WQ0040420_Application (FTSE)_20181205

Central Files.: APS SWP -
---:-_:17
11/13/2018
mat f mbe WQ0040420
Permit Tracking Slip
Program Category
Status Project Type
Non -discharge
In review New Project7"
Permit hype
Version Permit Classification
Gravity Sewer Extension; Pump Stations; & Pressure Sewer Extensions
A Individual
Primary Reviewer
Permit Contact Affiliation
dean.hunkele
Coastal SWRule
Permitted Flow
Facility Marne
Major/Minor Region
Circle K at Ridge Road Public Force Main
Minor Wilmington
Location Address
County
Onslow
Facility Contact Affiliation
w- for
Owner Name
Owner Type
Blue Creek Utilities- Inc
Non -Government
Owner Affiliation
Benny Thomas Pollard
2925 Richlands Hwy
De
Jacksonville NC 28540
Scheduled
Orig Issue App. Received Draft Initiated Issuance
Public Notice Issue Effective Expiration
11 /9/2018
R4..=1$aLed Activities
R9ei'slz!'vie��Y,c 33>.✓v+6�r1t9f'�fi Eve, -,its -

TIMMO-NS GROUP
YOUR VISION ACHIEVED THROUGH OURS.
TRANSMITTAL
TO: NCDEQ —Wilmington Regional Office
127 Cardinal Drive Extension
Wilmington, NC, 28405
ATT N :
❑ ENCLOSED PLEASE FIND:
❑ WE ARE SENDING UNDER SEPARATE COVER:
Date: 11 /08/2018 Job #: 37630.021
Project: Circle K NTI Ridqe Road
Reference:
Copies Sent To:
COPIES
DATE
NUMBER
DESCRIPTION
2
11/08/18
FTA 04-16 & Supporting Documentation
1
11/08/18
$480.00 Application Fee
1
11/08/18
Document Certifying Company is Registered with the State
1
11/08/18
Site Ma
1
11/08/18
Street Ma
1
11/08/18
Power Reliability Plan
1
11/08/18
Letter of Agreement with Blue Creek Utilities
THESE ITEMS ARE TRANSMITTED:
If enclosures are not as noted, please notify us at once.
COMMENTS: The Circle K NTI Ridge Road Project Pump station is to be a packaged pump station that connects
down -stream via forcemain into a private sewer collection system owned by Blue Creek Utilities. Circle K Stores Inc.
will retain ownership of the portion of on -site forcemain, approximately 320 L.F. Blue Creek Utilities will have
ownership over the approximate 130 L.F of forcemain within the NCDOT right-of-way. The pumping rate of this
packaged pump station is going to be 1500 gallons per day and will only serve this Circle K site.
Proposed store #: 2704589
Feel free to contact me with any questions at 919-532-3234 or [e-mail]
Thank you,
Chris Petree
Sr. Project Manager
SIGNED:
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Application Number: a�� to be completed b DWR
pp ( p y )
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1.
Applicant's name: Blue Creek Utilities (company, municipality, HOA, utility, etc.)
2.
Applicant type: ❑ Individual ❑ Corporation El General Partnership
® Privately -Owned Public Utility
❑ Federal ❑ State/County E:1 Municipal
El Other
3.
Signature authority's name: B.T. Pollard per 15A NCAC 02T .0106(b)
Title: President
4.
Applicant's mailing address: 2965 Richlands Hwy
City: Jacksonville State: NC Zip: 28540-3601
5.
Applicant's contact information:A,1ljD''
,y hCi.T(iSl
I !
Phone number: 910 455-1149 Email Address: N/A
iJ
rr
eNOV 0 9 2018
II. PROJECT INFORMATION:
1.
f7
Project name: Circle K - NTI Ridge Road 41 yam'..-�►�
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: Onslow
4.
Approximate Coordinates (Decimal Degrees): Latitude: 34.757804' Longitude:-77.480426'
5.
Parcel ID (if applicable): 435719606255
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Chris Petree License Number: 041935
Firm: Timmons Group
Mailing address: 5410 Trinity Road Suite 102
City: Rale_2 State: NC Zip: 27607-6003
Phone number: [phone] Email Address: chris.petree&timmons.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Blue Creek WWTP Permit Number: NCO056952
Owner Name: Blue Creek Utilites
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
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
Z 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 Operational Agreement (FORM: HOA) been attached?
❑ Yes E]No ®N/A
4. Origin of wastewater: (check all that apply):
❑ Residential Owned Z Retail (stores, centers, malls)
❑ Residential Leased ❑ Retail with food preparation/service
❑ School / preschool / day care El Medical / dental / veterinary facilities
❑ Food and drink facilities ❑ Church
❑ Businesses / offices / factories El Nursing Home
5. Nature of wastewater: % Domestic/Commercial 100 % Commercial
% Industrial (See 15A NCAC 02T .0103(20))
❑ Car Wash
❑ Hotel and/or Motels
E:1 Swimming Pool /Clubhouse
[:1 Swimming Pool/Filter Backwash
❑ Other (Explain in Attachment)
Is there a Pretreatment Program in effect? [:]Yes Z No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(fl? ❑ Yes E No
➢ If yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
8.
Establishment Type (see 02T.0114(fl)
Daily Design Flow 1,b
No. of Units
Flow
Service Stations, Gas Stations
250 gal/Plumbing Fixture
6
1500 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
1500 GPD
a See 15A NCAC 02T .01.14(b)L(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.01.1.4] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
Wastewater generated by project: 1500 GPD (per 15A NCAC 02T .01.14)
➢ Do 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
El Other (Explain):
