WQ0041611_Application (FTSE)_20200413 (2)

Permit Number WQ0041611
Program Category
Non -discharge
Permit Type
Gravity Sewer Extension, Pump Stations, & Pressure Sewer Extensions
Primary Reviewer
dean. hu nkele
Coastal SWRule
Permitted Flow
Facility
Facility Name
Carter Clinic Private Sewer
Location Address
Owner
Central Files: APS _ SWP
4/6/2020
Permit Tracking Slip
Status
Project Type
In review
New Project
Version
Permit Classification
A
Individual
Permit Contact Affiliation
Major/Minor Region
Minor Wilmington
County
Brunswick
Facility Contact Affiliation
Owner Name Owner Type
Carter Clinic PA Non -Government
Owner Affiliation
M Ojinga Harrison
MD
PO Box 99778
Dates/Events - Raleigh NC 2762497
Scheduled
Orig Issue App Received Draft Initiated Issuance Public Notice Issue Effective Expiration
3/30/2020 T - _ r
Regulated Activities Requested /Received Events
Additional information requested f - a -a
Additional information received

PARAMOUNTE
E N G 1 N E E R I N G, 1 N C.
1 2 2 CINEMA DRIVE
W I L M I N G T O N, NC 2 8 4 0 3
9 1 0- 7 9 1- 6 7 0 7( O) 9 1 0- 7 9 1- 6 7 6 0 ( F)
L E T T E R O F T R A N S M I T T A L
To:
NCDEQ
Date
1 03/30/20
127 N. Cardinal Drive
Wilmington, NC 28405
Re:
308 Village Road
910 796-7215
1
Fast Track Sewer
Attn:
Dean Hunkele
Project No.
I 18154.PE
e ate sendin
® Originals
® Prints
❑ Shop Drawings
❑ Calculations
❑ Correspondence
❑ Plans
❑ Specifications
❑ Other as listed below
he followin items:
Quantity
Date
Dwg. No.
Description
2
Fast Track Sewer Permit FTA 04-16 (Private)
1
Sanitary Sewer Narrative
1
$480 check
1
USGS Map with Project Location (8.5"xl1")
1
Sewer Site Map (11"xl7")
ssue Status: ® For Approval ❑ As Requested ❑ Construction ❑ Bid
❑ For Your Use ® For Review and Comment ❑ Approved as Noted ❑ See Remarks
ction Taken: ❑ No Exceptions Taken ❑ Make Corrections Noted ❑ Amend & Resubmit
❑ Rejected - See Remarks ❑ Approved as Submitted ❑ Other
emarks:
Cc:
n
14f It-
t
i OAR 0 &V
�o' SO I 4�� 0 f U
Signed:

State of North Carolina
Department of Environmental Quality
DWR ....... �.'11 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: W & W�1 k' � I (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Carter Clinic. PA (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: M. Oiinga Harrison. MD per 15A NCAC 02T .0106(b)
Title: Manager
4. Applicant's mailing address: 8360 Six Forks Road
City: Raleigh State: NC Zip: 27601-_
5. Applicant's contact information:
Phone number: (___) _-_ Email Address: oiingaharrison(a),gmail com
II. PROJECT INFORMATION:
1. Project name: 308 Village Road
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: W000_
3. County where project is located: Brunswick
4. Approximate Coordinates (Decimal Degrees): Latitude: 34.235635' Longitude:-78.001870'
5. Parcel ID (if applicable): 038BA014
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Chris Millis License Number: 036235
Firm: Paramounte En ing eering Inc.
Mailing address: 122 Cinema Drive
City: Wilmington State: NC Zip: 28403
Phone number: (2iOj 791-6707 Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Northeast Brunswick Regional W WTF Permit Number: NCO086819
Owner Name: Brunswick Co.
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): W00018449 Downstream (Receiving) Sewer Size: 10 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS_
Owner Name(s): Town of Leland
FORM: FTA 04-I6 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 NN/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 NN/A
3. If the Applicant is a Home/Property Owners' Association. has an Operational Agreement (FORM: HOA) been attached?
❑ Yes ❑No NN/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
N 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. Hasa flow reduction been approved under 15A NCAC 02T .0114(t)? ❑ Yes N No
➢ If yes, provide a coov of flow reduction aouroval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(fl)
Daily Design Flow a,b
No. of Units
Flow
General Business and office
25 gal/employee/shift
9
225 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
225 GPD
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 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 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: 225 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

VH. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 179 PVC
➢ 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:
2. Approximate Coordinates (Decimal Degrees): Latitude: 0Longitude: - °
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 - 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) & (g)
➢ 15A NCAC 02T.0305(fl contains minimum separations that shall be nrovided for sewer systems:
® 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.0305(g) contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ "Stream classifications can be identified using the Division's NC Surface Water Classifications webnage
➢ If noncompliance with 02T.0305(f) or (e). see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ® Yes [:]No
➢ 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 all setbacks found in the river basin rules per 15A NCAC 02B .02009 ® Yes [--]No
➢ This would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Does the project comply with an individual 404 Permit or any 401 Certifications? ® Yes ❑ No
➢ Wetland -related permits shall be requested, obtained, and adhered to for projects that impact wetlands or surface waters
➢ 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
➢ 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

