WQ0041850_Application (FTSE)_20200723

DocuSign Envelope ID- DA557F4D-3887-41)D4-8E7F-CiEA33960831
DhIslon of Water ReSOrIrCeS
State of North Carolina
Department of Environmental Quality
Division of Water Resources
I5A `CAC 02T .0300 — FAST TRACK SE%1 ER SYSTEM EXTENSION APPLICATION
I'TA 04-I6 S: SLl'PORTI.`G DOCUMENTATION
. s ..
Application; V,rntbcrA! (>r,/iy (} � (�� D
mcompleted or thea licatiun till he returned
t+, h: a mphAvd h% It+, R Q�
All items "lust he cunt 1 `
I. APPLICANT INFORNIATIO.V.
I. Applicant', name Tat}n_of HuAt SprinL,(c+tnipani. municipalit%. M) \ utilitN. etc-►
?. Applicanl i%pe: ❑ Indir;d«al ❑ Corporation ❑ Gerwral Partnership
❑ Federal ❑ Staw Count\ ❑ Municipal
+. Sil nalure auillorin's name: Kendra Parrish per I i1 `� It I I•rh -,
Title: Director of I'aginecrrn-
4 Applicant's mailing address: 128 South Main Street.+4-�,
C in: Nn1Iv. Sprimgs Slate: \L` zip:'
❑ PH%atck-Oti;ned Public Utility
N ' (Vt,ofEnvironmental Qtt:;lirn
JUL 2 3 2020
--3,�- c!,e
Raleigh Regional Oftic,
Applicant`scontact infiorrnanon
s3°138
Phone number: (919) �i Lrnail Iddre;,: kends. arrr;h,t ttullk, rirt•gsnc.ui Civ+Gi
II. PRO.IECT INFORNIATIOV: 5�0. • �M`� ��.p IL�SQ�+ S1`}G. US
I. I'rnfecl name: '1'riannle E.�pres,>.ta�
?. Application Project StatuS: ❑ Proposed tticu Periniti ❑ I \i,tim, Pennit Project
[fa modification. provide the existinL,, perinit number:and isued date
ifnck% construction but part ol'a master plan. pm%ida the e\isting permit numb, r 11(Gfi
-i. Count% where project is located: Wake
a. Appro\imateCoordinate;iDecimal Degrees): Laiklitle: 35.6852E I onUitudr
Parcel ID (if applicable):
(or Parcel ID to closest domnstream setter[
III. CONSULTAN1 INFORMATION. r
I. Professional Engineer. Ronald Wilkins License NUrnber: 1(1 I i-
Firm: Ilinde En•,ineerin,
4lailim! address; 401 Flarrison Oaks fihd.
Cit\: C;tn Stare: NC "Lip:
I'lione number: (7U4)975-.8CR I:rnail Addre»: milkins+ihindegn•_'irteerin!.cmn
IV. WASTrWATERTREATsNIEN'I' FACILITY(«'wm INFORMATION:
U� 1e�Cree 4t
I I ar ilit% blame ewC+qy— Permit Number: A/L.00(a,309j 6
arrci-
O�tnerName: Founol'I1okS rings
V. RFCEIVI,NG DOWNSTREAYI SrN�'Elt INFORMATION (if different than N111TF):
1. Pemlit Number(s)- \\'() WQ0017170, WQg991?? 711e,tnt (Receiting) Sewer Siic 8 _ 1nL11
V., ;111 it.l !. I :.I .;tl�lrS_tiLa:_Ill i�Cr'a{Ir 1,tt ;i,'Cr(,4( [ mvl Ik {,%QCS001}2
0%%ner `antc(s). —Town 0� PO /ly Ser-l'.7j5
FORM: F'l'A 04-10 n,,.., 1 ..r;

DocuSign Envelope ID DA557F4D-38B7-4DD4.8E7F-C1EA33960831
THE COMPLETED APPLICATION PACKA(;E I\CLUINC ALL, St-1311ORTM; INFORMATION A\1'D
11.\TI?RI:11.S, SIIUt'1.l) BE SENT TO Till: - PPROPRI 1-I-E, Rh:GMN \L (1FFICEI:
REGIONAL_ OFFICE
Asheville Regional Office
Water Quality Section
Fayetteville Regional Office
Water Ouality Section
Mooresville Regional Office
Water Quality Section
Ralei h Regional Office
Water Quality Section
Washington Regional Office
Water Quality Section
Wilmington Regional Office
Water ouality Section
Winston-Salem Regional Office
Water Quality Section
l _..
