WQ0041788_Application (FTSE)_20200707

State of North Carolina
nWR Department of Environmental Quality
Division of Water Resources
ISA NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: W O 0 �� (to be completed by DWR): Q� a` D�(�V
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All items must be completed or the application will be returned S
I. APPLICANT INFORMATION:
I. Applicant's name: Hilltop Village Shol2l2ing, Center LLC (company, municipality, HOA, utility, etc.) 1 {, �✓I
2. Applicant type: ❑ Individual ® Corporation ❑ GeneraI Partnership ❑ Privately -Owned Public Utility
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❑ Federal ❑ State/County ❑ Municipal ❑ Other
3.
Signature authority's name: Robert L Ratliff. RI per 15A NCAC 02T.0106ib)
Title: President
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4.
Applicant's mailing address: 16I5 Tynecastle Highway
City: Banner Elk State: NC Zip: 28604-
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5.
Applicant's contact information:
Phone number: 82$ 387-1906 Email Address: boatdriver47(aol.com
II. PROJECT INFORMATION:
1.
Project name: Replacement ofan_Existing Lift Station Located at Hilltop Village Shopping Center -Oxford, NC
2.
Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
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: Granville
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4.
Approximate Coordinates (Decimal Degrees): Latitude: 31.3169' Longitude:-78.5708
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5.
Parcel ID (if applicable): 192315646557
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(or Parcel ID to closest downstream sewer)
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III. CONSULTANT INFORMATION:
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I.
Professional Engineer: John R. Harman, PE License Number: 9810
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Firm: Consulting Engineer
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Mailing address: 2112 White Oak Rd
City: Raleigh State: NC Zip: 27608-
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Phone number: (9818-2077 Email Address: jackharman53aMail.com
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IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: City of Oxford
Owner Name: Citv of Oxford
Permit Number: NC 0025054
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ Downstream (Receiving) Sewer Size: inch
S,,stem Wide Collection Svstem Permit Number(s) (if applicable : WQCS 0 JO
Owner Name(s): O)
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 ®NIA
2. If the Applicant is a Developer of lots to be sold, has a Develoaer's O erational.Aareement (FORM: DEV) been attached?
❑ Yes [:]No ®NIA
3. If the Applicant is a Homerprou M Owners' Association has an Operational Agreement (FORM: HOA) been attached?
[:]Yes ❑No ®NrA
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 % Commercial
_ % Industrial {See 15A NCAC 02T ,0103120 )
-Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0 114f1j? ❑ Yes ® No
�i, If ves, provide a copv of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 021.0114(11)
Daily Design Flow'b
No. of Units
Flow
Carry Out Restaurant -Top China
50 gal,' 100 s.f
10
500 GPD
Food Lion Grocery Store
100 gal/]000
20
2000 GPD
Dentist Office -Granville Co Health
250 gal/Practitioner
1
250 GPD
Misc. Business Oriented Tenants
25 gal, -Employee
16
400 GPD
Excess Allowance
25 gal. -Employee
2
50 GPD
gal,'
GPD
Total 1
3200 GPD
a See I A_N_ CAC Q2T .0114(b). (d), (e)(1) and, 2 for caveats to wastewater design flow rates (i.e., minimum flaw 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.01141 shall
be determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 3200 GPD (per I SA 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: Refer to Item IV
❑ Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain):
rr%n ok A. rrA n.l /I

