WQ0041515_Application (FTSE)_20200227

State of North Carolina
WR
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Dl�lslan of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: w (j� r� �(lo becompleled by DWR)
All items must be completed or the application will be returned
1. APPLICANT INFORMATION:
1. Applicant's name: City of Mebane (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State/County ® Municipal
3. Signature authority's name: David Cheek per 15A NCAC 02T.QI06(b
Title: Ci!y Manager
4. Applicant's mailing address: 106 E. Washington Street
City: Mebane State: NC Zip: 27302-
5. Applicant's contact information:
Phone number: 9( I9) 563-5901 Email Address: dcheekt cityofinebane.com
11. PROJECT INFORMATION:
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❑ Privately -Owned Public Utility
❑ Other
1. Project name: Project Tomorrow "Medline Mebane"
2. Application/Project status: ® Proposed (New Permit) ❑ Existing PermitlProject
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: Orange
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.072623' Longitude:-79.211701'
5. Parcel ID (if applicable): 9834868296
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: R. Blake Day, P.E License Number: 045238
Firm: Kimley-Hom and Associates
Mailing address: 200 South Tryon Street
City: Charlotte State: NC Zip: 28202-
Phone number: 704) 319-5691 Email Address: blake.da kimle-horn.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: City, of Mebane WWTP(WRRF) Permit Number: NC 0021474
Owner Name: City of Mebane
V. RECEIVING DOWNSTREANI SEWER INFORMMATION (if different than WWTF):
1. Permit Number(s): WQ i Downstream (Receiving) Sewer Size: 12 inch
System Wide Collection System Permit Number(s) (if app icab1c): WQCS00081
Owner Name(s): City of Mebane
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FORM: FTA 04-16 Page of 5

VI. GENERAL REQUIREMENTS
I. 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 ®NIA
3. If the Applicant is a Flome/Pro ert Owners` Association has an Operational Agreement FORM: HOA been attached?
❑ Yes ❑No ®NrA
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/Filler Backwash
® Businesses! offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: % Domestic/Commercial 100 % Commercial
% Industrial See 15A NCAC 027" _0103(20))
bIs there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .01 14(f)? ❑ Yes ® No
➢ if -Yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
160 Jf WIJOJ�5 iA?
Establishment Type (see 22T.0114a
Daily Design Flow' a
No. of Units
Flow
Warehouse
100 gal/day
440
44,000 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gat/
GPD
Total
44,000 GPD
a See 15A NCAC 02T .01 141b). (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. 42A4).
b Per 15A NCAC 02T .01 14(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: 44,000 GPD (per 15A NCAC 02T _01 14)
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 & 14IDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 2,728 DIP
➢ 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)
D 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 & KIDC(Pump StationslForce Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
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) Material
6. Power reliability in accordance with 15A NCAC 02T .0305 h 1 :
❑ Standby power source or pump with automatic activation and telemetry - I5A 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 telcmetry - l5A NCAC 02T .0305(h)(1)(C):
Y 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 & SEPA.R.ATIONS — (02B .0200 & 15A NCAC 02T.0305(f)):
1. Does the project comply with all separations found in 15A NCAC 02T .0305 f &
➢ 15A NCAC 02T.0305(f) contains minimum separations that shall be orovided for sewer systemc-
® Yes ❑ No
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 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 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.0305u contains alternatives where separations in 02T.0305 t cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
➢ 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 ❑ NIA
➢ 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 .0200? ® Yes ❑ No ❑ NIA
➢ 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 Permittinsi Branch
5. Does project comply with 15A NCAC 02T.0105 c 6) (additional permitsicertifications)? ® Yes [:]No
Per I SA NCAC 02'C.OI05(c)(6), directly related environmental permits or certification applications are being prepared, have
been applied for, or have been obtained. Issuance of this pern it 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 ❑ NIA
➢ 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:
Does the submitted system comply with 15A NCAC 02T, the tdinimu«t Design Criteria 1br 111C Permiitilyr* nt' Pump S.1ations
and Force Mains latest versionand the Gravity Sew r Minin um Desigg Criteria flatesi VCINJO01 as applicable?
V tv,4- Yes [I No
If No, complete and s bmit the Variance/Alle ative Design Request application (VADC 10-14) and supporting documents for
review. Approval of the reguest is 'e uired iirior to submittal of the Fast Track Application and su ortin documents.
2. Professional Engineer's Certification:
I R. Blake Day, P.E.
(Professional Engineer's name from Application Item III.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 (Iatest 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 $ I0,000, as well as civil penalties up to $25,000 per violation.
IsIur
North Carolina Professional Engineer's seal, signature, and date: ICA
2,N Qom°
SEAL '•
0�45238
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3. Applicant's Certification per 15A NCAC 02T .0106(b):
1, �Ivj S. ChG�!� _
attest that this application for
(Signature Authority's name & title from Application Item 1.3.)
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 t43-215.6A 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.
Signature: Date: l J g v
FORM: FTA 04-16 Page 5 of 5

