WQ0041760_Application (FTSE)_20200616

Division of Water Resource
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State of North Carolina
Department of Environmental Quality
Division of Writer Resources
I5A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number U�yf rt bec,}1„ptcredt,% ot\ut
All items must be completed or the application %%ill be returned a 1'
I. APPLICANT INFORMATION-,
r
p r r /,s
1
I.
Applicant's name: St. Charles Place Apartments, LLC (company, municipality. HOA, utility. etc.)
2.
Applicant type: ❑ Individual El Corporation ❑ General Partnership
❑ Privately -Owned Public Utility
❑ Federal ❑ State.'County ❑ Municipal
❑ Other
3.
Signature authority's name: Lucius S. Jones Sr. per 15A NCAC 02T .0106(bi
Title: Managing Member
NC Dept of Environmental Quality
4.
Applicant's mailing address: PO Box 128
JUG! 16 2020
City: Wendell State: NC Zip: 27591-
5.
Applicant's contact information:
Raleigh Regional Office
Phone number: (9l9) 427-3706 Email Address:
11. PROJECT INFORMATION:
I. Project St. Charles Place —
name: Apartments
2.
Application/Project status: X❑ 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: Vance
4.
Approximate Coordinates (Decimal Degrees): Latitude: 36.3307 Longitude:-78.4537
5.
Parcel I D (if applicable): 41103004
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Homer S. Wade License Number: 10666
Firm: Borum Wade & Associates PA
Mailing address: 621 Eugene Court, Suite 100
City: Greensboro State: NC Zip: 27401-.
Phone number. [phone] Email Address: hswade0borum-wade.com
IV, WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
I. Facility Name: Henderson Water Reclamation Pacili1% Permit Number: NCO020559
0%%ner Name, City of Henderson
V. RECEIVING DOWNSTREANI SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ0014291 Do%►nstream (Receiving) Se%Ner Size: 8 inch
S%stem Wide Collection System Permit Number(s)(if apd)ficable4: WQCS.!0
Owner Name(s): City of I-lenderson
FORM; F`l'A 04-16 Page i of,5

VI. G1: NERAL REQUIREMENTS
1. 1 f 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: DF V) been attached?
❑ Yes [:]No EIN/A
;. II'the Applicant is a I-lomc; Pro ferny Owners' Association. has an Operational Agreement FORM: 110A been attached')
❑ Yes ❑No QNIA
4. Origin of wastewater: (check all that apply):
❑ Residential Owned ❑ Retail (stores, centers, malls) ❑ Car Wash
❑x. Residential Leased ❑ Retail with food preparationiservice ❑ Hotel and. -or Motels
❑ School preschool / day care ❑ Medical / dental / veterinary facilities ❑ Swimming, Pool ;'Clubhouse
❑ Food and drink facilities ElChurch ElSwimming 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 .0103 20 )
4 Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .01 1 4(f)? []Yes ❑ No
i If provide a conv of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 921.0114(f))
Daily Design Flow ° b
No. of Units
Flow
gall
GPD
gall
GPD
gall
GPD
gall
GPD
gal/
GPD
gal/
GPD
Total
GPD
a See 15A NCAC 02T .01 14 b d e I and c 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 .0I 14(c), design flow rates for establishments not identified [in table 15A NCAC 02T.01 Id] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project; 0 GPD (per 15A NCAC 02T .01 14)
Do not include future flows or previously permitted allocations
If permitted flow iszero, indicate why:
El Pump Station or Gravity Sewer where flow %%ill 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 I-1 A 04-16 Paue 2 of-5

