WQ0041066_Application (FTSE)_20190725

Transmittal Letter
Date: July 23, 2019
To: NC Department of Environmental Quality
Water Quality Section
450 W. Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
Phone # [phone]
Project: Universal Preserv-A-Chem
Mebane, NC
We Transmit:
(X) herewith
() under separate cover
NC Department of
Environmental Quality
Received
Project #: 18-022/D
For Your:
() approval
(X) review and comment
() use
JUL 2 5 2019
Winston-Salem
Regional Office
Copies Date Description
2 Fast Track Sewer System Extension Application (FTA 04-16)
1 $480.00 Application Fee
2 USGS Location Map, Vicinity Map
Comments:
The proposed project is to install a private pump station and force main to serve an industrial
building expansion located on Park Center Drive in Mebane, NC. The proposed force main will
tie into an existing public sanitary sewer main located in the northern right-of-way of Park Center
Drive. The total length of private force main to be permitted under this application is approximately
988 linear feet. If you have any questions or require additional information, please call.
Copies: File
Submitted by:
L. Allan Hill, P.E.
L. AUai/haV
Chief Civil Engineer
4807 - C Koger Boulevard, Greensboro, NC 27407 1 T - 336-218-8282 F - 336-218-8010 1 www.triad-designgroup.com

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: -WO(to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: A Samet 2390 Park Center Drive. LLC (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: Arthur Samet per 15A NCAC 02T .0106(b)
Title: Mamuz
NC Department of
4. Applicant's mailing address: 309 Gallimore Dairy Road, Suite 102 Environmental Quality
City: Greensboro State: NC Zip: 27409-_ R2C21Ved
5. Applicant's contact information: t x. JUL 2 5 2019 -;
Phone number: [phone] Email Address: asametna sametcom com 3 i Winston-Salem }
Regional Office
H. PROJECT INFORMATION:
1. Project name: Universal Preserv-A-Chem
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: WQ00_
3. County where project is located: Alamance
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.086°Longitude: -79302'
5. Parcel ID (if applicable): 172591
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: L. Allan Hill, P.E. License Number: NC 15809
Firm: Triad Design Group, PC
Mailing address: 4807 Koger Boulevard, Ste C
City: Greensboro State: NC Zip: 27407
Phone number: [phone] Email Address: ahillntriad-designproull.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Ci1y of Mebane W WTP Permit Number: NC 0021474
Owner Name: City of Mebane
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than W WTF):
1. Permit Number(s): WQ_ Downstream (Receiving) Sewer Size: _ inch
System Wide Collection System Permit Number(s) (if applicable): 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 Developer's Operational Agreement (FORM: 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: 8 % Domestic/Commercial N/A % Commercial
922 % Industrial (See 15A NCAC 02T .0103(20))
"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 cony of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f)1
Daily Design Flow',b
No. of Units
Flow
Manufacturing
25 gal/employee/shift
30
750 GPD
Process Waste
8700 gal/day
1
8700 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
9450 GPD
a See 15A NCAC 02T .0114(bt(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-41.
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: 9.450 GPD (per 15A 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

VIL GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
➢ 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: Private Pump Station 2
2. Approximate Coordinates (Decimal Degrees): Latitude: 36.086° Longitude:-79.302°
3. Design flow of the pump station: 0.00945 millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): 54 gallons per minute at 60 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
4
988
HDPE
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(f) &(a) ® Yes ❑ No
➢ 15A NCAC 02T.0305(f) contains minimum separations that shall be Drovided 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 Df.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
➢ 15A NCAC 02T.0305(e) contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webnee
➢ 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
➢ 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 213.0202
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)? ® 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 ® 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:
1. Does the submitted system comply with I SA NCAC 02T, the Minimum Design Criteria for the Permitting of Pump Stations
and Force Mains (latest version), and the Gravi1y Sewer Minimum Design Criteria (latest version) as applicable?
® Yes ❑ No
If No, complete and submit the Variance/Altemative 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, L. Allan Hill, PE attest that this application for
(Professional Engineer's name from Application Item III.1.)
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans, specifications,
engineering calculations, and all other supporting documentation to the best of my knowledge. I further attest that to the best
of my knowledge the proposed design has been prepared in accordance with the applicable regulations, Gravity Sewer
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track Permitting
of Pump Stations and Force Mains (latest version). Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that I have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.613, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $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):
�.........,�N... �,,,............. .
r=OP��ess,oa`�
7/z3%�iq
I, Arthur Samet 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 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.
Date: / I
FORM: FTA 04-16 Page 5 of 5

