WQ0041092_Application (FTSE)_20190808

Division of Water Resources
State of North Carolina
Department of Enviromnental Quality
Division of Water Resources
ISANCAC 02T.0300—FAST TRACK SEWER SYS77EM EXTENSION APPLICATION
FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number. W o a o q� (I o be completedby DWR)
A[HIRms must be cormileted or the n1diciation will he returned
I. APPLICANT INFORMATION:
I. Applicant's name: lomm of Holly Sprinus (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State,County ® Municipal
3. Signature authority's name: Kgndra D. Parrish, P.E per
Title: Director ofEnn Ppr;,,�
4. Applicant's mailing address:Street
City; Holly Springs Stale: jC Zip- 275Q0-
5. Applicant's contact information.-
❑ Privately -Owned Public Utility
❑ Other
Phone number. (2& 5„ZS -; S Fail Address: n
}a-,, i�
�11. PROJECT INFORMATION: s O1rt"Q "Q�'1tj nol SfrtS
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l_ Project name; UNC Rex Community Heafth Campus
2. ApplicationlProject status; x❑ Proposed(New Permit) ❑ Eximing Penh/Project
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If a modification, provide the existing permit number WQ00 and issued date:
If new construction but part of master plan, provide the existing permit number. WQ00
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3. County where project is located: Wake
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4. Approximate Coordinates (Decimal Degrees): latitude: 35•642 ° Longitude: -78c
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5. PamID {if applicable): 06488839641064868679710648897356
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'Parcel
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
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I. Professional Fnginecr.Jamie Powless license Number 38704
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Firm CALYX Engineers+Consultants
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Mailing address: 6750 Tryon Road
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City: Cary State: NC Zip: 27518
Phone number. U 858-1842 Snail Address: [e-mail]
1V. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Permit Number: NCO063096
Owner Name: Town of Holly 5 lriLS
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Numbcr(s): W4L6MOki542.8 Downstream (Receiving) Sewer Sine: . L inch
System Wide Collection System Permit Number(s) (if applicable): WQCS 0Of9Z
Owner Name(s): W
FORM: FTA 04-16
Page 1 of 5

VL GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Ut$ity, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑ No [9N/A
2. If the Applicant is a Developer of lots to be sold, has a p .s 1�kper'; ±cr,1laonil I AgL 27.1I fQU ! been attached?
❑ Yes ❑No ®NIA
3. If the App licant is a I is}cm.- y4F i --QRNJ: HUAi been attached?
❑ Yes ❑ No 91NIA
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 19) 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/Connntercial % Commercial
% Industrial &r� . NCAt_; 02T ,010.12[)
�Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under ? ❑ Yes M No
7. Summarize wastewater generated by project:
Establishment Type (see I1IT&1140
Hospital
Daily Design Flow '-b
gal/
gall
gal/
gal/
gal/
gal/
Na of Units
r' D
Total Id 7 CiPD
a See 15A NCAC. 02T .0114(b).{ill (e](l) and feif2l 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 orcast ofthe Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in G.S. 42A 4).
b Per 15A NCAC 02T .0 },�sigg flow rates for establishments not identified [in table L5A_NCAC 02T.0114] shall be
determined usin ailable flow data, wa sing fixtures, occupancy or operation patterns, and other meas ured data.
8. Wastewater enerat h 25,740
g y project: _ CAD t T i)
Do not include future ow _ permitted allocations
If permitted flow is am, indicate why:
❑ Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this lure
❑ Flow has already been allocated in Permit Number
❑ Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain):
FORM: FTA 04- l 6 Page 2 of 5

VIL GRAVITY SEWER DESIGN CRITERIA (If Applicable)-02T,0305 & MK (Qrgwity; Sewers):
1. Summarize gravity sewer tobe permitted:
Size(inches) Length (feet) Material
8 324 PVC
8 221 DIP
➢ Section 11 & III of the MDC for Permitting of Cdavity Sewers contains information related to design criteria
➢ Section III contains information related to minimum slopes for gravity sewcr(s)
➢ O%ersizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — :1 ,U3U5 & AJUL U,ump Stal[flm,,,yprct :49aini l:
1. Pump station number or name;
2. Apprordmate Coordinates (Decimal Degrees): Latitude: Longitude: - -
3. Design flow of the pump station: millions gallons per day (firm capacity)
4. Operational point(s) of thepump(s): gallons per minute at feet total dynamic head CTDH)
5. Surmnarim the force main to be permitted (for this Pump Station):
Size¢nches) Length (feet) Material
6. Power reliability in accordance with IM NCAC 02T .0305(h )i D:
❑ Standby power sourceorpump 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'stotage
capacities and the rotation schedule of the portable power source or pump, including travel timefames, shall be provided
in the case of multiple station power outage.
FORM: FTA 04- l 6 Page 3 of 5

