WQ0039927_Issuance of Permit_20180419

ROY
1 COOPER
Gavel-110J
: ,x€ MICHAEL S. REGAN
10% Seoetary
!;,,71V:4 LINDA CULPEPPER
Water Resoutces In[eru}r Director
En\uroninental Quality
April 19, 2018
William B. Kerr, Director of Engineering
City of Rocky Mount
P.O. Box 1180
Rocky Mount, NC 27802-1180
Subject: Permit No. WQ0039927
City of Rocky Mount
NCDOT Project: U-4762 Springfield Road Widening
Wastewater Collection System Extension Permit
Edgecombe County
Dear Mr. Kerr.:
In accordance with your application received March 7, 2018 we are forwarding herewith Permit No.
WQ0039927 dated April 19, 2018, to the City of Rocky Mount (Permittee) for the construction and
operation upon certification of the subject wastewater collection system extension. This permit shall be
effective from the date of issuance until rescinded and shall be subject to the conditions and limitations as
specified therein. This cover letter shall be considered a part of this permit and is therefore incorporated
therein by reference.
Please pay particular attention to the following conditions contained within this permit:
Condition 11.1: This permit shall not be automatically transferable; a permit modification request for a
name change must first be approved by this office.
Condition II 4. Requires that the wastewater collection facilities be properly operated and maintained in
accordance with 15A NCAC 2T .0403 or any individual system-wide collection system
permit issued to the Permittee.
It shall be the responsibility of the Permittee to ensure that the as-constructed project meets the
appropriate design criteria and rules. Failure to comply may result in penalties in accordance with North
Carolina General Statute §143-215.6A through §143-215.6C, construction of additional or replacement
wastewater collection facilities, and/or referral of the North Carolina-licensed Professional Engineer to the
licensing board.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the right to
request an adjudicatory hearing upon written request within 30 days following receipt of this permit. This
request must be in the form of a written petition, conforming to Chapter 150B of North Carolina General
Statutes,and filed with the Office of Administrative Hearings, 6714 Mail Service Center, Raleigh, NC 27699-
6714. Unless such demands are made,this permit shall be final and binding.
Division of Water Resources,Raleigh Regional Office,Water Quality Operations Section www.ncwaterquality.org
1628 Mail Service Center,Raleigh,NC 27699-1628 Phone [phone]
location• 1800 Rarrett Drive Raleigh.NC 27609 Fax (91 91 78S-7159

City of Rocky Mount
Permit No W0,0039927
If you need additional information concerning this matter, please contact Jason Robinson at(919) 791-
4200 or via e-mail at Jason.T [e-mail]
Sincerely,
71,12,-//11/1111r
for Linda Culpepper.
Interim Director, Division of Water Resourc-s
by S. Daniel Smith, Regional Supervisor
Water Quality Regional Operations Section •
Raleigh Regional Office •
Division of Water Resources, NCDEQ
cc: Corey Bousquet, PE: [e-mail]
Edgecombe County Health Department ' "'
Raleigh Regional Office Files -
Water Resources Central Files
Page 2 of 8

North Carolina Department of Environmental Quality
.
STATE OF NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENTAL QUALITY
WASTEWATER COLLECTION SYSTEM EXTENSION PERMIT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules, and Regulations, permission is hereby granted to the
City of Rocky Mount
Edgecombe County
for the construction and operation of approximately 212 linear feet of 8-inch and 2,443 linear feet of 12-
inch relocated gravity sewer lines as part of the NCDOT Project: U-4762 Springfield Road Widening project,
and the discharge of zero additional gallons per day of collected wastewater into the City of Rocky Mount's
existing sewerage system, pursuant to the application received March 7, 2018 and in conformity with 15A
NCAC 2T;the Division's Gravity Sewer Minimum Design Criteria adopted February 12, 1996 and updated in
March 2008, as applicable; the Division's Minimum Design Criteria for the Fast-Track Permitting of Pump
Stations and Force Mains adopted June 1, 2000 and updated March 2008, as applicable, and other
supporting data subsequently filed and approved by the Department of Environmental Quality and
considered a part of this permit.
This permit shall be effective fro he to of is, Once until rescinded and shall be subject to the specified
conditions and li, i ations con i therei.
.. ----: t ,
Linda Culpepper
Interim Director, Division of Water Resources
By Authority of The Environmental Management Commission
Permit Number: WQ0039927
Permit Issued: April 19, 2018
•
Page 3 of 8

