WQ0041609_Application (FTSE)_20200326

State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
15A NCAC 02T 90300 a FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
DIvlston of WAter Resources FTA 04I6 & SUPPORTING DOCUMENTATION
Application Number, (to be completed by DWR)
•rr a ,• � � •� � 1• :�, � �: •�.
I. APPLICANT INFORMATION:
1. Applicant's name: Qity of Mebane (company, municipality, I-IOA, utility, ete,)
2, Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership CI Privately -Owned Public Utility
❑ Federal [] State/County E Municipal ❑ Other
3, Signature authority's name% David Cheek per i.SA NCAC. 02'1'_,O i 06 b
Title: .0ty M.anager
4, Applicant's mailing address: 106 E. Washington StSt
City: Mebane State; NC Zip: 27302.
5. Applicant's contact information:
Phone number: ( 1) 563-5901 Email Address: [e-mail]
II. PROJECT INFORMATION:
1, Project name: Cambridge Park Tovknhq�rses
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; Alarnance
4, Approximate Coordinates (Decimal Degrees)% Latitude: 36,0507460 Longitude; ; 97 .29087°
5. Parcel ID (if applicable), 163252
(or Parcel ID to closest downstream sewer)
III, CONSULTANT INFORMATION:
1. Professional>ngineer; Robert S. Discltingrer• License Number': 1891A
Firm; Evans En ng eering,Inc,
Mailing address; 4609 Dundas Dr
City; Greensbgro State; NC Zip: ZMQZ7
Phone number; (M) 854-8n Email Address; ad cOevanseena.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1, Facility Name: City �G�•a�am WWTP Pet�nit Number: NC002121 l
Owner Name: CIIy pf Graham
V. RECEIVING DOWNSTREAM SEWER INFORMATION (If different than WWTF):
1, Petrnit Nutnbea'(s): WQ,,_ Q4� Downstream (R.eeeiving) Sewer Siae; � inch
System u►ide Collection System�'ermit NumberCsl tit ttgplicuble�: WQCS00081
Owner Name(s): 01fV of Mebane
FORM; FTA 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
Z. If the Applicant is a Developer of lots to be sold, has a Dey_eloper's-Qperational Aar_eemcnUFOR MV) been attached?
❑ Yes ❑No ®N/A
3. If the Applicant is a Home]PropertY Qwners' Association, -has n-Operational Agreement_(FORM;_HOA) been attached?
❑ Yes ❑No ®N/A
4. Origin of wastewater: (check all that apply):
® Residential Owned
❑ Residential Leased
❑ School / preschool / day care
❑ Food and drink facilities
❑ Businesses / offices / factories
❑ Retail (stores, centers, malls)
❑ Retail with food preparation/service
❑ Medical / dental / veterinary facilities
❑ Church
❑ Nursing Home
5. Nature of wastewater : 100 %Domestic/Commercial
Commercial
❑ Car Wash
❑ Hotel and/or Motels
❑ Swimming Pool /Clubhouse
❑ Swimming Pool/Filter Backwash
❑ Other (Explain in Attachment)
_ %Industrial (See 15A NCAC 02T ,0103(20))
4 Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 02T ,0114(fl? ❑Yes ®No
➢ If yes, provide a copy of flow reduction approval letter
7
0
Summarize wastewater generated by project:
Establishment Type (see 02T,0114(fl)
Daily Design Flow a,n
No. of Units
Flow
360 gal/day
83
2%880 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
29,880 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. 42A4).
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.
Wastewater generated by project: 29,880 GPD (per 15A NCAC 02T .O 114)
➢ 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 of 5

