WQ0040226_Application (FTSE)_20180927

Permit Number WQ0040226
Program Category
Non -discharge
Permit Type
Gravity Sewer Extension, Pump Stations, & Pressure Sewer Extensions
Primary Reviewer
dean.hunkele
Coastal SWRule
Permitted Flow
Facility
Central Files: APS SWP
8/14/2018
Permit Tracking Slip
Status
Project Type
In review
New Project
Version
Permit Classification
A
Individual
Permit Contact Affiliation
Facility Dame Major/Minor Region
Hampstead Hardees Private Pump Station Minor Wilmington
Location Address County
Pender
Owner
Owner Name
Boddie-Noell Enterprises Inc
Facility Contact Affiliation
Owner Type
Non -Government
Owner Affiliation
Michael H. Hancock
PO Box 1908
Dates/Events
Rocky Mount NC 27802190
i
Scheduled
i
i
Orig Issue App (Received Draft Initiated Issuance
Public Notice issue Effective Expiration
8/14/2018
Regulated Activities
Requested eceived Events
• i
Additional information requested 8/14/18
Additional information received
.SS.t`Z_li:l..^Y O
-

;

LETTER OF TRANSMITTAL
Stocks Engineering, PA
PO Box 1108
J. Michael Stocks, PE Nashville, NC 27856 J. Kevin Varnell
252.903.6891 252.459.8196 252.382.0012
To:
Dean Hunkele
NCDEQ-DWQ
127 Cardinal Drive Ext.
Wilmington, NC 28405
Phone:
910-796-7215
Overnight No
Yes
We are sending you the following:
❑ EC Plans ❑ Prints/Plans
❑ Contracts x Permit Applications
These are transmitted as checked below:
x For Approval ❑ As Discussed
❑ For Review and Comment
Job No.
2017-013
Job Name:
Hardee's Hampstead
Date:
8/13/18
Sent By:
Ethan Averette
❑ Construction Plat ❑ Site Plan Drawings ❑ Computer Disk
❑ Site Work Calculations ❑
❑ For Your File ❑ As Requested
❑ For Your Signature, then return to:
❑ For Your Use
Copies
Date
Description
2
8-13-18
Fast Track Sewer Application
2
8-13-18
Flow Tracking/Acceptance for Sewer Extension Applications
2
8-13-18
USGS Map with location of site shown CEIVED/ CD /DW
2
8-13-18
Street Map of Surrounding Area AUG 14 2018
2
8-13-18
Certificate of Existence Water Quality Regional
Operations Section
Wilminglon Regional Office
2
8-13-18
Certificate of Public Convenience and Necessity
1
8-13-18
Permit Fee Check
Remarks
Copies To:

State of North Carolina
Department of Environmental Quality
Division of Water Resources
1)WR
15A NCAC 02T .0300 —FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 04-16 &SUPPORTING DOCiTMENTATION
Application Number: 66-6t006919�_(to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Boddie-Noell Enterprises, Inc. (company, municipality, HOA, utility, etc.)
2. Applicant type:. ❑Individual E Corporation ❑General Partnership ❑Privately -Owned Public Utility
El Federal ❑State/County El Municipal ❑Other
3. Signature authority's name: Michael H. Hancock per 15A NCAC 02T .0106(bl
Title: Excecutive Vice -President
4. Applicant's mailing address: PO Box 1908
City: Rocky Mount State: NC Zip: 27802-1908
Vt5. Applicant's contact information:
Phone number: [phone] Email Address: [e-mail] 4 2018
H. PROJECT INFORMATION:
1. Project name: Hardees Hampstead
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: Pender
4. Approximate Coordinates (Decimal Degrees): Latitude: 34.36582' Longitude:-77.713060
5. Parcel ID (if applicable): 3282-86-3602
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: J. Michael Socks License Number: 19843
Firm: Stocks Engineering, P.A.
Mailing address: PO Box 1108
City: Nashville State: NC Zip: 27856-
Phone number: [phone] Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Pluris Hampstead Wastewater Treatment Plant Permit Number: WQ0037287 Ver. C
Owner Name: Pluris Hampstead, LLC.
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ aa _3�`No)_� 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
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
E Yes ❑No ON/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: Dbeen attached?
[I Yes F]No EN/A
3. If the Applicant is a Home/Property Owners' Association, has an Operational Aereement (FORM: HOA) been attached?
❑ Yes E]No EN/A
4. Origin of wastewater: (check all that apply):
❑ Residential 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
E 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
% Industrial (See 15A NCAC 02T .0103 (20))
Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 02T .0114(f}? ❑ Yes ® No
f ,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
Restaurant
20 gal/day
30
600 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
600 GPD
a See 15A NCAC 02T .0 1 14(b), (d), (e)(1) and (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 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: 600 GPD (per 15A NCAC 02T .0114)
o not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
❑ Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit Number:
❑ Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain):
I
0
FORM: FTA 04-16 Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (G ravit- Sewers):
1 S
ummarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
➢ S
ection II & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ I S
ection III contains information related to minimum slopes for gravity sewer(s)
➢ O
versizing 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 Mains3:
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: 1
2. Approximate Coordinates (Decimal Degrees): Latitude: 34.36582' Longitude:-77.71306' &Z to EIV.
:3
3. Design flow of the pump station: 0.010 millions gallons per day (firm capacity) rAVG ► 4 nts
6 j
4. Operational point(s) of the pump(s): 16 gallons per minute at 157 feet total dynamic head (TDH) '
5. Summarize the force main to be permitted (for this Pump Station):"
Size (inches)
Length (feet)
Material
2
130
PVC
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):
➢ R
equired for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
➢ M
ust be permanent to facility
Or if the pump station has an average daily flow less than 15,000 gallons per day:
Z 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):
FORM: FTA 04-16 Page 3 of 5

