WQ0041695_Application (FTSE)_20200506

DocuStgn Envelope ID. CB83D263-705D-4490-8647-F197CD853076
, {J� F I J --�, V State of North Camlina
SDepartment of Environmental Quality
DWR
Division of Patel- Resources
15ANCAC 021'.I)300—FAS'f TRACT: SIIVIA1 SYSTMI GKTENSION APPLICATION
Division of Water Resources FFA 114-16& SUPPORTING DOCUMENTA110N
Application Nutr.berw(_L? 10(4con, cerndlsy l]Wlt}
11 items nutst be eninpided or the allmAicalinp %mill Iw returned
1. APPLICANT INFORhIATION:
I. Applicant's nacre: Tnwn of Holly SpriM (Company, municipality, I IOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ corporation ❑ General Partnership
❑ Federal ❑ State/Counly ® Municipal
3. Signature authority's name. Kendra D. Parrish. P.F., per I.SA NC U 02T .0106I_b)
Title: Director ofFii ine rift
4. Applicant's rruiling address: 129 South Main Street
City: Holt S r;n n Statc. L((", Zip: 27540-
5. Applicant's contact information:
Phone number: (219) 55 -20.1 Grmil Address: keuclrr. martish�ilhnll springsnaus
❑ Privately•Owncd Public Utility
❑ Other
and sara.cmig�uhollyspringsncros
11. PROJFDCT INF011MATION: y r
I. Project name; ! 1I uLU 3 u i9� c I 3e wS C 4 � n �� •'t5 t L` +'t
2. Application/Project status; 126roposed(New Pennit) ❑ 1=dsting, 1'erwit/1'roject
lfanxtdification, providetheexisling permit number: WQOO and issueddatc:
If new constntction but part of a master plan, provide the. existing permit number. WQOO
3. Cormly where project is located: di
4. Approximate Coordinates (Dccinmal Degrees); l,mmtitude:.j5 t 5,15,si `1 Longitude: -71.7 7t 5 ti
5. Parcel ID (if applicable): PI N 0 tit ,el tl 3 {
(or Parcel ID to closest dom%vstrcamsewcr)
III. CONSULTANT INI-.0101AT1ON-:
I. !'rofessionalrrinoineer. Em)I riw'rfit License Nmuber. C�
Finn:
Mailing address: 27L+�j Vic•: tla��ti ��% LAQ.
city: e ,, �.s1, state: N C zip: 7- 0- Lt3 3 s
PhnnennmbeclClIq��L'-R 21*7 rnmail Address: �].I���p,�'�2l?�,(.�,1e.Ct+0
IV. WASTL1VA'I'E.lt 9'ItUA'I'i<11,N"I' FACILITY (WW'1[) 1NFOIthIATION:
I. Facility Name: t t cy Creek WastewaterTrealment Plan Permit Nitmber: NC:0063096
Owner Name. Town of I lollY S r'n s
V. RIMAVING DOWNSTI(EAM SLIVER 1NI,0101ACION (ifdilfereut than WWTn:
1. Pennit Nurnber(s): WO 0017170 Downstruaw (Receiving) Sewer Si«: 30 inelm
System Wide Collection SysicnmPenuit Nuntber(s) (if applicable): WQCS 00192
Owner Name(s ): 'town of Holly Springs
FORM:117A 04-16 Page I of

DocuSign Envelope ID: C883D263-70504490-8647-F197CD853076
THE COMPLETED APPLICATION PACKAGE INCLDI'NG ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD BE SENT -1.0 THE APPROPRIATE REGIONAL OFF ICE:
REGIONAL, OFFICE
ADDRESS
COUNTIES SERVED
Asheville RegionafOffice
2090 US Highway70
Avery, Buncombe, Burke, Caldwell, Cherokee,
Water Quality Section
Swannanoa, North Carolina 28778
Clay, Graham. Haywood, Henderson, Jackson,
(828) 2964500
Macon, Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Harnett, Hoke,
WatcrQuality, Section
Fayetteville, North Carolina 28301-5094
Montgomery, Moore, Robes on, Richmond,