CERTIFICATIONS:
I. 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 Graviry Sewer Minimum Design Criteria (latest version) as applicable?
®❑ %'es ❑❑ No
If No. complete and submit the Variance'Alternaliw-e 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 Engineers Certification:
1VJ I r [ t 3 attest that this application for
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 N4inimum 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 1 have reviewed this
material and ha%ejudged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143.215.6A and 143-215.68, 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 S10.000, as well as civil penalties up to S25.000 per violation.
A
ration for
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, andior criminal prosecution. I will make no claim against the Division of \later 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 S10,000 as well as civil penalties up to S25,000 per violation.
Sienature: Date: (
FORM: FTA 04.16 Page 9 of 5

5W.W 211
North Carolina Secretary of State Search Results
• Upload a PDF Filing • Order a Document Online • Add Entity to My Email Notification List • View Filings
Professional Corporation
Legal Name
Carter Clinic, P.A.
Information
Sosld: 0902692
Status: Current -Active
Date Formed: 3/9/2007
Citizenship: Domestic
Annual Report Due Date:
CurrentgnnuaL Report Status:
Registered Agent: Harrison, Myleme Nyerere Ojinga
Addresses
Reg Office
4009 Barrett Drive
Raleigh, NC 27609
Professions
Medical Services
Mailing
8360 Six Forks Road
Raleigh, NC 27601
Principal Office
8360 Six Forks Road
Raleigh, NC 27601
Reg Mailing
P O Box 99778
Raleigh, NC 27624
https://w .sosnc.gov/online_services/search/Business_Registration_Results 1/1

308 VILLAGE ROAD
LELAND, BRUNSWICK COUNTY, NORTH CAROLINA
SANITARY SEWER DESIGN NARRATIVE
Prepared for:
CARTER CLINIC, PA
6026 Six Forks Road
Raleigh, NC 27609
Prepared by:
pA RA MOUNTS
E N C3 1 N E H R 1 N C3. INC
122 Cinema Drive
Wilmington, NC 28403 "1100.1N 0"ItA 111 "" ••CAO+0„`w;
p ;•'Tess" liy
/':q
Project #18154.PE a AE r i
? : 235
March 2020

PROJECT NARRATIVE
The property served by this proposed sewer extension is located at the corner of Village Road and
Townsend Lane in the Town of Leland. The latitude and longitude of 34°14'8.4"N, 78°00'6.7"W.
The project is within the drainage basin which drains to the Cape Fear River.
Carter Clinic, PA desires to install a gravity sewer system to serve a commercial doctor's office. It is
proposed that wastewater from the development, calculated to be 225 GPD, be ultimately collected
and carried to the Town of Leland WWTF.
For the permit, it will consist of 179 LF of 8" private gravity sewer, which represents all the gravity
sewer for the entire development.
In coordination with the Town of Leland Public Services Manager and NCDEQ, the Flow
Tracking/Acceptance for Sewer Extension Application (FTSE) is not required for this application
based on the proposed flow of 225 gpd, which is not greater than the previous occupant's flow.
Please, refer to email correspondence included in this submittal for additional information.

Andrew Richards
From: Lynn Vetter <[e-mail]>
Sent: Monday, March 30, 2020 7:25 AM
To: Chris Millis; Andrew Richards
Cc: David Hollis
Subject: RE: 308 Village Road
USE — DEQ will not require submittal, based on the proposed flow of 225 gpd.
Please include this information on the application, no increase in flow from the previous occupant.
Thanks,
From: Chris Millis <[e-mail]>
Sent: Thursday, March 26, 2020 2:46 PM
To: Lynn Vetter <[e-mail]>; Andrew Richards <[e-mail]>
Cc: David Hollis <[e-mail]>
Subject: RE: 308 Village Road
WARNING:This email originated from outside of the Town of Leland network.
Thanks Lynn, since the sewer is permitted as private there is no Town approval that we need (just coordination with you
all accepting the flow from an USE standpoint)... just as long as we have the completed FTSE form for our submittal to
the state (DEQ) that will be all we need. Thank you for your email and looking forward to receiving the FTSE early next
week ... we will be ready to submit to the state next week when the USE comes in ... thanksl
CHRIS MILLIS, PE
pARAMOUNTE
PARAMOUNTE ENGINEERING, INC
122 Cinema Drive
Wilmington, NC 28403
OFFICE: [phone]
FAX: [phone]
www.paramounte-eno.com
From: Lynn Vetter <[e-mail]>
Sent: Thursday, March 26, 2020 2:43 PM
To: Andrew Richards <[e-mail]>
Cc: Chris Millis <[e-mail]>; David Hollis <[e-mail]>
Subject: FW: 308 Village Road
Andrew,
FTSE — I am currently reviewing the USE with DEQ and expect completion tomorrow or Monday.
Regarding your sewer app; on 3/13, 1 completed items IV and V on the sewer application and emailed it back to you
Indicating the application required an engineer seal and signature. What Town approval are you waiting for?
Thanks,