u
t 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.
➢ I
f 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 4 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations found in 15A NCAC 02T .0305(fl & (g), ® Yes ❑ No
➢ 1
5A NCAC 02T.0305(f) contains minimum separations that shall be nrovided for sewer systems:
Setback Parameter*
Separation Re uired
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 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
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
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
5A NCAC 02T.0305( ) contains alternatives where separations in 02T.0305(fl cannot be achieved.
*Stream classifications can be identified using the Division's NC Surface Water Classifications webpa_e_
f noncompliance with 02T.0305( or (g), see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) 0 Yes ❑ No
➢ S
ee the Division's draft separation requirements for situations where separation cannot be meet
➢ N
o variance is required if the alternative design criteria specified is utilized in design and construction
➢ A
s 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 ❑ No
➢ T
his would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Does the project comply with an individual 404 Permit or any 401 Certifications? E Yes El No
➢ W
etland-related permits shall be requested, obtained, and adhered to for projects that impact wetlands or surface waters
➢ I
reformation can be obtained from the 401 & Buffer Permitting Branch
5. Does project comply with 15A NCAC 02T.0105(c,�(_6_) (additional permits/certifications)? E Yes El No
FORM: FTA 04-16
Page 5 of 5

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. Issuance of this permit is contingent on issuance of dependent permits (erosion and
sedimentation control plans, stormwater management plans, etc.).
6. Does this project include any sewer collection lines 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 to erosion that undermines or deteriorates the sewer.
E]Yes Z No
f 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 6 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Pump Stations
and Force Mains (latest versions 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
dnenmentc
2. Professional Engineer's Certification:
�: GV�G�.� S��—S 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.
..............................•4 ... ......................................................
North Carolina Professional Engineer's seal, signature, and date:��, A
• 0 •.17
•
SEAL
ers . we
19843 s �,
a. o •�
ev too' so, 44e co
f �
3. Applicant's Certification per 15A NCAC 02T .0106(b): A V-40000d.. . . ... ....
I, c e A�l�Ac e V�-r ��-- attest that this application for
(Signature Authority's name & title from Application Item I.3.)
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 sub j ect 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: Date:
FORM: FTA 04-16 Page 7 of 5

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: Boddie-Noell Ent. Inc Restaurant
Project Name for which flow is being requested: Hardees Hampstead
More than one FTSE may be required for a single project 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 the owner of the wastewater treatment plant.
a. WWTP Facility Name: Pluris Hampstead, LLC
b. WWTP Facility Permit ##: WQ0037287
All flows are its MGD
c. WWTP facility's permitted flow 0.250
d. Estimated obligated flow not yet tributary to the WWTP 0.100
e. WWTP facility's actual avg. flow 0.048
f. Total flow for this specific request 0.0006
g. Total actual and obligated flows to the facility 0.1486
h. Percent of permitted flow used 60%
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 Firm Flow* * Current Avg. Tributary Flow Plus
(Name or Capacity, * (Firm / pf), Daily Flow, Daily Flow, Obligated Available
Number) MGD MGD MGD MGD Flow Capacity***
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 (pi) not less than 2.5.
*** 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 < o.
Downstream Facility Name (Sewer): Pluris Hampstead, LLC
Downstream Permit Number: WQ0037324
Page 1 of 6
FTSE 04-- 16

