WQ0041079_Application (FTSE)_20190911

Permit Number WQ0041079
Program Category
Non -discharge
Permit Type
Gravity Sewer Extension, Pump Stations, 8 Pressure Sewer Extensions
Primary Reviewer
dean.hunkele
Coastal SWRuIe
Permitted Flow
Facility
Facility Name
Island Creek Fire Station Private Pump Station
Location Address
Owner
Owner Name
Pender EMS and Fire Inc
Dates/Events
Scheduled
Ong Issue App Received Draft Initiated Issuance
8/6/2019
Central Files APS _ SWP
8/6/2019
Permit Tracking Slip
Status
Project Type
In review
New Project
Version
Permit Classification
A
Individual
Permit Contact Affiliation
MajorlMinor Region
Minor Wilmington
County
Pander
Facility Contact Affiliation
Owner Type
Non -Government
Owner Affiliation
Woody Sullivan
805 Ridgewood Ave
Burgaw
Public Notice Issue Effective
NC 28425
Expiration
Regulated Activities Requested /Received Events
Additional information requested

-PA RAMOUNTE
JL _LE N G I N E E R 1 N G, I N C.
1 2 2 C I N E M A D R I V E
W I L M I N G T O N, N C 2 8 4 0 3
9 1 0- 7 9 1- 6 7 0 7( O) 9 1 0- 7 9 1- 6 7 6 0 ( F)
L E T T E R O F T R A N S M I T T A L
To:
NCDEQ
Date
1 08.05.19
127 N. Cardinal Drive
Wilmington, NC 28405
Re:
Island Creek Fire Station
910 796-7215
Fast Track Sewer PRIVATE
Attn:
Dean Hunkele
Project No. I
18466.PE
e are sendin
® Originals
® Prints
❑ Shop Drawings
❑ Calculations
❑ Correspondence
❑ Plans
❑ Specifications
❑ Other as listed below
he following items:
Quantity
Date
Dwg. No.
Description
2
Fast Track Sewer Permit FTA 04-16
(original and 1 co
2
Flow Tracking/Acceptance Sewer Extension Application FTSE 04-16
on 'nal and 1 co
1
Sanitary Sewer Narrative (Cover Letter)
1
USGS Map
1
Site Map
1
$480 check
ssue Status: ® Fox Approval ❑ As Requested ❑ Construction ❑ Bid
❑ For Your Use ® For Review and Comment ❑ Approved as Noted ❑ See Remarks
cdon Taken: ❑ No Exceptions Taken ❑ Make Corrections Noted ❑ Amend & Resubmit
❑ Rejected -See Remarks ❑ Approved as Submitted ❑ Other
emarks:
Cc:
Feel free to contact me with any questions or if you need additional information. Thank you.
jblair eparamounte-eng.com
Signed:
my R. B1ak, FE p
EO
AUG 0 6 2019
n:

JL
DARAMOUNTE
E N G I N E F rz N G N C.
August 5, 2019
NCDEQ — DWR — Fast Track Sewer Extension
127 Cardinal Dr. Ext
Wilmington, NC 28405
RE: Island Creek Fire Station
Private Pump Station and On -Site Force Main
Pender County, North Carolina
To Whom It May Concern,
Enclosed is a sewer extension application with supporting documentation for the proposed Fire & EMS
Station on Island Creek Road in Pender County, North Carolina. As shown in the attached supporting
documents, this 2-inch on -site force main from the private pump station will connect to and discharge a
proposed 2-inch force main to be owned and operated by Pluris along the right of way of Island Creek
Road.
The proposed project will serve a new Fire & EMS station with 7 employees per shift, generating 350
gallons per day of wastewater.
The enclosed documents include the following items:
• Check in the amount of $480.00
• Fast Track Sewer System Extension Application
• Flow Tracking for Sewer Extension Applications
• Site Map
• USGS Map
On behalf of Pender EMS and Fire, Inc., we request that you grant a permit for construction of this sewer
system.
Sincerely,
amounte Engineerin ,Inc.
Jere y R. Bla r, P
Vice President
Enclosure: as noted
1 2 2 C 1 N E M A D R I V E. W I L M I N G T D N. N C 2 8 4 G 3
P H ( 9 1 0 1 7 9 1- 6 7 0 7 V A X: 1 9 1❑ I 7 9 1- 6 7 6 D