[phone]
Sampson, Scotland
[phone] Fax
Mooresville_ Regional Office
610 E. Center Avenue
Alexander, Cabarrus, Catawba, Cleveland,
Water Quality Section
Mooresville, North Carolina 28115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
Raleigh -Regional Office
1628 Mail Service Center
Chatham, Dufham,Edgecombe, Franklin,
Water Quality Section
Raleigh, North Carolina 27699-1628
Granville, Halifax, Johnston, Lee, Nash,
[phone]
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
Warren, Wilson
Washington Regional Office
943 Washington Square Mall
Beaufort, Bertie. Camden, Chowan, Craven,
WaterQualily Section
Washington, North Carolina 27889
Currituck, Dare, Gates, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquolank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
Wilinington Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
Watergivility Section
Wilmington, North Carolina 28405
Hanover, Onslow, Pender
[phone]
[phone] Fax
Winston-Salem Regional Office
450W. Hanes Mill Road
Alamance,Alleghany,Ashe, Caswell, Davidson,
Water Quality Section
Suite 300 •
Davie, Forsyth, Guilford, Rockingham, Randolph,
Winston-Salem, North Carolina 27105
Stokes. Surry, Watauga, Wilkes, Yadkin
[phone]
INSTRUCTIONS FOR FORyf: FTA 0,1-16 & SUI'1'DRT[iNG DOCUMENTATION Page ol'3

DocuSign Envelope ID: CB83D263-705D4490.8647-F197CD853076
Vl. G1WERAl, REQ[Jilt ENIEN'TS
I. If the Applicant is a Privately-O►>•necl Public titility, has a Certificate ofpubiic Convenience and Necessity been attached?
❑ Yes ❑ No 064/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's >ner•a io tal A vrecnxnt fORvl: DF been attached?
❑ Yes ❑No L7NIA
3. If the Applicant is a
❑ Yes ❑ No 9N/A
4. origin ofwastemaler: (check all that apply):
been attached?
❑ Residential Owned ❑ Retail (stores,centers,nialls) ❑ Car Wash
❑ Residential Leased ❑ Retail with food prcpnration/service ❑ Hotel and/or Motels
L! School / preschool/ day care ❑ Medical / dental / veterinary facilities ❑ Swimming Pool /Clubhouse
❑ Food and drink facilities ❑ C7nurclt ❑ Swimming Pool/Filter Backwash
❑ Businesses/offices I factories ❑ Nursing Flume ❑ Other (Dqrlain in Attachment)
5. Naturcofwastewater: /00 'ADomestic/Commercial %C'ommercial
Industrial (ties 15A NC'AC 0TI' .0103(20))
4 Is there a Prefreaftuent Program in efruct? 1:1 Yes ❑ No
6. Has a flow reduction been approved under ISA N ICAC 021' .01 1,J1 ❑Yes (P No
If yes. proxide a envy of flow reduc inn a i nvnl letter
7. Sumnaari7,e waslcwatergener-tied byproject:
1,Mablishment 'Type (see 02T.01 I4f 11)
Daily Design Ifoty a,h
No. of Units
[low
SC 1) dev
!Lti gav y JE"1 -
1-13
21,430 GPD
Sall
GPD
gall
GPD
ball
GPD
gal/
GPD
guv
GI'D
!'nhrl
LI30 GPD
a See 15A NC'AC 02T .0114 In d e I and c ? l'or caveats to wastewaterdcsign flow rates (i.e., rninimurn pow per
dwelling; proposed unknown non-residential development uses; pubk-access facilities located nearhigh public useareas;
and residential property located south oreast ofthe Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in G.S. 42A-4).