FORM: FTA 04-16 Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & 1V1DC (Gravity 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 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 1Vlains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: Circle K NTI Ridge Road Pump Station
2. Approximate Coordinates (Decimal Degrees): Latitude: 34.758172' Longitude:-77.480272'
3. Design flow of the pump station: 0.0015 millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): 14 gallons per minute at 12 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
2
130
SDR 21 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)_
➢ 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
El 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(f)):
1. Does the project comply with all separations found in 15A NCAC OZT .0305(f) ® Yes [:1 No
➢ 15A NCAC n?T 0105(f) rnntainc minim»m cenaratinnc that shall he nrnvided fnr sewer cvctPmc-
Setback Parameter*
S e aration 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 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
➢ 15A NCAC 02T.0305(g2) contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface 'Water Classifications webpage
);o- 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) E Yes [:]No ❑ N/A
➢ See the Division's draft separation requirements for situations where separation cannot be meet
➢ No variance is required if the alternative design criteria specified is utilized in design and construction
➢ As built documents should reference the location of areas effected
3. Does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ® Yes [:] No ❑ N/A
➢ This would include Trout Buffered Streams per 1.5A NCAC 2B.0202
4. Does the project require coverage/authorization under a 404 Nationwide or ❑ Yes ® No
individual permits or 401 Water Quality Certifications?
➢ Information 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 [:] No
Per 1.5A_ 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.
[:]Yes [:]No ®N/A
➢ 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:
Does flier stabimited Se SIQIII com lk k'� tl��,� �„
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w
y pg ¢ r d, k� p g tile
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f
_....... _ I." 11�1 J � t � l_. 1 11 }ts {!p h ca -tib l e
I fNo, c:omplcw antl 14113171it tlile V a1*4111ce Alternative Design Request application (V ADC 10.14) and for
review, A21)roved o rthe rec n�:�st i�; re tired rior to s�abu)Ittal or the Fast Track A� �lieation and stumorting, doetiments.
?. [)rofessional gineer's Certi ficatic :
h
1 attest that this application
' ct for
l' rot6sjon tl Engineers name from .Appl ication Iteitl I11,1. )
has been reviewed b� nee and is accurate, complete and consistent with the information supplied in the plans, specifications,
engineering calculations, and all other supp01-ting documentation to the best of mN knowledge. I further attest that to the best
of itiv knowledge the proposed design has been prepared in accordance with the applicable regulations, Gravity Sewer
Miitiiraiini Desigr'a Criteria for Gravity Sewers, 'te ► latest 4�.=�` ic)n)) and the Minimum Design Criteria for the Fast -Track Permitting
c,�f Pump Stations fated Force Mains (latest version). Although other professionals ma;, have developed certain portions of'this
submittal package. inclusion of these materials under m\ S't;�n�iture and seal signifies that I have reviewed this material and
leave judged it to be consistent with the proposed design.
o pE - In accordance with General Statutes 1 4 }-? 15.6A and 14--)-15.613, anN person who knowin d
No makes any false
statement._representation, or certification in any. application package shall be guilty of a Class ? misdemeanor, which may
include a fine not to exceed S 10.000. as well as cavil penalties up to S25_000 per violation.
.__1.1AIN A.11. I'll 1 rf.
\\
'forth Carolina Professional Engineer's seal, signature, and date: *:N� �A,Cf�
V o
+r �
wr. ow*
041935
�►
fe• fj�''�y /{ �}^+' ere '+�/V
CPHER9-
3. Applicant's C`ei-titication pc��r._ >A ' CAC 1'+ ; ,0106(b):
-
. _ _ - - tttst that this application for
- - - a
(Signature Authority*s name & title from Application Item I-) )
has been reviewed b'- me and is accurate and complete to the best of ink 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 recorded as incomplete. i understand that any discharge of wCastewater from this non -
discharge sN.steri to surface kv-atess or the land will result in an immediate enforcement action that may include civil penalties,
111,1MI :tiVe relief, and!or criminal prosecution. I �vjll nitake no claim against the Division ofwater Resources should a condition
of this permit be violated, I �Ilso Understand that it"all required p<art5 of this application package are not completed and that if
all regnlred 5upp011111g [III'01-nitttion and aluachments are not included. this application package will he returned to clue as
Incomplete.
NOTE In accordance ��, ith General Statutes 14 1:' ,6A and 1 43'- 215,6B. an\ person who knowingly Makes any Use
statement, representation, or certification in and appllc:ation package shall be guilty of a Class ? misdemeanor, which may
include a fine not to exceed S 10.()00 as well as civil penalties up tO S25,000 per violation.
a�.
Dates �r
F
FORM : i- i A 04-16 Page 5 of 5

