WQ0041692_Application (FTSE)_20200511

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number:
(to be completed by DWR)
All items must be completed or the application 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
❑ Federal ❑ State/County ® Municipal
3. Signature authority's name: David S. Cheek per 15A NCAC 02T .0106(b)
Title: City Manager
4. Applicant's mailing address: 106 E. Washington Street
City: Mebane State: NC Zip: 27302
5. Applicant's contact information:
Phone number: [phone] Email Address: [e-mail]
❑ Privately -Owned Public Utility
❑ Other
i .. ��partnient of
Environmental Quality
Received
II. PROJECT INFORMATION:
1. Project name: Signature Flooring
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: Alamance
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.0667' Longitude:-79.2667'
5. Parcel ID (if applicable): 0167499
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: L. Allan Hill License Number: 15809
Firm: Triad Design Group
Mailing address: 4807 Koger Blvd, Suite C
City: Greensboro State: NC Zip: 27407-_
Phone number: 3( 36) 218-8282 Email Address: ah�triad-designgroup.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: WRRF Permit Number: NCO024210
Owner Name: City of Mebane
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than W WTF):
1. Permit Number(s): W00036835 Downstream (Receiving) Sewer Size: 8 inch
System Wide Collection System Permit Number(s) if applicable): WQCS0008I
Owner Name(s): City of Mebane
Valk`! 11 2020
Winston-Salem
Regional Office
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: 60 % Domestic/Commercial 40 % 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(f) ❑ Yes ® No
➢ If yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow a•b
No. of Units
Flow
Restaurant, Full Service
40 gal/seat
167
6,680 GPD
General Business
25 gal/employee/shift
8
200 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
6,880 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.
S. Wastewater generated by project: 6 880 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

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 889 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
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: 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 - 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) N 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, 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(¢) contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications weboaee
➢ 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) N Yes ❑ No ❑ N/A
➢ 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? N Yes ❑ No ❑ N/A
➢ This would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Does the project require coverage/authorization under a 404 Nationwide or []Yes N No
individual permits or 401 Water Quality Certifications?
➢ Information can be obtained from the 401 & Buffer Permitting Branch
5. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? N 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 N 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 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 Permitting of Pump Stations
and Force Mains (latest version), and the Gravity 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 of the Fast Track Application and supporting documents
2. Professional Engineer's Certification:
that this application for
(Professional Engineer's name from Application Item III.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 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 $10,000, 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):
D cv-,A 45. Ch,-6 le 1 ` [ ):! 1( `GvICc
(Signature Authority's name & title fro& Applicatior
I.3.)
.,W\-\ n po •.,,•,
Q� �ESSlp i
SEAL
Fh'-GINEEP•'• a
attest that this application 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, 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 143-215.613, 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 $10,000 as well as civil penalties
_upp ttoo $25,000 per violation.
Signature: 7:/nQ4d--
Date: 3 17 Zp
FORM: FFA 04-16 Page 5 of 5

State of North Carolina
9 t .,0-
wlmww�
Dlvlslon of Water Resources
Department of Environmental Quality
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: Signature Flooring
More than one FTSE may be required for a single project if the owner of the WWTP is not responsible for all pump
stations along the route of the proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: City of Mebane WRRF
b. WWTP Facility Permit #: NC O021474
AQ flows are in MGD
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
2.5
0.6817
1.597
.00688
2.285
91.4%
II. 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)
(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***
SE Reg
2.5
1.0
0.2307
0.344
0.575
0.425
* 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 by a peaking factor
(pf) 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): City of Mebane
Downstream Permit Number: WQ0039116
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I David S. Cheek 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.
3(17/20
Signing O ial Signature Date
CA-r MA--1A6oClZ
Title of Signing Official
Page 2 of 6
FTSE 10-18