III. Certification Statement:
I Randy Hoffer, er, Regional Manager certify to the best of nay 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 Nvhere applicable. This
analysis has been performed in accordance with local established policies and procedures usinty
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.
�v
Signinge+JZWCil Sig' ncatur-e//%� kl;o, � 'Ucrte
Pa°e 2 of 6
FTSE 04-16

NORTH CAROLINA
Department of the Secretary of State
CERTIFICATE OF EXISTENCE
I, Elaine F. Marshall, Secretary of State of the State of North Carolina, do hereby
certify that
BODDIE-NOELL ENTERPRISES, INC.
is a corporation duly incorporated under the laws of the State of North Carolina,
having been incorporated on the 7th day of February, 1962, with its period of duration
being Perpetual.
I FURTHER certify that, as of the date set forth hereunder, the said corporation's
articles of incorporation are not suspended for failure to comply with the Revenue Act of
the State of North Carolina; that the said corporation is not administratively dissolved for
failure to comply with the provisions of the North Carolina Business Corporation Act;
that its most recent annual report required by N.C.G.S. 55-16-22 has been delivered to
the Secretary of State; and that the said corporation has not filed articles of dissolution as
of the date of this certificate.
�tiPAR7�
MAY 20.
Y14AY
4S-�F QUAM 1VIU "
IN WITNESS WHEREOF, I have hereunto set
0 - 0 my hand and affixed my official seal at the City
of Raleigh, this 31 st day of July, 2018.
Scan to verify online.
Certification# 103088772-1 Reference# 14717660- Page: 1 of 1 Secretary of State
Verify this certificate online at http://vvww.sosnc.gov/verification

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PO Box 995
Burgaw, NC 28425
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BODDJE-NDELL ENTERPRISES.
:ENG.IE INSIGHT
PO.BOX 12.4.40.
SPOKANE WA .99210-2440
Previous Balance.
$130.33
Payment Received On 06/1-212018
65.55
Unpaid Previous- Balance
Due.By 0711-512018
�
$64.78
Current0harges
$73.95
Total Due
$138,73:
Rate Schedule A tillable Upon
V 535`US HWY 17 N
- -­--­----- -- ------------ ­
.ACCOUNT WMBEk
CUSTOMER' NUMBER
BILL DATE:
CURRENT CHARGES DUE BY
CUTOFF DATE
2021,36
3171
07101/2018
08/15/2018.
!DMW2018
-SERVICE PERIOD
DAY-S
METER -NUMBER:
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USAGE
06/081201.,8 -.05/3112-018-
.28
"67136801
115270
108920
6350
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CHARGE.
I,WCFR. COMMERCIAL FEE -:-ROCKY POINT
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$138.33:
BILL$ ARC QUE.-UPON RECEPT"DAT.ES REI - ECTEIR ON 8ILL.ARE:.4.5 DAY& ]C. WONT HOLDER:. CH008FES TO PAY E.V�ERY 45 DAYS: THE
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605 E. Fremont Street
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Buraaw. NC 28425
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BODDE-NO LL. ENTERPRISES
C/O' FN IE INSIGHT
PO BOX 2440
SPOKANE WA 9210-24.40
Previous Bal fte
$384-73
Payment Received On 071 OI0.8
735
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$0,00
Current: -Charges
$94.04
Total Due
94.04
Rate. c ai I AvaI1 Ie span .lie 1. 9t
14,5315 US HWY 17 -N
A .NT NUMBER CUSTOMER NUMBER BILL SATE :CURRENT CHAR S.D J� SY CUTOFF DATE
202135. 3,17 00/0112013 OO117I2 ! 0 8/211 018
ERVIC P5R.100 DAYS DETER Nu. MBER URRFNT PR'WOU °USAGE
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220.
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Total Current Charges $94 0
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Total 940
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DETACIITHI%S�POR : ION ; ETURN IT PA. YMENTIN THEENCL0 D ENVELOPE
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Unoa� `ro aus Salat�ca .
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MADE CHECK PAYABLE & REMIT TO::
P NDE..R COUNTY.UTIL TIES
PO 130X 05
SURGA , N.0 28425-0095
Total ' .Due:.
$94s0'4
l k fax for cha e o . a. wess a mark
an r coons bn .the. revere tWe of thisform.
BQDDJ -NO LL ENTERPRISES
{ EN IE .INSIGHT
PO -BOX 2440.
POKANEVA 992- 10-244Q