b Per 15A NCAC 02T .0114(c), design pow rates for establishments not identified [in table ],jA_NCAC 02T.0114j shall be
detennined using available flow data, water using fixtures, occupancy or operation patterns, and other meas tired data
S. Wastcwatergencrtcdby project:2'IACPD (per 15A NC'A(`. 02T .0114)
i Du not include future flows orpreviously pemrfited allocations
Ifpermitted flow is zero, indicate why:
❑ Pump Station or Gravity Sewer where flow will be permitted in subsequcntpunnits thatconnecl to this lane
❑ Flow has already been allocated in Pennit Number:
❑ Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (EVIain):
FORM, FTA 04-16 Pagc2or5

DocuSign Envelope ID: CB830263-705D-4490-8647-FI97CD853076
V11. GRAVITY SMgt DISIGN CRf1'I+1Z[A (lf Applicable) - 421 .030-5 & iti11C Wr:nily Se%lers):
1. SuinntarLe gravity sewer to be pens ittcd:
Size(iuclies) U-11gilr (feel) N131Cs-i.11
1 3c _PVC
i Section 11 & III of the MDC for Pcmtilting of Gravity Sewers containsfnibrnlation related to design criteria
Scclion III contains infonnation related to minimum slopes forgrtvity sewer(s)
0%vrsizing lines to creel minimum slolic requirement is nut a11U111.'rl ould a violation of the muC
Vlll. PUMP S'1'A'1-IOIN DINICN CRrrEmA (If Applicable) --1321 -03(i5 & ,XlI C (Pump Slationslivrl-ce-Mainsl:
COMPLITC C'OR FAC'II 1!llall' STATION INCIAID :D IN'1'111S uni a"f
1. Pump station number or name:
2. Approxisnate Coordinates (Deciulal Degrees): Lmtiludc: ° Longitude. -
3. Design flow oftheptnnp station: millions gallons per day (finn capacity)
4. operational point(s) oft lie pump(s): gallons per mirnne Fit leet total dynatnic head (TIM)
5. Surnma ize the fork main to be permitted (for this Pump Station):
Size(inehes) Length (feel) Material
0. Power reliability in accordance with 15 1 NCAC 01T .0105 h I :
Cl Standby power sourceorptlmp with automatic activation and telemetry - 15A NCAC 02'l' .0305(h)(1)(13)_
Required 1br all pump stations with an averagedi ly flow greater than or equal to 15,6U0 gallons per day
i Must be pernwnent to facility
Or if the pump station has an average daily flow less than 15,000 gallwas per day:
❑ Portable power Source with manual activation, quick -connection receptacle and telemetry - ISA NCAC UZI'
.0305(h)(1)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and tclensetry - 15A NCAC 021' .0305(h)(I)(C):
It sltull be dunionstialct1 to the Division that the portable sourceis owned or contracted by the applicant (draft agreement)
and is compatible with the station.
`r If the portable powersomccorpump is dedicated to multiple pump stations,:la cvafu,ltion ofafl Ihepuulp stalions'storlge
capacities and the rotation schedule of the portable power source or purnp, including travel timel-rarncs, shalt be provided
in the case ofn multiple station power oulage-
rORfv1:I'TA 04-16 Page 3 of 5

DocuSign Snvelope ID: CB83D263-705D4490-8647.F197CD853076
IBC. Si lBACI S & SUTARATIONS —(ll2ti.0200 & 15A NCAC 02'I'.0305(I)):
1. Dues theproject comply with all separations found in 15A NCAC 021'_0305(D & (e}
i 15A NCAC 02T.0305(n contains ininintwu scnaratiuns thalshall tie nrnvided for sewer cvcW-,rn-
la'Ves ❑ No
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (VCrtiLal)
24 Inches
Water rnains (vertical -water over sewer includig, in benched trenches)
15 inches
Water mauls (horizontal)
10 feet
Reclaimed water lines vertical -reclaimed over sewer)
l8 incites
Reclaimed water lines horizontal -reclaimed oversw6ver
2 feel
**Any private orpublic water supply source, including any wells, WS-1 walcts nf0ass I or
Class H impounded reservoirs used as a sourceof drinking water
100 feel
"Waters classified WS (except WS-1 or WS-V), B, SA, ORW, I IQW, or SB rrom normal
high eater (or tide elevation) and wetlands (sce item IX.2)
50 teet
""Any otherstrearn, lake, impoundment, or ground water lowering andsurface drainage
ditches
10 feet
Any building foundation
5 feet
Any basement
10 feet
Top slopeofembankment orcuts of 2 fact ormorc vertical height
10 rect
Draina e s sterns and interceptor drains
5 reet
Any swiniming pools
10 fact
Final earth gnkde (vertical)
36 inches
15A NCAC 02T..0305(g) contains alternatives where separations in 021'.0305(i1 cannot be achieved.
