WQ0041314_Application (FTSE)_20191108

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: ba completed by DWR) V v0 G
All items most be completed or the application will he returned
I. APPLICANT INFORMATION:
2
I. Applicant's name:4318_Medical Par LTC (company, municipality, HOA, utility, etc.) LDS
2. Applicant type: ❑ Individual ® Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ❑ Municipal ❑ Other
3. Signature authority's name: Salvatore DiFranco per I SA NCAC 02T .0106(b) NC Dept of Environmental Quality
Title: Manaeer
4. Applicant's mailing address: 11901 Possum Track Road NOV - 8 2019
City: Raleigh State: C Zip: 27614- ,,
5. Applicant's contact information: Meigh Regional Office
Phone number: (Q)_Q) 604-2140 Email Address: sdifranco@triniLy:partners"com
II. PROJECT INFORMATION:
1. Project name: 343T_echnology Drive
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 master plan, provide the existing permit number: WQ00
3. County where project is located: Johnston
4. Approximate Coordinates (Decimal Degrees): Latitude: 35,61360' Longitude:-78.56824
5. Parccl ID (if applicable): 06EO2902U
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
l . Professional Engineer: Chri§ Petrce License Number: 40 1935
Firm: Timmons r
Mailing address: 5410 Trinity Road Suite 102
City: Raleigh State: 1C Zip: 27607-6003
Phone number: (2n) 01-12.}A Email Address:
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
I. Facility Name: Central Johnston County RegionalWastewater i i
Owner Name: Johnston County
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQCS00060 Downstream (Receiving) Sewer Size: Z inch
Sy5trm Widc Collwiop. System Pernrrt Nurtthcr[%j [ifapplicablr]: WQCS06539
Owner Name(s): Johnston County
Permit Number: NC 030716
FORM: FTA 04-16 Page I of 5

V1. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
[:]Yes [:]No ®NfA
2. If the Applicant is a Developer of lots to be sold, has a Developer's Onerational Agreement (FORM: DEV), been attached?
[—]Yes ❑No ®NIA
3. 1f the Applicant is a Homc/ProVc[jy Own cm' Association has an Operational Agreement (FOR _ A). been attached?
❑ Yes [:]No GIN. -'A
4. Origin of wastewater: (check all that apply) -
El 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 1 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: JW:fo Domestic/Commercial % Commercial
% Industrial (See I SA NCAC 02T .0I LI 2111)
4-Is there a Pretreatment Program in effect? ❑ Yes ® No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114f 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' °
No. of Units
Flow
General Business & Office Facilities
25 galicmployec;shifi
50
2,500 GPD
gall
GPD
gall
GPD
gall
GPD
gal/
GPD
gal/
GPD
Total
GPD
a See 15A NCAC 02T .0114(b). (d). (c)(1) and fcl(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 cast of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in G.5.42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.01 141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 1.180 GPD (per 15A NCAC 02T .01 14)
D 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 04-16 Page 2 of5

Vil. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & 1%IDC (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 sewcr(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
I . Pump station number or name: 343 Technology Drive Duplex Pump Station
2. Approximate Coordinates (Decimal Degrees): Latitude: 35.61360-- Longitude.-78.56824
3. Design flow of the pump station: 0.001872 millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): 1 I.0 gallons per minute at 43,2 feet total dynamic head (TDH)
5. 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)(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):
D 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.
D 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 — (0213.0200 & 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 orovided for sewers stems:
Setback Parameter'
Separation 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 sec item IX.2
50 feet
"Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches
10 feet
Anv building foundation
5 feet
Any basement
10 feet
Top slope of embankment or cuts of 2 feet or more vertical hci ,ht
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade vertical
36 inches
➢ 15A NCAC 02J,0305N) contains alternatives where separations in 02T.0305f f> cannot be achieved.
➢ "Stream classifications can be identified using the Division's NC Surface Water Classifications •• tions web a *e
➢ If noncompliance with 02T.030.5(f) or (0. 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 ofareas 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 I5A NCAC 213.0202
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 & Ruffer Permittine 13ranch
5. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/ccrtifications)? ® 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, stormwatcr 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 ® NIA
➢ 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