VII.
VIII,
GRAVITY SEWER DESIGN CRITERIA (If Applicable)" 02'I• .O.I()5 & MDC (Gravity SewcrsY
Summarize gravity sewer to be permitted;
Size (inches)
Length (feet)
Matei ral
8"
1355.9
SDR35
8"
97.3
DIP
A Section II & III of the MDC far Perrttitting of t3ravity S®wars contains information related to design criteria
A Section III contains information related to minimum slopes for gravity sower(s)
A Oversizing lines to meet minimum slope requirement is not allowed and a violation of the M_DC
PI1M�' STATION I)IESION CRIT�li2,IA (If Applicable) -= 03T , U5 & .MbC tptuun Station�llf'u rc Ma ns):
COMPLETE FOR EACH PUMP STATION INCLUDED IN TIi<IS PII;O,IICOT
1, Pump station number or name;
2, Approximate Coordinates (Decimal Degrees); Latitude; Q 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 (far this Pump Station);
6,
Size (inches) Length (feet) Material
Fower reliability In accordance with I SA NCAC 02'f }0305(11)(1)�
❑ Standby power source or pump with automatic activation and telemetry % 15A NCAC 02T ,0305(h)(I)(B),
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
Qr if the pump station has an average daily flaw lass than 15,000 gallons per day;
[� Portable power source with njanual activation, qulclCncotrnection receptacle and telemetry • ISA NCAC 02T
,0305(h)(I)(C)
or
® Portable pumping unit with plugged emergency pump connection and telemetry � I $A NCAC 02T ,0305(h)(1)(C);
It shall be demonstrated to the Division that the. portable source is owned or conG•acted by the applicant (draft agreement)
and is compatible with the station,
If the portable power source or pump is dedicated to multiple putnp stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel timetiames, shall be provided
in the case of a multiple station power outage,
FORM; FTA 04-16 Fage 3 of5

1X. SETBACKS & SEPARATIONS — (02B e0200 & 1SA NCAC 02T ,0305(0):
1, Does the project comply with all separations found in 15A NCAC 02 r .0305(0 & (k:)
A 15A NCAC 021.0305M contains minimum separations that shall be provided for sewer systems:
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
1S 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 11 Impounded reservoirs used as a source of drinking water
1001 at
**Waters classified WS (except WS"1 or WS%V), B, SA, ORW, HQW, or SB Nonni normal
high water or tide elevatloo and wetlands see Item M.2
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surfaco 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 sterns and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade vertical
36inches
A 15A NCAC U2 T,U30SC� contains alternatives whore separations in 92'I',0305(t) cannot be achieved,
A **Stream classulcatlons can be identified using the Division's Nc Surf ggyg er C ass cations webpaee
If noncompliance with 02T,0305(ff) or (&), see Section X of this application
2, >�oes the project comply with separation requirements far wetlands? (50 feet of separation) � Yes ❑ Na ❑ N/A
A Sae tlae Division's dl'aft separation requirements for situations where separation cannot be nisei
A No variance is required If the alternative design criteria specified is utilized In design and construction
A As built documents should reference the location of areas effected
3, Daes the praJect comply with setbacks found 1n the river basin. rules per lSA NCAC 02B ,02007 � Yes ❑ No j] N/A
This woald include Trout Buffered Shearns per l SA NrrAC 2[3.U202
4• Does the praJect require coverage/authorization under a 404 Nationwide or
Individual permits or �01 Water Quality Certif#cat#ans?
);�
Information can be obtained from the 401 & Buffer permitting Branch
5. Does project comply with l5A NCAC 02T,OIOS(v(e) (additional penults/cartiiicatlons)?
Per .1SA NCAC 02�',OlOSCc tS� directly related onviranmental permits or certification applications are being prepared, have
been applied for, or have been obtained. Issuance of this permit is contingent an issuance of dependent permits (erosion and
sedimentation control plans, stormwater management plans, etc.),
6, Does this project include any sewer collection lines that era deemed "high�prlor•lty?"
.Per I;�A NCAC 02T,040?"high-1?riority s@wer" to®ens "any aerial sew@r, se�vea• contacting, surface waters, siphon, or sower
positioned parallel to str'eambanlcs that is subject to erosion that undermines or deteriorates the sewer.
Yes 0 No El NIA
1f yes, prelude an attaclunent with details it�%r each line, including type (aerial line, size, material, and #oeatlon�,
#g!a pt'#or#tv ##nes steal# be inspected by the p�arnalttcc orits representative at least otrce svery al�tamontlta and inspcet#cna
decumented per laA NCAC 02T,0403(a)(0) or the pernritee's Individual SystearsWlde Collection perm#ta
FpR.IYI; l~TA 04v%1t Rage 4 oi'5