:- **Stream classifications can be identified usingtheDlvislon's NC Surface Water Classifrcatious tech a c
i if noncornpliauce with 02T.0305(f) or(yf. sceSection X orlhis application
2. Does the project comply with separation requirements for weltands? (50 feet of separation) i"Yes ❑ No
)i- See the Division's draft separation requirements for situations where sepuration cannotbe meet
i No variance is required if thealtenrutive designcriteria specified is utilized in design and constntct.on
> As built documents should reference the location ofareas efrecled
3. Does the project comply with all setbacks found in theriver hasin rules per 15A NCAC 02B .0200? IdYes ❑ No
Y This would includeTrout BLICrCred Streams per 15A NC'A(' 211.0202
4. Does the project comply with an individual 404 Permit or any 401 Certifications? 1-59 Ycs ❑ No
Y Wetland -related permits shall be requested,obtained, and adhered to for projects that impact wetlnuds or surface waters
Y InforTnation can be obtained Dorn (he 401_ & Huffer Pern Uing Munch
5. Does project comply with MI NCAC 02T.0105(c )(6) (additional pernihslcertifications)? LJ Yes ❑ No
Per 15A NVAC 071'.0105(c)(6), directly related environmental permits nr ccrtificatinn applications are being prepared, have
been applied for, or have been obtained. Issuance of this permit is contingent on issunnceof dependent permits (erosion and
sedimentation control plans, stormwater rmnagernent plans, etc.).
6. Does this project include any sewer collection Imes that are deemed "high -priority?"
Per IiA NCAC 027.0IO2, "high -priority sewer" means "any atrial sewer, sewer contactingsurfnce waters, siphon, or sewer
positioned parallel to streatnbanks that is subject to*msion thatundennincs or deteriorates the sewer.
❑ Yes TrNo
Ifyes, includcan attachment with details forcach line, including type (aerial line, sim, material, and location).
High priority fines shall be irts]rected by the permillee or its rclwcsenlati%v at leastonce eiery six -months and inslxclions
documented per ISA NCAC 02'1'.041I3(a)(5) or (he pernritee's iudiOdual Syslem-Witk Calieciion permit.
FORM: FTA 04-16 Page 4 or

DocuSign Envelope ID. CB83D263-705D-4490-8647-F197CD853076
X. CERTIFICATIONS:
1, Does the subiiiiitcd sysierticoinply with 15A NCAC 02-f, the h•linin o w Desigri-CAteFia ior_thc Perntittiii of Pttn_tn Stations
and Farce Mains flytent_veysio l 1, and the Griv-,i_ySewer Miginlum Design Crilcria (totem vcrsianl as applicable?
d Yes ❑ No
If No,complete and submittileVariance/AItemntive Design Request application(VADC 10-14) andsupporling documents for
review. ApRrovol of the request is reiprlred prior to submittal o£ the Last Track Almlicaliou and supporting documents .
