WQ0041274_Application (FTSE)_20191030

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T.0300--FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Dlvlslon of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: �li) ' U (to be completed by MR)
All items must be comuleted or the aunlication will be returned
1. APPLICANT INFORMATION:
1. Applicant's name: Town of Pittsboro (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: John PQteatper 1 A.t CAC 0210101i_bj
Title: Public Utilities Director
4. Applicant's mailing address. PO Box 759
City: Pittsboro State: NC Zip. 27312-_
5_ Applicant's contact information;
Phone number: (2L9) 533-5480 Email Address: ipoteat ittsboronc.gov
II. PROJECT INFORMATION:
1. Project name: Old Rock Snrin,s Cemeten Rd
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: Chatham
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.742755' Longitude: - 9.17 _ 69149°
5. Parcel ID (if applicable): 0006542
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Matthew I. Grant License Number: 33292
Firm: Jordan Grant & Associated, PLLC
Mailing address: PO_Box_151
City: S3atesville State: NC Zip: 28687-
Phone number: [phone] Email Address: matte:@iordan-erant.com
IV_ WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: oLgf Pittsboro WWTP Permit Number: NCO020354
Owner Name: Town of Pittsbo
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ Downstream (Receiving) Sewer Size: inch
S, stem Wide Collection S stem Permit Number s if a, . licable : WQCS
Owner Name(s):
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 ®NIA
2. If the Applicant is a Developer of lots lobe sold, has a Develu;-er's O. erational A. reement -1'OR-%I- DCV been attached?
❑ Yes ❑No ®NIA
3. If the Applicant is a Home/Proper!+. Owners'_ Association has an O lerat[onal A: reement__FOR.M: HOA been attached?
❑ Yes ❑No ®NIA
4. Origin of wastewater: (check all that apply):
❑ Residential Owned ® Retail (stores, centers, malls) ❑ Car Wash
❑ Residential Leased ❑ Retail with food preparationlservice ❑ Hotel and -or Motels
❑ School / preschool / day care ❑ Medical / dental {veterinary facilities ❑ Swimming Pool rClubhouse
® Food and drink facilities ❑ Church ❑ Swimming Pool -Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: % Domestic/Commercial 100 % Commercial
% Industrial (See l.5A_N_C C 02T .0103i 20 �}
�Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0l 14 ? ❑ Yes ®No
D If s es. vrovide a con of flow reduction a royal letter
7. Summarize wastewater generated by project:
Establishment Type (see 021.01140 Daily Design Flow "b
No. of Units
Flow
Retail Building I 25 gal.'employeefshift/day
12
300 GPD
Restaurant, Full Service 40 gal/seat
170
6,800 GPD
gall
GPD
gall
GPD
gall
GPD
gal/
GPD
Total
7,100 GPD
a See 15A NCAC 02T .0114 b), d e I and e ? 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 15 a NCAC 14j shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 7,100 GPD (per 15A NCAC 02T .0114)
D Do not include future Bows 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 (Gravid Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) I Length (feet) I Material
8" 1 216 1 PVC
D Section II & 1I1 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
n Applicable) atians/Force Mains):
III. PUMP STATION DESIGN CRITERIA f A [icablc—02T.0305 & 1lIDC IPumE, St„ ,,.
COMPLETEPOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: -
3. Design flow of the pump station: millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): gallons per minute at feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) I Material
i I y
6. Power reliability in accordance with 15A NCAC 027 .03051 h,., 1,
❑ Standby power source or pump with automatic activation and telemetry - 1 SA 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 aclivation, quick -connection receptacle and telemetry - I SA NCAC 02T
.0305(h)(1)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry - ISA 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: F'TA 04-16 Page 3 of

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(1)):
I. Does the project comply with all separations found in 15A NCAC 02T .0305 .4 n ® Yes [:]No
➢ 15A NCAC 02T.0305() contains minimum separations that shall he nrnviried fhr aewrr «<tom-
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below I vertical 1
24 inches
Water mains )vertical -water over sewer includin, in benched trenches) IS inches
Water mains I horizontal) ] 0 feet
Reclaimed water lines ( vertical - reclaimed over sewer) IS inches
Reclaimed water lines Ihorizontal - reclaimed over se►ver1 2 feet
"Any private or public water supply source, including any wells, WS-1 waters of Class I or
Class 11 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
Anti• building foundation 5 feet
i
' Anv basement { 10 feet
To slope of embankment or cuts of 2 feet or more vertical hei.:ht { 10 feet
{ Drainage s�stems and interceptor drains ( 5 feet
1 Any swimming pools
10 feet
Final earth grade (vertical!
36 inches
➢ 15A NCAC 02T.0305{Y y contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ "Stream classifications can be identified using the Division's NC Surface Water Classifications we_br,a�c
➢ If noncompliance with 02T.0305(t) or NO, see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ® Yes ❑ No ❑ NfA
➢ 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 0213 .0200? ® Yes ❑ No ❑ N!A
➢ 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 or401 Water Quality Certifications?
➢ Information can be obtained from the 401. & Buffer Permittin Branch
5. Does project comply with 15A NCAC 02T_0105(c a 6) (additional permitslcertifications)? ® Yes ❑ No
Per 15A ;'CAC 02T OlO��cu6ti, 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 ❑ MA
➢ 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 permilee'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 Minimum Desi_ n Criteria for the Permittin of Pum: . Stations
and Force Mains latest version: and the Gravi •Sewer Minimum Desi: n Criteria I latest version as applicable?
® Yes ❑ No
IfNo, complete and submit the Variance/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 SU1113ortin;- documents
2. Professional Engineer's Certification:
1, Matthew Grant _ attest that this application for
(Professional Engineer's name from Application Item 111.1.)
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: 0" N\15CARO •, `
4 SEAL lr
33292 _
02-05-2020 -,, ''s,,, vo-%S, -
'�f►flllYllt�t��`
3. Applicant's Certification per 15A hk'AC 02T.0106(b):
attest that this application for
��.5 �at� thor�nAl m&�tle Orr 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. 1 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 143-215,6,E 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:
r
Date:
FORM: FTA 04-16 Page 5 of 5

