WQ0041031_Application (FTSE)_20190618

State of North Carolina
I) Department of Environmental Quality WRDivision of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: `L v �j
pp -- _ / . (io becompleted by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Town of Tarboro (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: Troy R. Lewis per 15A NCAC 02T .0106(b)
Title: To -Manager
4. Applicant's mailing address: 500 N Main St
City: Tarboro State: NC Zip: 27886-�
5. Applicant's contact information:
Phone number: (252) 6414250 Email Address: TroyLewis(a,Tarboro-NC.com
II. PROJECT INFORMATION:
I. Project name: Sandy_ Ridge Subdivision Sewer Extension
2. ApplicationlProject 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: Ed ec ombe
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.923250 Longitude:-77.536889'
5. Parcel ID (if applicable): 473933439300
(or Parcel ID to closest downstream sewer)
111. CONSULTANT INFORMATION:
1. Professional Engineer: David C. Revoir, PE License Number: 026959
Firm: Appian Consulting Engineers, PA
Mailing address: PO Box 7966
City: Rock Mount State: NC Zip: 27804-_
Phone number: [phone] Email Address: drevoiraa appianengineers.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Town of Tarboro Wastewater Treatment Plant Permit Number: NCO020605
Owner Name: Town of Tarboro
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ unknown (15+ years Downstream (Receiving) Sewer Size: 8" inch
System Wide Collection System Permit Number(s) (i f applicable): WOCS00045
Owner Name(s): Town of Tarboro
FORM: FTA 04-16 Pagel of 5

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
[--]Yes ❑No ®N1A
2. If the Applicant is a Developer of lots to be sold, has a Dcvgl 's ftwia:tl,t Agmguteig lF[]ttivi_DEyt been attached?
❑ Yes [:]No ®NIA
3. If the Applicant is a HomelProperty Ownem—'Association-has an Operational Agreement (FORM: HOA) been attached'?
❑ Yes [:]No ®NIA
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 i day care ❑ Medical dental i veterinary facilities ❑ Swimming Pool :Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
❑ Businesses i offices r factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater : l00 "}o Domestic/Commercial % Commercial
% Industrial (Sec 15A NCAC 02T .0103(20))
bIs there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(f)? [-]Yes ® No
> If ves. nrovide a cony of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 2J.01140
Daily Design Flow'°
No. of Units
Flow
Single -Family Dwelling (3 bedroom)
120 gal'per day per bedroom
4
1440 GPD
gat/
GPD
gat/
GPD
gat/
GPD
gat/
GPD
gall
GPD
Total
1,440 GPD
a See 15A NCAC 02T .01 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: 1440 GPD (per 15A NCAC 02T .0114)
➢ 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
❑ Other (Explain):
FORM: FTA 04- l6 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" 392 PVC
➢ Section II & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
r Section Ill 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_LPumn Stations/Force Mains
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: NIA
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)
S. 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)(I)(13)_
D 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):
t 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 withal] separations found in 15A NCAC 02T .0305(f) & (e)
15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
® Yes [-]No
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
24 inches
Water mains (vertical-wa(er over sewer including in benched trenches)
18 inches
Water mains orizontal
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 11 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 feel
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
it 15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(f) cannot be achieved.
r **Stream classifications can be identified using the Division's NC Surface Water Classifications webpaee
If noncompliance with 02T.03050) or (e). see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ® Yes ❑ No ❑ N1A
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 Iocation 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
7 This would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Does the project require coverage/authorization under a 404 Nationwide or [_-]Yes ® No
individual permits or 401 Water Quality Certifications?
t Information can be obtained from the 401 & Buffer Permitting Branch
S. 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 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 ling 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 15A NCAC 02T, the Minimum Design Criteria for the Pt:TTpittin_g of Pump Stations
and Force Mains (latest versionl and the Gravity. Sewer Minimum Design Criteria (latest version) as applicable?
® Yes ❑ No
If No, complete and submit the Variance.-:Altemative 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:
Or,. (� C . ReVo,
(Professional Engineer's name from Application Item IILI.)
attest that this application for
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 I43-215.613, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation.
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0I06(b):
rnv R . Lewi`5 , r.y► MM...,eT
(Signature Authority's name & title from A plical
Item I.3.)
attest that this application for
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: Date
/ 3 tJAW& Lot I
FORM: FTA 04-16 Page 5 of 5