U(_
IX. SETBACKS & SEPARATIONS —(02B .0200 & 15A NCAC 02T.0305(1)): � ` G.--
1- Does the project comply with all separations found in 15 1C O ,I ,t1 051#1 tit es ❑ No
D 15A NCAC OZT.0305(e) contains alternatives where separations in QZI&3= cannot be achieved.
D •«Stream classifications can be identified using theDivision's NF,.
D If noncompliance with 02 0345(f),,,¢r(e), see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) x❑ Yes ❑ No
➢ Seethe 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
➢ As built documents should reference the location of areas effected
3. Does theproject comply with all setbacks found in theriver basin rules per 15A NLAC 02 7 ® Yes ❑ No
➢ This would include Trout Buffered Streams per 15A NCAC 213.0202
4. Does the project comply with an individual 404 Permit or any 401 Certifications? NIA ❑ Yes ❑ No
D Wetland -related permits shall be requested,obtained,and adhered to for projects that impact wetlands or surface waters
D Information can be obtained from the; tins ,c,
5. Does project comply with L�f1 Cf C OZI.D1DSEr.1! f�3 (additional permits/certifications)? IN Yes ❑ No
Per IM NCAC' 07 1 dLQaUUJ, directly related environmental pernrits or certification applications are being prepared, have
been applied for, or have been obtained. Issuanceofthis permit is contingent on issuance of dependent permits (erosion and
sedimentation control plans, slormwater management plans, etc.).
6. Does this project include any sewercoIlection 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 ordeteriorates the sewer.
❑ Yes ® No
➢ If yes, include an attachment with details for each fine, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at leastonce 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. Does the submitted system comply with I5A NCAC 02T. the htu,in,Wrn I]chign Criteria fnr the Perrnil inL of Punter Siatinms
iad l-orcc M aims {latest version). and the On, v mt Y Scwcri v as applicable?
®Yes ❑No
If No, complete and submit the VarianceAltemative Design Request application (VADC I0-14) and supporting documents for
review. Ap rrn oval of the request is required prior to submittal of the Fast Track „Application and sulgl2rting_documents
2. Professional Engineees Certification:
I, Jamie Powless
(Professional Engineer's name from Application Item 111.1.)
attest 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 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 143-215.6D, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 nsdemeanor, 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 Cerlificption per 15A NF3,AC 02T .0106(b):
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�F1ESS/p�l�
2 ¢ SEAL 9r
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r I attest that this application for
atureAuth rity's name & title from Application Item 1.3.)
has been reviewed by me and is accurate and complete to the bestof 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. 1 understand that any discharge of wastewater from this non -
discharge systemto surface waters orthe land will result in an immediate enforcement action that may include civil penalties,
injunctive relief, andlorcriminal prosecution, I will make no claim against the Division of Water Resources should a condition
of this pemvt be violated. I also understand that if all required parts of this application package are not completed and t hat 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 143-215.613, 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.
Signature: y Date-.
FORM: FTA 04-16 Page 5 of 5

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation:
Project Name for which flow is being requested: UNC Rex Community Health Campus
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.
11.
a, WWTP Facility Name: Utley Creek Wastewater Treatment Plant
b. WWTP Facility Permit M NC 0063096
All flows are in MG
c. WWTP facility's permitted flow 6.0
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 • w
Complete this section for each pump station you are responsible for along the route of iiis
proposed wastewater flow. U
z
List pump stations located between the project connection point and the WWTP:
`-9
(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 i pl),
Daily Flow,
Daily Flow,
Obligated
Available
Nu bber) MGD
MGD
MGD
MGD
Flow
Capacity***
* 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): Wh .
Downstream Permit Number;
Page I of 6
FTSE 04-16

III. Certification ement:
I certify to the best of my knowledge that the addition of
the o ume of was water 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 acceptagee of this wastewater flow.
Date
Page 2 of 6
FTSE 04-16