I
SUPPLEMENT TO PERMIT COVER SHEET
Name of Applicant is hereby authorized to:
Construct, and then operate upon certification Ithe aforementioned wastewater collection extension. The
sewage and wastewater collected by this system shall be treated in the City of Rocky Mount's Tar River
Regional Wastewater Treatment Facility in accordance with Permit Number NC0039927
Permitting of this project does not constitute an acceptance of any part of the project that does not meet
15A NCAC 2T, the Division's Gravity Sewer Minimum Design Criteria adopted February 12, 1996 and
updated March 2008, as applicable, and th'e Division's Minimum Design Criteria for the Fast-Track
Permitting of Pump Stations and Force Mains adopted June 1,2000 and updated March 2008,as applicable,
unless specifically mentioned herein. Division approval is based on acceptance of the certification provided
by a North Carolina-licensed Professional Engineer in the application. It shall be the Permittee's
responsibility to ensure that the as-constructed project meets the appropriate design criteria and rules
' I
Construction and operation is contingent upon compliance with the Standard Conditions and any Special
Conditions identified below.
I. SPECIAL CONDITIONS
No Special Conditions.
II. STANDARD CONDITIONS
1 This permit shall not be transferable. In the event there is a desire for the wastewater collection
facilities to change ownership, or there ii a name change of the Permittee, a formal permit request
shall be submitted to the Division accompanied by documentation from the parties involved, and other
supporting materials as may be appropriate The approval of this request shall be considered on its
merits and may or may not be approved [15A NCAC 02T 0104; G.S 143-215 1(d3)]
2. This permit shall become voidable unless the wastewater collection facilities are constructed in
accordance with the conditions of this -Permit, 15A NCAC 2T; the Division's Gravity Sewer Minimum
Design Criteria adopted February 12, 1x96 and updated March 2008, as applicable; the Division's
Minimum Design Criteria for the Fast-Trak Permitting of Pump Stations and Force Mains adopted June
1, 2000 and updated March 2008, as allpplicable, and other supporting materials unless specifically
mentioned herein. [15A NCAC 02T.0110_
3 This permit shall be effective only with respect to the nature and volume of wastes described in the
application and other supporting data. [15A NCAC 02T.0110]
Page 4 of 8

4. The wastewater collection facilities shall be properly maintained and operated at all times. The
` Permittee shall maintain compliance with an individual system-wide collection system permit for the
operation and maintenance of these facilities as required by 15A NCAC 2T 0403 If an individual permit
is not required,the following performance criteria shall be met• [15A NCAC 02T 0108(b)]•
a The sewer system shall be effectively maintained and operated at all times to prevent discharge to
land or surface waters, and to prevent any contravention of groundwater standards or surface
water standards
b. A map of the sewer system shall be developed and shall be actively maintained
c An operation and maintenance plan including pump station inspection frequency, preventative
maintenance schedule, spare parts inventory and overflow response has been developed and
implemented
d. Pump stations that are not connected to a telemetry system shall be inspected every day (i.e. 365
days per year). Pump stations that are connected to a telemetry system shall be inspected at least
once per week.
e. High-priority sewer lines shall be inspected at least once per every six-months and inspections are
documented.
f. A general observation of the entire sewer system shall be conducted at least once per year.
g Overflows and bypasses shall be reported to the appropriate Division regional office in accordance
with 15A NCAC 2B .0506(a), and public notice shall be provided as.required by North Carolina
General Statute §143-215.1C.
h. -A_Grease Control Program is in place as follows.
1. For public owned collection systems,the Grease Control Program shall include at least biannual
distribution of educational materials for both commercial and residential users and the legal
means to require grease interceptors at existing establishments. The plan shall also include
legal means for inspections of the grease interceptors, enforcement for violators and the legal
means to control grease entering the system from other public and private satellite sewer
systems
2 For privately owned collection systems, the Grease Control Program shall include at least bi-
annual distribution of grease education materials to users of the collection system by the
permittee or its representative.
3. Grease education materials shall be distributed more often than required in Parts (1) and (2)
of this Subparagraph if necessary to prevent grease-related sanitary sewer overflows
i. Right-of-ways and easements shall be maintained in the full easement width for personnel and
equipment accessibility.
.i. Documentation shall be kept for Subparagraphs (a) through (i) of this Rule for a minimum of three
years with exception of the map, which shall be maintained for the life of the system.
Page 5 of 8

