WQ0041554_Application (FTSE)_20200313

State of North Carolina
DWR3-(3 Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Numb' . c comple[cd by DWRi
00
All items must be c tedror the application will he returned
I. APPLICANT INFORMATION:
1. Applicant's name: Orange Water & Sewer Authority (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: Ed Kerwin per 15A NCAC 02T .0I 06(b)
Title: Executive Director
4. Applicant's mailing address: 400 Jones Ferry Road
City: Carrboro State: NC Zip: 27510-
5. Applicant's contact information:
Phone number: [phone] Email Address: n arker aowasa.or
I1. PROJECT INFORMATION:
I. Project name: Beaumont Subdivision
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permi0roject
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: 35.897313 Longitude:-79.073689-
5. Parcel ID (if applicable): 9778-81-2446
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Charles Huffine License Number: NC 24924
Firm: The LEADS Group, PA
Mailing address: 505 East Davis Street
City: Burlington State: NC Zip: 27215-
Phone number: [phone] Email Address: chuffinc08 cu mail.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Mason Farm Wastewater Treatment Plant Permit Number: NC 0025241
Owner Name: OWASA
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
I. Permit Number(s): WQ 13482(University Commons Downstream (Receiving) Sewer Size: 8 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS00031
Owner Name(s): Orange Water & Sewer Authority
FORM: FTA 04-16 Page 1 of 5

i
VI. GENERAL REQUIREMENTS
L 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 v 's Operational reement (FORM: DEV) been attached?
❑ Yes ❑No ®NIA
3. If the Applicant is a Hurne�Pruporry, Owpiers' Association, has an Operational Agreement (FORM .; HOA) been attached?
❑ Yes ❑No ®N/A
4. Origin of wastewater: (check all that apply):
®Residential Owned ❑Retail (stores, centers, malls) ❑Car Wash
❑Residential Leased ❑Retail with food preparationtservice ❑Hotel and/or Motels
❑ School / preschool / day care ❑Medical f 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 NL CAC 02T .0103(20))
'Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under 15A NNCAC 02T .01 14Lt)? ❑ Yes ❑ No
t If yes, provide a cony of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T=b114ff)
Daily Design Flow")
No. of Units
Flow
3 residential homes @ 6 Bedrooms /home
120 gal/day
18
2,160 GPD
gall
GPD
gal/
GPD
gal/
GPD
gall
GPD
gall
GPD
Total
2,10 00
a See 15A NCAC: 02T .01 14(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 C.S. 42A4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NC'AC 02T.01 141 shall
be determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 2.160 GPD (per .LSA NCACO2T .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

i
Vll. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305&MDC(Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) I Length (feet) I Material
1 8 I 180 I DIP I
r Section 11 & 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
Vill. 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: 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)
S. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
6. Power reliabilityin accordance with 15A NCAC 02'1" _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
z 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)(l)(C):
z It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant (draft agreement)
and is compatible with thestation.
Y If the portable power source or pump is dedicated to multiple pump stations, anevaluation 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: 1:TA 04-16 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200&I5A NCAC 02T .0305(f)):
1. Does the project comply with all separations found in I $A NCAC 02T .0305(f) & 1 L�) ® Yes ❑ No
D 15A NCAC 02T.0305(f1 contains minimum separations that shall be nrovided for sewer svcremc-
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-1 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 swimm ng pools
10 feet
Final earth grade vertical
36 inches
15A NCAC 02T.030U contains alternatives where separations in 02T.03 cannot be achieved.
"Stream classifications can be identified using the Division's NC Surface Wager Classifications wcbpage
If noncompliance with 0.2T,0305(Q or (€*,),see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ❑ Yes ❑ No ® N.A
i- 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
z As built documents should reference the location of areas effected
3. Does the project comply with setbacks found in the river basin rules per 1.5A NCAC 0213 0200? El Yes[] No N.'A
This would include Trout Buffered Streams per 1 >A NCAC,2B.0202
4. Does the project require coverage/authorization under a 404 Nationwide or ❑ Yes ® No
individual permits or 401 Water Quality Certifications?
t Information can be obtained from the 401 & Rufficr Permitting Brancb
5. Does project comply with ] 5A.NCAC 02T.01(i5fc1(6) (additional permitslcertifications)? ®Yes ❑ No
Per 1.5A_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 ❑ N:A
r- 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:
1. Does the submitted system comply with 15A NCAC. 02T, the Minimum Design Criteria for the ftrmitting of Pump Stations
and Force Mains flaiest version], and the Ciffivity Sewer Minimum Desie,n Criteria (latest version) as applicable?
® Yes ❑ No
1fNo, complete and submit the Variance. -'Alternative Design Request application (VADC 10-14) and supporting documents
for review. Approval or the request is required prior to submittal of the Fast Track Application and supporting
documents.
2. Professional Engineer's Certification:
U1
(Professional Engineer's name from Application Item
that this application for �e a��wcorv-C- jt, 611%JtS'
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 �Ct*svaornopemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violatiq,Q.�• C A
..�.,,. _:....7.1� !ter ...............
North Carolina Professional Engineer's seal, signature, and date: 1 4z ; - r V
SEAL
3. Applicant's Certification perl5A NCAC 02T .0106(b):
1, S_d KtrIr �(&g-A13 -., pty- t - attest that this application for
(SignatureAuthority's name& title from Application Item I.3.)
has been reviewed by me and is accurate and complete to the best of my knowledge.) 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 143-215.6A and 14 .6 , 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.
C_
Signature: Date.
FORM: FTA 04-16 Page 5 of 5