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: City of Mebane
Project Name for which flow is being requested: Project Tomorrow "Medline Mebane"
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 wasteimter flow
I. Complete this section only if you are the owner of the wastewater treatment plant.
a.
WWTP Facility Name: City of Mebane WWTP
Z.
b.
WWTP Facility Permit M NC 0021474
CY
All, flows are in MGD
c.
WWTP facility's permitted flow
2.5
d.
Estimated obligated flow not yet tributary to the WWTP
0.638
e.
WWTP facility's actual avg. flow
1.597
.3:
C.,
f.
Total flow for this specific request
.044
w
M
g.
Total actual and obligated flows to the facility
2.279
°
�r
It.
Percent of permitted flow used
91 %
o
II. Complete this section for each pump station you are responsible for along the route of this 1roposed
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 / pf),
Avg. Daily
Daily Flow,
Obligated
Available
Number) No.
MGD
MGD
Flow, MGD
MGD
Flow
Capacity***
Gray Hill tad OoMO
.288
.115
.027
0.00
.027
.0882
GE
.720
.288
.163
0.00
.163
.125
* 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 iiy a peaking factor
(pi) 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): Orange County Buckhorn Outfall
Downstream Permit Number: IV& Oi0 o-7
Page 1 of 6
FTSE 10-18

III. Certification Statement:
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 transport and treat the proposed new wastewater.
51 W
Signing OPIcial Signature
Title of Signing Official
Date
Page 2 of 6
FTSE l0-18

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KimlepMorn
February 25, 2020
NCDENR-DEQ
Attn: Mr. Jason Robinson
Raleigh Regional Office
3800 Barrett Drive
Raleigh, NC 27609
RE: Medline Distribution Center (Project Tomorrow)
5511 West Ten Road, Mebane, NC
Public Gravity Sewer Extension
FTA 04-16 Narrative
Mr. Robinson
NC Dept of Fnvironmental Quality
Raleigh Regional Office
The proposed public gravity sewer system being proposed will serve a 1,200,000 square -foot
distribution center and future site development. The proposed structure will gravity feed via 2,728 LF
of 8" DIP and eight (8) proposed manholes to an existing manhole and 12" gravity line along the
existing stream on the eastern boundary of the development. The existing sanitary sewer
infrastructure ultimately terminates at the City of Mebane WWTP (WRRF) permit #NC0021474.
This submittal package consists of the following:
• Check #3375 — Payable to NCDEQ in the amount of $480.00
• FTA 04-16 — Medline Mebane
• FTSE 10-18 — Medline Mebane
• USGS Topographic Map
• Site Location Map
• Site Utility Plans and Sewer Profiles
We trust this meets your needs for approval of this project; please feel free to call me at (704) 319-
5691 if you have any questions or concerns. We look forward continuing our relationship on this
project.
KIMLEY-HORN AND ASSOCIATES, INC.
WIN,1
.�.
R. Blake Day, P.E.
Project Manager

Cashion, Ted
From: Day, Blake <[e-mail]>
Sent: Monday, March 23, 2020 12:01 PM
To: Cashion, Ted; [e-mail]
Cc: Robinson, Jason; Watts, Austin
Subject: [External] RE: Project Tomorrow "Medline Mebane" fast track sewer extension
application
� External email. Do not click Ilnks or open attachments unlessyou verify. Send all suspicious email as an attachmsnb-to
eoort. soam EDS. Lov 410L—
Ted,
Please mark it with "yes" to certify it is compliance with the minimum design criteria. You have my permission. Thank
you for your assistance with this!
Thank you,
R. Blake Day, P.E. (NC, SC, TX)
Kimley-Horn
Direct: 704 319 5691
Mobile: [phone]
From: Cashion, Ted <[e-mail]>
Sent: Monday, March 23, 2020 11:57 AM
To: Day, Blake <[e-mail]>; [e-mail]
Cc: Robinson, Jason <[e-mail]>
Subject: Project Tomorrow "Medline Mebane" fast track sewer extension application
We are reviewing the subject application. item X.1 of the application was not marked as required. Please indicate how
this needs to be marked ('yes' or'no') and with your permission, we'll make the revision and continue with
review/drafting of the permit.
ted
Ted Cashion
Water Quality Regional Operations
Division of Water Resources
NC Department of Environmental Quality
Raleigh Regional Office
919-791-4254
[e-mail]
1628 Mail Service Center
Raleigh, NC 27699-1628
3800 Barrett Drive
Raleigh, NC 27609