5. The Permittee shall report by telephone to a water resources staff member at the Raleigh Regional
Office, telephone number [phone], as soon as possible, but in no case more than 24 hours,
following the occurrence or first knowledge of the occurrence of either of the following:
a. Any process unit failure, due to known or unknown reasons,that renders the facility incapable
of adequate wastewater transpor , such as mechanical or electrical failures of pumps, line
blockage or breakage, etc.; or
b. Any SSO and/or spill over 1,000 gallons, or
c. Any SSO and/or spill, regardless of volume, that reaches surface water
Voice mail messages or faxed information is permissible, but this shall not be considered as the initial
verbal report. Overflows and spills occurr ng outside normal business hours may also be reported to
the Division of Emergency Management lat telephone number [phone] or [phone]
Persons reporting any of the above occurrences shall file a spill report by completing and submitting
Part I of Form CS-SSO (or the most current Division approved form) within five days following first
knowledge of the occurrence. This reportl must outline the actions taken or proposed to be taken to
ensure that the problem does not recur. Part II of Form CS-SSO (or the most current Division approved
form) can also be completed to show that the SSO was beyond control. [G S 143-215 1C(a1)]
6. Construction of the gravity sewers, pump stations, and force mains shall be scheduled so as not to
interrupt service by the existing utilities Hr result in an overflow or bypass discharge of wastewater to
the surface waters of the State. [15A NCAC 02T.0108(b)]
7. Upon completion of construction and prior to operation of these permitted facilities, the completed
Engineering Certification form attached to this permit shall be submitted with the required supporting
documents to the address provided on the form. A complete certification is one where the form is fully
executed and the supporting documents are provided as applicable Any wastewater flow made
tributary to the wastewater collection system extension prior to completion of this Engineer's
_ Certification shall be considered a violation of the permit and shall subject the Permittee to appropriate
enforcement actions
If the permit is issued to a private entity with an Operational Agreement,then a copy of the Articles of
Incorporation, Declarations/Covenants/Restrictions, and Bylaws that have been appropriately filed with
the applicable County's Register of Deeds office shall be submitted with the certification.
A complete certification is one where tl7e form is fully executed and the supporting documents are
provided as applicable. Supporting documentation shall include the following
a. One copy of the project construction record drawings (plan & profile views of sewer lines &force
mains) of the wastewater collection system extension. Final record drawings should be clear on
the plans or on digital media (CD o DVD disk) and are defined as the design drawings that are
marked up or annotated with after construction information and show required buffers,separation
distances, material changes, etc.
b. One copy of the supporting applicab e design calculations including pipe and pump sizing,velocity,
pump cycle times, and level control settings, pump station buoyancy, wet well storage, surge
protection,detention time in the wet well, and force main, ability to flush low points in force mains
with a pump cycle, and downstream sewer capacity analysis. If a portable power source or pump
is dedicated to multiple stations, an evaluation of all the pump stations' storage capacities and the
Page 6 of 8