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NC,\C 02T, the 1Vlininunn Donn Criteria for the I'ennittine UIA"Ll"IR Stations
and force Mains (alesi ►erNion ). and the Gra►:v, Sc%%cr llinirntun Desl •n 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. Apormal or the reguest is required prior to submittal or the Fast Track Application and supporting documents.
2. Professional [ngincer's Certification.
I, ..,CHR1S PETREE _ _ _ __ __ _ attest that this application for
(Professional Engineer's name from Application Item IILI.)
has been reviewed b) me and is accurate, complete and consistent with the intormation 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 ofthese materials under my signature and seal signifies that I have reviewed this material and
have judged it to be consistent with the proposed design.
NO CE — In accordance with General Statutes 143-215.6A and 143-215.613, 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 S10,000, as well as civil penalties up to $25,000 per violation.
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certit�tign per 15A NC�C 0'_T .0106(b);
(Signature A
's name g title trom Application Item 1.3.)
``►tttttittrf���/
�.� w0it-
A
C AL
041935
GINS
OPHCRR P►►v`�
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. 1 understand that any discharge of wastewater from this non -
discharge system to surface waters or the land ►►ill result in an immediate enforcement action that ma) include civil penalties,
injunctive relief, and or criminal prosecution. 1 will make no claim against the Division of Water Resources should a condition
of this permit be violated. I also understand that ifall required pans of this application package are not completed and that if
all required supporting information and attachments are not included, this application package ►►ill be returned to me as
incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.613. any person who knowingly makes any false
statement, representation. or certification in an% 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 S35,000 per violation.
Signature; �' / Date:
MRM: FTA 04-16 Page 5 of 5

Fri - 1 7
Division of WV r Rewnurces
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: 4318 Medical Parlc, LLC
Project Name for which flow is being requested: 343 Technology Dr.
More than one FTSE nay be required for a single project #Wie owner of the WIVTP is not responsible for all pump
stations along the route of the proposed wasteivaterJlow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Narne: Central Johnston County Regional WW Facility
b. WWTP Facility Permit #: NC 030716
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
AlI locus are hi MGD
9.5
_ 2.296 (0.4 Clayton)
5.841
f. TotaI flow for this specific request 0.0025
g. Total actual and obligated flows to the facility 8.1391
h. Percent of permitted [low used 85.7% paper, 61.5 % trib
11. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
List pump stations Iocated between the project connection point and the WWTP:
(A) (B) (C) (D)=(B+C)
(E)=(A-D)
Design Obligated,
Pump Pump Average Approx. Not Yet Total Current
Station Station Firnt Daily Flow" Current Tributary Flow Plus
(Name or Permit Capacity, * (Firm! pf), Avg. Daily Daily Flow, Obligated
Available
Number) No. MGD MGD Flow, MGD MGD Flow
Capacity***
Tetra 29418 0.576 _ 0.2304 0.0312 0.0642 0.0954
0.135
Swift
6359 0.720 0.288 0.2486 0.208 0.457
(0.169)
Jos ehine 28867 3.384 1.354 0.679 0.487 1.166
0.1875
Landfill
20340 1.9296 1.6718 0.8359 0.6639 1.4997
0.I721
* The Firm Capacity (design flow) 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 he attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is <0.
Downstream Facility Name (Sewer): 'Petra WWPS
Downstream Permi l Number: WQ0029418
Page I of 6
FTSE 10-18

Ill. Certification Statement:
I Chandra C. harmer, P.E. 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 Iocal established policies and procedures using the best available data. This certification applies to
those items listed above in Sections I and 11 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.
c� C- ' L ioUbA
Signing Official Signature Date
Tille of Signing OJIcial
Page 2 of G
FTSE 10-18

PLANNING ASSESSMENT ADDENDUM (PAA)
Submit a planning assessment addendum for each pump station fisted in Section If where Available Capacity is <
0.
Pump Station (Name or Number):
Given that:
a. The proportion and amount of Obligated, Not Yet Tributary Daily Flow (C) accounts for
72 % and 0.208 MGD of the Available Capacity (E) in Pump Station
Swift Creek ; and that
b. The rate of activation of this obligated, not yet tributary capacity is currently approximately
0.02 MGD per year; and that
e. A funded Capital Project that will provide the required planned capacity, namely
Swift Creek Interceptor & WWPS is in design or under construction with
CCS370560-171 _
planned completion in _late 2019, early 2020 ; and/or
d. The following applies:
The County will not accept flow from this project until the Swift Creek Interceptor &
WWPS is com lete. Iftlie343TeclinologyDr.prpjectiscoinpletept,iortotliecaiitplction
of the Swift Creek Interceptor & WWPS project, the facility owner will need to apply for a
pump and haul permit.
Therefore:
Given reasonably expected conditions and platuiing information, there is sufficientiustiFication to allow
this flow to be permitted, without a significant likelihood of over -allocating capacity in the system
infrastructure.
I understand that this does not relieve the collection system owner from complying with G.S. 143-
215.67(a) which prohibits the introduction of any waste in excess of the capacity of the waste disposal
system.
fining Official Signature (" ' Date
Page 3 of 6
FTSE 1 0-1 8

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Project Site And Surrounding Area Map T I M M O N S GROUP
YOUR VISION ACHIEVED THROUGH OURS.

