WQ0041196_Application (FTSE)_20190913

* the/jam 1
�L!—f len9ineennc�
I4archilecrore I1(' fln !il
GROUPR O U P environmontol EnviF0M_1 1� .-t1 � J,iay
�7 tJ rn
w Jhelencgroupincxom i�CC 1. ved
SEP 13 sLI19
September 9,2019 Winston-Salem
NCDEQ—Division of Water Resources _ f-;cblOrlaiC)ifice -
Winston-Salem Regional Office Water Quality Section
450 W.Hanes Mill Road, Suite 300
Winston-Salem,NC 27105
Re: Maple Street/Merritt Street Sewer Improvements Project
City of Mount Airy,NC
Dear Sir/Madam:
Please find enclosed for your review/processing the following items for the above referenced project:
— original and one(1) copy of Form FTA 04-16 Fast-Track Sewer System Extension Application
one(1)completed and executed Form FTSE 04-16
— one(1)copy of the 8.5"x 11"Site Map
— check for$480.00 made out to NCDEQ for the application fee
This project includes replacement of existing sanitary sewer lines in the Maple,Street/ Merritt Street area of the
City of Mount Airy.Construction will include replacement of approximately 8,000 if of sewer line, all related sewer
appurtenances,and street repairs.
If you have any questions or need additional information,feel free to call.
Sincerely
THE LANE GROUP
Tln
Kevin Heath,P.E.
cc: Mitch Williams,P.E.,City of Mount Airy
KH/sct
Engineers•Architects•Surveyors•Planners•Environmental Specialist
119 North Main Street•Galax,Virginia 24333
Phone:[phone]•Fax: [phone]•www.thelanegroupinc.com

State of North Carolina
DWIR Department of Environmental Quality j
Division of Water Resources
15A NCAC 02T.0300—FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 04-16&SUPPORTING DOCUMENTATION
r
Application Number: (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 Mount A ry(company,municipality,HOA,utility,etc.)
2. Applicant type: ❑Individual ❑ Corporation ❑ General Partnership ❑Privately-Owned Public Utility
❑Federal ❑ State/County ®Municipal ❑Other f
3. Signature authority's name:Mitch Williams,P.E. per 15A NCAC 02T.0106(b)
Title: CityEneineer NC Department cf
Enviwrm ut,�! Quality
4. Applicant's mailing address:440 East Pine Street Rece'ved
City:Mount Airy State:NC Zip: 27030- SEP 13 2010
i
5. Applicant's contact information: Winston-S8!em
Phone number: 376-3580 Email Address: milliamsC&,mountaiy.ore) g UCldl JCee
II. PROJECT INFORMATION:
1. Project name:Maple Street/Merritt Street Sewer Improvements Project
2. Application/Projectstatus: ❑.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:W000
3. County where project is located: Sorry
i
4. Approximate Coordinates(Decimal Degrees): Latitude: 36.504446' Longitude: -80.613859°
5. Parcel ID(if applicable): 5020-10-47-2261
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer:Kevin Heath,P.E. License Number: 021204
Firm:The Lane Group,Inc.
Mailing address: 119 North Main Street
City: Galax State:VA Zip:24333-
Phone number: [phone] Email Address: kheath(a,thelanegroupine.com
IV. WASTEWATER TREATMENT FACILITY(WWTF)INFORMATION:
1. Facility Name:The City of Mount Airy Wastewater Treatement Plant Permit Number:NC 0021121
Owner Name: City of Mount Airy
V. RECEIVING DOWNSTREAM SEWER INFORMATION(if different than WWTF):
1. Permit Number(s): WQ Downstream(Receiving)Sewer Size: 18 inch
System Wide Collection System Permit Number(s)(if applicable):WQCS
Owner Name(s): City of Mount Airy
FORM: ETA 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 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 []No ®N/A
4. Origin of wastewater: (check all that apply):
Z 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. Nature of wastewater: 100%Domestic/Commercial %Commercial Il
0%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(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 s,b No.of Units Flow
Residential House/Apartments: 1-2 BR 240 gal/Apartment 89 21,360 GPD
Residential House: 3 BR 360 gal/House 22 7,920 GPD
Businesses/Offices(7 total) 25 gal/Employee 48 1,200 GPD
Car Wash 1,200 gal/Bay 4 4,800 GPD
Medical Office 250 gal/Practicioner 2 500 GPD
Strip Mall 130 gal/1,000 SF 12 1,560 GPD
Total 37,340 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 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:_GPD (per 15A NCAC 02T.0114)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero,indicate why: j
❑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:
r
®Rehabilitation or replacement of existing sewer with no new flow expected f
I
❑Other(Explain):
it
FORM: FTA 04-16 Page 2 of 5