rotation schedule of the portable power source or pump, including travel timeframes, shall be
` provided.
c Changes to the project that do not result in non-compliance with this permit, regulations, or the
Minimum Design Criteria should be clearly identified on the record drawings, on the certification
in the space provided, or in written summary form
Prior to Certification (Final or Partial): Permit modifications are required for any changes resulting in
non-compliance with this permit (including pipe length increases of 10% or greater, increased flow,
pump station design capacity design increases of 5% or greater, and increases in the number/type of
connections), regulations, or the Minimum Design Criteria. Requested modifications or variances to
the Minimum Design Criteria will be reviewed on a case-by-case basis and each on its own merit. Please
note that variances to the Minimum Design Criteria should be requested and approved during the
permitting process prior to construction After-construction requests are discouraged by the Division
and may not be approved,thus requiring replacement or repair prior to certification &activation. [15A
NCAC 02T 0116]
8. Gravity sewers installed greater than ten percent below the minimum required slope per the Division's
Gravity Sewer Minimum Design Criteria shall not be acceptable and shall not be certified until
corrected If there is an unforeseen obstacle in the field where all viable solutions have been examined,
a slope variance can be requested from the Division with firm supporting documentation. This shall be
done through a permit modification with fee. Such variance requests will be evaluated on a case-by-
case basis. Resolution of such request shall be evident prior to completing and submitting the
construction certification. [ 15A NCAC 02T.0105(n)]
9. A copy of the construction record drawings shall be maintained on file by the Permittee for the life of
the wastewater collection facilities [15A NCAC 02T.0116]
10. Failure to abide by the conditions and limitations contained in this permit, 15A NCAC 2T; the Division's
Gravity Sewer Design Criteria adopted February 12, 1996 and updated March 2008,
as applicable;the Division's Minimum Design Criteria for the Fast-Track Permitting of Pump Station and
Force Mains adopted June 1, 2000 and updated March 2008 as applicable, and other supporting
materials may subject the Permittee to an enforcement action by the Division, in accordance with North
Carolina General Statutes §143-215.6A through §143-215.6C,_ construction of additional or
replacement wastewater collection facilities,and/or referral of the North Carolina-licensed Professional
Engineer to the licensing board. [15A NCAC 02T.0104, 15A NCAC 02T .0108(b-c)]
11. In the event that the wastewater collection facilities fail to perform satisfactorily, including the creation
of nuisance conditions,the Permittee shall take immediate corrective action, including those as may be
required by this Division, such as the construction of additional or replacement facilities. [15A NCAC
02T.0110, 15A NCAC 02T.0108(b)]
12 The issuance of this permit shall not exempt the Permittee from complying with any and all statutes,
rules, regulations, or ordinances that may be imposed by the Division any other Federal, State, or Local
government agencies which have jurisdiction or obtaining other permits which may be required by the
Division or any other Federal, State, of Local government agencies. [G S. 143-215.1(b)]
Page 7 of 8

rI'1J I I I111l.I\3L111/En ID JIIVCCI\IIVl7 LCr\I IrII.H I IIJIN
PERMITTEE: City of Rocky Mount
PERMIT#: WQ0039927
PROJECT: NCDOT Project: U-4762 Springfield Road Widening
ISSUE DATE: April 19, 2018
This project shall not be considered complete nor allowed to operate in accordance with Condition 7 of this
permit until the Division has received this Certification and all required supporting documentation It
should be submitted in a manner that docume is the Division's receipt. Send the required documentation
the Regional Supervisor, Water Quality Region I Operations Section at the address at the bottom.
Any wastewater flow made tributary to the wastewater collection system extension prior to completion of
this Certification shall be considered a violation of the permit and shall subject the Permittee to appropriate
enforcement actions. The Permittee is responsible for tracking all partial certifications up until a final
certification is received. A Final Certification shall be a complete set of record drawings and design
calculations regardless of whether partials have been submitted.
PERMITEE'S CERTIFICATION
I, the undersigned agent for the Permittee, hereby state that this project has been constructed pursuant
to the applicable standards & requirements, the Professional Engineer below has provided applicable
design/construction information to the Permi tee, and the Permittee is prepared to operate & maintain
the wastewater collection system permitted horein or portions thereof.
Printed Name,Title Signature Date
ENGINEER'S CERTIFICATION
I, , as a duly registered Professional Engineer in the State of North Carolina,
having been authorized to observe(I I periodically,I I weekly, I I full time)the construction of the project
name and location as referenced above for 'the above Permittee hereby state that, to the best of my
abilities, due care and diligence was used in the observation of the construction such that the construction
was observed to be built within substantial compliance of this permit, 15A NCAC 02T, the Division of Water
Resources' (Division) Gravity Sewer Minimum Design Criteria adopted February 12, 1996 and updated
March 2008, as applicable; the Division's Minimum Design Criteria for the Fast-Track Permitting of Pump
Stations and Force Mains adopted June 1, 2000 and updated March 2008, as applicable; and other
supporting materials.
North Carolina Professional Engineer's Seal w/signature & date:
Final [ I Partial (include description) •
Certification Comments/Qualifiers(attach if n cessary):
Division of Water Resources,Raleigh Regional Office,Water Quality Operations Section www ncwaterquality.org
1628 Mail Service Center,Raleigh,NC 27699-1628 Phone[phone]
I-nrnt;nn• 1Rf1f1 Ran•Ptk rlr,va T?niatnh NC 77r,r1Q Fn.•/Q1 Q1 7RR-71 SQ