ADDRESS
COUNTIES SERVED
2090 US Highway 70
Avery Buncombe, Burke, Caldwell, Cherokee.
Swannanoa, North Carolina 26778
Clay, Graham Haywood. Henderson, Jackson,
[phone]
Macon Madison, McDowell, Mitchell, Palk,
[phone] Fax
Rutherford Swain Transylvania, Yancey
225 Green Street Suite 714 Anson, Bladen, Cumberland, Harnett, Hoke,
Fayetteville. North Carolina 26301.5094 Montgomery Moore, Robeson, Richmond,
[phone] Sampson, Scotland
19 10) 4a6-0707 Fax
610 E. Center Avenue Alexander. Catarrus, Catawba. Cleveland,
Mooresville. Nor1h Carolina 28115 Gaston. Iredell, Lincoln, Mecklenburg, Rcwan,
[phone] Staniy. Union
[phone] Fax
1628 Mail Service Center
Raleigh, North Carolina 27699.1626
[phone]
[phone] Fax
943 Washington Square Mall
Washirgton, North Carolina 27889
(252)946-64211
[phone] Fax
127 Cardinal Drive Extension
Wilmington, North Carolina 28405
[phone]
[phone] Fax
450 W. Hanes Mill Road
Suite 300
Winston-Salem, hiorth Carolina 27105
[phone]
Chatham Durham, Edgecombe, Franklin.
Granville Halifax. Johnston, Lee, Nash,
Norhampton. Orange, Person, Vance, Wake.
Warren, V/sIson
Beaufort. Bertie, Camden, Chowan, Craven,
Currituck, Dare, Gates Greene, Hertford, Hyde,
Jc-,es Lenoir l0artin, Pamlico, Pasquotank,
Perquimans. P tt. Tyrrell, Washington. Wayne
Brunswick, Carteret, Columbus. Duplin. New
Hanover. Onslow, Pender
A amarce Ai'eahany Ashe, Caswell, Davidson,
Dave, Forsyth. Guilford, Rock'ngham, Randolph,
Stakii�5, Surry, '1'latauga Wi kes. Yadkin
I`S1 RUCTIONS FOR FORM: I -FA 04-1fa & SWIVORT[`G DOCU%IF\TAI'101\ 11,uze 3 of 3

DocuSign Envelope tD: DA557F4D-3887-4DD4-8E7F-C1EA33960831
V1. GE`ERAL ItEQUIRENIE`TS
I . If the Applicant is a Pritiate] %-Ot+ned Public l `tihn, ha, a CertifICate 01' Public Con+cnicnce and Necessity been attached"
Yei ❑\o ❑\ .1
2. lftlie Applicant is a Developer oflot; to be sold. has a I t: .': , 113 ',; at10en+' I L)R\f '�i 1 1 been aItacIled
'
❑ Ye> ❑\u ®\ :1
3. Ifthe Applicant is a IfomL! Pri, cn t + .. 1 t._:. - ,,n: iI {iE�\1. I11) V been attached'
❑ Yes ❑Vu ®` .1
4. Origin of+tastettater: (check all that apply'):
❑ Residential Ot+ned ❑ Retail imore;. centers- malls) ❑ Car Ua,h
❑ Residential Leased ❑ Retail +t ith lord preparation sera ice ❑ hotel and or .'.lutrls
❑ School preschool day care ❑ 41edlcal dental facilities ❑ St%immine Pool Clubhouse
❑ Food and drink facilities ❑ Church ❑ Sea inunim, Pool I:ilter Backwash
❑ Businesses offices factoric; ❑ Nursing Ilonic ❑ Other (E\plain in Attachment)
Nature of t+a;tet+ater : °n Domestic Commercial' "„ Commercial
"a Indwitrlal (5..' I ` 1 \L.1 t'' 1 ,Sll is i_'ils}
�Is t1wrc a Pretreatment Program in efteit^. ❑ 1-ci ❑ No
6. l [as a Ilo+t reduction been appro+ed under I :,A V ', t :{f>'' ❑ Ye; No
Imes. pirmide a cn % of flm% reduction :r irm-al letter
7. Summarize mastettater gencrated by project:
Establishment Type (see (11'T.111 1.111)) --� Dull% Dvsilpn Him :,No. or Unitsl Hon
al G,PD
l,ll CJPD
!) CrNU
Ual UPI)
Tutc+! GPI)
a Sec I 1 `.( AI I;- I I}: .:I. 1 -)1'_ t6l' cateat, to t+a,tet+aler design Iloo rates (i.c.. minimum Ilou per
d+telling; proposed unknottit non-r4sidentiul detLloptneni uses. public acco, Iacilnies located near high public use areas.
and residemial property located sump or eatit of llte :Atlantic Intracoa,tal 14,tlen+a% to be used as %,acatiun rentals a, delined
illt,-, t21 I}
b I'er I;A ~CAC (321-.01 I4(cl, design Ilou rate, for establishments not identihcd Jill I.tlile I 1 \(' It i�.' I ; j,hall be
determined using available Ilott Bala- ++a1er u,inr fimmres. uculpancy or operation patterns. and other measured data.
