WQ0041309_Application (FTSE)_20191118

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/Division of Water Resources
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State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
INSTRUCTIONS FOR FORM: ETA 04-16 & SUPPORTING DOCUMENTATION
This application is for sewer extensions involving gravity sewers, pump stations and force mains, or my 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, HA NCAC 02T.0300, Division Policies and good engineering 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 in t5A NCAC 02T.0303.
Projects not eligible for review via the fast track process (must be submitted for full technical review):
➢ Projects that require an environmental assessment in accordance with 15A NCAC 1 C .0100;
➢ Projects that do not meet my part of the minimum design criteria (MDC) document;
➢ Projects that involve a variance from the requirements of 15A NCAC 2T;
➢ Pressure sewer systems utilizing septic tank -effluent pumps (STEPS) or simplex grinder pumps;
➢ STEP or simplex grinder pumps connecting to pressurized systems (e.g. force mains);
➢ Vacuum sewer systems.
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 -reaview time
and reduce the amount of requested additional information. Failure to submit all ed //'((eaY�1 -I
I osisg1bif \ ditional
processing and review time, and may result in return of the application. Unless sA, hotddt l�p Y Y 1 submit
one original and one copy of the application and supporting documentation. �'j
A. One Original and One Copy of Application and Supporting Documents
® Required unless otherwise noted
B. Cover Letter (Required for All Application Packages): WaferQualityRegionalOperafienS
® List all items included in the application package, as well as a brief description 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):
® 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 documentationit is registered for business with
the North Carolina Secretary of State.
❑ If the Applicant Type in Item I.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 II.1 shall be consistent with the project time 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 I.
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: ETA 04-16 & SUPPORTING DOCUMENTATION Page] of 3

THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional Office
2090 US Highway 70
Avery, Buncombe, Burke, Caldwell, Cherokee,
Water Quality Section
Swannanoa, North Carolina 28778
Clay, Graham, Haywood, Henderson, Jackson,
[phone]
Macon, Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Harnett, Hoke,
Water Quality Section
Fayetteville, North Carolina 28301-5094
Montgomery, Moore, Robeson, Richmond,
[phone]
Sampson, Scotland
[phone] Fax
Mooresville Regional Office
610 E. Center Avenue
Alexander, Cabarrus, Catawba, Cleveland,
Water Quality Section
Mooresville, North Carolina 28115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
Raleigh Regional Office
1628 Mail Service Center
Chatham, Durham, Edgecombe, Franklin,
Water Quality Section
Raleigh, North Carolina 27699-1628
Granville, Halifax, Johnston, Lee, Nash,
[phone]
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
Warren, Wilson
Washington Regional Office
943 Washington Square Mall
Beaufort, Bartle, Camden, Chowan, Craven,
Water Quality Section
Washington, North Carolina 27889
Currituck, Dare, Gates, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
Wilmington Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
Water Quality Section
Wilmington, North Carolina 28405
Hanover, Onslow, Pander
[phone]
[phone] Fax
Winston-Salem Regional Office
450 W. Hanes Mill Road
Suite 300
Alamance, Allegheny, Ashe, Caswell, Davidson,
Davie, Forsyth, Guilford, Rockingham, Randolph,
Water Quality Section
Winston-Salem, North Carolina 27105
Stokes, Burry, Watauga, Wilkes, Yadkin
[phone]
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 3 of 3

State of North Carolina
„ ] Department of Environmental Quality
WDivision of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources Q a�{.
FTA 04-16 & SUPPORTING DOCUMENTATION
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Application Number: (to be wmpbted by Dwa)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
I. Applicant's name: Mountaintop Golf and Lake Club (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: Chris Robinson per 15A NCAC 02T .0106(b)
Title: General Manager In/`l�_.�I����
4. Applicant's mailing address: 34 High Mountain Drive #4 __
City: Cashiers State: NC Zip: 28717-�\\_ 111 NOV 1 3 11110
5. Applicant's contact information:
Water �w:ility Regional Operatioric
Phone number: 828 743-4755 EmailAddress: crobinsonAmountaintopeolfclub.co ,sileville Region810{iice
U. PROJECT INFORMATION:
1. Project name: Tate House Sanitary Sewer Improvements
2. Application/Project status: ® 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: WON
3. County where project is located: Jackson
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.102795' Longitude:-83.096132o
5. Parcel ID (if applicable); 7571-57-1318
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION
1. Professional Engineer: William A. Stillwell License Number: 026081
Firm: Stillwell Engineering PA
Mailing address: PO Box 838
City: Sylva State: NC Zip: 28779-_
Phone number: 8( 28) 586-6066 Email Address: w.sfillwell@stillwelleneineerinamet
IV. WASTEWATER TREATMENT FACILITY(WWTF) INFORMATION:
I. Facility Name: TWSA Plant#3 Permit Number: NCO063321
Owner Name: Tuckaseieee Water and Sewer Authority
V. RECEIVING DOWNSTREAM SEWER INFORMATION(ifdifYerent than WWTF):
1. Permit Number(s): WQUnknown Downstream (Receiving) Sewer Size: 8 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS00108
Owner Name(s): Tuckaseieee Water and Sewer Authority
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?
❑ 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):
��}1�esidential Owned ❑ Retail (stores, centers, malls) El Car Wash
j� 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))
"Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 02T .0114(f)? ❑ Yes ®No
➢ Ir yes, provide a copy of flow reduction approval letter
7. Summarizewastewater generated by project:
Establishment Type (see 02T.01140
Daily Design Flow '•°
No. of Units
Flow
Residential
120 gal/Bed
28
3360 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
3360 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 new 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 dot water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 3360 D (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: ETA 04-16 Page 2 of