State of North Carolina
'fir Department of Environmental Quality
Division of Water Resources
- 15A NCAC 02T.0300—FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 04-16&SUPPORTING DOCUMENTATION
Application Number:VJLjf Q Cil (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: City of Rocky Mount(company,municipality,HOA,utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately-Owned Public Utility
❑ Federal ❑ State/County ® Municipal ❑ Other
3. Signature authority's name: William B.Kerr per 15A NCAC 02T.0106(b)
Title: Director of Engineering
4. Applicant's mailing address: P. O.Box 1180
City:Rocky Mount State:NC Zip:27802-1180
5. Applicant's contact information:
Phone number: [phone] Email Address:[e-mail]
II. PROJECT INFORMATION:
1. Project name:NCDOT Project: U-4762 Springfield Road Widening
2. Application/Project status: ❑Proposed(New Permit) ® Existing Permit/Project
If a modification,provide the existing permit number: WQ00 and issued date:
If new construction but part of a master plan,provide the existing permit number: WQ00
3. County where project is located:Edgecombe 4.,,
4. Approximate Coordinates(Decimal Degrees): Latitude: 35.952963° Longitude: -77.753677°
5. Parcel ID(if applicable): d y�
(or Parcel ID to closest downstream sewer) t O
III. CONSULTANT INFORMATION: i c
1. Professional Engineer: Corey Bousquet License Number: 023041
c1:7 cc C4
Firm:Hinde Engineering o
Mailing address:401 Harrison Oaks Blvd., Suite 145
City: Cary State:NC Zip:27513-
Phone number: [phone] Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY(WWTF)INFORMATION:
1. Facility Name:Tar River Regional WWTP Permit Number:NC0030317
Owner Name: City of Rocky Mount
V. RECEIVING DOWNSTREAM SEWER INFORMATION(if different than WWTF):
1. Permit Number(s): WQ Downstream(Receiving) Sewer Size: inch
System Wide Collection System Permit Number(s)(if applicable): WQCS
Owner Name(s):
FORM: FTA 04-16 Page 1 of 5

VI. GENERAL REQUIREMENTS
L
1. If the Applicant is a Privately-Owned Public Utility,has a Certificate of Public Convenience and Necessity been attached?
1
❑ Yes ❑No ®N/A
2. If the Applicant is a Developer of lots to be sold, as a Developer's Operational Agreement(FORM: DEV)been attached?
Yes ❑No EN/A
3. If the Applicant is a Home/Property Owners'Association,has an Operational Agreement(FORM: HOA)been attached?
1
❑ Yes ❑No EN/A
4. Origin of wastewater: (check all that apply):
®Residential Owned ❑Retail(1 tores,centers,malls) El Car Wash
®Residential Leased Ill Retail with food preparation/service ❑ Hotel and/or Motels
El School/preschool/day care Ill Medicall/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: 100%Domestic/Commercial %Commercial
I
%Industrial(See 15A NCAC 02T.0103(20))
>Is there a Preleatment Program in effect? ❑Yes ®No
6. Has a flow reduction been approved under 15A NAC 02T .0114(f)? ❑Yes ®No
> If yes,provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type(see 02T.0114(f)) Daily Design Flow a,b No.of Units Flow
gal/ GPD
gal/ GPD
gal/ GPD
gal/ GPD
gall GPD
gal/ GPD
Total GPD
a See 15A NCAC 02T .0114(b), (d), (e)(1) anc (e)(2)for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling;proposed unknown non-residential development uses;public access facilities located near high public use areas,
and residential property located south or east 1 f 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 ra es 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:0 GPD(per 15. NCAC 02T.0114)
> Do not include future flows or previously per itted allocations
If permitted flow is zero,indicate why:
❑Pump Station or Gravity Sewer where flow w'll be permitted in subsequent permits that connect to this line
❑Flow has already been allocated in Permit Nu ber:
®Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other(Explain):
FORM: FTA 04-16 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
8 212 PVC, SDR 26
12 2443 PVC, SDR 26
> 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 requirement is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA(If Applicable)—02T.0305&MDC(Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:N/A
2 Approximate Coordinates(Decimal Degrees): Latitude. ° Longitude: - .
3. Design flow of the pump station: millions gallons per day(firm capacity)
4. ,Operational point(s)of the pump(s): gallons per minute at feet total dynamic head(TDH)
5. Summarize the force main to be permitted(for this Pump Station):
Size(inches) Length(feet) Material
6. Power reliability in accordance with 15A NCAC 02T.0305(h)(1):
❑ Standby power source or pump with 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
Or if the pump station has an average daily flow less than 15,000 gallons per day:
❑ Portable power source with manual activation,quick-connection receptacle and telemetry- 15A NCAC 02T
.0305(h)(1)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry- 15A NCAC 02T.0305(h)(1)(C):
> It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant(draft agreement)
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
in the case of a multiple station power outage.
FORM: FTA 04-16 Page 3 of 5

