WQ0040510_Application (FTSE)_20200508

State of North Carolina
DWR 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 Q 009 65, b y)(to be completed by DWR)
All items must be comnleted or the aunlication will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: City of Mebane (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: David Cheek per I5A NCAC 02T .0106(b)
Title: City Manager N C Uepartment of
Environmental Quality
4. Applicant's [nailing address: 106 E. Washington Street Received
City: Mebane State: NC Zip: 27302-_
5. Applicant's contact information: MAY 0 8 2020
Phone number: 9( 19)563-5901 Email Address:dcheekQacityofinebane.com Winston-Salem
Regional Office
H. PROJECT INFORMATION:
1. Project name: Cambridge Park Sanitary Sewer Improvements
2. Application/Project status: ❑ Proposed (New Permit) ® Existing Pennit/Project
If a modification, provide the existing pennit number: WQ0040510 and issued date: 04/24/19
If new construction but pan of a master plan, provide the existing permit number: W000_
3. County where project is located: Alamance County
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.0616670 Longitude:-79.31861 l °
5. Parcel ID (if applicable): 160191
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Mark Lacy, P.E. License Number: 036286
Firm: LKC Engineering, PLLC
Mailing address: 140 Aqua Shed Court
City: Aberdeen State: NC Zip: 28315-
Phone number: (2-10) 420-1437 Email Address: mark a lkceneineerine.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: City of Graham W WTP / Permit Number: NCO021211
Owner Name: City of Graham
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ_ Downstream (Receiving) Sewer Size: 15 inch
System Wide Collection System Pennit Number(s) (if applicable): WQCS00081
Owner Name(s): City of Mebane
FORM: FTA 04-16 Page I 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 ®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 ®N/A
3. If the Applicant is a Home/Property Owners' 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 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
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 % Domestic/Commercial 0 % Commercial
0 % Industrial (See 15A NCAC 02T .0103(20))
►,Is there a Pretreatment Program in effect? ❑ Yes ❑ No
G. Hasa flow reduction been approved under 15A NCAC 02T .0114(f) ❑ Yes ❑ No
➢ If Yes, provide a cony of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(fl)
Daily Design Flow °•"
No. of Units
Flow
gal/
GPD
gal/
GPD
gall
GPD
gall
GPD
gall
GPD
gall
GPD
Total
0 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. 42A4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.0114j shall be
deternimed using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: _ 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
16-inch
1,5401f
DIP
12-inch
1,6201f
PVC/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)
➢ 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: Cambridge Park Pump Station
2, Approximate Coordinates (Decimal Degrees): Latitude: 36.0413890 Longitude:-79.302500°
3. Design flow of the pump station: 0.720 millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): 500 gallons per minute at 139 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
10-inch
7,430 IS.
PVC C900/DIP
6. Power reliability in accordance with 15A NCAC 02T .0305(It)(l):
® 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) & (e)
® Yes ❑ No
➢ 15A NCAC 02T.0305 contains minimum separations that shall be provided for sewers stems:
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, hnpoundrnent, 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 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(e) contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications weboage
➢ If noncompliance with 02T.0305(t) or (g), see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ®Yes ❑ No ❑ N/A
➢ 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 02B .0200? ®Yes ❑ No [:]N/A
➢ This would include Trout Buffered Streams per 15A NCAC 28.0202
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 Permitting Branch
5. Docs project comply with 15A NCAC 02T.0105(c)(6) (additional permits/ccrtificatfons)? ® 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, stonnwater 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 sreambanks that is subject to erosion that undermines or deteriorates the 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 lines shall be inspected by the permittee or its representative at least once every six -months and inspections
documented per ISA 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 Permitting of Puntn Stations
and Force Mains (latest version), and the Gravity Sewer Minimum Design Criteria (latest version) as applicable?
® Yes ❑ No
If No, complete and submit die Variance/Alternative
review. Anpr_ovaIof the request is required Prior
2. Professional Engineer's Certification:
Engineer's name from Application Item 111.1.)
(VADC 10-14) and supporting documents for
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 (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
havejudged 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 $ I0,000, as well as civil penalties up to $25,000 per violation.
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
David S.
(Signature Authority's name & title from Application Item 1.3.)
that ttris application for
has been reviewed by me and is accurate and complete to die 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 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shalt 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:
P*"' . ' Date: 5/6/2020
FORM: FTA 04-16 Page 5 of 5