2. Professional Engineer's Certification:
1, ���! llir�iyl C. �� c� attest that ill is application for
(Pmfessionnl Engineer's name from Application Itern II1,1.)
has been reviewed by ine and is accurate, complete and consistent with the information supplied in the plans, specifications,
engineering calculations, and all other supporting docunientation to the best of my knowledge. 1 further attest that to tine 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 develupcdcerlain 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 143-215.6B, any person who lnowingly makes any false
statement, representation, or cettifrcation in any application package shall be guilty of a Class 2 inisderneanar, which niay
include a fine not to exceed $10,000, as well as civil penalties up to $5,000 per violation.
..................__
North Carolina Nrofessiunal lEngineer's seal, signature, and date:
3. Applicants Certification per 15A NCAC 02T .0106(b):
Kendra Parrish
(Signature Authority's name & title from Application Item 1.3.)
.attest that this application for
has been reviewed by me and is accurate and complete to the hest 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 systemto surface waters orthe land will result in ail immediate enforcement action that may include civil penalties,
injunctive relief, and/orcriminal prosecution. I will make no claim againsttire Division of Water Resources should acondition
of this permit be violated. I also understand thntif all required parts o£this application package arc not complcicd and t hat if
all required supporting infommation and altachrnents are not included, this application package will be returned to are as
incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.CB, any person who knowingly makes any false
statement, representation, or cetiflcation 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.
Docuftned by:
�K.,.O. Pik
Signature: r115GB143E5346A.- —
515/2020
Date:
FORM: FVA 04-16 Page 5 of 5

DocuSign Envelope ID: CB83D263-705D-4490-8647-F197CD853076
State of North Carolina
Department of Fuvirolunental Quality
Division of Witter Resources
Flow Tracking/Acceptance for Sewer Extension Applications
(FTSL 04-16)
Entity Requesting Allocation: The Town of Holly Springs
Project Name for which flow is being requested: New School Sewer Extension
Adore than one VI Sls +nay be regxired.j<u- a single pri yeti if the owner of the 11'117T is no/ +-esponsible for till pump
stations along, the route nfnce In wposed wc+stctrutcr flow.
I. Conip[etc this section only if you tire the owner of the wastewater treatment plant.
a. W WTP Facility Name: UFlcy Creek Wastewater Treatment Plant
b. WWTP Facility Permit ff: NC 0063096
All flows are in AIGD
c. WWTP facility's permitted flow 6.0
d. Estimated obligated Ilow not yet tributary to the " W'I'P 0.758
c. WWTP facility's actual avg. flow 2.495
f. 'Total flow for this specific request 0.002
g. 'Iblal actual and obligated claws to fife facility 3.255
li. Percent of permitted flow used 54%
11. Complete this section for each pump station you are responsible liar along the route ol" lhis
proposed wastewater flow.
List pump slations located between the project connection point and the WWTP:
(it)
Design
I'urnp
Average Daily
Station
Firm
Flow"
(Ncanc or
Capacity, •
(Firm / p0,
Number)
WID
MCiD
Middle Creek PS
1.08
0.432
Sunset Ridge PS
2.45
0.979
Obligated,
Approx.
Not Yet
Curren Avg.
'tributary
Daily Flow,
Daily Flow,
NIGTD
MOD
0.192
0.093
0.642
0.106
(l))-(Is+q
(r)-(A-D)
Total Current
Flow Plus
Obligated
Available
Flow
Capacity"
0.285
0.147
0.749
0.230
* The Firn: capacity or any pump station is defined as the maximum pumped flow that
can be achieved with the largest pump taken oul ol'service.
** Design Average Daily Flow is the firm capacity or the pump station divided by a peaking
factor (po not less than 2.5.
*** A Planting Assessment Addendum shall be attached ror each pump station located
between the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): Middle Creek PS & Sunset Ridge PS
Downstream Permit Number: WQ0017I70
Page I of 6
t-I'A 0 1- 16

DocuSign Envelope ID: CB83D263-705D-4490-8647-Fh97CD853076
Ill. Certification Statement:
I Kendra Parrish 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 froth 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 hest
available data. This certification applies to those items listed above in Sections I and I1 plus all
attached planning assessment addendums for which I am the responsible party. Signature of this
form indicates acceptance of this wastewater flow.