IX. SETBACKS&SEPARATIONS—(02B.0200 & 15A NCAC 02T.0305(t)):
1. Does the project comply with all separations found in 15A NCAC 02T.0305(f)&(g) ® Yes ❑No
D 15A NCAC 02T.0305(f)contains minimum separations that shall be provided for sewer systems:
Setback Parameter* Separation Required
Storm sewers and other utilities not listed below(vertical) 24 inches
Water mains(vertical-water over sewer including in benched trenches) 18 inches
Water mains(horizontal) 10 feet
Reclaimed water lines(vertical-reclaimed over sever) 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 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(see item IX.2) 50 feet
**Any other stream,lake, impoundment,or ground water lowering and surface drainage
ditches 1 10 feet
Any building foundation 5 feet
Any basement 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
D 15A NCAC 02T.0305(1z)contains alternatives where separations in 02T.0305(f)cannot be achieved.
D **Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
D If noncompliance with 02T.0305(f)or(g),see Section X of this application
2. Does the project comply with separation requirements for wetlands?(50 feet of separation) ® Yes El No
D See the Division's draft separation requirements for situations where separation cannot be meet
D No variance is required if the alternative design criteria specified is utilized in design and construction
D As built documents should reference the location of areas effected
3. Does the project comply with all setbacks found in the river basin rules per 15A NCAC 02B .0200? ® Yes CI No
D This would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Does the project comply with an individual 404 Pi rmit or any 401 Certifications? ® Yes ❑No
D Wetland-related permits shall be requested,obtained,and adhered to for projects that impact wetlands or surface waters
• Information can be obtained from the 401 &Buffer Permitting Branch
5. Does project comply with 15A NCAC 02T.0105(z)(6)(additional permits/certifications)? ® Yes ❑No
Per 15A NCAC 02T.0105(c)(6), directly related environmental permits or certification applications are being prepared,have
been applied for, or have been obtained. Issuancof this permit is contingent on issuance of dependent permits (erosion and
sedimentation control plans,stormwater manageent plans, etc.).
6. Does this project include any sewer collection lin s that are deemed"high-priority?"
Per 15A NCAC 02T.0402, "high-priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streambanks that is subject o erosion that undermines or deteriorates the sewer.
❑ Yes ®No
D 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 permitee's individual System-Wide Collection permit.
FORM: FTA 04-16 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with I 5A NCAC 02T, the Minimum Design Criteria for the Permitting of Pump Stations
and Force Mains(latest version),and the Gravity Sewer Minimum Design Criteria(latest version)as applicable?
®Yes ❑No
If No,complete and submit the Variance/Alternative Design Request application(VADC 10-14)and supporting documents for
review. Approval of the request is required prior to submittal of the Fast Track Application and supporting documents.
2. Professional Engineer's Certification.
I GOR el, .i ' i 6 t. attest that this application for
(Professional Engineer's name from Application Item III.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, Gravity Sewer
Minimum Design Criteria for Gravity Sewers(latest version), and the Minimum Design Criteria for the Fast-Track Permitting
of Pump Stations and Force Mains (latest version). Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that 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 143-215.6B, 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.
North Carolina Professional Engineer's seal,signature,and date: .c‘,,A CAA-8
ople9rseO�ega
4.
,mfiZ041
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g
B0\1 ,04
‘slf°SSR. ti+
3. Applicant's Certification per 15A NCAC 02T.0106(b): /
I, W; I]i ct rn 0( -44,1-„,Linattest that this application for
(Signature Authority s name&title from Application Ite3.)
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. 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: //I Date: 2/8
FORM:FTA 04-16 Page 5 of 5

