WQ0039868_Issuance of Permit_20180320

ROY
COOPER
�:• Gover,M,
MICHAEL S REGAN
secretary
LINDA CULPEPPER
Watet Resources
Interim Drttcla
Enti noninental Quality
March 20, 2018
Rick Overturf, President—Board of Directors
Triangle Church of Christ RECE VED!DENRIDWR
5510 Barbee Chapel Rd
Chapel Hill, NC 27517 MAR 2 6 20'8
Resources
Subject Permit No WQ0039868 peermrmittingr ng Section
Triangle Church of Christ
Triangle Church of Christ- Private
Wastewater Collection System Extension Permit
Durham County
Dear Mr Overturf
In accordance with your application received February 2, 2018, and additional information received on
March 18,2018,we are forwarding herewith Permit No WQ0039868 dated March 20,2018,to the Triangle
Church of Christ (Permittee) for the construction and operation upon certification of the subject
wastewater collection system extension This permit shall be effective from the date of issuance until
rescinded and shall be subject to the conditions and limitations as specified therein This cover letter shall
be considered a part of this permit and is therefore incorporated therein by reference
Please pay particular attention to the following conditions contained within this permit
Condition II 1 This permit shall not be automatically transferable, a permit modification request for a
name change must first be approved by this office
Condition II 4 Requires that the wastewater collection facilities be properly operated and maintained in
accordance with 15A NCAC 2T 0403 or any individual system-wide collection system
permit issued to the Permittee
It shall be the responsibility of the Permittee to ensure that the as-constructed project meets the
appropriate design criteria and rules Failure to comply may result in penalties in accordance with North
Carolina General Statute §143-215 6A through §143-215 6C, construction of additional or replacement
wastewater collection facilities, and/or referral of the North Carolina-licensed Professional Engineer to the
licensing board
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the right to
request an adjudicatory hearing upon written request within 30 days following receipt of this permit This
request must be in the form of a written petition, conforming to Chapter 150B of North Carolina General
Statutes, and filed with the Office of Administrative Hearings, 6714 Mail Service Center, Raleigh, NC 27699-
6714 Unless such demands are made, this permit shall be final and binding
Division of Water Resources,Raleigh Regional Office,Water Quality Operations Section www ncwaterquality org
1628 Mail Seivice Center,Raleigh NC 27699-1628 Phone [phone]
location 1800 Ranett Dove Raleigh-NC 27609 Fax [phone]

Triangle Church of Christ—Private
Permit No WQ0039868
If you need additional information concerning this matter, please contact Jason Robinson at (919) 791-
4200or via e-mail at Jason T Robinson@ncdenr gov
Sincerely,
ceji /
for Linda Culpepper
Interim Director, Division of Water Resources
byS Daniel Smith, Regional Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, NCDEQ
cc Debra Ferm, PE @ Withers & Ravenel dfem@WithersRavenel corn
Stephanie Brixey of Durham County sbrixey@dconc gov
Durham County Health Department
Raleigh Regional Office Files
Water Resources Central Files
Page 2 of 8

• North Carolina Department of Environmental Quality
STATE OF NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENTAL QUALITY
WASTEWATER COLLECTION SYSTEM EXTENSION PERMIT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules, and Regulations, permission is hereby granted to the
Triangle Church of Christ
Durham County
for the construction and operation of approximately 555 linear feet of 8-inch gravity sewer, a 25—gallon
per minute grinder pump station with duplex pumps, on-site audible and visual high water alarms,
telemetry, and a permanent generator with automatic transfer switch, as well as approximately 550 linear
feet of 1 5-inch force main to serve a 1,492 seat church with a kitchen and ten-fixture park with restrooms
as part of the Triangle Church of Christ - Private project, and the discharge of 9,960 gallons per day of
collected domestic wastewater into Durham County's existing sewerage system, pursuant to the
application received February 2, 2018, and additional information received on March 18, 2018 and in
conformity with 15A NCAC 2T, the Division's Gravity Sewer Minimum Design Criteria adopted February 12,
1996 and updated in March 2008, as applicable, the Division's Minimum Design Criteria for the Fast-Track
Permitting of Pump Stations and Force Mains adopted June 1, 2000 and updated March 2008,as applicable,
and other supporting data subsequently filed and approved by the Department of Environmental Quality
and considered a part of this permit
This permit shall be effectiveyo the dat@-F3f issuance until rescinded and shall be subject to the specified
conditions ancHtii nitations 1taine ther in
h,7 �-h 7
Linda Culpepper
Interim Director, Division of Water Resources
By Authority of The Environmental Management Commission
Permit Number: WQ0039868
Permit Issued: March 20, 2018
Page 3 of 8

