WQ0040572_Application (FTSE)_20190110

ap, Odom
Engineering imw
January 2, 2019
Tim Heim
NCDEQ— Asheville Regional Office
2090 US Highway 70
Swannanoa, North Carolina 28778
Subject: Fast Track Sewer System Extension Application
Henderson County —The Hamlet
Dear Mr. Heim:
169 Oak Street • Forest City, NC 28043
office 828.247.4495 • fax [phone]
We are submitting a Fast Track Sewer System Extension Application for The Hamlet project located in
Henderson County. This submittal will include the following items:
• Fast Track Sewer Application
• Flow Tracking/Acceptance Form
• Application Fee
• USGS Topographic Map
If you have any questions or need additional information, please contact me at 828-247-4495 or
davidociom(@odomengineering.com.
Sincerely,
do -
David Odom, P.E.
bMcion of Watcr aesoume! -
JAN - 7 2019
i-z
Water ouelfty Raglonol operations
AshoN!Ve t7r.nl OfPce

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
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION
This application is for sewer extensions involving gravity sewers, pump stations and force mains, or any combination that has been
certified by a professional engineer and the applicant that the project meets the requirements of 15A NCAC 02T and the Division's
Minimum Design Criteria and that plans, specifications and supporting documents have been prepared in accordance with, 15A
NCAC 02T, 15A NCAC 02T.0300, Division policies and good enetneerine practices.
While no upfront engineering design documents are required for submittal, in accordance with 15A NCAC 02T .0305(b), design
documents must be prepared prior to submittal of a fast track permit application to the Division. This would include plans, design
calculations, and project specifications referenced in 15A NCAC 02T .0305 and the applicable minimum design criteria. These
documents shall be available upon request by the Division.
Projects that are deemed permitted (do not require a permit from the Division) are explained inFew):
303b JSProjects not eligible for review via the fast track process (must be submitted for full technical r➢ Projects that require an environmental assessment in accordance with 15A NCAC 1C .➢ Projects that do not meet any part of the minimum design criteria (MDC) document;- 7 2019
➢ Projects that involve a variance from the requirements of 15A NCAC 2T;➢ Pressure sewer systems utilizing septic tank -effluent pumps (STEPs) or simplex grindD STEP or simplex grinder pumps connecting to pressurized systems (e.g. force mains);b Pplonal OPnratlons
D Vacuum sewer systems.'.�� Ps'
General — When submitting an application, please use the following instructions as a checklist in order to ensure all required
items are submitted. Adherence to these instructions and checking the provided boxes will help produce a quicker review time
and reduce the amount of requested additional information. Failure to submit all required items will necessitate additional
processing and review time, and may result in return of the application. Unless otherwise noted, the Applicant shall submit
one original and one copy of the application and supporting documentation,
A. One Original and One Copy of Application and Supporting Documents
® Required unless otherwise noted
B. Cover Letter (Required for All Application Packages):
® List all items included in the application package, as well as a brief description of the requested permitting action.
➢ Be specific as to the system type, number of homes served, flow allocation required, etc.
➢ If necessary for clarity, include attachments to the application form.
C. Application Fee (All New and Major Modification Application Packages):
N Submit a check or money order in the amount of $480.00 dated within 90 days of application submittal.
➢ Payable to North Carolina Department of Environmental Quality (NCDEQ)
D. Fast Track (Form: FTA 04-16) Application (Required for All Application Packages):
® Submit the completed and appropriately executed application.
➢ If necessary for clarity or due to space restrictions, attachments to the application may be made.
® If the Applicant Type in Item 1.2 is a corporation or company, provide documentation it is registered for business with
the North Can Secretary of State.
❑ If the Applicant Type in Item 1.2 is a partnership or d/b/a, enclose a copy of the certificate filed with the Register of
Deeds in the county of business.
® The Project Name in Item 11.1 shall be consistent with the project name on the flow acceptance letters, agreements, etc.
® The Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a North
Carolina licensed Professional Engineer.
® The Applicant's Certification on Page 5 of the application shall be signed in accordance with 15A NCAC 02T .0106(b).
Per 15A NCAC 02T .0106(c), an alternate person may be designated as the signing official if a delegation letter is
provided from a person who meets the criteria in 15A NCAC 02T .0106(b).
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Pagel of 3