State of North Carolina
Department of Environmental Quality
Division of Water Resources
,K t Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Ijequesting Allocation: A Samet 2390 Park Center Drive, LLC
Project Name for which flow is being requested: Universal Preserv-A-Chem (PRIVATE)
More than one FTSE may be required for a single project ifthe 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 Mebane
b. WWTP Facility Permit M NCO021474
All flows are in MGD
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
2.5
.620
1.45
0.00945 MGD
2.07
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)
Design
Pump
Average Daily
Station
Firm Flow**
(Name or
Capacity, * (Firm / pl),
Number)
MGD MGD
Fieldstone 1.58 .633
(B)
(C)
(D)=(B+C)
(E)=(A-D)
Obligated,
Approx.
Not Yet
Total Current
Current Avg.
Tributary
Flow Plus
Daily Flow,
Daily Flow,
Obligated
Available
MOD
MGD
Flow
Capacity***
.372
.142
.514
0.119
* The Firm Capacity of any pump station is defined as the maximum pumped flow that
can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking
factor (pf) not less than 2.5.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): City of Mebane - NCIC Phase 3
Downstream Permit Number:
Page 1 of 6
FTSE 04-16

III. Certification Statement:
I Chris Rollins, Acting City Manager 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.
Signing Official Signature
MPMe
Page 2 of 6
FTSE 04-16

m
Ci
U
c
m

me to the Alamance County GIS Site. THIS IS NOT A LEGAL DOCUMENT. Alamance County shall assume no liability for any errors, omissions, or Inaccuracies in the inl
or actions taken or not taken by user in reliance upon any information or data furnished hereunder. The user knowingly waives any and all claims for damages s
TY GIS SYSTEM that may arise from the mapping data. The well & septic layer is a representation of well and septic data collected or plotted by the Alamance Cou
nent and training. GPS data collection began in 2013, it is not a complete representation of all parcels within the county that have wells and septic systems. This d
7RTANT NOTE: This web map is intended to provide general information as to the individual school attendance zones. The completeness or accuracy of the mapping

Henderson, Justin L
From: Allan Hill <[e-mail]>
Sent: Thursday, August 1, 2019 8:22 AM
To: Henderson, Justin L
Subject: [External] RE: Universal Preserv-A-Chem FTA
Good morning Justin. Hope you are doing well. The owner of the building and property located at 2390 Park Center
Drive (A Samet 2390 Park Center Drive, LLC) will retain ownership of the sewer extension. The system will remain
private and under single ownership. Do you need a letter from the owner stating this or will my email response be
sufficient? Thanks!
Best regards,
L. Allan Hill, P.E.
Principal
triaddesigngroup
4807-C Koger Boulevard
Greensboro, NC 27407
T-336-218-8282
F-336-218-8010
w triad-desianarouo.com
From: Henderson, Justin L [mailto:[e-mail]]
Sent: Thursday, August 01, 2019 8:03 AM
To: Allan Hill <[e-mail]>
Subject: Universal Preserv-A-Chem FTA
Allan,
Please confirm that the applicant intends to retain ownership of the sewer extension proposed by the subject project.
Thanks.
Justin Henderson
Environmental Specialist II
Winston Salem Regional Office
Division of Water Resources
[phone]
lusti n. henderson @ ncdenr.gov
Subscribe to Collection System & Sewer Permitting Updates