SUPPLEMENT TO PERMIT COVER SHEET
Triangle Church of Christ is hereby authorized to
Construct, and then operate upon certification the aforementioned wastewater collection extension The
sewage and wastewater collected by this system shall be treated in Durham County's Triangle Wastewater
Treatment Facility in accordance with Permit Number NC0039868
Permitting of this project does not constitute an acceptance of any part of the project that does not meet
15A NCAC 2T, the Division's Gravity Sewer Minimum Design Criteria adopted February 12, 1996 and
updated March 2008, as applicable, and the Division's Minimum Design Criteria for the Fast-Track
Permitting of Pump Stations and Force Mains adopted June 1, 2000 and updated March 2008, as applicable,
unless specifically mentioned herein Division approval is based on acceptance of the certification provided
by a North Carolina-licensed Professional Engineer in the application It shall be the Permittee's
responsibility to ensure that the as-constructed project meets the appropriate design criteria and rules
Construction and operation is contingent upon compliance with the Standard Conditions and any Special
Conditions identified below
I. SPECIAL CONDITIONS
1 This permit shall become voidable unless the agreement between Triangle Church of Christ and
Durham County for the collection and final treatment of wastewater is in full force and effect [15A
NCAC 02T 0304(h)]
2 Each pump station shall be clearly and conspicuously posted using a weatherproof sign with a pump
station identifying name/number, 24-Hour Emergency telephone number, and name of the
owner/operator of the sewer system/pump station and instructions to call the number in the event of
alarm activation or other emergency [15A NCAC 02T 0305(h)(2)]
II STANDARD CONDITIONS
1 This permit shall not be transferable In the event there is a desire for the wastewater collection
facilities to change ownership, or there is a name change of the Permittee, a formal permit request
shall be submitted to the Division accompanied by documentation from the parties involved, and other
supporting materials as may be appropriate The approval of this request shall be considered on its
merits and may or may not be approved [15A NCAC 02T 0104, G S 143-215 1(d3)]
2 This permit shall become voidable unless the wastewater collection facilities are constructed in
accordance with the conditions of this permit, 15A NCAC 2T, the Division's Gravity Sewer Minimum
Design Criteria adopted February 12, 1996 and updated March 2008, as applicable, the Division's
Minimum Design Criteria for the Fast-Track Permitting of Pump Stations and Force Mains adopted June
1, 2000 and updated March 2008, as applicable, and other supporting materials unless specifically
mentioned herein [15A NCAC 02T 0110]
3 This permit shall be effective only with respect to the nature and volume of wastes described in the
application and other supporting data [15A NCAC 02T 0110]
Page 4 of 8