State of North Carolina
i ,
Department of Environmental Quality
1-71 '' 1' ‘Li s I,�'„ Division of Water Resources
Division of Water Razsonices Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: City of Rocky Mount
Project Name for which flow is being re nested: NCDOT Project U-4762 Edgecombe Cty
More than one FTSE may be required for a single roject if the owner of the WWTP is not responsible for all pump
stations along the route of the proposed wastewater flow.
I. Complete this section only if you are t I e owner of the wastewater treatment plant.
a. WWTP FacilityName: Tar River Regional WWTP
g
b. WWTP Facility Permit#: NC0030317
All flows are in MGD
c. WWTP facility's permitted flow 21.00
d. Estimated obligated flow not yet tributary to the WWTP 0.53
e. WWTP facility's actual avg. flow 10.83
f. Total flow for this specific request 0
g. Total actual and obligated flows to the facility 11.36
h. Percent of permitted flow used 54.10%
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) (C) (D)=(B+C) (E)=(A-D)
Design Obligated,
Pump Average Daily Approx. Not Yet Total Current
Station Finn Flow** Current Avg. Tributary Flow Plus
(Name or Capacity, * (Firm/pf), Daily Flow, Daily Flow, Obligated Available
Number) MGD MGD MGD MGD Flow Capacity***
Legg. Rd. 0.159 0.064 0.063 0 0.063 0.001
Harper St. 0.475 0.190 0.187 0 0.187 0.003
97 Lift St. 30.0 12.0 6.5 0.2 6.7 5.3
* The Firm Capacity 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(p1) not less than 2.5.
***A Planning Assessment Addenum 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): Tar River Regional
Downstream Permit Number: Nb 0030317
.Page 4....0.f..6"
FTSP 04-1 6

HINDS
ENGINEERING NC Dept of Environmental Quality
401 Harrison Oaks Blvd. MAR 7
Suite 145 2018
Cary, NC 27513
Phone: [phone] Raleigh Regional Office
Fax: [phone]
LETTER OF TRANSMITTAL
To: Raleigh Regional Office Water Quality Section Date: March 05, 2018
1628 Mail Service Center
Raleigh, NC 27699-1628
** HAND DELIVER **
Re: U-4762 Edgecombe—Sewer Line Relocations
along Springfield Road from US 64 to Leggett
Job No.: A2015902.00
NCDOT—U-4762
I am sending you the following item(s):
COPIES DATE NO. DESCRIPTION
1 03-05-18 Sewer Permit Application
1 03-05-18 Sewer_Topo_Map
1 03-05-18 $480.00 Permit Review Fee
Description of Project:
Relocation of existing 8" and 12"sanitary sewer lines along Springfield Road from US 64 to Leggett
Road. No additional flow will be generated.
These are transmitted as checked below:
❑ As requested ❑ For your use
® For approval ❑ • For Signatures
❑ For review and comment ❑
Remarks:
Copy to: File Signed: 4,xe74.00______
Brad Kerr
Corey D. Bousquet, PE
Project Manager

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/ . :/ &' PROP. 8" PVC SEWER 10 .,,�', ` V
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��' LINES, SDR 26 •/ .IC% ik /.:\ s, PROP. 12" PVC SEMI i.-."-�
I� ``� LIKES, SDR 26
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� Latitude = 35. 952963 _- ( 1 30~-, ' I
- MI64 \ Longitude: _ -77. 753677 - `•Ij ' ir _ 1
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e �� �.,�� /.. _� ; �� EXIST. 12 SEWER •� ! ')11 :��..
` i• • LINES WEST SIDE • \ PROP. 8" PVC SEWER
L__.... ,� 1° OF SPRINGFIELD RD. __•
II _ I,1NFS, SDR 26 r
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Rock Mount
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VICINITY MAP
NCDOT PROJECT:U-4762 EDGECOMBE COUNTY-RELOCATION OF 8"AND 12"
SEWER LINES ALONG SPRINGFIELD ROAD.
1000 FT= 1 INCH

III. Certification Statement:
I William B. Kerr 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 route 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 indicates acceptance of this wastewater flow.
i
i/7 �- /
,� h-f
Signing irffi ial Sigriat re z
Date
Page 2-of4
FTSP (14-16