WQ0040813_Application (FTSE)_20200616

State of North Carolina
DWR Department of Environmental Quality
Division of Water Resources
ISA NCAC 02T ,0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Divislon of Water Resources PTA 04-16 & SUPPORTING DOCUMENTATION
P (YYi e c DWR)
Application Number:1.Jt�Oli�iJgI7J' � (tobosonrpietodbyAWlt)
All lttW§ must be completed or the annfleanon will be returned
1. APPLICANT INFORMATION:
1. Applicant's name; City of Mebane (company, municipality, HOA, utility, etc,)
2, Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership Q Privately -Owned Public Utility
❑ Fedora[ ® Stato/County ® Municipal ❑ Other
3, Signature authority's name: Qayid Cheek per ISA NCAC 02T.0106(b)
Title: City Managg Environmental Quality
4. Applicant's mailing address; 106 E. Washington St Received
City; Mebane State: NQ zip; 27302 JUN 12 2020
S. Applicant's contact information:
Winston-Salem
Phone number: (2& 53-59901 Email Address; dcheeMilcilyoftebang,roni Regional Office
II, PROJECT INFORMATION:
1, Project name: Conabridgg Park Phase 10
2, Application/Project status; ❑ Proposed (Now Permit) Existing Permit/Project
if a modification, provide the existing permit number: WQ0040g13 and Issued dato; J 22—I9
If now construction but part of a master plan, provide the existing permit number; WQ00
3, County where project is located: Alaminca
4, Approximate Coordinates (Decimal Degrees): Latitude: 36.0307461 Longitude:-?2.;Q$T@
5, Parcel ID (if applicable): 163252
(or Parcel ID to closest downstream sewer)
Ili. CONSULTANT INFORMATION:
1. Professional Engineer: Robert S. Dischinger License Number: HM
Firm: Evans Engineering, Inc
Mailing address; 4602 Dmmdas Dr
City: Greensboro State: NC• Zip: 27407-____
Phone number. QM 15A-8877 Email Address: rsdrdevans-eng,com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION.,
1. Facility Name; Graham WgI(ewalgg Treatment Plant Permit Number: N00021211
Owner Natuat City of Graham
V, RECEIVING DOWNSTREAM SEWER INFORMATION (ifdiffer@ntthanWWTF)t
1, Permit Number(s)t WQ 0482 Downstroatu (Receiving) Sewer Sloe: 4 inch
System Wide Collection System Permit Numbers) (if ap Itn •cabley WQCS 008I
Owner Namc(s): QItX of Mobanc
FORM; FTA 04.16 Page I of S

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 MN/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement _(FOP M: 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):
® 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(201)
L----*Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0 14(t)? [-]Yes ®No
➢ If yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(fil
Daily Design Flow a,b
No. of Units
Flow
480 gal/day
48
23,040 GPD
gall
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
23,040 GPD
a See 15A NCAC 02T .0l 14(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: 23 040 GPD (per 1 A 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):
FORM: FTA 04-16 Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T ,0305 & MDC (Gravity Sewersl:
1, Summarize gravity sewer to be permitted:
Size (Inches)
Length (feet)
Material
8"
1875.3
SDR35
8"
8703
DIP
Section II & Ill of the MDC for Permitting of Gravity Sewers contains information related to design criteria
A Section Ill contains information related to minimum slopes for gravity sewer(s)
B Oversizing lines to meet minimum slope requirement is not allowed and a vlolation of the MDC
VILE, PUMP STATION DESIGN CRITERIA (It Applicable)— 02T,0305 & MDC (Pump Stations/Force Mains)
COMPLETE FOR EACH PUMP SLUION INCLUDED IN THIS PROJECT
L Pump station number or name: —
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: - °
1 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 dynastic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (Incites) Length (feet) Material
6, Power reliability In accordance with ISA NCAC 02T ,0305(h)(1):
❑ Standby power source or pump with automatic activation and telemetry - ISA NCAC 02T ,0305(h)(l)(®)i
> Required for all pump stations with an average daily flow greater than or equal to IS,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(hXl)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry - ISA NCAC 02T .0305(h)(1)(C):
B 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 thueflttmes, shall be provided
In the case of a multiple station power outage,
FORM; PTA 04.16 Page 3 of

IX, SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T ,0305(f))r
1. Does the project comply with all separations found In I5A NCAC 02T .0305(f) & (e)
➢ I SA NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systoms;
Setback Parameter*
Separation Ro uitcd
-Storm sewers and other utilities not listed below vertical
24 inches
Water mains vertical -water over sewer including In benched tranchas
1.8 inches
Water mains horizontal
10 feet
Reclaimed water lines vertical - reclaimed over sewer
18 inches
Reclaimed water line horizontal - reclaimed over sewer
2 feet
**Any private or public water supply source, including any wells, WS-1 waters of Class 1 or
Class II impounded reservoirs used as a source of drinklop water
100 fiat
**Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SR 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 fact
Any basement
10 Not
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and Interceptor drains
5 feet
&U swimming ools
10 feet
Final earth grade vertical
36 inches
➢ 1 SA NCAC 02T,0305(a) contains alternatives where separations in 02T,0305(t) cannot be achieved,
➢ **Stream classifications can be identified using the Division's NC Wtace Water Classifications_wehnaae
➢ If noncomplianco with 02T,0305(1) or (u), sac Section X of this application
2. Does the project comply with separation requirements for wodands? (50 Not of separation) Z Yos [] No ❑ N/A
Y Soothe Division's draft separation requirennonts 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 affected
3. Does the project comply with setbacks found In the river basin rules per 15A NCAC 02B ,02007 0 Yes 0 No CK 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 Permitting Branch
5. Does project comply with ISA NCAC 02T,0105(cN6) (additional portults/certifioations)? ® Yes ❑ No
Per 15A NCAC 021.0105(cH61 directly related envirotunental permits or cortiftcation opplivations ore being prepared, have
been applied tor, 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, Duos this project Include any sewer collection lines that ore deemed "high-prtorhy?T'
Par ISA NCAC 02T.0402, "high-prtertty sewer" means "any aarial sewer, sower contacting surface waters, siphon, or sewer
positioned parallel to stroambanks that Is subject to erosion that undermines or dowlorates the sower.
Q Yes 0 No M N/A
➢ If yea, Include an attachment with details for each line, Including type (aerial line, aim, material, and location),
Hlgh priority Ross shall he Inspected by the pormitteo or its representative at loot once every six -months and inspaotions
documented per 16A NCAC 02T.0403(a)(S) or the permltco's Individual Systom-Wide Collection permit.
FORM; FTA 04-16 Page 4 of 5

