1. Professional Engineer: Marie U. Peedin License Number: 20212 u
Firm: Johnson. Mirmiran 8t Thompson
Mailing address: 3508 Trent Rd. Unit A
City: New Bent State: NC Zip: 28562-
Phone number: (252) 242-1� Email Address: mt>eedin m mt.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: City of New Bern W WTF Permit Number. NCO025384
Owner Name: City of New Hem
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQN/A
2. Downstream (Receiving) Sewer Information: 12 inch ❑ Gravity ® Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS00052
Owner Name(s): City of New Bem
FORM: FTA 10-23 Page 1 of 5

V1. 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 I been attached?
[]Yes []No ®N/A
3. If the Applicant is a Home/Property Owners' Association, has an HOA/POA Operational Asreement (FORM: HOA) and
supplementary documentation as required by I SA 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: 95 % Domestic 5 % Commercial 0 % Industrial (See 15A NCAC 02T .0103t201)
If Industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC O.'.T,01 1 ff)? ❑ Yes ® No
➢ If ves 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 's
No. of Units
Flow
gal/
GPD
gal/
GPD
gall
GPD
gal/
—
GPD
gal/
GPD
gal/
GPD
Total
GPD
a See 15A NCAC 02T 0114(b). (d). jeXl) 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. 42A4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NC AC 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: 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/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 (Graviri Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
➢ 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 tines 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
8"
8155
PVC, C905
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.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(hxl)(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 timefiames, 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(t)):
1. Does the project comply with all separations/alternatives found in h 5A NCAC 021.030, & iel? ®Yes ❑ No
15A NCAC 02T.0305 contains minimum separations that shall be provided for sewertern
Setback Parameter*
s s s. _
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)
I0 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 11 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 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
r if noncompliance with 021'.0305(t) or (e). see Section X.1 of this application
*15A NCAC 02T.0305(e) contains alternatives where separations in 021.0305W 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 webpatte
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. Dees 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 i SA 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, stornwater management plans, etc.).
7. Dees 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.
)o 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:
1. Does the submitted system comply with I5A NCAC 02T, the Minimum Design Criteria for the Pennittine of Pumo 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 reguirine a variance approval mar be subject to Ionizer
2. Professional Engineer's Certification:
I, Mar' e �, �2� ^ attest that this application for u LDof- t' Ille, L(C f01&4,T
(Professional Engineer's came from Application Item IU.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 'ravi[y Sewers [latest version n, and the Minimum De , n_Crilcria for the Fast -Track Permitting
of Punnp 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
_..__
North Carolina Professional Engineer's seal, signature, and date
jSEAL
,Q1V/V*4C"
�"frrtnttt'
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I, fQ )-rC2 H-c mg S —,attest that this application for /VC& I A-S777G U LPk*.i
(Signature Authority Natty from Application Jim 1.3.) (Project Name fmm Application item ILI)
attest that this application has been reviewed by me and is accurate and complete to the best of my knowledge.
1 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. 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_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: _4eat Date:
FORM: FTA 10-23 Page 5 of 5

Division o Wate Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-23)
Entity Requesting Allocation: City of New Bern
Project Name for which flow is being requested: NCDOT R-5777C UC - New Bem
More than one FTSE may be required for a single project if the owner of the WWTP is not responsible for aftpump
stations along the route of the proposed wastewater flow.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. W WTP Facility Name: Cityof New Bem
b. WWTP FacilityPermit #: NCO025348
Ali Jiows are in MGD
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
6.500
0.377
4.126
0.000
4.503
h. Percent of permitted flow used 69.3%
II. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
List pump stations located between the project connection point and the WWTP:
(A)
(B)
Design
Pump
Pump
Average
Approx.
Station
Station
Firm
Daily Flow"
Current
(Name or
Permit
Capacity, •
(Firm / pf),
Avg. Daily
Number)
No.
MGD
MGD
Flow, MGD
95
0.769
0.301
0.118
(C)
(D)=(B+C)
(E)=(A-D)
Obligated,
Not Yet
Total Current
Tributary
Flow Plus
Daily Flow,
Obligated
Available
MGD
Flow
Capacity***
0.048
0.166
0.135
EQ-basin 2.664 1.066 0.674 0.270 0.944 0.122
" The Firm Capacity (design flow) of any pump station is defined as the maximum pumped flow that can be
achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor (pf) not
less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located between the
project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): New Bern WWTP
Downstream Permit Number: NCO025348
Page 1 of 6
FTSE 10-23

III. Certification Statement:
I _ Fa 17 g rL NvUH £S certify to the best of my knowledge that the addition of
the volume of wastewater to be permitted in this project has been evaluated along the mute to the receiving
wastewater treatment facility and that the flow from this project is not anticipated to cause any capacity
related sanitary sewer overflows or overburden any downstream pump station en route to the receiving
treatment plant under normal circumstances, given the implementation of the planned improvements
identified in the planning assessment where applicable. This analysis has been performed in accordance
with local established policies and procedures using the best available data. This certification applies to
those items listed above in Sections I and II plus all attached planning assessment addendums for which I
am the responsible party. Signature of this form certifies that the receiving collection system or treatment
works has adequate capacity to transport and treat the proposed new wastewater.
�\J
Signing Cyficial Signature
Title of Signing
Page 2 of 6
FTSE 10-23

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VII. 'GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC tGravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inch,
$) Length (feet) Material
LEE E I
➢ Section H & 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
Vill. 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) I Length (feet) I Material
1 g" 1 .10,229 1 PVC, C905
If any portion of the force main is less than flinches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.01C. Lb. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify) _
6. Power reliability in accordance with 15A NCAC 02T .0305(h)111:
❑ Standby power source or 0 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 timefmmes, 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