August 15, 2019
NCDEQ - Raleigh Regional Office
1628 Mail Service Center
Raleigh, NC 27699-1628
RE. Power Reliability Plan - 343 Technology Drive
Dear NCDEQ Regional Office;
Prior to commissioning of the packaged duplex pump station, a portable back-up power generation unit
capable of providing adequate power will be purchased by 4318 Medical Park, LLC.
Very Respectfully,
Salvatore Difranco
4318 Medical Park, LLC.

August 15, 2019
NCDEQ - Raleigh Regional Office
1628 Mail Service Center
Raleigh, NC 27699-1628
RE. Power Reliability Plan - 343 Technology Drive
Dear NCDEQ Regional Office;
Prior to commissioning of the packaged duplex pump station, a portable back-up power generation unit
capable of providing adequate power will be purchased by 4318 Medical Park, LLC.
Very Respectfully,
Salvatore Difranco
4318 Medical Park, LLC.

TIMMONS GROUP
YOUR VISION ACHIEVED THROUGH OURS.
TRANSMITTAL
TO: NCDEQ — Raleigh Regional Office
1628 Mail Service Center
.Raleigh, North Carolina 27699-1628
ATTN:
❑ ENCLOSED PLEASE FIND:
❑ WE ARE SENDING UNDER SEPARATE COVER:
Date: 11 /06/2019
NC Dept OfEnvironmenmIlounlity
NOV - 8 l
Raleig%Regional 0
Job #; 43376
Project: 343 Technology Drive
Reference:
Copies Sent To:
COPIES
DATE
NUMBER
DESCRIPTION
2
11/06/19
FTA 04-16 & Supporting Documentation
1
11/06/19
$480.00 ADPlication Fee
1
11/06/19
Document Certifying Company is Registered with the State
1
11/06/19
Site Ma
1
11/06/19
Street Ma
1
11/06/19
Power Reliability Plan
THESE ITEMS ARE TRANSMITTED:
If enclosures are not as noted, please notify us at once.
COMMENTS:
The 343 Technology Drive pump station project is to be a duplex packaged pump station that connects down -stream
via force main into a public collection system owned by Johnston County. Currently, a simplex pump station is
providing service to the 343 Technology Drive complex. Based on NC 2T regulations for general business and office
facilities (25 gallons/employee/shift) and an estimated 12 employees working an 8 hr shift with a peaking factor of 8.0,
the peak existing flow is 5 GPM. However, with the addition of another commercial building to the complex, the
simplex pump station is undersized to handle the additional flow. For estimating future wastewater output, Timmons
Group assumed 50 employees at buildout working 2 shifts a day, for a total of 16 hours. Using NC 2T regulations and
a peaking factor of 6.0, the peak wastewater production at buildout is 10.42 GPM. The average wastewater
production at buildout will be 1.74 GPM. The simplex pump station is to be replaced by an Environment One duplex
pump station, but the existing 2-Inch on -site force main, approximately 1,160 L.F will be still be utilized to convey the
pumped wastewater. The duplex packaged pump station will have the capacity to pump 3,500 GPD; however, it is
anticipated that only 2,500 GPD will be utilized by the current and proposed commercial tenants of this complex.
Feel free to contact me with any questions at 919-532-3234 or [e-mail]
Thank you,
Chris Petree
Sr. Project Manager
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State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION
This application is for sewer extensions involving gravity sewers, pump stations and force mains, or any combination that has been
certified by a professional engineer and the applicant that the project meets the requirements of 15A NCAC 02T and the Division's
Minimum Design Criteria and that plans, specifications and supporting documents have been prepared in accordance with, 115A
NCAC 02T, 15A NCAC 02T .0300. Division policies and good engineering ractices.
While no upfront engineering design documents are required for submittal, in accordance with 15A NCAC 02T .0305(b), design
documents must be prepared prior to submittal of a fast track permit application to the Division. This would include plans, design
calculations, and project specifications referenced in I SA NCAC 02T .0305 and the applicable minimum design criteria. These
documents shall be available upon request by the Division.
Projects that arc deemed permitted (do not require a permit from the Division) arc explained in 15A NCAC 02T.0303.
Projects not eligible for review via the fast track process (must be submitted for full technical review):
➢ Projects that require an environmental assessment in accordance with 15A NCAC IC .0100;
➢ Projects that do not meet any part of the minimum design criteria (MDC) document;
➢ Projects that involve a variance from the requirements of 15A NCAC 2T;
➢ Pressure sewer systems utilizing septic tank -effluent pumps (STEPS) or simplex grinder pumps;
➢ STEP or simplex grinder pumps connecting to pressurized systems (e.g. force mains);
➢ Vacuum sewer systems.
General .. When submitting an application, please use the following instructions as a checklist in order to ensure all required items
arc submitted. Adherence to these instructions and checking the provided boxes will help produce a quicker review time and
reduce the amount of requested additional information. Failure to submit all required items will necessitate additional
processing and review time, and may result in return of the application. Unless otherwise noted, the Applicant shall submit
one original and one copy of the application and supporting documentation.
A. One Original and One Copy of Application and Supporting Documents
❑ Required unless otherwise noted
B. Cover Letter (Required for All Application Packages):
❑ List all items included in the application package, as well as a brief description of the requested permitting action.
➢ Be specific as to the system type, number of homes served, flow allocation required, etc.
➢ If necessary for clarity, include attachments to the application form.
C. Application Fee (All New and Major Modification Application Packages):
❑ Submit a check or money order in the amount of $480.00 dated within 90 days of application submittal.
➢ Payable to North Carolina Department of Environmental Quality (NCDEQ)
D. Fast Track (Form: FTA 04-16) Application (Required for All Application Packages):
❑ Submit the completed and appropriately executed application.
➢ If necessary for clarity or due to space restrictions, attachments to the application may be made.
® If the Applicant Type in Item 1.2 is a corporation or company, provide documentation it is registered for business with
the North Carolina Secretary of State.
❑ If the Applicant Type in Item 1.2 is a partnership or d/b/a, enclose a copy of the certificate filed with the Register of
Deeds in the county of business.
❑ The Project Name in Item Il. I shall be consistent with the project name on the flow acceptance letters, agreements, etc.
❑ The Professional Engineer's Certification on Page 5 of the application shall be signed, scaled and dated by a North
Carolina licensed Professional Eneineer.
❑ The Applicant's Certification on Page 5 of the application shall be signed in accordance with 15A NCAC 02T A 106(b).
Per 15A NCAC 02T .0106(c), an alternate person may be designated as the signing official if a delegation letter is
provided from a person who meets the criteria in 15A NCAC 02T .0106(b).
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 1 of 3