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Beaumont Narrative:
Orange County North Carolina
Carrboro
End of University Commons at Smith Level Road
Project proposes 3 residential units of 6 bedrooms each connecting to existing public OWASA
infrastructure. Project to be completed in one phase.
No surface waters present.
Land disturbance permitting through Orange County.
Project to begin Spring 2020 upon permitting.
Project Engineer:
The L.E.A.D.S. Group, PA 1 505 East Davis Street Burlington, North Carolina 27215
Project Owner:
Parker Louis, LLC 1 301 Mont Clair Way, Chapel Mill, North Carolina 27516

1]
State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
Division of Water Resources Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: Orange Water and Sewer Authority
Project Name for which flow is being requested. Beaumont Subdivision
More than one FTSE maj, be retluh-ed for a .single project jute owner- of the IVIVTP is not responsible fa- all pttntp
stations along the rottle of the proposed waslewaleJ' flora'.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Mason Farm Wastewater Treatment Plant
b. WWTP Facility Permit #: NCO025241
A1I flo►vs are in MGD
c. WWTP facility's permitted flow 14.5
d. Estimated obligated flow not yet tributary to the WWTP 0.717
e. WWTP facility's actual avg. flow 7.600
f. Total flow for this specific request 0.002 (2160 GPD)
g. Total actual and obligated flows to the facility 8.319
h. Percent of permitted flow used 57.4
11. 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)
(R)
Design
Pump
Average Daily
Approx.
Station
Firm Flow**
Current Avg.
(Name or
Capacity, * (Firm I po,
Daily Flow,
Number)
MGD MGD
MGD
(C)
(D)=(R+C)
(E)=(A-D)
Obligated,
Not Yet
Total Current
Tributary
Flow Plus
Daily Flow,
Obligated
Available
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 (pi) 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):
Downstream Permit Number:
Page l of 6
FTSE 04-16

+ II1. Certification Statement:
I Ed Kerwin 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 indicates acceptance of this wastewater flow.
A -
,7g Official Signature
r-
3NIV O
Duce
Page 2 of 6
FTSE 04-16

Cashion, Ted
From: Cashion, Ted 3 Sent: Monday, March 16, 2020 3:48 PM r
To: Nick Parker ([e-mail]); Jessica Godreau
Cc: Robinson, Jason
Subject: Kentfield and Beaumont fast track sewer extension applications
Hi Nick and Jessica,
We have entered these applications into our database and noted the following discrepancies:
The signature authority's name in item 1.3 must be the same name as in U.
For these 2 applications, Jessica is listed in 1.3, but Ed is listed in X.3.
Please revise these 2 applications to reflect the same person in each location.
Also, if Jessica is to sign as the signature authority for OWASA, we need a signed statement from Ed delegating this
authority to Jessica.
Thanks, call if questions.
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.gov
1628 Mail Service Center
Raleigh, NC 27699-1628
3800 Barrett Drive
Raleigh, NC 27609
Subscribe to Collection System & Sewer Permitting IJ dates
Email correspondence to and from this address may be subject to the North Carolina Public Records Caw and may be
disclosed to third parties unless the content is exempt by statute or other regulation.

Orange Water and Sewer Authority
OWASA is Carrboro-Chapel Hill's not -for -profit public service agency
delivering high quality water, wastewater, and reclaimed water services.
March 9, 2020
NCDEQ Water Quality Section
1628 Mail Service Center
Raleigh, NC 27699-1628
SUBJECT: Permit Application for Beaumont Subdivision
DWR Staff,
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Enclosed are the following items for your review and approval. The project includes an
extension of the public sanitary sewer system to serve a single family home development
with 3, 6 bedroom homes.
Fast -track Application form FTA 04-16 (original and copy)
Flow Tracking/Acceptance form FTSE 04-16 (original and copy)
Check in the amount of $480.00
Project Narrative
Please contact me by telephone at 919 537-4201 or email to nparker(mowasa.org if you
have any questions or comments.
Respectfully,
2
Nicholas L. Parker
Engineering Associate
cc: Jessica Godreau, PE — OWASA
Chad Huffine —The LEADS Group, PA
Adam Zinn, Omar Zinn — Parker Louis LLC
400 !ones Ferry Road, Carrboro, NC 27510 49 919-968.4421 (D [e-mail] 0 @0WASA1 0 www.owasa,org