5, 11 aste+cater {generated b% project: _ GPD {Per - ', �-C 1+ "1 ; t 1
Do not include lilture Mutts orpre%iou-;lti permitted atkxmiuns
Ifpertnitted floe is zero, indicate tthy:
❑ Pump Station orGra+it\ 5euer tthere flott ++ill be pertititted in subsequent permits that connect to this line
❑ Floe+ has already been allocated in Pcrntil -Ntonher:
❑ Rehabilitation or replacement ol'etisting Nc\%er tctth fro iieN Ilot+ e\ptcted
❑ Other (L\plain):
I.ORll• 14lA 04-1(1 M..•••~-.re

DocuSign Envelope ID DA557F4D-38B7.4DD4-8E7F-CIEA33960831
VIL GRAVITY SFN!'F.R I)I.SIGN' CItITFRIA (If Applicable) - tr'- k .030; &. %IM
i . Summarize -,,rariq sex%er to be pernlitted:
VIH
Size (incites) Lendyth (feet) �laterirrl
764
12„ 457 —_ DI PC350
I
r Section 11 fi Ill of the MDC ror Penn,11,11r. of Cir,r+it� Se�%ers contains intimtiation related to dciiim criteria
r Section I[I contains inforniation rekated to minimum slope; tor ura%n� ,e+%vrt;)
Oiersizing lines to nice[ minimum slope regtiirernient is not 1110%%e(l and a %iolation of the NIDC
PUMP STATION DESIGN CRITERIA ( It at)le) — 0'_ I .'1Si); S 1E11( t k'unrL.t:ruuus }Ore Ni.tin+
COMPLETE FOR EACII I'LINIP STATION INCLUDIFI) IN' THIS PROJECT
N/A — No change in flow to
l , Pump station number or name downstream pump Stations
'_. rlppru\imate Coordinates (Decimal Degree,l: I atitude:
I 'j, flog+ of the pump nation: niilhon; uallon, per da, 1 firm capacity I
-i Operational po3riH-) ut' llre pump(,). _ rllrm, per niinutt at _ feet trttal d%narnic ncad l [ 1)I'11
Sttntmdrizc thr force main to be permitted (tor this Pump Station):
Size (inches) Leniith (feet) Material i
( i i 1 4 i'1,-C. C400 DR IS
6. Po%%er reliability in accordance a ith V
❑ 5tandbti po++er source or pump Wth autorn,ttic atiutiattun and to ler,tetr} - 15,% SICAC 021 .0105 h)( 1)(I3).
r Required t-or all pump Station; %%idi an atiera,­c d.tiK Ilut% _reawr than or equal to 15 ,t)00 __allons per day
r Must be pernianew to racilit}
(fir if the pump station has tin avcl`age dail% klov- less 111a11 15.000 gallons per day :
❑ Portable po++er source s+ith manual actkation. quick-COMICCtion rceeptacle and telekttetr\ - I5A NC AC" 0'_ C
.030511)(1)(C)
or
❑ Portable prrtnpin�� unit �+ith plu ,_ed enrLrgenL: prune conm.ctirn and le :ntetn - I5A NC'AC Oy 1 .0305(h)( l)(C'):
r It ;hall he denionwaicd to tht Di�i3inri that lire port,ible �otirce is o�cned or contracted h} the applicant fdrah tt'Urccment)
and is compatible r+ith the S1111iutr.
lithe portable po%%vr source or pump i, dedicated to rtltiltiple pump Staliurt�. an eN ;tltt.t;'un ofall the pump stations' storage
capacities and the rottuiun Schedule of the portable po«cr source or pump, itrcludinL t%n el uutctrarnc,. shall be pro% idea
in the case ol'a multiple station pu`+er uutd_e.