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0.0 0.1 0.2 0.3 0.4 0.5 0.6 KILOMETERS
078 ° 49' 3 .0000" W 078 ° 49'
Location: 035 ° 38' 28.7806" N, 078 ° 49' 44.8944" W
Caption: «Type caption here.»
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11=4CALYX
ENGINEERS + CONSULTANTS SUL ANTS
14C Dept of Environmental Quality
ALIG - R 2019
Raleigh Regional Office
TO: NCDEQ DWR
FROM: Jamie Powless, CALYX Engineers
RE: UNC Rex Community Health Campus Sanitary Sewer Permitting Cover Letter
DATE: 06.24.19
This project consists of installation of 545 if of 8"public sanitary sewer line to serve a new hospital Holly
Springs. The improvements include 221 If of DIP, 324 If of PVC pipe sewer main and 4 manholes. The
hospital will have 48 beds on opening day with space provided for future expansion to 72 beds. The total
anticipated flow for the hospital is 25,740 GPD calculated based on 72 beds.
SANITARY SEWER FLOW
Total number of proposed beds, 48
Total Building SF: 227,000 SF
• SF associated with Beds: 156,000
• SF associated with Auxiliary Services: 46,000
o Auxiliary Services include: registration, administration, building support, materials
management, etc
• SF reserved for future Bed Expansion (Shell Space): 25,000 SF
Future Bed Expansion: 24
Wastewater Flow Allocation per 15A NCAC 02T. 01114, 300 gallons per bed
Wasterwater flow determination per DEQ: 72 beds " 300 GPD/bed = 21,600 GPD.
Wasterwater Flow (Beds): 21,600 GPD
Auxiliary Services wastewater flow allocation: Utilizing Town of Holly Springs standards for office and
institutional uses, an average daily wastewater flow of 0.09GPDISF can be used to calculate additional
wastewater can be allocated for the square footage associated with Auxiliary Services:
Auxiliary Services, SF: 46,000 SF
Wastewater Flow, Auxiliary Services: 0.09 GPD/SF ' 46,000 SF = 4,140 GPD.
Wastewater Flow(Auxiliary Services): 4,140 GPD
TOTAL WASTEWATER FLOW: 25,740 GPD
6750 Tryon Road, Cary, NC 27518 P 919.836.4800 F 919 B51 1918 CAMengineers com

CALYX -
ENGINEERS + CONSULTANTS
These improvements are scheduled to be installed as soon as permitting allows.
The following items are enclosed with this permit application package:
• Application fee
• Fast Track Form FTA 04-16
• Flow Tracking Acceptance Form
• Site Maps
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Please contact me at 919-858-1842 or ' owless cal xen ineers.com if there are any questions or if
additional information is required.
Sincerely,
Jamie Powless, PE
Project Manager
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6750 Tryon Road, Cary, NC 27518 P 919 836.4800 F 919.851 191a

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THE TOWN OF 01�y CY
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August 5, 2019
Director, Division of Water Resources
Raleigh Regional Office
Water Quality Operation Section
1628 Mail Service Center
Raleigh, NC 27699-1628
Re: Application for Sewer Extension Permit
Project: UNC Rex Community Health Campus
Dear Sir or Madam:
NC Dept of Environmental Quality
AUG - 8 2019
Raleigh Regional Office
Please find enclosed the following items in application for a sewer extension permit to the Town
of Holly Springs existing sewer distribution system:
0 One original and one copy cover letter including a project narrative
o A check in the amount of $480.00
0 One original and one copy of the State of North Carolina !'ast Track Sewer System
Extension Application (FTA 04-16)
0 Two copies of FTSE 04-16 Flow Tracking/Acceptance Form
0 Two color copies of a 8.5-inch by 11-inch portion of a 7.5 minute USGS Topographic
Map showing project area
0 Two copies of a street Ievel map showing all relevant project areas
0 One copy of the locally -required Design and Application Certification
Feel free to contact me at 919-557-3938 should you have any questions or need additional
information in order to process this application.
Sincerely,
Kendra D. PaPh, P.E., CFM
Director of Engineering
KP/se
cc: Project Consultant Engineer, Jamie Powless, CALYX Engineers
Administrative Manager (for addition to sewer permit log)
Rodney Campbell, Development Administrator
Project file/Correspondence #41750
3002
04 17.201 R
Enginling eparbnent
P.O. Box 8 • 128 S. Main Street • H lly Springs, NC 27540 • www.hollyspringsnc.us

DO NOT SUBNHT SEWER EXTENSION APPLICATIONS UNTIL
CONSTRUCTION DRAWINGS HAVE BEEN APPROVED BY STAFF!
Sewer Design and Application Certification
Note: This form must be submitted with the Fast -Tract Application for Gravity Sewem. um
Stations, and Force Mains for extension to the Town of Holly Springs Sewer System
Project: UNC Rex Community Health Campus a
Design Engineer:
Jamie Powless
Address: 6750 Tryon Road Cary, NC
Phone Number: 919-858-� Email: [e-mail] o
Date Complete Application Package Received by Town: �-S —C
U
Date Approved: ��/ — (by RLC) (by KDP)
As design engineer for this project, I certify the following (please check (x) each applicable box):
That the design of the project is in complete conformance with Town of Holly Springs
Engineering Design and Construction Standards and NCDENR Sanitary Sewer Design
Regulations;
[tf That each of the following items are completed and enclosed for submittal to the State for
a sewer extension permit:
0 One original and one copy cover letter including a project narrative
o A check in the amount of $480.00 to DENR
o A check in the amount of $200.00 Town processing fee
0 One original and one copy of the State of North Carolina Fast Track
Application for Gravity Sewers, Pump Stations, and Face Mains
0 Two copies of FTSE 08-13 Flow Tracking/Acceptance Form
0 Two color copies of a 8.5-inch by l 1-inch portion of a 7.5 minute USGS
Topographic Map showing project area
0 Two copies of a street level map showing all relevant project areas
0 One copy of the locally -required Design and Application Certification
Design Engineer's Signature
In addition, once your construction drawings are approved and this application is complete, you
will receive a copy of the Town's letter of transmittal to the State as your confirmation that the
application is complete and has been forwarded to the State for permitting. Please contact Sara
Emig at [phone] if you do not receive this confirmation or if you have any questions.
Engineering Department - P.O. Bar 8, Holly Springs, NC 27540
919-557-3938 - 919-552-9881 (fax)
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2003 Sewer Design Application Certification
04.I 1,2018

