WQ0041575_Application (FTSE)_20200320

DocuSign Envelope ID- F2CD0666-440DAD58-9A7B. 5C46FDF45FAt
—4 b
State of North Carolina
nWR 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 Number: W q00 l� J �(to he completed by DWR)
V
All items most be comnleted or the application will be returned
1. APPLICANT
INFORMATION:
I.
Applicant's name: South Granville Walerand 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: Scott Schrover per 15A NCAC 021' 0 M,(Ab'r
Title: Executive Director
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4'D
4.
Applicant's mailing; address: 415 Central Ave
City: Butner State: NC 7.ip: 27509-
5.
Applicant's contact information:PC
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Phone number: [phone] Email Address: sschroyer(a�sgwasa ore
ca
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H. PROJECT INFORMATION:
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ti
I.
Project name: U-6020
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2.
Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ00__ and issued date:
Nei
A
If new construction but part of master plan, provide the existing permit number: WQ00
3.
County where project is located: Granville
4.
Approximate Coordinates (Decimal Degrees): Latitude: 36.149005" Longitude-78.726235-
5. Parcel ID (if applicable):
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer. Clint Stevens License Number: 040370
Firm: Winde Engineering
Mailing address: 401 1larrison Oaks Blvd.
City. Cary State: NC Zip: 27513
Phone number. 9( 19) 653-0001 Email Address: cstevensCd-hindeengineering.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: SGWASA Permit Number: NCO026824
Owner Name: SGWASA
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
L Permit Number(s): WQ Downstream (Receiving) Sewer Size: inch
System Wide (.'olicction System Permit Number{s) {ifap1dicabluj: WQCS00068
Owner Nanre(s): SGWASA
FORM: FTA 04-16 Page I of 5

DocuSign Envelope ID: FM00666.440D-4068-WS 5C46FDF45FA1
Vl. 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 to be sold, has a DevelojX s C erdtional Agreement t FORM! DL V I been attached?
❑ Yes ❑No ®NIA
3. if the Applicant is a HorneiPmncsrty Owners' tlsrciation- lrps au Unerational Agreement F R1L1: HDA been attached?
❑ Yes [:]No ®N/A
4. Orrin 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 PoollFilter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: 0 % Domestic/Commercial 100 ° o Commercial
% Industrial See 15A NCAC 02-F .01.03{?01)
ioIs there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 021 .0 1 14(t}? ❑ Yes ® No
> If ves, Provide n cow of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see PTLO1140
Daily Design Flow ".1'
No. of Units
Flow
gall
GPD
gall
GPD
gal/
GPD
gall
GPD
gall
GPD
gal/
GPD
Total
GPD
a Sec 15A NCAC 02T .01 141b1, fd), (c}(l 1 and (s}t2 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. 4?A-4).
b Per 15A NCAC 02T.0I14(c), design flow rates for establishments not identified [in table 15A NK,AC: 021'.01,141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
S. Wastewater generated by project: 0 GPD (per II SA 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: WOCS 00068
❑ Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain):
FORM: iTA 04-16 Page 2 of5

DocuSign Envelope ID F2CDO666-44oD4D68-9A7H-5046FdF45FAt
VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T _11305 & MDC�Crayity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8" 314 PVC, SDR 35
:- Section 11 & III ofthe MDC for Permitting of Gravity Sewers contains information related to design criteria
1- Section III contains information related to minimum slopes for gravity sewer(s)
Z Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
Vill. PUMP STATION DESIGN CRITERIA (If Applicable)—t12-f .0305 & MIX' (Pump Stations,'l:orce 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)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) I Length (feet) I Material
6. Power reliability in accordance with 15A NCAC 02 F _0305(hX1):
❑ Standby power source or pump with automatic activation and telemetry - I SA NCAC 02T .0305(h)(l)(13)_
> 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 die 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 timefmmes, shall be provided
in the case of a multiple station power outage.
FORM: FTA 044-16 Page 3 of 5