Cashion, Ted
From: Cashion, Ted
Sent: Monday, March 23, 2020 11:57 AM
To: '[e-mail]'; [e-mail]
Cc: Robinson, Jason
Subject: Project Tomorrow "Medline Mebane" fast track sewer extension application
We are reviewing the subject application. Item X. 1 of the application was not marked as required. Please indicate how
this needs to be marked ('yes' or'no') and with your permission, we'll make the revision and continue with
review/drafting of the permit.
ted
Ted Cashion
Water Quality Regional Operations
Division of Water Resources
NC Department of Environmental Quality
Raleigh Regional Office
919-791-4254
ted.cashion(Mncdenr.sov
1628 Mail Service Center
Raleigh, NC 27699-1628
3800 Barrett Drive
Raleigh, NC 27609
V
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Q,
Osv+r'. nsrt c! Im�orrrr.:sl 6ui
Subscribe to Collection System & Sewer Permitting Updates
Email correspondence to and from this address may be subject to the North Carolina Public Records Low and may be
disclosed to third parties unless the content is exempt by statute or other regulation.

Cashion, Ted
From:
Cashion, Ted
Sent:
Monday, March 23, 2020 12:45 PM
To:
Henderson, Justin L
Cc:
Robinson, Jason
Subject:
Fast track sewer extension project to Mebane WWTP, 44,000 gpd
Hi Justin,
Hope you're doing well. We have an application for a project in Orange Co. to discharge 44,000 gpd of 100% commercial
waste from a 1.2 million square feet distribution center and future development.
The project is called Project Tomorrow "Medline Mebane".
Are you ok with us issuing this permit for the waste to go to Mebane WWTP?
We'll cc you on the permit.
Thx,
ted
Ted Cashion
Water Quality Regional Operations
Division of Water Resources
NC Department of Environmental Quality
Raleigh Regional Office
919-791-4254
[e-mail]
1628 Mail Service Center
Raleigh, NC 27699-1628
3800 Barrett Drive
Raleigh, NC 27609
Subscribe to Collection System & Sewer Permitting Updates
Email correspondence to and from this address may be subject to the North Carolina Public Records Law and may be
disclosed to third parties unless the content is exempt by statute or other regulation.

Cashion, Ted
From:
Henderson, Justin L
Sent:
Monday, March 23, 2020 1:19 PM
To:
Cashion, Ted
Cc:
Robinson, Jason
Subject:
Re: Fast track sewer extension project to Mebane WWTP, 44,000 gpd
Ted,
We have no objections to the issuance of this permit. Thanks for the notification.
Get Outlook for iOS
From: Cashion, Ted <ted.cash ion @ncdenr.gov>
Sent: Monday, March 23, 202012:45:08 PM
To: Henderson, Justin L <[e-mail]>
Cc: Robinson, Jason <[e-mail]>
Subject: Fast track sewer extension project to Mebane WWTP, 44,000 gpd
Hi Justin,
Hope you're doing well. We have an application for a project in Orange Co. to discharge 44,000 gpd of 100% commercial
waste from a 1.2 million square feet distribution center and future development.
The project is called Project Tomorrow "Medline Mebane".
Are you ok with us issuing this permit for the waste to go to Mebane WWTP?
We'll cc you on the permit.
Thx,
ted
Ted Cashion
Water Quality Regional Operations
Division of Water Resources
NC Department of Environmental Quality
Raleigh Regional Office
919-791-4254
ted.cash ion @ncdenr.eov
1628 Mail Service Center
Raleigh, NC 27699-1628
3800 Barrett Drive
Raleigh, NC 27609
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