—Docuftnea by:
1rlw P. ,,,,,"
5/5/2020
Signature Date
Page 2 of 6
I til 0-1-16

DocuSign Envelope ID: CB83D263-705D4490-8647-F197CD853076
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William C. Piver, PE, LEED AP
Development Engineering
February 25, 2020
Engineering Department
Town of (folly Springs
P.O_ sox 8
Holly Springs, NC 27540
Re: New School Sewer Extension Project #19-14-01
Attn: Drew Johnson
Mr. Johnson:
We are hereby applying for Final Approval of the Construction Plans permitting of the referenced sewer
project. The existing New School Montessori has, until recently, relied on an onsite low pressure
subterranean discharge treatment system for its wastewater disposal. Due to its age the existing
disposal system is no longer viable and has been de -activated. This has forced the school into a pump
and haul situation that is not sustainable. The only viable option is to discharge into the Town of Holly
Springs public sewer collection system. After discussions with the Town's Engineering Department an
evaluation of available routes determined that the least costly, as well as the least environmentally
harmful route, was to extend a line from the school to the Town's existing Fairshare outfali that is on
Town property adjacent to the school site.
The school currently has an enrollment of 243 students. Based on this enrollment and, because the
school has no gym, cafeteria or showers, a daily discharge rate of 10 gallons/day/student (gpd)
according to 1SA NCAC 02T _0114 was employed to calculate that the current flow to be 2,430 gpd.
However, there are currently plans by the school to add another building on the campus that would
allow a doubling of the student enrollment. Therefore an assumed average daily flow of S,000 gpd from
the school was utilized.
Although it is doubtful that the adjacent area north of the school, when developed, would route their
sewer to the school's proposed sewer extension the anticipated flow from this area was calculated.
Given that the adjacent 12 Acres are zoned R-30 and, by applying the Town's standard discharge rate of
255 gpd for two (2) bedroom residential dwelling units, the projected average flow from the adjacent
area would be 91,800 gpd_ Multiplying this rate by 2.5 generates a peak flow rate of 229,500 gpd. The
proposed sewer line can support this flow if it becomes a reality.
We are hereby submitting the following items as directed on the referenced project:
• One copy of our responses to 2nd redline review comments
• One copy of the local=y required Certification of Plan Submittal (TONS form 9035)
• One copy of the locally required Design and Application Certification (TOHS form 2003)
• Three hard copies of the Town approved Construction Plans and a CD with a digital file of the plan set
• One original and one copy of this Cover letter including a project narrative
• One original and one copy of the State of North Carolina Fast Track Sewer System Extension
Application (FTA 04-16)
• Two copies of FTSF 04 - 16 Flow Tracking/Acceptance Form
2709 Scottsdale lane, Ra'eigh, NC 27613 0 [e-mail]7) m f 919) 880-4217

William C. Piver, PE, LEED AP
Development Engineering
Page 2
• Two color copies of a 8.5-inch by 11-inch portion of a 7.5 minute LISG5 Topographic Map showing
project area
• Two copies of a street level map showing all relevant project areas
• A check in the amount of $200.00, made out to the Town of Holly Springs, for the sewer permit
processing fee
■ A check in the amount of $450.00, made out to the Town of Holly Springs, for the sewer permit review
fee
• A check in the amount of $480.00, made out to NCDEQ, for the permit application fee
We trust we have included all the required information and documents to insure approval of the
Construction Plans. However, if you need additional information please do not hesitate to let us know so
it can be promptly provided.