Vil. GRAVITY SEWER DESIGN CRITERIA (If Applicable) -02T.0305& MDC (Gravity Sewers):
1. Summarizegravitysewer to be permitted:
Size (inches) Length (feet) Material
6 541 SDR 35 PVC
➢ Section II & ID 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
VIM PUMP STATION DESIGN CRITERIA (If Applicable) — 02T.0305 & MDC (Pump Stations/Force Mains):
1. Pump station number or name: Pura Sp tahon
2. Approximate Coordinates (Decimal Degrees): Latitude: 35.102795' Longitude:-83.096132'
3. Design flow of the pump station:.03 millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): 30 gallons per minute at 41 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
2
50
SDR21PVC.
6. Power reliability in accordance with 15A NCAC 02T .0305(Ir)(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 navel 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(Q):
1. Does the project comply with all separations found in 15A NCAC 02T .0305(1) & (a) ® Yes ❑ No
➢ iSA NCAC 02T OZOSlfl contains minimum.cenaratinnc that shall he nmvided fnr.cewer sysremc�
Setback Parameter*
Separation Re aired
Storm sewers and other utilities not listed below vertical
24 inches
Water mains vertical -water over sewer including in touched trenches
18 inches
Water mains orizontal
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-1 waters of Class I or
Class It impounded reservoirs used as a source ofdrinking water
100 feet
**Waters classified WS (except WS-1 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 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(2) contains alternatives where separations in 02T.0305(fl cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webuage
➢ If noncompliance with 02T 0305(il or W 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 0213.0200? ❑ Yes ❑ No ®N/A
➢ This would include Trout Buffered Streams per 15A NCAC 211.0202
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/certfications)? ® Yes ❑ No
Per 15A NCAC 02T.0 105(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 sic -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 15A NCAC 02T, the MInimmn Design Criteria for the Permitting of Pump Stadona
and Force Mains (latest version), and the Gravity Sewer Minimum➢esiun Criteria (latest version) as applicable?
® Yes ❑ NO
3.
If No, complete and submit the Variance(Alternative Design Request application (VADC 10.14) and supporting documents
for review. Approval_ of the.rwuest isresulred: nrlor_to_submittal oftht.Fad Mrack_Amilication.and.sunuortine
Certification:
this application for
has been reviewed by we and is acc m% complete and consistent with the information supplied in the plans, specifications,
angineertmg calculations, amd all other supporting documentation to the best ofmy knowledge. I further attest that to the best
of my knowledge the proposed design has been prepared in mccordance with the applicable regulations, Gmvity Sewer
Ministrant Design Commit for Gmvkty Sewers (latest vonacn), and the Minimum Design Crierta for the Fmt-Tack
Permitting of Pump Stadons and Fome Maims (latest version). Although other professionals may have developed certain
portions oftiris submittal package, inclusion ofinese materials under my signature and seal signifies that I have reviewed this
material and havejudged it to be consistent with the proposed design.
NOTE — In accordance with General Starnes 143.215.6A and 143-215.6B, any person who knowingly makes any false
statement repmsmmtion, or certification in soy application package shall be guilty of a Class 2 misdamee tor, which rosy
include a fine not in exceed $10,000, as well as civil p relties up to $25,000 pm violation _
lion for
has been reviewed by m, and is accurate and complete to the best of my knowledge. I understand that if all required pars of
this application are not completed and that if all required supporting documentation and manhments = not included, this
application package is subject to being mounted as incomplete. I understand that any discharge of wastewater from this non -
discharge system to surface waters or the land will result in an immediate enforcement action that may include civil penalties,
injunctive retie$ and/or admdnel prosecution. I will make no claim against the Division of Water Resources should a
condition of this permit be violated I also understood that if all required parts of this application package am nut completed
and that if all requited 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. arty person who knowingly makes any false
statement representation, or certification in any application package shall be guilty of a Class 2 miedemeaoor, which may
Include a fine not to exceed $10,000 ae well as civil penalties up to $25,000 per violation.
Signaarg�.v 1'=.YLdl<dr�..�.. .�_ Data:
FORM: FTA 04-16 Page 5 of 5