State of North Carolina
Department of Environmental Quality
Division of Water Resources
tet Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: Town of Pittsboro
Project Name for which flow is being requested: 29 Old Rock Springs Cemeter, Rd _
More than one FTSE may be required for a single project if the owner of the W1VTP 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:
b. WWTP Facility Permit #
Town ofPittsboro WWTP
NCO020354
All, j2'ows are in MGD
c.
WWTP facility's permitted flow
0.750
d.
Estimated obligated flow not yet tributary to the WWTP
0.118
e.
WWTP facility's actual avg. flow
0.503
f.
Total flow for this specific request
0.0071
g.
Total actual and obligated flows to the facility
0.628 _
h.
Percent of permitted flow used
83.4%
I1. 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 Pump Average Approx. Not Yet Total Current
Station Station Firm Daily Flow** Current Tributary Flow Plus
(Name or Permit Capacity, * (Firm / po, Avg. Daily Daily Flow, Obligated Available
Number) No. MGD MGD Flow, MGD MGD Flow Capacity***
* The Firm Capacity (design flow) 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, 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 connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer):
Downstream Permit Number:
Page l of 6
FTSE 10-18

III. Certification Statement:
1 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 certifies that the receiving collection system or treatment
works has adequate capacity to trxisport and treat the proposed new wastewater.
_ �1 y �
r
i„✓ter*`
Signing Official Si; natzrre
Title of Sigizing 00icia1
�, S �o,-;zCD
Date
Page 2 of 6
FTS E 10-1 S

NC Dept of Environmental Quality
NCDEQ Raleigh Regional Office
1628 Mail Service Center
Raleigh, NC 27699
Re: Old Rock Springs Cemetery Road Fast Track Sewer Extension Application
Town of Pittsboro, North Carolina
OCT 3 0 2019
Raleigh Regional Office
Please find attached our Fast Track Sewer Extension submittal package for a commercial development
located in the Town of Pittsboro, North Carolina. The proposed system will be a gravity sewer system
extension including three manholes and 216 linear feet of 8" PVC. The system will be installed by the
developer in accordance with NCDEQ standards and specifications for gravity sewer. Once complete and
accepted, the proposed sewer extension will be owned, operated, and maintained by the Town of
Pittsboro.
The commercial development consists of two stand-alone buildings. One building will be retail space and
include 12 employees at 25 gallons per employee per shift per day for a total daily flow rate of 300 gpd.
The other building will be a full -service restaurant including 170 seats at 40 gallons per seat per day for a
total daily flow rate of 6,800 gpd. The total average daily flow from the proposed commercial
development will be 7,100 gallons per day.
Below is a list of items included in the submittal package:
• A check in the amount of $480.00 made payable to North Carolina Department of
Environmental Quality (NCDEQ) as the application fee
• Fast Track Application
• Flow Tracking/Acceptance Form
• Site Maps
Please contact me should you have any questions or require additional information.
Thanks,
Barrett Blackburn, PE
CAMBRIDGE PROPERTIES, INC.
831 E. Morehead Street, Suite 245
Charlotte, NC 29202
(D) 980.260.2775
(C) 704.661.1893
(F) 704.333.2394
bbb@cambridk,eproo.com

JORDAN
Jordan Grant & Associates, PLLC 4b GRANT
April 18, 2019
Elizabeth Goodson, PE
Town Engineer
480 Hillsboro Street
Chatham Mills, Suite 400
Pittsboro, NC 27312
Re: Water and Sanitary Sewer Capacity Assurance Request for Cambridge-Pittsboro (PID
0006542)
Dear Ms. Goodson,
With this letter we hereby request the review and approval stating the existing water and
sanitary sewer infrastructure contains adequate capacity to service the water and sanitary
sewer flow for the proposed commercial development. The subject development is known as
Cambridge-Pittsboro in Chatham County located at 29 Old Rock Spring Cemetery Road located
in Pittsboro, North Carolina.
The existing land use consist of one (1) single family home, a garage, a barn, and a storage
building on 1.826 acres currently served by septic system. The existing structures shall be
demolished.
The proposed use of the C-2 zoned property is a 7,225 square foot retail building and a 4,000
square foot restaurant containing 170 seats. Proposed sewer for both retail and restaurant will
connect to the existing 10" PVC sanitary sewer along U.S. Highway 15-501. The retail building
will be served by an existing water service along U.S. Highway 15-501. The projected flow from
the retail building is 300 gallons per day. The 2" water service for the restaurant will be served
from main along Old Rock Spring Cemetery Road. The projected flow from the restaurant is
6,800 gallons per day. Please see attached for a breakdown of the calculations based on the
NCDEQ 15A NCAC 02T .0114. The total proposed flow from the site will be 7,100 gallons per
day.
Both buildings will be constructed as soon as all required permits are issued. The retail building
will be completed 90-110 days after breaking ground. The restaurant building is planned to take
120-150 days from breaking ground to obtaining a certificate of occupancy.
Let me know should you require additional information on this matter.
Sincerely,
= p�ESS/q,,
SEAL
33292 -
Matthew I. Grant, PE, PLS
P.O. Box 151 Statesville, NC 28687 [phone]
jordan-grant.com

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