Cashion, Ted
From:
Jamie Powless <Jamie. [e-mail] >
Sent:
Wednesday, September 18, 2019 2:57 PM
To:
Sara Emig; Cashion, Ted; Drew Johnson; Robinson, Jason; Kendra Parrish
Cc:
Bobby Boling
Subject:
RE: [External] RE: RE: Rex Sewer Permit
External email. Do not click Rnks of open attachments unless you verify. Send all -suspicious emall as an attaaF m6rit to
Ted,
The project complies with the separation requirements. Please check the yes box and thank you for your willingness to
mark the box to help expedite.
Jamie Powless, PE I Land Development Project Manager I NV5 CALYX
CALYX Engineers and Consultants —An NV5 Company
6750 Tryon Road I Cary, NC 27518 1 P: 919.858.1842 1 C: 919.452.7963
From: Sara Emig <[e-mail]>
Sent: Wednesday, September 18, 2019 2:04 PM
To: Cashion, Ted <[e-mail]>; Drew Johnson <[e-mail]>; Robinson, Jason
<[e-mail]>; Kendra Parrish <[e-mail]>
Cc: Jamie Powless <[e-mail]>; Bobby Baling<[e-mail]>
Subject: RE: [External] RE: RE: Rex Sewer Permit
Jamie,
As the Design Engineer, will you please advise on the other comment regarding item IX.1?
Thanks,
Sara Emig
Administrative Manager
Kngincering Department
Town of Holly Springs
P.O. Box 8 1 128 S. Main Street
HoIIY Springs, NC 27540
r Direct 919-557-3925
� 1
From: Cashion, Ted <ted.cashion(a ncdenr.gov>
Sent: Wednesday, September 18, 2019 11:50 AM
To: Drew Johnson <[e-mail]>; Robinson, Jason <[e-mail]>; Kendra Parrish
<kendra.parrish@hollysr)ringsnc.us>
Cc: Sara Emig <[e-mail]>; ' owless cal xen ineers.com; Bobby Baling
<[e-mail]>
Subject: RE: [External] RE: RE: Rex Sewer Permit
Thanks Drew

Cashion, Ted
From:
Drew Johnson<[e-mail]>
Sent:
Wednesday, September 18, 201911:33 AM
To:
Cashion, Ted; Robinson, Jason; Kendra Parrish
Cc:
Sara Emig; [e-mail]; Bobby Boling
Subject:
[External] RE: RE: Rex Sewer Permit
+ Extema-11 emal. bo not a-114 li-ks or open attachments unless you verify_ Send all susplcious email as an attachment to
c, ov
Ted,
There are no high priority or aerial lines associated with the Rex project.
Thank you,
j9~ V 546m
Town of Holly Springs I Engineering Department
128 S. Main St. I Holly Springs, NC 27540
[phone] (0) 1 drew.iohnson hall s rin snc.us (E)
Town of Holly Springs j Holly Springs Engineering
HOLLY
SPRINGS
From: Cashion, Ted <[e-mail]>
Sent: Wednesday, September 18, 201911:19 AM
To: Robinson, Jason <[e-mail]>; Kendra Parrish<[e-mail]>
Cc: Drew Johnson <[e-mail]>; Sara Emig <[e-mail]>;
[e-mail]
Subject: RE: RE: Rex Sewer Permit
Hi Kendra,
We are reviewing the UNC Rex community health campus fast -track sewer extension application. Item IX.1 on the
application was not marked as required. Please review and let us know how this should be marked. To expedite issuing
the permit we'll mark the box for you.
Also, from the topo submitted with the app, it appears there is/are surface waters on the site. Please confirm whether
there will be high priority/aerial lines in this project.
We'll issue the permit asap.
Thx
ted