.`t. CERTIFICATIONS;
1, Does the submitted system comply with i SA NCAC 021, the Minimum Critcria for the i'erntitt
and l=orce Mains latest version and the Gravity Sewer Minimum De3igtt Criteria as app
2,
3.
Yes Li No
If No, complete and submit the Variance/Ahomative Design Request application (VADC 1-0.14) and supporting documents for
review. Approval of the request is reauired prior to submittal of the Fast Track Application and suimortine documents
Professional Engineer's C ettifioation;
I,
(Professional &ngincer's name fl•om Application Item III, l
attest that this application for
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans, specificatiensI
enghteering 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 h1 accordance with the applicable regulations, Gravity Sewer
Idinimum 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.
IVpTE — In accordance with General Statutes 143-21S,tiA and I43-21S,b13, any person who lctrawingly 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 $101000, as well as civil penalties up to $25,000 per violation.
North Carplina Professional 1•�trgiueer's seal, signature, and date:
j L741`�0 GAt;;qvfi'w4r,
,.�
ra
� -.. •11ta`l� ?
Applicant's Cettification per (SA NCAC 02T .0106(b);
t, David S. Cheek, City Manager attest that this application for
(Signature Authority's name & title 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 i£ all required supporting documentation and attachtments are not includ®d, 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 agattist the Division of Witter Resources should a condition
of this permit be violated. I also understand that if all required parts of this application package arc 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 I 43-2 I S,tiA and 143-21514B any person who knowingly makes any Ise
statement, r•epresentatlon, or oortlpcation in any application package shall be guilty of a Class 2 misdenreanor, whioh tnay
Include a fine not to exceed 10,000 as well as Or penalties up to $25,000 per violation,
Signature; ��
Data.; 5/6/2020
FORM; FTA 04-16
Page S of S

March 3, 2020
Justin Henderson
NCDENR — Division of Water Resources
450 W. Hanes Mill Road — Suite 300
Winston-Salem, NC 27105
Re: Cambridge Park Townhouses
Dear Justin:
Enclosed you will find aFast-Track Sewer Application package for a proposed
subdivision in the City of Mebane for your review. Items included in this package
consists of; check for $480, FTA 04-16, FTSE 01-16, and USGS Map. This project is
called Cambridge Park Townhouses, located on Jones Drive in Mebane, NC. This phase
consists of 83 townhouse units for sale and is part of a larger subdivision. This project is
served by an onsite gravity sewer system (WQ0050582) flowing to a proposed pump
station (WQ0040510) than ultimately tying on to an existing City of Mebane sewer
system. The proposed daily design flow is 29,880 GPD, based on (83) 3-bedroom
townhouse units at 360 GPD/unit. Feel free to contact me with any questions or
comments.
Sincerely,
Dave Southard
Project Manager
4609 Dundas Drive
Greensboro, NC 27407
Phone [phone]
Fax [phone]
License #C-0168

;{
D IV1 s ' a I k
€3f VIl ter
RL f.0i 5'&,e
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: City of Graham -Mebane Allocation
Project Name for which flow is being requested: Cambridge Park Townhomes
More than one FTSE may be required for 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: City of Graham WWTP
b. WWTP Facility Permit #: NC 0021211
c. WWTP facility's permitted flow
All flows at•e in MGD
.796860
2.101
029880 eaMeb Allocation
2.897
82.8%
]I. Complete this section for each pump station you are responsible far along the route of this proposed
wastewater now.
List pump stations located between the project connection point and the WWTP:
(A) (B) (C) (D)=(BkC)
Design Obligated,
Pump Pump Average Approx. Not Yet Total Current
Station Station Firm 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***
Cherry Lane 2.5 1.0 .017895 .750 .767895 .2341
x 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.
*X 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 WWTP where the Available Capacity is < 0.
UNNEV
Downstream Facility Name (Sewer); Cherry Lane Force Main
Downstream Permit Number: WQ 0029492
Page 1 of 6
FTSE 10-18