E. Flow Tracking/Acceptance Form (Form: FTSE 04-16) (If Applicable):
® Submit the completed and executed FTSE form from the owners of the downstream sewers and treatment facility.
➢ Multiple forms maybe required where the downstream sewer owner and wastewater treatment facility are different.
➢ The flow acceptance indicated in form FTSE must not expire prior to permit issuance and must be dated less than one
year prior to the application date.
D Submittal of this application and form FTSE indicates that owner Iran adequate capacity and will not violate G.SI43-
215.67(a).
➢ Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific FTSE.
F. Site Maps (All Application Packages):
® Submit an 8.5-inch x I l-inch color copy of a USGS Topographic Map of sufficient scale to identify the entire project
area and closest surface waters.
➢ Location of the project (gravity sewer, pump stations & force main)
➢ Downstream connection points and permit number (if known) for the receiving sewer
❑ Include a street level map (aerial) showing general project area so that Division staff can easily locate it in the field.
G. Existing Permit (All Modification Packages):
❑ Submit the most recently issued existing permit.
❑ Provide a list of any items within the permit the Applicant would like the Division to address during the permit
modification (i.e., permit description, flow allocation, treatment facility, etc.).
H. Power Reliability Plan (Required if portable reliability option utilized for Pump Station):
❑ Per ISANCACO2T0305(h)(1). submit documentation of power reliability for pumping stations.
➢ This alternative is only available for average daily flows less than 15,000 gallons per day
➢ It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant and is
compatible with the station. The Division will accept a letter signed by the applicant (see 15A NCAC 02T .0106(b)) or
proposed contractor, stating that "the portable power generation unit or portable, independently -powered pumping
units, associated appurtenances and personnel are available for distribution and operation of this pump 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. (Required at time of certification)
I. Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per 15A NCAC 02T .0115(a)(1) provide the Certificate of Public Convenience and Necessity from the North Carolina
Utilities Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served by
the sewer extension, or
❑ Provide a letter from the North Carolina Utilities Commission's Water and Sewer Division Public Staff stating an
application for a franchise has been received and that the service area is contiguous to an existing franchised area or
that franchise approval is expected.
J. Operational Agreements (Applications from HOA/POA and Developers for lots to be sold):
❑ Home/Property Owners' Associations
❑ Per 15A NCAC 02T 0115(c), submit the properly executed Operational Agreement (FORM: HOA).
❑ Per ISA NCAC 02T .0115(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
❑ Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(b), submit the properly executed Operational Agreement (FORM DEV).
For more information, visit the Division's collection systems website
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 2 of 3