VI1. GRAVITY SEWER DESIGN CRITERIA (if Applicable) - 02T .0305 & MDC (Gravity Sewers):
I, Summarize gravity se%%er to be permitted -
Size (inches) Length (feet) Material
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
Vlll. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC(Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT l a�
I . Pump station number or name: I ,
2. Approximate Coordinates (Decimal Degrees): Latitude: 36.3311 Longitude:-78.4544
3. Design flow of the pump station: 45 millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): 57 gallons per minute at 35 feet total dynamic head {TDH}
5. Summarize the force main to be permitted (for this Pump Station). t ��
Size (inches) Length (feet) Material]
i
6. Power reliability in accordance with 13A NCAC _02T,0..30 IL) 1-
❑X 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 plug+-ed emergency pump connection and telemetry - 15A NCAC 02T .0305(h)(I)(C):
It shall be demonstrated to the Division that the portable source is o+%med or contracted by (lie applicant (drab a__reement)
and is compatible with the station_
If the portable power source or pump is dedicated to mtiltiple pump stations. an evaluation of all the pump stations'storage
capacities and the rotation schedule of the portable po%per source or pump, includin�t, travel timeframes. shall be provided
in the case of a multiple station power auta-1e.
1-ORNI: F FA 04-16 Paxe 3 of5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(n):
I. Does the project comply with all separations found in 15A NCAC 021' .0305i j & (g) ❑X Yes ❑ No
15A NCAC 02T.0305(f) contains minimum separations that shall be provided I'or sewer sysrenm-
Setback Parameter*
Sc aration 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)
I8 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 I I impounded reservoirs used as a source of drinking water
100 feet
"Waters classified WS (except WS-1 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 -round 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
Drainages stems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
15A NCAC 02T.0305u, contains alternatives where separations in 02T.0305(f) cannot be achieved.
"Stream classifications can be identified using the Division's NC Surface Water Classifications webnase
If noncompliance with 02_i'.0305(f) or (t*h see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ❑X 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 I5A NCAC 02B .0200? ❑X Yes ❑ No ❑ N:A
o- This would include Trout Buffered Streams per 15A NCAC 213.0202
4. Does the project require coveragelauthorization under a 404 Nationwide or ❑X Yes ❑ No
individual permits or401 Water Quality Certifications?
Information can be obtained from the 401_& Buffer Permitting Branch
5. Does project comply with 15A NCAC 02T.0 I 05(c)(6) (additional permits/certifications)? ❑X Yes ❑ No
Per 15A NCAC 02T.0105 c G , 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 02 ]".0402, "high -priority sewer' means "any aerial sewer, sewer contactim, surface waters, siphon, or sewer
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes ❑ No ❑ N:A
If yes_ include an attachment with details far each line. inClUdingtype (aerial line, size_ material, and location).
I ligh priority lines shall be inspected I)% the permitlee or its representali,,a at least once every six -months and inspections
documented per IiA NC.-%C 02T.0403(a)(5) or Ilse perntiteCs individual S%-stent-Wide Collection permit.
UORIVI: FTA 04-16 Page4 of5

CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Pump Station,
and Force Mains (Iatest 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 re uired prior to submittal of the Fast Track Application and su ortin
documents.
2. Pro fession�I jE=ngineer's Certification:
FA _K Y W=4 I pp� AN
Engii{eer's name from Application Item 1I1.1.)
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 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' Certification
/per
�15A NCAC 02T .0106(b):
Authority's name & title" from Application Item 1.3.)
N CAAp''•,
�Q Q 0FE5S,0���2
SEAL
10771 -
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 arc 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. 1 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 shall be guilty of a Class 2 misdemeanor, which may
include a fine not to ex d $10,000 as well as civil penalties up to $25,000 per violation.
Signature: Date: -4 •�Z�
FORM: FTA 04-16 Page 9 of 5

State of North Carolina
Y I.TDepartment of Environmental Quality
•* Division of Water Resources
17hisfo11 of Wdtvr RV%OUt(V% Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: City of Henderson
Project Name for which flow is being requested: ST. Charles Place
More than one FTSE may he required for a single project if the owner of the WWTP is not responsible for all pump
stations along the route of the proposed wastin ester. low.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Henderson Water Reclamation Facility
b. WWTP Facility Permit #: NC 0020559
AUflows are in MGD
c. WWTP facility's permitted flow 4.14
d. Estimated obligated flow not yet tributary to the WWTP 0.1364
e. WWTP facility's actual avg. flow 1.95
f. Total flow for this specific request 0.00
g. Total actual and obligated flows to the facility 2.0356
h. Percent of permitted flow used 49.17 %
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)
Design
Obligated,
Pump
Average Daily
Approx.
Not Yet
Station
Firm
Flow**
Current Avg.
Tributary
(Name or
Capacity, *
(Firm pf),
Daily Flow,
Daily Flow,
Number)
MGD
MGD
MGD
MGD
RedBud
2.952
1.181
0.65
0.07412
Zeb
l] ..L:.a —
0.18
0.072
0.021
0.02208
(D)=(B+C)
Total Current
Flow Plus
Obligated
Flow
0.72412
0.04308
(E)=(A-D)
Available
Capacity***
0.4568
(]_ 137
* The Firm Capacity 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.
*** 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): HWfkc ry LEV. kf (AmT,�roty FA Gr_f_=Tr
Downstream Permit Number: N C 0 GoSS I
Page I of 6
FTSE 04-16