VIL GRAVITY SEWER DESIGN CRITERIA(If Applicable)-02T.0305&MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size(inches) Length(feet) Material
8" 7,997 PVC SDR-26 or D.I.
➢ 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:
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
I
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.
II
FORM: FTA 04-16 Page 3 of 5

1a s�Z-c_) �ecfe 'Je& 9 //9/ t�
IX. SETBACKS&SEPARATIONS—(02B.0200& 15A NCAC 02T.0305(f)):
1. Does the project comply with all separations found in 15A NCAC 02T.0305(f)&(g) ®Yes ❑No
➢ 15A NCAC 02T.0305 contains minimum separations that shall be provided for sewers stems: f
Setback Parameter* Separation Required
Storm sewers and other utilities not listed below(vertical) 24 inches
I
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-1 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(e)contains alternatives where separations in 02T.0305(f)cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications weboaee
➢ If noncompliance with 02T.0305(t)or(g),see Section X of this application
2. Does the project comply with separation requirements for wetlands?(50 feet of separation) ❑ 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 0213 .02009 []Yes ❑No ®N/A
➢ This would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Does the project require coverage/authorization under a 404 Nationwide or ❑ Yes 0 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.0 1 05(c)(6)(additional permits/certifications)? ® Yes ❑No
Per 15A NCAC 02T.0 I 05(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

i
i
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 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:
1 RONALD'kVIN NEAIN 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 p�•` RO �'
,_o QEE55/p* Tp�
4 e :
SEAL
021204
'moo`' 9/09/19 i a:
�OL2.9'•.F'fGI N•fEPr P,,�C i
3. Applicant's Certification�er 15A NCAC 02T.01066(((b')]:,.
), 1 �••�.i.—r::' Y" i tktA1, S r G C; �J&'4 stest that this application for
(Signature Authority's name&fitle 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 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: 9• lo.
FORM:FTA 04-16 Page 5 of 5

LEGEND 151 �
ro 4 NO
- � £ R
3TM Y �,S
PROP. 8"SEWER +
EX SEWER •�"���� (}� �a x ,n aar �* £r, w^
1 �T.i'+�'• �J � 41 � �
I Sxyyr � w�"
.r 9}��/ �y._ a'1 'rllf G a u a wy N. �• ^Y 35i r y 4
WwEST §_T
f
tfi 3 i p I '. sUH
an< i r s ✓ .Yp i a k7i .
1'51 e
S'f+� �`„t�1 rw �1 ♦ s ,,�1� y��w gti�A �'�sq�s � 1� _}�, r�*^�f��'"�,��; 1 � ��`�� y, / r n.
1gW
qi
?6�a1° .�
k 3;� 3 \ dirt A a ♦ "b d n ti4 d!
0, x1
'a.0
�Y
Ai
��� u;
NM, j h �t W l 1 V r`! Y T9 Ti
a 7 � �Ya ��£I G C ti 1 R ✓C Iu Y w rY r� a x -td
{ kt. �k R9 �„� t `�
� Y.} '. rT 4i 4;AM—
tWe ue� � � +
k-0W§�q� 1�fr fE 8
I ( �
h
gtg
iq
W
OTEY
40,
,,a x � Wd4 "N ',j(F' y6 d% { t � ', �Ixm�P1.m"9^W1N'•
L 's �1h r 0 r g '3 K �
Plo�ecl o 1e90
MAPLE / MERRITT STREET Ra
the Rev2
engl"ee, PROJECT Rve
LANE Iarchilect"re SEWER IMPROVEMENTS LOCATION MAP Dawn By BIT Page
surveYin9 CheckeJ 5'
.
GROUP PROJECT Dre: 00130,2019
THE LANE GROUP INC.®2014

�r
4
ORDER OF _
MEMO 1/dp)tJ OT+ q �W LC '` S4TV dt/W' "- 6f�
Tffi§P34a"'aSLatiP!3G31 nao_enc50-Y o3x wxlTe^A�-L"'cn4Pw�Jysyacffieo3e�_oW Trvigwnnrvixu3^vo -
it