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 ETA 04-I6 & SUPPORTING DOCUMENTATION
Application Number: (to be completed by DWR)
All items must be completed or the application will be returned
L APPLICANT INFORMATION:
1. Applicant's name: Simple Life -Hendersonville. LLLP (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: Mike McCann per 15A NCAC 02T .0106(b)
Title: Chief Executive Officer
4. Applicant's mailing address: 135 2n' Avenue North Suite 3
City: Jacksonville Beach State: Florida Zip: 32250-_
5. Applicant's contact information:
Phone number: (9oa) 685-7976 Email Address: [e-mail]
U. PROJECT INFORMATION:
1. Project name: The Hamlet
2. Application/Project status: 0 Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: WON and issued date:
If new construction but part of a master plan, provide the existing permit number: W000
3. County where project is located: Henderson
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.300115' Longitude:-82.391702o
5. Parcel ID (if applicable): 9588-81-1468
(or Parcel ID to closest downstream sewer)
1. Professional Engineer: David W. Odom License Number: 21130
Firm: Odom Engineering, PLLC
Mailing address: 169 Oak Sheet
City: Forest City State: NC Zip: 28043-_
Phone number: (M 247-4.495 Email Address: davidodom6fodomeneinerine corn
blos'en of VJulor aesourca9
3 JAN — 7 2019
Water 0..ab,
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: City of Hendersonville W WTP Permit Number: NC 0025534
Owner Name; City of Hendersonville
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different then WWTF):
1. Permit Number(s): WQ Downstream (Receiving) Sewer Size: _inch
System Wide Collection System Pei mit Number(s) (if ap I' able): WQCS_
Owner Name(s):
FORM: FTA 04-16 Pagel 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 Revelope's Operational Ae'ee ne rt (FORM: DEVI been attached?
❑ Yes ❑No ®N/A
3. If the Applicant is a Hone/Property Owners' Association, has sit Operational Ainceinciat (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 preparationtservice ❑ Hotel and/or Motels
❑ School / preschool / day care ❑ Medical / dental / veterinary facilities ❑ Swimming Pool /Clubhouse
❑ Food and drink facilities El Church ❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: >00%Domestic/Commercial _%Commercial
_ % Industrial (See 15A NCAC 02T 0103(20))
"Is there a Pretreatment Program in effect? [-]Yes [-]No
6. Hasa flow reduction been approved under I SA NCAC 02T 01 14(D? ❑ Yes ❑ No
➢ If yes. Provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114lD1
Daily Design Flow°'a
No. of Units
Flow
Campgrounds with water&sewer hookups
100 gal/campsites
141
14,100 PD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
14,100Q D
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.5 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: 14 100 GPD (per 15A NCAC 02T .01 14)
D Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
❑ Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit Number:
❑ Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain): _
FORM: FTA 04-16 Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) -02T .0305 & MDC (Gravity Selvers):
I. Summarize gravity sewer to be permitted:
Vlll.
1.
2.
3.
4.
5.
Size (inches)
Length (feet)
Material
8
4650
SDR-21 PVC
8
780
DIP
3�
➢ Section 11 & 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 sewers)
D Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
PUMP STATION DESIGN CRITERIA (If Applicable)—02T.0305 & MDC (Pump Stations/Force Mainsl:
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
Pump station number or name: SLI Lift Station
Approximate Coordinates (Decimal Degrees): Latitude: 35.299083' Longitude:-82.366666°
Design flow of the pump station: �03 millions gallons per day (firm capacity)
Operational point(s) of the pumps): 190 gallon per minute at 60 feet total dynamic head (TDH) ,
Summarize the force main to be permitted (for this Pump Station):
n
Size (inches) I Length (feet) I Material I JAN _ 7 niq
Wat r
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);
D Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
D Must be permanent o 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
03
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(0):
I. Does the project comply with all separations found in 15A NCAC 02T 0305(D & (a) ® Yes ❑ No
Setback Parameter*
Separation Ruired
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 sloe of embankment or cuts of feet or more vertical height
10 feet
Drama e systems and interceptor drains
5 feet
An swimming ools
10 feet
Final earth grade (vertical)
36 inches
D 15A NCAC 02T 0305(u) 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 welopme
D If noncompliance with 02T.0305(f) or (e) see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ®Yes, ❑ No ❑ N/A
➢ Seethe 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 .02007 ®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?
➢ Information can be obtained from the 401 & Buffer Permitting Branch
5. Does project comply with 15A NCAC 02T 0105(c)(6) (additional permits/certifications)? N Yes ❑ No
Per 15A NCAC 02T 0105(c)(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 15A NCAC 02T 0402, "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streand anks 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. CERTIFICATIONS:
I. Dues the submitted system comply with 156 NC_AC IT, the blmimnm Design C'.'u': lip the 1'e rapirg e of lhmp St�rions.
and pnrco Nn'tS lletust ve's'or0, and the'n.�' Sew_r Minimum Design Cr'ter'u (I^tee ve's'on as applicable?
® Yes ❑ No
If Nu, complete still submit the VurionedAlteritance Design Request application (VADC 10-14) and supporting documents
for tcvicw. Ardi of flic request is ell nrior to submi of the Fall Track Application and supporting
documents.
2. Prokssinnal Gtginecr's Certification:
1 David Odom, PE Latest that this application for
(Professional ingineer's name from Application Item 111.1.)
has been reviewed by me and is accurate, complete Laid consistent with the information supplied in Ilse plans, specifications,
engineering calculations, and all other snppnrLing 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 fluted version); and the Minimum Design Criteria for the Fast -Track
Permitting of Pump Stations and Farce Mains (hdest version). Although otter professionals may have dovcloped certain
portions of this submittal package, inclusion of these nationals under my signature and Load signifies that I have reviewed this
material and huvejodged it to be consistent with the pmPosed design.
NDTE— In accordance with General Statutes 143-2I5.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or cenific:dion in any application package shall be guilty of It Class 2 misdenreunur, which may
include a tine lotto exceed $10,000. as well as Evil penalties up to $25,000 per violation.
North Carolina Professional Engineer's seal, ligation u, and date:
3. Applicnnt'SCerlificntion per 15A NCAC O2T .0106(b):
la(s(Ig
1 Mike McCann, CEO attest that this npplicution for
(Signuturc Authority's name ,1: title from Application Item 1.3.)
hats been reviewed by one and is accurate and complete to the best of my knowledge. I understand that if till required Parts of
this application Lire 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 tram this non -
discharge system to surface waters or the lend will result in all immediale calm cement action that may include civi l penalties,
injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water Resources should It
condition of this permit be mlated. I also understand that fall required parts of Ihis application package are not completed
and that ifall required supporting information and attachments are not included, this application package will he 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, rcpres'entntfon, or ccdi0cntion in any application package shall be guilty ern Class 2 misdcmc:aor, which may
include It line not to exceed $10,000 Lis well as civil penalties up to $25,000 per violation.
Signature: 4 it � - Date: / 2-/ V&N
FORM: F'rA 04-16 Page 5 of 5

JAN - 'II19 State of North Carolina
+ ( Department of Environmental Quality
Division of Water Resources
' ti Il, •A 0' ; t ..a,T 1 Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: Simple Life -Hendersonville LLLP
Project Name for which flow is being requested: The Hamlet
More dma one FTSEmay be required for a slagle project lffhe Owner ofthe WWTP is not responslblefor all pump
smtious rtlong die route ofthe proposed wastOrater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. W WTP Facility Name: Hendersonville Water Treatment Plant
b. W WTP Facility Permit #: NC O0255 44
c. W WTP facility's permitted flow All flows are in MGD
d. Estimated obligated flow not yet tributary to the W WTP 4.8
0 07794
e. W WTP facility's actual avg. flow 2.880
f. Total flow for this specific request 0.01410 /
g. Total actual and obligated flows to the facility 2797
h. Percent of permitted flow used 61.9
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 W WTP:
(A) (B) (C) (D)=(B+C) (B)=(A-D)
Pum pain Design Obligated,
p p Avenge 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. MOD MOD Flow, MOD MGD
Flow Capacity"**
*The Firm Capacity (design fl
thow) of any pump station Is deYned as the maximum pumped flow
at can be achieved with the largestpump 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 connectionpointand the W WTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer):
Downstream Permit Number:
Page 1 of 6
FTSE 10-19

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