X, CERTIFICATIONS:
1, Does the submitted system comply with ISA NCAC 02T. the Minimum Design Criteria for the Permitting of pump Stations
and Force Mains_ flatest version1 and the Gravity Sewer Minimum Design Criteria (latest version) as applicable?
® Yes E-71 No
If No, complete and submit the Variance/Alternativo Design Request application (VADC 10.14) acid supporting documents for
review. Approval of the regpest is required prior to submittal of the Fast Track Apnlleatton and sunnor tjpa documents,
2. Professional Engineer's Certification:
nLruF•;
that this application for
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 Sower
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast-Traok 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 m In accordance with General Statutes 143.215,6A and 143.2I5,6H, any person who knowingly makes any false
statement, representation, or cartifloation 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 data:
3. Applicant's Certification per ISA NCAC 02T A106(b):
David S.
(Signature Authority's name & title from
Yftyy4;
that this application for
has been reviewed by me and is accurate and complete to the bast 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 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 tmmedlete enfurcetnent action that may include civil penalties,
Nunotivc relief, stutter criminal prosecution, I will mako no claim agahnsttito Division of Watcr Resources should a condition
of this patult 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 143-21S,6A and 14)-2I5,,613 any person who knowingly makes any fhtso
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.
D.S.Cheek
Signature: Date; 5/7/2020
FORM: FTA 04-16 Page 5 of 5

—&am 1974=
Surveyors Planners
May 20, 2020
Justin Henderson
NCDENR — Division of Water Resources
450 W. Hanes Mill Road — Suite 300
Winston-Salem, NC 27105
Re: Cambridge Park Phase I Permit Modification for WQ0040813
Dear Justin:
Enclosed you will find a Fast -Track Sewer Application package for a proposed
subdivision in the City of Mebane for your review. This is a modification to Permit
#WQ0040813, this original permit had -0- flow allocated and this modification now
accounts for 23,040GPD of flow. Items included in this package consists of, check for
$480, FTA 04-16, FTSE 01-16, Flow Tracking/acceptance, approved permit WQ0040813
and USGS Map. This project is called Cambridge Park Phase 113, located on Jones Drive
in Mebane, NC. This phase consists of 48 single family lots for sale and is a phase of a
larger subdivision. This project is served by an onsite gravity sewer system flowing to a
proposed pump station (design/processing by others) than ultimately tying on to an
existing City of Mebane sewer system. Feel free to contact me with any questions or
comments.
Sincerely,
Dave outhard
Project Manager
4609 Dundas Drive
Greensboro, NC 27407
Phone [phone]
Fax [phone]
License #C-0168

State of North Carolina
Dw
Cxtv Department of Environmental Quality
.�.
Division of Water Resources
Oh'Isiou of watek Re=sources 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 Phase 1 B
More than one FTSE maybe required for a single project if the owner of the WWTP is not responsible for all pump
stations along the route of the proposed wastewaterflow,
1, 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 O021211
A11 flows are in MGD
c. WWTP facility's permitted flow 3.50
d. Estimated obligated flow not yet tributary to the WWTP .796860
e. WWTP facility's actual avg. flow 2.101
f. Total flow for this specific request .023040 - Meb Allocation
g. Total actual and obligated flows to the facility 2.897
h. Percent of permitted flow used 82,8%
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)m(A-D)
Design
Obligated,
Pump
Pump
Average
Approx.
Not Yet
Total Current
Station
Station
Firm Daily Flow**
Current
Tributary
Flow Plus
(Name or
Permit
Capacity, * (Firm / pt),
Avg. Daily
Daily Flow,
Obligated Available
Number)
No,
MOD MOD
Flow, MOD
MOD
Flow Capacity***
Cherry Lane 2.5 1,0 .017895 .750 .767 2341
* The Firm Capacity (design Bow) of any pump station is defined as the maximum pumped Bow
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
(pi) 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): Cherry Lane Force Main
Downstream Permit Number: WO 0029492
Page 1 of 6
FTSE 10-18

IIl. Certification Statement:
I Rankle Maness certify to the best of my knowledge that the addition of
the volume of wastowater to be permitted in this project has boon 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 sower overflows or overburden any downstream pump station on 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 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.
Signature
Signing
- r -.2 2 aa
Date
Rage 2 of 6
FTSE 10-18

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State of North Carolina
DW-R
Dlvlslon of Water Resources
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 lB
More than one FTSE maybe 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: Allocation to Graham WWTP
b. WWTP Facility Permit #: NC O021211
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 0.023040
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: W00040466
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.
Signing Official Signature
City Manager
Title of Signing Official
David S. Cheek
2020.06.02 07:34:52-04'00'
Page 2 of 6
Date
FTSE 10-18

CAMBRIDGE PARK - PHASE 1 B