Re�full fitted,
illiam C. Piver, PE
2709 Scottsdale Lane, Raleigh, NC 27613 ® [e-mail] w (9191880-4217

DocuSign Envelope ID: CB83D263-70504490-8647-F197CD853076
THE •rowN OF
April 28, 2020
Director, Division of Water Resources
Raleigh Regional Office
Water Quality Operation Section
1628 Mail Service Center
Raleigh, NC 27699-1628
�Ily Sprin
Re: Application for Sewer Extension Permit
Project: New School Sewer Extension
Dear Sir or Madam:
S
Please find enclosed the following items in application for a sewer extension permit to the Town
of Holly Springs existing sewer distribution system:
0 One digital copy cover letter including a project narrative
o A check in the amount of $480.00
0 One digital copy of the State of North Carolina Fast Track Sewer Systeln Extension
Application (FTA 04-16)
0 One digital copy of FTSE 04-16 Flow Tracking/Acceptance Form
0 One color copy of a 8.5-inch by 1 1-inch portion of a 7.5 minute USGS Topographic
Map showing project area
0 One copy of a street level map showing all relevant project areas
0 One copy of the locally -required Design and Application Certification
Feel free to contact me at 919-557-3938 should you have any questions or need additional
information in order to process this application.
Sincerely,
�
Docu51 dby:t p,..t�
EA35C6A43E5346A
Kendra D. Parrish, P.E., CFM
Director of Engineering
KPlse
cc: Project Consultant Engineer, William C. Piver, PE
Administrative Manager (for addition to sewer permit log)
Rodney Campbell, Development Administrator
Project file/Correspondence #41814
3002
04 17. oIR
Engineering Department
P.O. Box 8 - 128 S- Main Street - Holly Springs, NC 27540 - www.hollyspringsnc.us

DocuSign Envelope ID_ CB83D263-705D-4490-8647-F197CD853076
�DO NOT SUBMIT SEWER EXTENSION APPLICATIONS UNTIL
CONSTRUCTION DRAWINGS HAVE BEEN APPROVED BY STAFF!
Sewer Design and Applicatioii Certification
Note: This form must be submitted with the Fast -Tract Ap liration for Gravit Sewers Pump
Stations and Force Mains for extension to the Town of Holly Springs Sewer System
Project:
Design Engineer:
Address:
New School Sewer Extension
Willaim C. Piver, PE
2709 Scottsdale Lane, Raleigh, NC 27613
Phone Number: [phone] Email:
[e-mail]
Date Complete Application Package Received by Town: 03/04/2020
5/5/2020 r (by RLC)—5/5/2Q2Q
Date Approved: Fr;P (by KDP)
eay .
As design engineer for this project, I certify the following (please check Cz) each applicable box):
Iff That the design of the project is in complete conformance with Town of I lolly Springs
Engineering Design and Construction Standards and NCDENR Sanitaly Sewer Design
Regulations;
M That each of the following items are completed and enclosed for submittal to the State for
a sewer extension permit'
o One original and one copy cover letter including a project narrative
o A check in the amount of $480.00 to DEN -
o A check in the amount ot'$200.00 Town processing fee
o One original and one copy of the State of North Carolina Feist Track
Applicaliortfor•Greivit},.Se tees, Prunp,Stations, and Force Alain.•
o Two copies of FTSE 08-13 Flow Tracking/Acceptance form
o Two color copies of a 8.5-inch by l ]-inch portion ofa 7.5 minute USGS
Topographic Map showing project area
0 Two copies of a street level map showing all relevant project areas
0 One copy of the locally -required Design and Application Certification
Design Engineer's Signature X ,
In addition, once your construction drawings are approved and this application is complete, you
will receive a copy of the Town's letter of transmittal to the State as your confirmation that the
application is complete and has been forwarded to the Slate for permitting. Please contact Sara
Emig at [phone] ifyou do not receive this confirmation or if you have any questions.
L'11girreerilr8 Deparlrrlerrt - A0, !lase 8, Hol& Springs, NC 27540
919-S57-3938 - 919-552-9881 (free)
2001 Smer Design Applicnrion Cerlprr, KNI
04.11 20M