DocuSign Envelope ID: F2CDO666-44OD-4DG8-gA7&SC46FDF45FA1
IX. SETBACKS& SEPARATIONS—(02B.0200 & 15A NCAC 02T.0305(t)):
I. Does the project comply with all separations found in 15 NCAC 2 _4 & ® Yes ❑ No
> 15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
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 1 or
Class Il impounded reservoirs used as a source of drinkin ■ water
100 feet
**Waters classified WS (except WS-I or WS-V), B, SA, ORW, FIQW, 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
Anv building foundation
5 feet
Any basement
10 feet
Top slope of embankment or cuts of 2 feet or more vertical hei 2ht
10 feet
Drainages stems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth prade (vertical)
36 inches
15A NCAC 0?F.03051t;1 contains alternatives where separations in O i'.[1 0sil cannot be achieved.
> "*Stream classifications can be identified using the Division's NC Surface 1Vater Classifications webnaue
> If noncompliance with 0?T.0303if] or (Kl, see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) [--]Yes [:)No ®NiA
i Seethe Division's draft separation requirements for situations where separation cannot be meet
Y 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 07B .0200? ❑ Yes ❑ No 10 MA
This would include Trout Buffered Streams per 1- A NCAC 2B.0303
4. Does the project require coverage/authorization under a 404 Nationwide or ❑ Yes ® No
individual permits or 401 Water Quality Certifications?
i Information can be obtained from the 401 & Bufler Permitting_Hranoh
5. Does project comply with IIiA NCAC 02T.0101(c06) (additional permits/certifications)? ® Yes ❑ No
Per 15A.NCAC 02T.Ql0_%t;J 6t, 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 021.0402, "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streamtatnks that is subject to erosion that undermines or deteriorates die 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 linesshall 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

• DocuSign Envelope ID- F2CD0666-440D-4D68.9A78-5C46FDF45FA1
X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 023, the Minimum Design Criteria for the Permitting of Pump Stations
and l•orce Mains (latest version), and the Gravitv Sewer Minimum -Design Criteria latest version) as applicable?
® Yes ❑ No
If No, 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 orthe Fast Track Application and supporting documents.
2. Professional Engineer's Certification:
Clint L. Stevens _ _ attest that this application for
(Professional Engineer's name from Application Item Ill. I.)
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 ofmy 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 sea] 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 143-215.6B, 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.
North Carolina Professional Engineer's seal, signature, and date: CARo",,� r
QVQ.rpF Essr.
_ SEAL
o.r .r1,.,1.
3. Applicant's Certification per 15A NCAC 02T .0106(b): 10/24/2019
Scott Schroyer, Executive Director _.attest that this application for
(Signature Authority's name & tide from Application Item 1.3.)
has been reviewed by me and is accurate and complete to the best of my knowledge. 1 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. 1 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 pans 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 $10,000 as well as civil penalties up to $25,000 per violation.
Signature: jw/ Date:
FORM: FTA 04-16 Page 5 of 5

�J ENGHI�NEDE
March 16, 2020
NCDEQ — Water Quality Section ]TCDept ofpnvironm,,tp+
Raleigh Regional Office QI�I�IIIi
3800 Barrett Drive
Raleigh, NC 27609 MAR 2 0 2020
w
Subject: Wastewater Collection System Fast Track Application
U-6020 West Lyon Station Road, Granville County
�� Reg1Qn�� ���
8-inch Sanitary Gravity Sewer along West Lyon Station Road realignment
I am submitting this cover letter and supporting documentation for an 8-inch sanitary gravity sewer along
the West Lyon Station Road realignment. The sewer line construction is a result of the roadway
improvements for the NCDOT U-6020 (West Lyon Station Road) Project. The project consists of the 314
linear feet of 8-inch Gravity Sewer (PVC SDR 35) being installed to maintain service to a business that is
losing current access to the existing gravity sewer that is being removed due to conflict with the roadway
project. There are no new customers, no increased demand, and there are no pump stations being
affected/relocated.
This package includes the following:
1. Cover Letter
2. Permit Application
3. Application Fee
4. USGS Map and Street Level Map
If you have any questions or need additional information, please give me a call.
Sincerely,
Jordan Chapman
Designer
Hinde Engineering, Inc.
I linde Engineering. Inc.
401 1larrison Oaks 131vd., Suite 220 Cary. North Carolina 27513
Phone: [phone] Ftm 704-814-9042 a m.hindeengineering.com

AJ ENGHI�NEDE
401 Harrison Oaks Blvd.
Suite 220
Cary, NC 27513
Phone: [phone]
Fax: [phone]
LETTER OF TRANSMITTAL
To: Raleigh Regional Office Date:
NCDEQ — Water Quality Section
1628 Mail Service Center
Raleigh, NC 27699-1628
Re: U-6020 West Lyon Road (Granville County)
am sending you the following item(s):
=Deptofavironmental Quxlitt
MAR 2 0 2020
x. Weigh Regional Office
March 16, 2020
,lob No, - A2017705.00
Item #
Date
Quantity
Description
1
3-16-20
2
U-6020 Cover Letter
2
3-16-20
2
U-6020 Fast Track Application
3
3-16-20
1
$480 Application Fee
4
3-16-20
2
U-6020 Site Maps Aerial & To 0
These are transmitted as checked below.
❑ As requested
® For approval
❑ For review and comment
Remarks:
❑ For your use
❑ For Signatures
Copy to: File Signed:
Jordan Chapman
Designer

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