4 The wastewater collection facilities shall be properly maintained and operated at all times The
Permittee shall maintain compliance with an individual system-wide collection system permit for the
operation and maintenance of these facilities as required by 15A NCAC 2T 0403 If an individual permit
is not required, the following performance criteria shall be met [15A NCAC 02T 0108(b)]
a The sewer system shall be effectively maintained and operated at all times to prevent discharge to
land or surface waters, and to prevent any contravention of groundwater standards or surface
water standards
b A map of the sewer system shall be developed and shall be actively maintained
c An operation and maintenance plan including pump station inspection frequency, preventative
maintenance schedule, spare parts inventory and overflow response has been developed and
implemented
d Pump stations that are not connected to a telemetry system shall be inspected every day (i e 365
days per year) Pump stations that are connected to a telemetry system shall be inspected at least
once per week
e High-priority sewer lines shall be inspected at least once per every six-months and inspections are
documented
f A general observation of the entire sewer system shall be conducted at least once per year
g Overflows and bypasses shall be reported to the appropriate Division regional office in accordance
with 15A NCAC 2B 0506(a), and public notice shall be provided as required by North Carolina
General Statute §143-215 1C
h A Grease Control Program is in place as follows
1 For public owned collection systems,the Grease Control Program shall include at least biannual
distribution of educational materials for both commercial and residential users and the legal
means to require grease interceptors at existing establishments The plan shall also include
legal means for inspections of the grease interceptors, enforcement for violators and the legal
means to control grease entering the system from other public and private satellite sewer
systems
2 For privately owned collection systems, the Grease Control Program shall include at least bi-
annual distribution of grease education materials to users of the collection system by the
permittee or its representative
3 Grease education materials shall be distributed more often than required in Parts (1) and (2)
of this Subparagraph if necessary to prevent grease-related sanitary sewer overflows
i Right-of-ways and easements shall be maintained in the full easement width for personnel and
equipment accessibility
j Documentation shall be kept for Subparagraphs (a) through (i) of this Rule fora minimum of three
years with exception of the map, which shall be maintained for the life of the system
Page 5 of 8

5 ;The Permittee shall report by telephone to a water resources staff member at the Raleigh Regional
Office, telephone number [phone], as soon as possible, but in no case more than 24 hours,
following the occurrence or first knowledge of the occurrence of either of the following
a Any process unit failure, due to known or unknown reasons, that renders the facility incapable
of adequate wastewater transport, such as mechanical or electrical failures of pumps, line
blockage or breakage, etc , or
b Any SSO and/or spill over 1,000 gallons, or
c Any SSO and/or spill, regardless of volume, that reaches surface water
Voice mail messages or faxed information is permissible, but this shall not be considered as the initial
verbal report Overflows and spills occurring outside normal business hours may also be reported to
the Division of Emergency Management at telephone number [phone] or [phone]
Persons reporting any of the above occurrences shall file a spill report by completing and submitting
Part I of Form CS-SSO (or the most current Division approved form) within five days following first
knowledge of the occurrence This report must outline the actions taken or proposed to be taken to
ensure that the problem does not recur Part II of Form CS-SSO (or the most current Division approved
form) can also be completed to show that the SSO was beyond control [G S 143-215 1C(a1)]
6 Construction of the gravity sewers, pump stations, and force mains shall be scheduled so as not to
interrupt service by the existing utilities nor result in an overflow or bypass discharge of wastewater to
the surface waters of the State [15A NCAC 02T 0108(b)]
7 Upon completion of construction and prior to operation of these permitted facilities, the completed
Engineering Certification form attached to this permit shall be submitted with the required supporting
documents to the address provided on the form A complete certification is one where the form is fully
executed and the supporting documents are provided as applicable Any wastewater flow made
tributary to the wastewater collect on system extension prior to completion of this Engineer's
Certification shall be considered a violation of the permit and shall subject the Permittee to appropriate
enforcement actions
If the permit is issued to a private entity with an Operational Agreement,then a copy of the Articles of
Incorporation, Declarations/Covenants/Restrictions, and Bylaws that have been appropriately filed with
the applicable County's Register of Deeds office shall be submitted with the certification.
A complete certification is one where the form is fully executed and the supporting documents are
provided as applicable Supporting documentation shall include the following
a One copy of the project construction record drawings (plan & profile views of sewer lines &force
mains) of the wastewater collection system extension Final record drawings should be clear on
the plans or on digital media (CD or DVD disk) and are defined as the design drawings that are
marked up or annotated with after construction information and show required buffers,separation
distances, material changes, etc
b One copy of the supporting applicable design calculations including pipe and pump sizing,velocity,
pump cycle times, and level control settings, pump station buoyancy, wet well storage, surge
protection,detention time in the wet well, and force main, ability to flush low points in force mains
with a pump cycle, and downstream sewer capacity analysis If a portable power source or pump
is dedicated to multiple stations, an evaluation of all the pump stations'storage capacities and the
Page 6 of 8