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May 7, 2019
Mr. Rick Ringler, PE
Triad Design Group. P.C.
4807 Koger Blvd., Suite C
Greensboro, INC 27407
Subject: Signature Flooring— Water and Sewer System
Dear Mr. Ringler:
Regarding subject Preliminary Site Plans and in accordance with paragraph 7-4.3 A.3.a. in the UDO, this letter is
provided to indicate that I have reviewed the preliminary water and sewer system layout and find it acceptable and
meets City standards based on the following:
1. Water system —The project is proposed to be served by extending a new 8 inch public water line by tapping
the 12 inch existing waterline on the west side of Mebane Oaks Road and terminating with a new site fire
hydrant located adjacent to the driveway access connection. This new public line will be used for fire
protection and for the proposed individual water service connections (1 inch and 2 inch with backflow
devices). The estimated water use is 6,905 gallons per day. The City has adequate water capacity available
to meet the project's daily domestic demand and fire flow requirements.
2. Sanitary Sewer system —The project is proposed to be served by extending new public 8 inch sewer line
from an existing manhole located on the east side of Mebane Oaks Road approximately 600 feet south of
the project site, then adjacent to the existing road right-of-way to and through the project site terminating
near the northern project property line for possible future extension. The estimated wastewater from this
project is 6,905 gallons per day. The City has adequate wastewater capacity available at the downstream
Southeast Regional Pump Station and at the WRRF to meet this demand.
Please let me know if you have any questions.
Sincerely,
Franz K. Holt, P.E. City Engineer
CC: Montrena Hadley, Planning Officer
Cy Stober, Development Director
Chris Rollins, Assistant City Manager
Kyle Smith, Utilities Director
CITY OP' MEBANE, 106 East Washington Street I Mebane, NC 27302 0 919563 5901 ''a---' fboltLcityo8nebane.com

May 7, 2020
Mr. Justin Henderson
Winston Salem Regional Office
Water Quality Section
450 W. Hanes Mill Road
Winston Salem, North Carolina 27105
336-776-9701
RE: Signature Flooring
Mebane, NC
Sanitary Sewer Permit
Dear Justin,
• „�Narin-lent i,f
EnvironmentaeQuality
Receiv
1. Y 11 2010
Winston-Salem
Regional Office
We are enclosing for your review, one (1) original and (1) one copy of the Fast Track Sewer
System Extension application, (1) USGS Topo Map of the project location (1) City of Mebane
Approval Letter, and (1) Site Map with road locations. The project will consist of 889 LF of public
gravity sewer extension along Mebane Oaks Road in Mebane, NC. The sewer line will parallel
the existing road alignment. Sewer flow for this project has previously been allocated to the
downstream line under a City Council motion approved during the June 3, 2018 meeting. The
approval letter from the City Engineer that was included in the motion is attached.
If any additional information is needed, please feel free to contact me.
Sincerely, 1
L. Allan Hill, PE
Civil Engineer
trieddesigngrouit)
ARCHITECTU RE I ENGINE ERIN G IINTERIOR DESIGN
4807 - C Koger Boulevard, Greensboro, NC 27407 1 T - 336-218-8282 F - 336-218-8010 1 www.triad-designgroup.com

Transmittal Letter
Date: May 7, 2020
To: Justin Henderson
NC Department of Environmental Quality
Water Quality Section
450 W. Hanes Mill Road
Winston-Salem, NC 27105
336-776-9701
Project: Signature Flooring
Mebane N.C.
We Transmit:
(X) herewith
() under separate cover
Project #: 18-129
For Your:
(X) approval
Q review and comment
Q use
�cparnnent or
Environmental Quality
Received
h "5Y 11 2020
Winston-Salem
Regional Office
Copies Date Description
2 Fast Track Sewer System Extension Application (FTA 04-16)
1 3-10-2020 Signature Flooring Ck#016464($480.00App. Fee)
1 USGS Location Map, Vicinity Map, Supporting Documentation
Comments: Justin,
The proposed project is to extend a public sanitary sewer main from an existing City of Mebane
public manhole located on the east side of Mebane Oaks Road to the proposed Signature Flooring
site on Mebane Oaks Road in Mebane, NC. The total length of Public main to be permitted under
this application is approximately 889 linear feet. If you have any questions or require additional
information, please call.
Copies: File
Submitted by: L. Allan Hill, P.E.
Chief Civil Engineer
4807 - C Koger Boulevard, Greensboro, NC 27407 1 T - 336-218-8282 F - 336-218-8010 I www.triad-designgroup.com