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State of North Carolina
DW
r Department of Environmental Quality
Division of Water Resources
wi-T�tL-
Division of Water Resources Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: Town of Tarboro
Project Name for which flow is being requested: Sand Ride Subdivision SewerExtension
More than one FTSE may be required far 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: Town of Tarboro WWTP
b. WWTP Facility Permit #: NC0020605
All flows are in MGD
c. WWTP facility's permitted flow 5.000
d. Estimated obligated flow not yet tributary to the WWTP 0.023
e. WWTP facility's actual avg. flow 2.258
f. Total flow for this specific request 0.0014
g. Total actual and obligated flows to the facility 2.282
h. Percent of permitted flow used 45.65%
I1. 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? pi),
Daily Flow,
Daily Flow,
Obligated
Available
Number)
MGD
MGD
MGD
MGD
Flow
Capacity***
Baker St.
0.360
0.144
0.043
0.000
0.043
0.101 _
'*—The Firm Capacity of any pump station is defined as the maximum pumped flaw 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.
*** 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): Tarboro Collection System
Downstream Permit Number: WQCS00045
Page 1 of 6
FTSE 04-16

Ill. Certification Statement:
I Troy Lewis, Town Manager 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.
4-
Page 2 of 6
`i
Date

June 13, 2019
Mr. Jason T. Robinson, PE
NCDEQ DWR
Raleigh Regional Office
Water Quality Section
1628 Mail Service Center
Raleigh, NC 27699-1628
RE: Gravity Sewer Permit Application
Sandy Ridge Subdivision Sewer Extension
Town of Tarboro
Edgecombe County, NC
Dear Mr. Robinson:
Tmr
4zz�&
CONSULTING ENGINEERS, PA
NC !)eft ofFnvirnnrnenra! QUa1it
Y
JUN 8 2019
Raleigh Regional office
We are enclosing a Fast -Track Sewer System Extension Application for the Sandy Ridge Subdivision
Sewer Extension project on behalf of the Town of Tarboro. The Town will be boring four residential
gravity sewer taps after project is complete. The proposed new flow for project is 1,440 GPD.
We are enclosing:
• FTA 04-16 Fast Track Application
• FTSE 04-16 (Forthcoming)
• Check for $480 Application Fee
• USGS/ NRCS Maps/ Aerial
• 1 set of plans (11x17)
Let us know if you have any questions about the attached.
THANK YOU!
Sincerely,
Appian Consulting Engineers, P.A.
h Reason, Project Engineer
�
cc: David Revoir, P.E.
P.O. Box 7966 • Rocky Mount, NC 278Q4 • [phone]
www.appianengineers.com • [e-mail]

Cashion, Ted
From: David Revoir <[e-mail]>
Sent: Wednesday, July 17, 2019 3:20 PM
To: Cashion, Ted; [e-mail]
Cc: Robinson, Jason; Deck, Erin M; [e-mail]
Subject: [External] RE: Sandy Ridge Subdivision sewer fast track application
Attachments: Pagel from NCDEO Sewer FTA 04-16 Sandy Ridge.pdf
External eimail.. Do root dick Iln s ar open attachments"unless you verify. Send all suspicious enhaii as arr attachmentto
Ted- My apologies. Will the attached PDF of sheet 1 of 5 be acceptable?
Thank you!
David C. Revoir, PE
Appian Consulting Engineers, PA
154 Roundabout Court PO Box 7966
Rocky Mount, NC 27804
www.appianengineers.com
252.972.7703
From: Cashion, Ted [mailto:[e-mail]]
Sent: Wednesday, July 17, 2019 3:04 PM
To: [e-mail]; '[e-mail]'
Cc: Robinson, Jason; Deck, Erin M
Subject: Sandy Ridge Subdivision sewer fast track application
Troy and David,
We are reviewing the subject application and preparing to draft the permit. Item V of the application was not
completed as required. Please provide the downstream sewer permit number (if this line is really old and does not have
a permit number, state the approximate age of the line), the receiving sewer size, and the Town's collection system
permit number. We'll continue drafting the permit upon submittal of this info.
thx,
ted
Ted Cashion
Water Quality Regional Operations
Division of Water Resources
NC Department of Environmental Quality
Raleigh Regional Office
919-791-4254
[e-mail]
1628 Mail Service Center
Raleigh, NC 27699-1628
3800 Barrett Drive

d ail 0 3 j
Cashion, Ted ,A/�U
From: Cashion, Ted
Sent: Wednesday, July 17, 2019 3:04 PM
To: [e-mail]; '[e-mail]'
Cc: Robinson, Jason; Deck, Erin M
Subject: Sandy Ridge Subdivision sewer fast track application
Troy and David,
We are reviewing the subject application and preparing to draft the permit. Item V of the application was not
completed as required. Please provide the downstream sewer permit number (if this line is really old and does not have
a permit number, state the approximate age of the line), the receiving sewer size, and the Town's collection system
permit number. We'll continue drafting the permit upon submittal of this info.
thx,
ted
Ted Cashion
Water Quality Regional Operations
Division of Water Resources
NC Department of Environmental Quality
Raleigh Regional Office
919-791-4254
[e-mail]
1628 Mail Service Center
Raleigh, NC 27699-1628
3800 Barrett Drive
Raleigh, NC 27609
z:���ID E
praartmcni of EnArownental Quality
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