• rotation schedule of the portable power source or pump, including travel timeframes, shall be
provided
c Changes to the project that do not result in non-compliance with this permit, regulations, or the
Minimum Design Criteria should be clearly identified on the record drawings, on the certification
in the space provided, or in written summary form
Prior to Certification (Final or Partial) Permit modifications are required for any changes resulting in
non-compliance with this permit (including pipe length increases of 10% or greater, increased flow,
pump station design capacity design increases of 5% or greater, and increases in the number/type of
connections), regulations, or the Minimum Design Criteria Requested modifications or variances to
the Minimum Design Criteria will be reviewed on a case-by-case basis and each on its own merit Please
note that variances to the Minimum Design Criteria should be requested and approved during the
permitting process prior to construction After-construction requests are discouraged by the Division
and may not be approved,thus requiring replacement or repair prior to certification &activation [15A
NCAC 02T 0116]
8 Gravity sewers installed greater than ten percent below the minimum required slope per the Division's
Gravity Sewer Minimum Design Criteria shall not be acceptable and shall not be certified until
corrected If there is an unforeseen obstacle in the field where all viable solutions have been examined,
a slope variance can be requested from the Division with firm supporting documentation This shall be
done through a permit modification with fee Such variance requests will be evaluated on a case-by-
case basis Resolution of such request shall be evident prior to completing and submitting the
construction certification [ 15A NCAC 02T 0105(n)]
9 A copy of the construction record drawings shall be maintained on file by the Permittee for the life of
the wastewater collection facilities [15A NCAC 02T 0116]
10 Failure to abide by the conditions and limitations contained in this permit, 15A NCAC 2T, the Division's
Gravity Sewer Design Criteria adopted February 12, 1996 and updated March 2008,
as applicable,the Division's Minimum Design Criteria for the Fast-Track Permitting of Pump Station and
Force Mains adopted June 1, 2000 and updated March 2008 as applicable, and other supporting
materials may subject the Permittee to an enforcement action by the Division, in accordance with North
Carolina General Statutes §143-215 6A through §143-215 6C, construction of additional or
replacement wastewater collection facilities, and/or referral of the North Carolina-licensed Professional
Engineer to the licensing board [15A NCAC 02T 0104, 15A NCAC 02T 0108(b-c)]
11 In the event that the wastewater collection facilities fail to perform satisfactorily, including the creation
of nuisance conditions,the Permittee shall take immediate corrective action, including those as may be
required by this Division, such as the construction of additional or replacement facilities [15A NCAC
02T 0110, 15A NCAC 02T 0108(b)]
12 The issuance of this permit shall not exempt the Permittee from complying with any and all statutes,
rules, regulations, or ordinances that may be imposed by the Division any other Federal,State, or Local
government agencies which have jurisdiction or obtaining other permits which may be required by the
Division or any other Federal, State, of Local government agencies [G S 143-215 1(b)]
Page 7 of 8

