WQ0041315_Application (FTSE)_20191115

State of North Carolina
Department of Environmental Quality
D� R Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
F f
Application Number: '' d 15 (to be completed 6y pWft)
All items must be completed or the application will be returned
1. APPLICANT INFORMATION:
1. Applicant's name: Town of Fuquay-Varina (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privalely-Owned Public Utility
❑ Federal ❑ State/County ® Municipal ❑ Other
3. Signature authority's name: Jay Meyers, P.E. per 15A NCAC 02T .0106(b)
Title: Public Utilities Dir. eta 1 O j J� 6¢ � kr e#
4. Applicant's mailing address: 1415 Hot] d-Ro d fP NC Dept of Environmental QualitN
City: Funuay-Varina State: NC Zip: 27526-
Nov 15 2019
5. Applicant's contact information:
Phone number: 919 567-3911 Email Address: jme ers0fuquay-varina.org Raleigh Regional Office
11. PROJECT INFORMATION:
L Project name: Sam's Xpress Car Wash - Fuquay Varina
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Preject
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: Wake
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.595045' Longitude:-78.763538
5. Parcel ID (if applicable): 0677-01-1550
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
I. Professional Engineer: Matthew Lowder,PE License Number: NC24434
Firm: Trianele Site Design, PLLC
Mailing address: 4004 Barrett Drive, Suite 101
City: Raleigh State: NC Zip: 27609-
Phone number: 9�) 553-6570 Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. FaciIity Name: Terrible Creek WWTF Permit Number: NCO066516
Owner Name: Town of Fuquay-Varina
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQunknown Downstream (Receiving) Sewer Size: 8 inch
$ sigm„Wide Collection System Permit Numbe i licable : WQCS00193
Owner Name(s): Town of Fine uay-Varina
FORM: FTA 04-16 Page 1 01'5

VI. GENERAL REQUIREMENTS
L 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 Devel�o e� is Operational Agreement (FORM: DEV) been attached?
❑ Yes ❑No ❑N/A
3. If the Applicant is a Ow iers' Associ+ lip . has All O iendlicn al AAgrrrunrnt {FORM: HOAJ 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
El Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater : % Domestic/Commercial 100 % Commercial
% Industrial(See- 15A NCAC 02T .0103(20 )
4 is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under I SA NCAC 02T .0114(f)? ❑ Yes ®No
➢ If Yes, provide a cony of now reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 021.01140
Daily Design Flow'.6
No. of Units
Flow
Service Station
250 gal/water closet
2
500 GPD
gall
GPD
gall
GPD
gal/
GPD
gall
GPD
gall
GPD
Totat
500 GPD
a See 15A NCAC 02T .0114 b M. 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 I5A 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: 500 GPD (per 15A NCAC 02T .01)4)
Y 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 fine
❑ 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 of 5

Vil. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T.0305 & MDC (Gravity Sewers):
I. Summarize gravity sewer lobe permitted:
Size (inches) Length (feet) Material
8 63 DIP
D Section I1 &. III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
D Section III contains information related to minimum slopes for gravity sewer(s)
D Oversizing lines to meet minimum slope requirement Is not allowed and a violation of the MDC
V11I. PUMP STATION DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC !Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
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
6. Power reliability in accordance with 15A NCAQ 02T.0305(h)(1):
❑ Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(h)(1)($).
D Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
A 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-I6 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & I5A NCAC 02T .0305(t)):
L Does the project comply with all separations found in 15A NCAC 02T .0305,(f) & (e) ® Yes [:]No
Y 15A NCAC 02T.0305(f) contains minimum separations that shall be rovided for sewer syswins•
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)
IS incites
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-1 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 s stems and interce for drains
5 feet
Any swimm in& pools
I0 feet
Final earth grade (vertical)
36 inches
D 15A NCAC 02T.0305 contains alternatives where separations in 02T.0305(f1 cannot be achieved.
Y "Stream classifications can be identified using the Division's NC Surface Water Classifications weboaee
D If noncompliance with 021.0305(f) or (91 see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ❑ Yes ❑ No ® NIA
D 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
Y 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 028.0200? ❑ Yes ❑ No ® N/A
Y 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?
Y Information can be obtained from the 401 & Buffer PermittingBranch
5. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? ® Yes [:]No
Per 15A NCAC 02T.0105,(,(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 1SA 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 I SA NCAC 02T.0403(n)(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 ISA NCAC 02T, the MininjiM Deskll Criteria fur the Pent! illL, (114Illotl!} pjtLIs
and Force Mains_0alest version), and the Gravity Sq tiwer Minimum Design Criteria (halesi yerskip) as applicable?
® Yes ❑ No
IfNo, complete and submit the Variance/Altemative Design Request application (VADC 10-14) and supporting documents for
review. A t roval of (lie request is rc wired prior In submittal of Ilse Fnsl Track Application and supporling documents.
2. Professional Engineer's Certification:
L �_-e _ attest that this application for
(Professional Engineer's name from Application Item 111.1.)
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 143-215.613, 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 S 10,000, as well as civil penalties up to $25,000 per violation.
.whirl --
North Carolina Professinonal Engineer's seal, signature, and date: 1 `,,\\t�� •CAS rr���,
SEAL
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I, T_ MP 1�►9 S) �{•_�• �1�6�ICI�j�I_1]�'�'� attest that this application for
(Signature AuthoiiY4 name & title from Application Item 1.3.)
has been reviewed by me and is accurate and complete to the best of my knowledge. 1 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 retumed 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. 1 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 S 10,000 as well as civil penalties up to $25,000 per violation.
Signature:
Date: 3I QG� I?
FORM: FTA 04-16 Page 5 of 5