}
111. Certification Statement:
+ Lta n-s 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 I1 plus all
attached planning assessment addendums for which I am the responsible party. Signature of this
form indicates acceptance of this wastewater flow.
Signing Official Signature
(,& - 3 -tea
Date
Page 2 of G
F TS E 04-1 G

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an Amended a Annual Report form
Limited Liability Company
Legal Name
St. Charles Place Apartments, LLC
Information
Sosld: 1892956
Status: Current -Active
Date Formed: 9/16/2019
Citizenship: Domestic
Annual Report Due Date: April 15th
CurrentAnnual Report Status:
Registered Agent: Harrell, Matthew
Addresses
Reg Office
1201 Meadow Hill Place
Raleigh, NC 27609
Company Officials
Reg Mailing
1201 Meadow Hill Place
Raleigh, NC 27609
Principal Office
426 Old Wilson Road
Wendell, NC 27591
All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20.
Managing Member Manager
Lucius S. Jones , Sr. Lucius S. Jones , Sr.
426 Old Wilson Road 426 Old Wilson Road
Wendell NC 27591 Wendell NC 27591
Mailing
P. O. Box 128
Wendell, NC 27591

` ` 4'
r � is I;nnrcrs
1''1 I'Iaitnv rs
Survcvors
Biirum, Wade and Ass ociatcs, P..A,
June 11, 2020
North Carolina Department of Environment Quality
Water Quality Section
Raleigh Regional Office
1628 Mail Service Center
Raleigh, NC 27699-1628
[phone]
Regarding: St. Charles Place Apartments
Charles Rollins Road
Henderson, NC
To Whom It May Concern:
NCDcpt"13nvironmental Qua)�r►
Raleigh Regional Office
Please find attached fast track application for the gravity sewer line for the above referenced project.
Included in this package are the following-
1. One original and one copy of the Fast Track Application
2. One check for $480
3. One original and one copy of the Downstream Sewer Flow
Tracking/Acceptance Form
4. One original and one copy of the USGS Topographic map and street level map
The proposed sanitary sewer extension will serve 24 — three bedroom units, 44 — two bedroom units
& 24 — one bedroom units for St. Charles Place Apartments, The project is located off Charles
Rollins Road in Henderson, North Carolina, The sewer extension will tie into the existing City of
Henderson's 8" sanitary sewer located in Charles Rollins Road- The extension will consist of 524
linear feet of 8" SDR 35, 4 linear feet of 8" DIP and 3' forcemain sanitary sewer line. The pump
station associated with the project will be privately owned and permitted separately. The proposed
gravity sewer and forcemain extension will be owned and maintained by the City of Henderson.
Please call if you have any questions.
Very Truly Yours,
A� LAA/tIfl//�
Matt Williams, P E
Enclosures
621 Eugene Court, Suile 100, Greensboro, NC 27401.2711 - PO Box 21882, Greensboro, NC 27+20-1882
Phone [phone]+71 • Fax [phone]
Webwe ;YSp br;rum- tta&i - nut
NC Lirvnse #. C-0868

Cashion, Ted
From: Cashion, Ted
Sent: Friday, June 19, 202012:35 PM
To: [e-mail] erson.nc.us; 'Homer Wade'
Cc: Robinson, Jason
Subject: St. Charles Place Apartments fast track sewer extension applications
Clark and Homer,
We have received the subject 2 applications and want to let you know of a modification we will make.
For the app where the City of Henderson is the applicant, we will add "Public" at the end of the project name.
For the app where St. Charles Place Apartments, LLC is the applicant, we will add "Private" at the end of the project
name.
This distinction helps us to keep it straight in our office and our database.
Any objections to our modifications?
We are 5-7 weeks from issuing these permits.
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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