FAST TRACK SEWER ENGINEERING CERTIFICATION •
PERMITTEE: Triangle Church of Christ
PERMIT#: WQ0039868
PROJECT: Triangle Church of Christ- Private
ISSUE DATE: March 20, 2018
This project shall not be considered complete nor allowed to operate in accordance with Condition 7 of this
permit until the Division has received this Certification and all required supporting documentation It
should be submitted in a manner that documents the Division's receipt Send the required documentation
the Regional Supervisor, Water Quality Regional Operations Section at the address at the bottom
Any wastewater flow made tributary to the wastewater collection system extension prior to completion of
this Certification shall be considered a violation of the permit and shall subject the Permittee to appropriate
enforcement actions The Permittee is responsible for tracking all partial certifications up until a final
certification is received A Final Certification shall be a complete set of record drawings and design
calculations regardless of whether partials have been submitted
PERMITTEES CERTIFICATION
I, the undersigned agent for the Permittee, hereby state that this project has been constructed pursuant
to the applicable standards & requirements, the Professional Engineer below has provided applicable
design/construction information to the Permittee, and the Permittee is prepared to operate & maintain
the wastewater collection system permitted herein or portions thereof
Printed Name,Title Signature Date
ENGINEERS CERTIFICATION
I, , as a duly registered Professional Engineer in the State of North Carolina,
having been authorized to observe( periodically,1 I weekly, full time)the construction of the project
name and location as referenced above for the above Permittee hereby state that, to the best of my
abilities, due care and diligence was used in the observation of the construction such that the construction
was observed to be built within substantial compliance of this permit, 15A NCAC 02T; the Division of Water
Resources' (Division) Gravity Sewer Minimum Design Criteria adopted February 12, 1996 and updated
March 2008, as applicable, the Division's Minimum Design Criteria for the Fast-Track Permitting of Pump
Stations and Force Mains adopted June 1, 2000 and updated March 2008, as applicable, and other
supporting materials
North Carolina Professional Engineer's Seal w/signature & date
Final ri Partial (include description)
Certification Comments/Qualifiers(attach if necessary):
Division of Water Resources,Raleigh Regional Office,Watei Quality Operations Section www ncwatei quality org
1628 Mail Service Center,Raleigh,NC 27699-1628 Phone [phone]
T nenfinn 'ARM R,,,Pit ri,,,,P Ro1a,n11 NT'r7Qn0 F.,. /C11017QQ_'71 ca

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Our People Your Success
February 2,2018
NC DEQ
1628 Mail Service Center
Raleigh,NC 27699-1628
RE Triangle Church of Christ Sewer Permit(private)
Dear Sir or Madam:
This letter is to serve as a request to permit the private sewer collection system extension for a church site in
Durham County The site is located on Page Road just west of its intersection with the Page Road Extension
and south of Hwy 70 in Durham,NC The project will serve a 1,492 seat congregation and a pavilion with of a
flow 9,960 gpd. The project also consists of a small_grinder pump station to serve the pavilion and 550 of
forcemain. The sewer will tie into the downstream collection system permitted under WQCS00038.
Attached please find the application with fee, an original and a copy of the FTA04-16,FTSE 04-16,and site
maps for your review and approval
If you have any questions or need any additional information,please feel free to contact me at 919-469-3340.
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115 MacKenan Drive I Cary,NC 27511
t 919 469 3340 I f 919 467 6008 I www withersravenel corn I License No C-0832
Cary I Greensboro I Pittsboro I Raleigh I Wilmington