�OF WATE9Q State of North Carolina
G Department of Environment and Natural Resources
O
r Division of Water Quality
Flow Tracking/Acceptance for Sewer Extension Permit Applications
(FTSE 06-13)
Project Applicant Name: Town of Fu ua -Varina
Project Name for which flow is being requested: Sam's Xpress Car Wash
More than one FTSE may be required for a single project if ihi, ownerof f 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: Terrible Creek WWTP
b. WWTP Facility Permit #: NCO066516
All flows are in MGD
e. WWTP facility's permitted flow
3.000
d. Estimated obligated flow not yet tributary to the WWTP 0.848
e. WWTP facility's actual avg. flow
1,353
£ Total flow for this specific request
0.001
g. Total actual and obligated flows to the facility
2.202
h. Percent of permitted flow used
73.43%
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 WWTP:
(A) (B)
(C) (D)=(B+C) (E)=(A-D)
Design
Obligated,
Pump Averagc Daily Approx.
Not Yet 'Total Current
Station Firm Flow** Current Avg.
Tributary Flow PIus
(Name or Capacity,* (Firm 1 pf), Daily Flow,
Daily Flow, Obligated Available
Number) MGD MGD MGD
MGD Flow Capacity***
Eastern
T>--:., 1 1.800 _ 0.720 0.232
0.280 0.512 0.208
Holly
n:a__ 0.432 0.173 0.044
0.121 0.215 -0.042
* The Firm Capacity 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.
*** 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.
Page 1 of 7
FTSE 06-13

Certification Statement:
I Jay T. Meyers, P.E., Public Utilities certify to the best of my knowledge that the addition of
Director
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 II
plus all attached planning assessment addendums for which I am the responsible party.
Signature of this form indicates acceptance of this wastewater flow.
Page 2 of 7
Date
hTSE 05-13

FTSE PLANNING ASSESSMENT ADDENDUM (PAA)
Submit a planning assessment addendum for each pump station listed in Section 11 where Available
Capacity is C 0.
Pump Station (Name or Number):
Given that:
a. The proportion and amount of Obligated, Not Yet Tributary Daily Flow (C) accounts for
69 % and 0.121 MGD of the Available Capacity (E) in Pump Station
Holly Ridge PS ; and that
b. The rate of activation of this obligated, not yet tributary capacity is currently approximately
0.046 MGD per year; and that
c. A funded Capital Project that will provide the required planned capacity, namely
Holly Ridge Pump Station Upgrade is in design or under construction with
planned completion in 2020 ; and/or
d. The following applies:
The Town is currently working with Withers Ravenel for engineering services to
expand the pumping capacity of the Holly Ridge Pump station. Preliminary
Engineering study determined that the existing pump station would need to be
—replaced. Design of the R2LnR station replacement is currently complete, with
the project letting for bid in the November time frame.
We expect a 6-month construction time frame since existing forcemain will be
utilized. The Town has budgeted $250#00a in fiscal year 2019-2020 for the
rep]acementgroject.
Therefore:
Given reasonably expected conditions and planning information, there is sufficient justification
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.
Sighing Qfftcia]f Signature / Date
Page 3 of 7
FTSE 06-13

TRIANGLE
' S I T E D E S I G N
4004 Barrett Drive_ Suite 101
NODeptofFnvirnnmentalQuality Raleigh. North Carolina,27609
TEL [phone]
NOV 15 2M9
Transmittal
Raleigh Regional Office
Date: November 15, 2019 Job Number: 046008
Project Name: Sam's Xpress
Raleigh Regional Office
Water Quality Section
1628 Mail Service Center
Raleigh, NC 27699-1628
919-552-1429
We are sending these by
❑ L..S. Mail ® UPS ❑ Hand Delivery
❑ Other
J Ve are sending you
❑ Attached ❑ Under separate cover via the follotrirrg irerns
❑ Shop draNings ® Prints/Plans ❑ Samples ❑ Specifications ❑ Change Orders
❑ Other
copies Dale No. Description
2 Application — copy
I Application fee - $480 check
I USGS Topographic Map
I Street Level Map
I Aerial Map
These are transmitted as checked helatt-:
❑ For your use ❑ Approved as submitted ❑ Resubmit ❑ Copies for approval
❑ As requested ❑ Approved as noted ❑ Submit ❑ Copics for distribution
® For review and comment ❑ Returned for corrections ❑ Return ❑ Corrected prints
Remarks:
Copy to: Signed:
Ross Godwin

VC, M338.7 IIIw/
i 2ia`Vr�� /7
J
sir
Ln �- N.wEsrsrohF BLVD
•r in
�O�v 1 lO' FI r
ITan
1� -AS SJNNTR
n ,M
al
a.
k �F 1SM0�►OUDM-N—LU IA
�-
ALDERLEAF DR
ar

V
-r-
LLJ
CY)
0 0 c