Blue Creek Utilities, Inc.
2965 Richlands Hwy
Jacksonville, NC 28540
March 21, 2018
To Whom It May Concern: t
This letter certifies that Blue Creek Utilities, Incorporation owns and operates a
sewer collection and treatment system. The company has been granted a
Certificate of Public Necessity and Convenience by the North Carolina Utilities
Commission to provide sewer utility services Jonathon Popkins address
Intersection of Hwy 258/Ridge Road, which is located in Jacksonville NC 28540.
The North Carolina Department of Environment, Health, and Natural Resources
has issued NPDES sewer permit number NC0056952. The company is in
compliance with all State and Federal Laws regarding the same.
If you have any questions, or need additional information, please do not
hesitate to contact me.
Sincerely,
Allison Everett
Office Manager

Gil Stephens
Facilities Director — Coastal Carolina Division
Circle K Stores, Inc.
August 28, 2018
Timmons Group
Brian Downs
5410 Trinity Rd. Suite 102
Raleigh, NC 27607
Mr. Downs,
t
In response to your question about secondary or back up power for an NTI location on Ridge
Road, Jacksonville, NC; we have 4 portable generators with. sufficient capacity to supply power
to a private pump station. These generators are stored in Sanford, NC and can be mobilized
and on -site within 6 hours of notification.
If you have any questions or need any further information, you can contact me at 919-566-1189
or email me at [e-mail].
Sincerely Yours,
Gil Stephens
Director, Facilities
Circle K — Coastal Carolina Division
1100 Situs Court
Suite 100
Raleigh, NC 27606

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11/13/2018