State of North Carolina
Dw R
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 IN)Q.0 0 3 Q t 0 (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION
1 Applicant's name Triangle Church of Christ (company,municipality, HOA,utility,etc)
2 Applicant type ® Individual ❑ Corporation ❑ General Partnership ❑ Privately-Owned Public Utility
❑ Federal ❑ State/County ❑ Municipal ❑ Other
3 Signature authority's name Rick Overturf per 15A NCAC 02T 0106(b)
Title President-Board of Directors
4 Applicant's mailing address 5510 Barbee Chapel Road
City Chapel Hill State NC Zip 27517-
5 Applicant's contact information
Phone number [phone] Email Address rloverturf@aol corn
II. PROJECT INFORMATION:
1 Project name Triangle Church of Christ
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 Durham
4 Approximate Coordinates(Decimal Degrees) Latitude 35 93° Longitude -78 82° 4,
5 Parcel ID(if applicable) 0759-03-44-1782,0959-03-44-2227&0759-03-34-6944
(or Parcel ID to closest downstream sewer)
—
III. CONSULTANT INFORMATION: a) cm
1 Professional Engineer Debra Ferm License Number 028892
Firm WithersRavenel On
Mailing address 115 MacKenan Drive o L
a �
City Cary State NC Zip 27511-
Phone number [phone] Email Address dfem( WithersRavenel corn
IV. WASTEWATER TREATMENT FACILITY(WWTF)INFORMATION:
1 Facility Name TWWTP Permit Number NC0026051
Owner Name Durham County
V. RECEIVING DOWNSTREAM SEWER INFORMATION(if different than WWTF):
1 Permit Number(s) WQUNKNOWN- 1984 Downstream(Receiving) Sewer Size 8 inch
System Wide Collection System Permit Number(s)(if applicable) WQCS00038
Owner Name(s) Durham County
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
2 If the Applicant is a Developer of lots to be sold,has a Developer's Operational Agreement(FORM DEV)been attached?
El Yes ❑No ®N/A
3 If the Applicant is a Home/Property Owners'Association, has an Operational Agreement(FORM HOA)been attached?
El Yes ENO ®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))
I---->-Is there a Pretreatment Program in effect? ❑Yes ❑No
6 Has a 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 a,b No.of Units Flow
Churches with kitchen 5 gal/seat 1,492 7,460 GPD
Parks with restrooms 250 gal/plumbing fixture 10 2,500 GPD
gal/ GPD
gal/ GPD
gal/ GPD
gal/ GPD
Total 9,960 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 0114] shall be
determined using available flow data,water using fixtures,occupancy or operation patterns,and other measured data
8. Wastewater generated by project 9,960 GPD(per 15A NCAC 02T 0114)
D Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why
El 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 Sewers):
1 Summarize gravity sewer to be permitted
Size(inches) Length(feet) Material
8 417 PVC
8 138 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 Grinder Pump Station
2 Approximate Coordinates(Decimal Degrees) Latitude 35 56'04° Longitude -78 49'05°
3 Design flow of the pump station 0 036 millions gallons per day(firm capacity)
4 Operational point(s)of the pump(s) 25 gallons per minute at 38 feet total dynamic head(TDH)
5 Summarize the force main to be permitted(for this Pump Station)
Size(inches) Length(feet) Material
1 1/2 550 PVC
6 Power reliability in accordance with 15A NCAC 02T.0305(h)(I)
® 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(f)&(g) ❑Yes ❑No
D 15A NCAC 02T 0305(f)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) 18 inches
Water mains(horizontal) 10 feet
Reclaimed water lines(vertical-reclaimed over sewer) 18 inches
Reclaimed water lines(honzontal-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) 36 inches
D 15A NCAC 02T 0305(g)contains alternatives where separations in 02T 0305(f)cannot be achieved
D **Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
D If noncompliance with 02T 0305(f)or(g),see Section X of this application
2 Does the project comply with separation requirements for wetlands?(50 feet of separation) ® Yes ❑No ❑N/A
D See the Division's draft separation requirements for situations where separation cannot be meet
D No variance is required if the alternative design criteria specified is utilized in design and construction
D 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
D. 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?
D Information can be obtained from the 401 &Buffer Permitting Branch
5 Does project comply with 15A NCAC 02T 0105(c)(6)(additional permits/certifications)? /1 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, stormwater management plans,etc)
6 Does this project include any sewer collection lines that are deemed"high-priority?"
Per 15A NCAC 02T 0402, "high-priority sewer" means"any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer
❑Yes A. No ❑N/A
D 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. CERTIFICATIONS:
L Does the submitted system comply with 15A NCAC 021,the Miminium De'ien Critenu for the hermittitie of Pumn Station,'
and Force Main (latest%crsionl,and the Gra 'itv Sewer khiinnum oestrin Criteria tlatesi i.ctsioni as applicable?
Yes ❑No
If No,complete and submit the Vanance/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,_ ice re/Itte—N attest that this application for
(Professional Engineer's name from Application Item III L)
has been reviewed by me and is accurate,complete and consistent with the information supplied in the plans,specifications,
engineering calculations,and all other supporting documentation to the best of my knowledge. I further attest that to the best
of my knowledge the proposed design has been prepared in accordance with the applicable regulations, Gravity Sewer
Minimum Design Criteria for Gravity Sewers(latest version),and the Minimum Design Criteria for the Fast-Track Permitting
of Pump Stations and Force Mains(latest version) Although other professionals may have developed certain portions of this
submittal package,inclusion of these materials under my signature and seal signifies that I have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE —In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement,representation,or certification in any application package shall be guilty of a Class 2 misdemeanor,which may
include a fine not to exceed$10,000,as well as civil penalties up to$25,000 per violation.
North Carolina Professional Engineer's seal,signature,and date: ,`�`�,(`` iiC A4iR ffsf,,
[� d
, , 04 0 p4.,,, ,t.
F b 3 s & '�Z
I,,/ •.'2 is 1
(9' {
r •
_ ,,,,GJhf ¢.q. ,,``I—I2-I�
.,
3. Applicant's Certification per 15A NCAC 02T 0106(b)• °-othiiaiiinao
I, _ aje I d"L4 'Bob ri e 1uv !� attest that this application for
(Signature Authonty s name&title from Application Item 1.3.)
has been reviewed by me and is accurate and complete to the best of my knowledge I understand that if all required parts of
this application are not completed and that if all required supporting documentation and attachments are not included,this
application package is subject to being returned as incomplete. I understand that any discharge of wastewater from this non-
' discharge system to surface waters or the land will result in an immediate enforcement action that may include civil penalties,
injunctive relief,and/or criminal prosecution. I will make no claim against the Division of Water Resources should a condition
of this permit be violated. I also understand that if all required parts of this application package are not completed and that if
all required supporting information and attachments are not included, this application package will be returned to me as
incomplete
NOTE— In accordance with General Statutes 143-215.6A and 1-13-215.68, 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.
, /2
dir
lc, 1_,...._
Signature. i ±4111111P ' ! des 3a ;,„ i / Date. J iti
FORM:FTA 04-16 Page 5 of 5