E. Flow Tracking/Acceptance Form (Form: FTSE 04-16) (If Applicable):
❑ Submit the completed and executed FTSE form from the owners of the downstream sewers and treatment facility.
➢ Multiple forms maybe required where the downstream sewer owner and wastewater treatment facility are different.
D The flow acceptance indicated in form FTSE must not expire prior to permit issuance and must be dated less than one
year prior to the application date.
➢ Submittal of this application and form FTSE indicates that owner has adequate capacity and will not violate G.S. 143-
215.67(a).
➢ Intergovernmental agreements or other contracts will not be accepted in lieu of project -specific FTSE.
F. Site Maps (All Application Packages):
® Submit an 8.5-inch x 1 1-inch color copy of a USGS Topographic Map of sufficient scale to identify the entire project
area and closest surface waters.
➢ Location of the project (gravity sewer, pump stations & force main)
D Downstream connection points and permit number (if known) for the receiving sewer
® Include a street level map (aerial) showing general project area so that Division staff can easily locate it in the field.
G. Existing Permit (All Modification Packages):
❑ Submit the most recently issued existing permit.
❑ Provide a list of any items within the permit the Applicant would like the Division to address during the permit
modification (i.e., permit description, flow allocation, treatment facility, etc.).
H. Power Reliability Plan (Required if portable reliability option utilized for Pump Station):
❑ Per 15A NCAC 02T .0305(h)(1), submit documentation of power reliability for pumping stations.
D This alternative is only available for average daily flows less than 15,000 gallons per day
➢ It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant and is compatible
with the station. The Division will accept a letter signed by the applicant (see 15A NCAC 02T .0106(b)) or proposed
contractor, stating that "the portable power generation unit or portable, independently -powered pumping units, associated
appurtenances and personnel arc available for distribution and operation of this pump station."
D 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. (Required at time of certification)
I. Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per 15A NCAC 02T .01 15(a)(1) provide the Certificate of Public Convenience and Necessity from the North Carolina
Utilities Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served by
the sewer extension, or
p Provide a letter from the North Carolina Utilities Commission's Water and Sewer Division Public Staff stating an
application for a franchise has been received and that the service area is contiguous to an existing franchised area or that
franchise approval is expected.
J. Operational Agreements (Applications from HOAIPOA and Developers for lots to be sold):
❑ Home[Property Owners' Associations
❑ Per 15A NCAC 02T .01 l5{cc submit the properly executed Operational Agreement (FORM: HOA).
❑ Per 15A NCAC 02T .01 15(c), submit a copy of the Articles of Incorporation, Declarations and lay -laws.
❑ Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(b), submit the properly executed Operational Agreement FORM: DEV .
For more information, visit the Division's collection systems iuehsite
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 2 of 3