State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Divlslon of Waster Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number:wCLOOq(QRl (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
I. Applicant's name: Fender EMS and Fire Inc (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: Woodrow W. Sullivan. III per 15A NCAC 02T .0106(h)
Title: Chief/CEO (Registered A entl
4. Applicant's mailing address: $05 Ridgewood, Road
City: Burgaw State: N_Q Zip: 28425-_
5. Applicant's contact information:
Phone number: (91Q) 22-08911 Email Address: )Mllivan@pgnderems com
IL PROJECT INFORMATION:
I. Project name: Island Creek Fire Station VkVA< q_,_r , +d-t
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: Egqdff
4. Approximate Coordinates (Decimal Degrees): Latitude: 34.374� Longitude: -77.784,
5. Parcel ID (if applicable): 3262-69-4150
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
I. Professional Engineer: Jeremy Blair License Number: 28852
Firm: Paramounte Engineering Inc
Mailing address: 122 Cinema Drive
City: Wilmington State: NC Zip:28403-_
Phone number: (910) 791- 707 Email Address: tclinksgales@r)aramounte-eng.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Pluris Hampstead LLC Permit Number: W(M37287
Owner Name: Pluris Halstead, LLC
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
I. Permit Number(s): WQTo Be Assigned Downstream (Receiving) Sewer Size: 2 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS_
Owner Name(s): Pluris Hampstead, LLC 1 1�GU (I' q99 KQIJ
FORM: FfA 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?
❑ Yes [:]No ®N/A
2. If the Applicant is at 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 aHome/Property Owners' Association has an Operational Agreement (FORM• HOA) been attached?
❑ Yes ❑No ®N/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
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ® Other (Explain in Attachment)
5. Natureof wastewater: 100%Domestic/Commercial %Commercial
%Industrial (See 15A NCAC 02T.0103(20))
"Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(07 ❑ Yes ® No
Y If yes, mrovide n cony of flow reduction anoroval letter
7. Summarize wastewater generated by project:
Es(ablishment'rype (sec 02T.0114(0)
Daily Design Flow "•s
No, of Units
Flow
Fire Station with on -site stuff
50 gal/person/shift
7
350 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
CPD
Tool
350 GPD
a See 15A NCAC 02T .0114(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 properly located south oreast of the Atlantic Intracoas(al Waterway to be used as vacation rentals as defined
in G.S. 42A-41.
b Per 15A NCAC 02T .0114(c), design flow rates 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.
S. Wastewater generated by project: 350 GPD (per 15A NCAC 02T .0114)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate wiry:
❑ Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been allocated in Pennit Number:
❑ Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain):
FORM: PTA 04-16 Page 2 of 5