VII. GRAVITY SEWER DESIGN CRITERIA (if Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity scwer to be permitted:
Size (inches) Length (feet) Material
i Section li & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
i 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: Hilltop Village Shopping Center
2. Approximate Coordinates (Decimal Degrees): Latitude: 36.31W Longitude:-78.5708"
3. Design flow of the pump station: 0.0032 millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): 20 gallons per minute at 30 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
Existing 2"
520
Sch 40 PVC
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 — (026.0200 & 15A NCAC 02T.0305(f)): ( j
I. Does the project comply with all separations found in 15A NCAC 02T 0305 & Cc- Kyes ❑ 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 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?)
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_0305W contains alternatives where separations in 02T.0305(t cannot be achieved.
"Stream classifications can be identified using the Division's NC Surface Water Class ifcations_webnape
If noncompliance with 02T,0305(t) or{Q1. 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
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 erected.
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 I5A NCAC 2B.0202
4. Does the project require coverage'authorization under a 404 Nationwide or ❑ Yes ® No
individual permits or 401 Water Quality Certifications?
D Information can be obtained from the 401. & Buffer Permitting_ Branch
5. Does project comply with 15A NCAC 02T_0105(c 6) (additional permitsicertifications)? ® Yes ❑ No
Per IJA NCAC 02F.0I05(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 ® NIA
"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 [east once every six -months and
inspections documented per 15A NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit.

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A N[:AC 0:3.I, the lvfinitntlm Design Criteria ror the Permktin orpum Staliuns
and Force tvl 'ys st version and the CIrF vit Sewer Minimum Design Criteria (latest version) as applicable?
If No, complete and submit the Variance/Alternative Design Request application (VADC 10.14) and supporting documents
for review. A roval of the reguest is required Prior to submittal of the Fast Track Application and supportin
documents.
2. Professional Engineer's Certification:
vz1v] attest that this application for
(ProresFie;1al nginee 's name from App ieation Item Ill. l.)
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 shalt be guilty iof a Class 2 misdemeanor, which may
include a fine not to exceed S 10,000, as well as civil penalties up to $25,000 per violation. _ W
North Carolina Professional Enlinr's sell, side, and t/: .�a4�,:�,i�x�:
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3. Applicant's Certification per I5A NCAC 02T .0106(b);
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_— attest that this application for
(S gna rc AuthaJri yt) lroi licntian lte� r 1.3.}
has been reviewed by me and is accurate and complete to the best army 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. t 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 Genera[ Statutes 143-? I5.GA and l a3-2 t S.(Al, 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 S 10,000 as well as civil penalties up to $25,000 per violation.
Signature:
FORM: FTA 04-16 Page 5 of

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JOHN R. HARMAN P.E.
CONSULTING ENGINEER
2112 White Oak Road
Raleigh, North Carolina 27608
(o) 919.818.2077
email =. iackharman ]agmail.com
COVER LETTER & TRANSMITTAL
July 7, 2020
Mr. Scott Vinson, PE
Raleigh Regional Supervisor
NCDENR-DWR
3800 Barrett Drive
Raleigh, NC 27609
NC Dept "Environmental Quality
Jul - 7 2020
Raleigh Regional Office
Re: Project Narrative -Proposed Replacement of an Existing Lift Station -Hilltop Village
Shopping Center; Oxford, NC
Dear Mr. Vinson:
The purpose of this correspondence is to satisfy Item B of the Instructions for the Application for
Form FTA 04-16 for the Fast Track Sewer Extension review process:
Narrative of Proiect Description:
The project is described as a replacement of an existing lift station serving Hilltop Village Shopping
Center (Oxford, NC) which has been in service for approximately 40 years. The original permitting
records for the existing system have been lost over time. The existing lift station and its proposed
replacement serve only a single building and its multiple tenants.
The replacement of the existing lift station is necessitated by a suspicion that the existing tank may have
some structural defects, and has been found to be of non -traffic design/construction. The existing tank,
being located in a parking lot, and having approximately 4.5 feet of cover needs to be of traffic (H-20)
strength.
The project is further described as incorporating new duplex pumps, new control panel with telemetry
and auxiliary plug for a portable generator hook-up. The existing lift station features a 2" PVC force main
which will remain in place, which the replacement lift station will also utilize and connection made
thereto. It is proposed that existing lift station will remain in service, until the replacement lift station
and its components are certified and approved for service.