Deck, Erin M
From: Andy Pitts <[e-mail]>
Sent: Monday, December 16, 2019 4:11 PM
To: Deck, Erin M
Cc: Chris Petree; Sam DiFranco
Subject: [External] 343 Technology Drive Fast Track Sewer Extension
email. E]o.no# cllcio]I� ks orn en atfac�iments unlessyou verify -Send Wll suSpiatovs email as an attic me to. _`
►v
Erin,
Please see our responses in red.
We are in the process of reviewing the subject application and require additional information before we can
continue drafting the permit.
• V. Receiving Downstream Sewer information, lists WQCS06539, however that permit number does not
exist. Please provide the correct collection system permit number.
• The permit number given to us by Johnston County for the receiving downstream 12" gravity
main was WQ 06539. Johnston County's system wide collection system Pen -nit number is
WQCS 00060.
• V1. 7 lists the flow generated by this project as 2,500 gpd, however no total was provided and in section
V1.8 it states that the wastewater generated by this project is 1,780. Please revise.
• We understood the existing flows on -site to be 720 GPD from a combination of the water meter
records and the Pump Station draw -down test. The technology drive site will generate a total of
2,500 GPD after the proposed project is complete; therefore, we were stating that the proposed
project, by itself, will generate 1,780 GPD.
• We would like clarification in regards to the amount of flow that will be generated by this project. Are
you stating that the new building will house 50 employees per shift for two shifts a day (totaling 100
employees per day)? Or is are there 25 employees per shift with 2 shifts totaling 50 employees for the
day?
For the entirety of the technology site, existing and proposed, we are assuming a total of 100
employees per day. (50 employees per shift * 2 shifts * 25 GPD'Sliift = 2,500 GPD)
We apologize for any confusion.
Thank you for your time and help.
Respectfully,
Andrew Pitts, E.I.T.
Project Engineer
TIMMONS GROUP I www.timmons.com
5410 Trinity Road, Suite 102 Raleigh, NC 27607
Office: 919.532.3238 1 Fax: [phone]
andy_pittsCc_r7timmons.com
Your Vision Achieved Through Ow-s

Cashion, Ted
From: Andy Pitts <Andy. Pitts@tim mons.com >
Sent: Tuesday, November 19, 2019 3:06 PM
To: Cashion, Ted
Cc: Robinson, Jason; Chandra Farmer; Sam DiFranco; Chris Petree
Subject: [External] Technology Drive
Attachments: FTA page 1.pdf
not clink lift s or open attachments unless you verify. Send all suspicious email as an attachment to
Ted,
Here is the first page of the FTA with the revised legal name.
Please let us know if there are any further questions or concerns.
Respectfully,
Andrew Pitts, E.I.T.
Project Engineer
TIMMONS GROUP www.timmons.com
5410 Trinity Road, Suite 102 1 Raleigh, NC 27607
Office: 919,532.32381 Fax: [phone]
andy.pitts cr,timmons:com
Your Vision Achieved Through Ours

Cashion, Ted
From: Cashion, Ted
Sent: Tuesday, November 19, 201912:20 PM
To: [e-mail]; Chris Petree
Cc: Robinson, Jason; Chandra Farmer ([e-mail])
Subject: 343 Technology Drive fast track sewer extension application
We are reviewing the subject application. The applicant's name, "4318 Medical Park, LLC" is not listed with the NC
Secretary of State's office.
It appears the correct legal name may be as noted below:
4318 Medical Park Drive LLC El V ± r Q @ L® Annual Report
1268132 7I1012012 Current - Active Limited Liability Company
Please revise page 1 of the application to reflect the correct legal name of the applicant. You may email this page to us.
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
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