N o
N n — ---EXIT= - \ �..--_EXIT_152 OF
w l/ E \
S
Connection to
Existing Outfall
Proposed 16-inch
Gravity Sewer cNAF P
Proposed Pump
Station Site
c
m
4ol CAMBRIDGE PARK PROJECT MAP
SANITARY SEWER IMPROVEMENTS
PERMIT MODIFICATIONS MAY 2020
//rC ITY OF MEBANE, NC
Proposed 12-inch
Gravity Sewer - B
- 8
OLD
Proposed 10-inch
Forcemain
f,l
Legend
O Proposed Pump Station
'. Proposed Gravity
12-inch
^� 16-inch
.••�. Proposed Forcemain
0 500 1,000 2,000
Feet

CAMBRIDGE PARK USGS MAP
N r SANITARY SEWER IMPROVEMENTS
PERMIT MODIFICATIONS MAY 2020
W E' �'.._ ,%~ f - CITY OF MEBANE, NC
1. � , �_ z_:• : , ^,.. .,..��
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Connection to �`r��r ♦ - ti �, �., . Existing Outfall i }�8i \, • %r 1 j
a � ♦ . - — tJ ti ii
oposed 16-inch Proposed 12-inch r - _ ,
avity Sewer Gravity Sewer +
3. ftTragor
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p �,q
1
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i'
f aik
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s'
1 • \ `i ', Forcemaint`.�
�'1 �. 1 • f 1 y
Legend
O Proposed Pump Station
Proposed Gravity
12-inch
j
16-inch
Proposed Force Main
{ _ Proposed Pump r
Station Site
0 500 1,000 2,000

May 7, 2020
Mr. Lon Snider, PE
NCDEQ Winston-Salem Regional Office
450 West Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
Re: Permit Modification for WQ0040510 (2nd Modification)
Cambridge Park Off -Site Sewer Improvements
City of Mebane, Alamance County
Fast Track Sewer Extension Application
LKC Project No.: Evans-18.01
Mr. Snider,
In regard to the above referenced project, please find the following items:
1. Two copies of the Fast Track Application Package
2. One application fee check for $480.00
3. USGS and Area Maps
4. Current Permit Modification issued April 24, 2019
NC Department of
Environmental Quality
Received
MAY 0 8 2020
Winston-Salem
Regional Office
We are requesting a modification to the above referenced permit to adjust the gravity sewer and
forcemain lengths to match as -built quantities. The adjustments to the gravity sewer were made due to
conflicts that required us to install a portion of the line at a flatter grade. Because of the flatter grade,
the line size needed to be increased to provide the same capacity. In addition, the forcemain length
given in the previous permit modification was incorrect and needs to be increased. The modifications
requested for the permit description are as follows:
• Replace "860 linear feet of 16-inch, and 2,300 linear feet of 12-inch gravity sewer" with "1,540
linear feet of 16-inch, and 1,640 linear feet of 12-inch gravity sewer"
• Replace "6,430 linear feet of 10-inch forcemain" with "7,430linear feet of 10-inch forcemain"
If you have any questions, please do not hesitate to contact me at [phone] or by email at
[e-mail].
Sincerely,
LKC Engineering, PLLC
i�licL
Mark Lacy, P.E.
LKC Engineering, PLLC, 140 Aqua Shed Court, Aberdeen, North CaroLna 28315
PH: 910/420-1437 * FAX: [phone] * License No. P-1095