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resource, Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: Durham County
Project Name for which flow is being requested: Triangle Church of Christ-Private
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: Triangle Wastewater Treatment Plant
b. WWTP Facility Permit#: NC0026051
All flows are in MGD
c. WWTP facility's permitted flow 12
d. Estimated obligated flow not yet tributary to the WWTP 2.0728
e. WWTP facility's actual avg. flow 4.8570
f. Total flow for this specific request 0.00996
g. Total actual and obligated flows to the facility 6.93974
h. Percent of permitted flow used 57.83
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 Average Daily Approx. Not Yet Total Current
Station Firm Flow** Current Avg. Tributary Flow Plus
(Name or Capacity,* (Firm/PD, Daily Flow, Daily Flow, Obligated Available
Number) MGD MGD MGD MGD Flow Capacity***
Stirruplron 3.751 1.500 1.142 0.20196 1.34396 0.15604
*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(p1)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.
Downstream Facility Name(Sewer): Durham County Sewer
Downstream Permit Number: WQCS00038
Page l of 6
FTSE 04-16

• III. Certification Statement:
I Stephanie Brixey 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 indicates acceptance of this wastewater flow.
Nkfitl 1Q5 IQ0Ik
Signing Official Signature Date
Page 2 of 6
FTSE 04-16

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Produced by MyTopo Terrain Navigator MILES
Topography based on USGS 124,000 0 100 200 300 400 500 600 700 800 900 SOUTHEAST DURHAM, NC
Maps 1—i .----1 YARDS 1--1 F 1998
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