III, Certification Statement,
I Franlcie Maness 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 Il plus all attached planning assessment addendums for which I
in 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,
iO�C1C7� Sl�Ylatb11'0
7�tle o�'Sigr(r�g Offreial
Page 2 of 6
Date
FTS� 10-18
'd c�

City of Graham USE - WWTP
WWTP - 2019 Calendar Year Flows
GPD
WWTP
21101,000
F
Total Flow
211013000
WWTP - Obligated Flows - Nan -Tributary
Project Name
GPD
Graham Obligated Flows
46,860
Mebane NCCP Flows
Mebane Remaining Allocation
729,020
Hawfields Day Care MEB
21500
Cambridge Park, Phase 1A - Revised MEB)
18,480
Total Allocated - Non Tributary Flows
796,860
Proposed Flows
Project Name GPD
Cambridge Park, Townhomes (MEB Allocation)
29,880
Total Flows
20897,860
Permitted Flows
31500,000
Percentage of Permitted Flow
82.8%

QWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: City of Mebane
Project Name for which flow is being requested: Cambridge Park Townhomes
More than one FTSE may be required for 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: _
b. WWTP Facility Permit #
Allocation to Graham WWTP
NC 0021211
All flows are in MGD
c. WWTP facility's permitted flow
0.750 - MEB Allocation
d. Estimated obligated flow not yet tributary to the WWTP
0.277 (Cambridge all)
e. WWTP facility's actual avg. flow
0.000
f. Total flow for this specific request
0.02988
g. Total actual and obligated flows to the facility
0.277 (F included in
Approved)
h. Percent of permitted flow used
37.0%
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
Average Approx.
Obligated, Total
Pump Pump Daily Current
Not Yet Current Flow
Station Station Firm Flow** Avg. Daily Tributary Plus
(Name or Permit Capacity, * (Firm / pf), Flow,
Daily Flow, Obligated Available
Number) No. MGD MGD MGD
MGD Flow Capacity***
Cambridge Park 0.720 0.288 0.000 .277 .277 0.01082
* 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 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): Cambridge Park Onsite Outfall
Page 1 of 6
FTSE 10-18

Downstream Permit Number: WQ0040466
III. Certification Statement:
I David Cheek 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.
el'f David S. Cheek
1 1 1. 1 1 1 11
Signing Official Signature
City Manager
Title of Signing Official
Date
Page 2 of 6
FTSE 10-18

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: (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 Mebane (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State/County ® Municipal
3. Signature authority's name: David Cheek per 15A NCAC 02T .0106(b)
Title: City Manager
4. Applicant's mailing address: 106 E. Washington St
City: Mebane State: NC Zip: 27302-_
5. Applicant's contact information:
Phone number: [phone] Email Address: dcheek(),cityofinebane.com
❑ Privately -Owned Public Utility
❑ Other
NC Department of
Environmental Quality
Received
MAR 2 6 2020
Winston-Salem
II. PROJECT INFORMATION: Regional Office
1. Project name: Cambridge Park Townhouses
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: W000- - and issued date:
If new construction but part of a master plan, provide the existing permit number: W000
3. County where project is located: Alamance
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.050746' Longitude:-79.29087'
5. Parcel ID (if applicable): 163252
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Robert S. Dischinger License Number: 18914
Firm: Evans Engineering, Inc.
Mailing address: 4609 Dundas Dr
City: Greensboro State: NC Zip: 27407
Phone number: 336 854-8877 Email Address: rsd(a,evans-eng.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: City of Graham W WTP Permit Number: NCO021211
Owner Name: City of Graham
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): W00040482 Downstream (Receiving) Sewer Size: 10 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS00081
Owner Name(s): City of Mebane
FORM: FTA 04-16 Page I 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/Proeeny 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. Nature of wastewater: 100 % Domestic/Commercial % Commercial
% Industrial (See 15A NCAC 02T .0103(20))
3•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 e,b
No. of Units
Flow
240 gal/day
0
0 GPD
gaV
—GPD—
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
0 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: 0 GPD (per I5A 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): Downstream sewer installation isn't completed.
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"
1355.9
SDR35
8"
97.3
DIP
➢ 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
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.
FORM: FTA 04-16 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations found in 15A NCAC 02T 0305(t) & (tt) ® Yes [-]No
➢ 15A NCAC 02T.0305(fl contains minimum senarations that shall be provided for sewer systems:
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 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
36inches
➢ 15A NCAC 02T,0305(9) contains alternatives where separations in 2T cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webnane
➢ If noncompliance with 02T.0305(t) or (a), 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 02B .0200? ® 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 [-]No
individual permits or 401 Water Quality Certifications?
➢ 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(e1(61, 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 I SA NCAC 021,0402, "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