The existing Lift Station's force main discharges into a gravity collection sewer (City of Oxford) via a 4
inch sewer service tap and clean out which was permitted in i4$i.
Items that accompany this submittal are as follows:
• Cover Letter
Corporation Information (Ref: NC Secretary of State Website)
Project Location Maps
• Form FTA 04-16 (Fast Track Review Application)
+ Permit Application Fee Payment: Check for $480
• Power Reliability PIan Statement
+ Engineering Calculations
+ Technical Specifications
• Product Cut Sheets
• Plans (Sheets i through 6)
+ Document showing request to Natural Heritage Program has been applied for
*An Impact Determination Request to the Natural Heritage Program has been submitted, and will be
forwarded upon receipt. A finding of No Impact is expected.
Please advise of any questions, or comments.
Thank Yo
9810
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s-.�:yti.h©IN;
John R. Harman, PE '•. R. 4i
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Consulting Engineer ynn*

Cashion, Ted
From:
[e-mail]
Sent:
Tuesday, July 7, 2020 4:03 PM
To:
Cashion, Ted
Cc:
Vinson, Scott; Robinson, Jason
Subject:
Re: [External] Re: Hilltop Village Plans Are About Ready
� External email: 5o not click links or open attachments unless.you,verify. Send all suspicious entail as an attachment to
Gentleman: Forgive this oversight. To the best of my knowledge and belief the project complies with all separations and
setbacks in accordance with .02T .0305 (f) & (g). Please check off the appropriate box in my behalf.
Thank you
Jack Harman,PE
Sent from my iPhone
On Jul 7, 2020, at 3:53 PM, Cashion, Ted <[e-mail]> wrote:
Hi Jack,
We are working on the draft permit.
One question with the application - Item IX.1 of the application was not marked as required (does the
project comply with all separations found in 15A NCAC 02T .0305(f) & (g) f ?
Please let us know about this; we will mark the appropriate box with your approval.
Thx
ted
Ted Cashion
Water Quality Regional Operations
Division of Water Resources
NC Department of Environmental Quality
Raleigh Regional Office
919-791-4254
[e-mail]
1628 Mail Service Center
Raleigh, NC 27699-1628
3800 Barrett Drive
Raleigh, NC 27609

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Subscribe to Collection System & Sewer Permitting Updates
Email correspondence to and from this address may be subject to the North Carolina Public Records taw
and may be disclosed to third parties unless the content is exempt by statute or other regulation.
From: Vinson, Scott
Sent: Monday, July 6, 202011:25 AM
To: [e-mail]; Robinson, Jason <[e-mail]>
Cc: Cashion, Ted <[e-mail]>
Subject: RE: [External] Re: Hilltop Village Plans Are About Ready
Jack,
Thank you for working with us on the application and if you would please double check to make sure
every question & every check box item is answered fully it goes to turning these applications around
into permits that much quicker. You would be amazed at the high percentage of applications that come
in that do not have a several or more boxes simply not checked off that stalls the Fast -Track review
process. If there are any questions or items that you are not sure of on the application, please ask. Take
care.
Sincerely,
Scott Vinson
Regional Supervisor
Raleigh Regional Office
Water Quality Regional Operations Section
NCDEQ — Division of Water Resources
3800 Barrett Drive
Raleigh, NC 27609
[phone] office
[phone] direct line
Email: [e-mail]
<image003.png>
Email correspondence to and from this address is subject to the
North Carolina Public Records Law and may be disclosed to third parties
From: ][e-mail] <'[e-mail]>
Sent: Monday, July 6, 202010:43 AM
To: Robinson, Jason <'ason.t.robinson ncdenr. ov>
Cc: Cashion, Ted <[e-mail]>; Vinson, Scott <scott.vinson ncdenr. ov>
Subject: Re: [External] Re: Hilltop Village Plans Are About Ready
+ 17K#ertaa Yi1a ,,Do .. n7rs or'open atla 6h5eift"s pn ms-Vo i vefiry. yenda l "U ctdas emall as WA
TI
To, v
Very well. Thnx
Sent from my iPhone