VIL GRAVITY SEWER DESIGN CRITERIA (If Applicable) • 02T_0305 At MDC (Gravity Sewers):
I. 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 (Punm Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: I
2. Approximate Coordinates (Decimal Degrees): Latitude: 34.3800' Longitude: - 77 7844'
3. Design Flow of the pump station: 0.00035 millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): 25 gallons per minute at 67 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
2 240 SDR-21
6. Power reliability in accordance with 15A NCAC 021 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(f)):
I. Does the project comply with all separations found in 15A NCAC OYf O305(l) & (L)
> 15A NCAC 02T Oi05(f) rnntainc minimmn < rnt;nn, ri,.,, ..t...n t...., :,i..a r.
® Yes ❑ No
w�l
Setback Parameter*
J Se 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 inmounded 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
➢ 15A NCAC 02T 0305te) contains alternatives where separations in 02T 0"105(f) cannot be achieved.
> **Stream classifications can be identified using the Division's NC Sui lace Waicr Claw ications w ebn l
➢ If noncompliance with 02T0305(1) m 40, see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ® Yes ❑ No
➢ Seethe 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 all setbacks found in the river basin rules per 15A NCAC 0213 .0200:' ® Yes ❑ No
➢ This would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Does the project comply with an individual 404 Permit or any 401 Certifications? ® Yes [:]No
➢ Wetland -related permits shall be requested, obtained, and adhered to for projects that impact wetlands or surface waters
D Information can be obtained from the 401 ,l Buffer PermiuinE Branch
5. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 021'.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 O1 F.0401, "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
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 15A NCAC(32T, the Mininnun Dcsien Criteria for the Permitting or Pump Stations
and Force Main. (latest version; and the Gravity Sewer Mininuun Desi •tt�i C'rileria 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 Enginneeeerr''sss _(/ Certification:
1, :1 Gt�-e '—`�� � 1`' attest that this application for
(Professional Engineer's name from Application Item III. I.)
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;
3. Applicant's Certification per 15A NCAC 02T .0106(b):
IW V4. 70. Fat t CI oNl attest that this application for
(Signature Authority's name & tit a front 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 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
statement, representation, or,
include a fine not to exceed $1
4U
T
and 143-215 613, any person who knowingly makes any false
package shall Ix: guilty of a Class 2 misdemeanor, which may
up to $25,000 per violation.
4
Date: Z <
FORM: FTA 04-I6 Page 5 of 5

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: Pender EMS and Fire, Inc
Project Name for which flow is being requested: Island Creek Fire Station
D9ore than one FTSE tray be required for a single project if the owner of floe WWTP is not responsible for all pump
stations along the route of the proposed wasteivaterf ow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a.
W WTP Facility Name: Pluris Hampstead, LLC
b.
W WTP Facility Permit #: WQ0037287
AlIflows are in MGD
c.
W WTP facility's permitted flow
0.25
d.
Estimated obligated flow not yet tributary to the W WTP
0.080
e.
W WTP facility's actual avg. flow
0.062
f.
Total flow for this specific request
0.00035
g.
Total actual and obligated flows to the facility
0.14235
h.
Percent of permitted flow used
57%
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 W WTP:
(A)
(B)
(C)
(D)=(B+C) (E)—(A-D)
Design
Obligated,
Pump
Pump
Average
Approx.
Not Yet
Total Current
Station
Station
Firm Daily Flow**
Current
Tributary
Flow Plus
(Name or
Permit
Capacity, * (Firm / pt),
Avg. Daily
Daily Flow,
Obligated Available
Number)
No.
MOD MOD
Flow, MOD
MOD
Flow Capacity***
* The Firm Capacity (design Bow) of any pump station is defined as the maximum pumped flow
that can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor
(pf) not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the W WTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): Pluris Hampstead LLC
Downstream Permit Number: WQ0037324
Page I of 6
FTSE 10-18

111. Certification Statement:
I Randy Hoffer 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 certifies that the receiving
collection system or treatment works has adequate capacity to transport and treat the proposed new
wastewater.
_ _oy
Signing Official Signature
Page 2 of 6
FTSE 10-18

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Non -Profit Corporation
Legal Name
Pander EMS and Fire, Inc.
Prev Legal Name
Pander Volunteer EMS and Rescue, Inc
Information
Sosld: 0644764
Status: Current -Active
Annual Report Status: Not Applicable
Citizenship: Domestic
Date Formed: 9/9/2002
Registered Agent: Sullivan, Woodrow W., III
Addresses
Mailing Principal Office Reg Office
805 Ridgewood Road 805 Ridgewood Road 805 Ridgewood Road
Burgaw, NC 28425 Burgaw, NC 28425 Burgaw, NC 28425
Reg Mailing
805 Ridgewood Road
Burgaw, INC 28425

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1D NC Surface Water Classifications
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