X.
1. Does the submitted system comply with 15A NCAC 02T. the Minimum Desifft Criteria for the Permitting of BW 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:
I, ¢.OQxat' S. 1Di4jC4-%i attest that this application for
(Professional Engineer's name from Application Item I11.1.)
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 143-215.6E, 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):
Item
SEAL
18914
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: 7E�3�4- Date: 3 17
FORM: FTA 04-16 Page 5 of 5

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CAMBRIDGE PARK TOWNHOUSES

Singe 1974
Surveyors Manner®
March 3, 2020
Justin Henderson
NCDENR — Division of Water Resources
450 W. Hanes Mill Road — Suite 300
Winston-Salem, NC 27105
Re: Cambridge Park Townhouses
Dear Justin:
N C Department of
Environmental Quality
Received
MAR 2 6 2020
Winston-Salem
Regional Office
Enclosed you will find a Fast -Track Sewer Application package for a proposed
subdivision in the City of Mebane for your review. Items included in this package
consists of; check for $480, FTA 04-16, FTSE 01-16, and USGS Map. This project is
called Cambridge Park Townhouses, located on Jones Drive in Mebane, NC. This phase
consists of 83 townhouse units for sale and is part of a larger subdivision. This project is
served by an onsite gravity sewer system flowing to a proposed pump station than
ultimately tying on to an existing City of Mebane sewer system. At this time we are
permitting this as `zero flow' since the downstream force main has not been placed in
service yet. Feel free to contact me with any questions or comments.
Sincerely,
_140 *"
Dave Southard
Project Manager
4609 Dundas Drive
Greensboro, NC 27407
Phone [phone]
Fax [phone]
License #C-0168

®5lacc 1974-m
Surveyors Planners
Evans Engineering, hie.
4609 Dundas Drive
Greensboro, NC 27407
Phone[phone]
Fax [phone]
License #C-0168
NC Department of
Environmental Quality
Received
MAR 2 6 2020
Letter of Transmittal Winston-Salem
1' Regional Office
Attention: 3u6rtu #yEtJbEPfoo14 Date: 3��4 �Zo
tA6M4P-UVI"PA CFWATER RaftUP 6(7 Client/Project: 125 36,
4490 W. 444sys Mtu. 20 4Pw% -f- 30o Reason: Goucictroae FA9V- rcwtJ S
WtnWa4-S14LU".0 n46 211cS `EWER M94AI-rnwn
We are sending: 21' Attached ❑ Under separate cover via _ the following items
❑ Shop Drawings
❑ Sample
❑ Prints/Plans/Specs
❑ Other
❑ RFI
Copies
Document Date
Number
Description
I+ I oRl .
/�PVLIGA'r'iorl
1+1 Cairn.
Nctrh MdP
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These are transmitted as checked below:
I"for approval ❑ Approved as submitted
❑ for your use ❑ Approved as noted
❑ as requested ❑ Returned for corrections
❑ for review and comment ❑ Other
❑ Pricing: Bids due
Remarks:
❑ Resubmit copies for approval
❑ Submit copies for distribution
❑ Return copies
Copy to:
Si;ned:��4t So�7ti-LCR(� --