P rue 3 crl" t
I()R%I:f1A04-16

DocuSign Envelope ID: DA557F4D-3887-4DD4-8E7F-C1EA33960831
IX. SETBACKS & SEPAi2ATIONS — (02B .02m) & t;A NCAC 02T .1130510):
I. Does the project compl% with all separation: found in I -� ! `.( \I + : 41, 11 ' * 0 Yes ❑ No
r 15A `%iCAC 02T.U30i(I) contain,., rnioimuni separation; that %hall be nro%hied ti?r ic+ser s%sleni;:
Setback Parameter`
Sturm sc%%crs and other utilities not listed below (vertical
Water mains (terllcal-%%
W,iler mains thori/ontal
Reclaimed hater Iines c
Reclaimed %later lines it
over sewer includioU in hencl
ical - reclaimed o%er ie%%er)
zontal - reclaimed over se%%er)
ed treochcs 1
Separation Required
24 inches
10 ("t
18 inches
feet
"An. private or public %%alcr supply source. includinuzm %tells. 11'S-1 haters of Class I or
Class II im iLounded reservoirs used as a source of drinkint, %%ater 1Un feet
"Waters claisilied 11 S (except WS-1 or 11'S-%' ). H, SA. OR11. I It 111, or 513 trom normal
1ti'_h %cater (or tide elcvationl and %%etlind, (see item IX.2) _ _ _-;U feet
Tint other stream. lake, impoundment. or ,round hater !uu eon« and surface drainage
ditches _ lli Piet
:Inc buildim_ fuundaiion i feet
Am. basement — - 10 feet
op sloe ofembankment or cut, of 2 feet or more tenical hciuht IU left 4
Drainage st stems and interceptor drains ; feet
:in% st%immimg pools _ ..__------- - 10 feet
I• inal earth urade ( %ertical) 36 inclicti
( -5A .tii .fit' ; Icontains alternatite, a here iep,iratiowi in ' _ cannot be achie%ed.
"Stream classification, can he identitied usina, the Dlt islull's Nt_ tinr- t. V. o t " A!IOrl, t%c zl?:: L
If noncompliance %%ith t)2TAMiIi 1) c r I_ I, We Section X of this application
2. Does tilt project comply %% ith separation requirements tar %tctlandi" (50 I�et of separation) CD Yes ❑ No ❑ N A
Sec tilt Dtv i;ion's draft separation requirements for iituation; %t icre separations cannot tic meet
No tariancc is required il'the alicrnatite deii-gn criteria specified is utilized in dciisn and construction
As built document; should reference the location of area, cl'fectld
Dues the project comply %tith setback; found in the ricer basin rutei per ' i ` \t -I: k Q YCs ❑ ho ❑ t� �1
This %%ould include Trout Buffered Streams per t ! ,.r"".1a- 'it 11-, ,_
4. Does the project require co%erag-c.authorization under a 404 N:uitmu ide or Yes ❑ No
individual permits or 401 Water Qualii}' Certification;"
lnComiation can be obtained from the
:. hues project comps% with I > 1 \C `,c Is 1'-()1 , il'O (additional permits certiticitionsl:' Yes ❑ Igo
directl} related cot ironnlen!al pemiit, or certification applications are bcin,_ prepared. have
been applied fair, or have been obtained. Isivancc ol'this permit is contingent oil i,;uancc of dependent perrtliis (croiion and
sedimentation control plans, itormwater mana!,cment plan,, etc.)
6 Doc; this prpicct include ari% sewer collection lines that are de011t:d " hi_'h-prloritq
Per ! - \ \a_ 1. '.1' 1 I : -, "high -priority se%%er' nieani --ant' iwrial sc%ter. ,liter U'llU10111-1 surface %%ater.i. siphon. or w%%er
positioned parallel to stremnbanks that is suhjeci to erosion that undennioes or deteriorate, the seller,
❑Yes ❑`o ❑NA
include an attachment with delaili fur each Bale. incluthrng, t%pc [aerial fine, silt•, material, and location).
l ligh priorit% linershall he inspected by the penuittee or its representmi%e at least once r t cry siv-months and inspections
documented per I -SA 1CAC 02T.0403(a)(5) or the perrniteCs individual Slstein-%Vkle Colleetion permit.
DORM, FI'A 04-16 u.,.,. 1 „rc

DocuSign Envelope ID DA557F4D-38874DD4-8E7F-C1EA33960831
X. CERTIFICATIONS'
1 . Does Ilse submtted systela cum ph V-kI the \Is-iii ) _ .. ' Pert:iitiisl'Ol i'Lill—M
i or.r_4-:neit':4;, , and the 'r t' A- lusts applicable?
f No, complete and iubmit the 1'ariancc 1 hcriial i tie Des i«n Rcqucst application t \ \CK' 10-14 t and suppcirtin g ducttmnents Ittr
ref ictt. A a I)ro%al ortIte request is rer aired prior to suhrnitmI or the 1-ast 1'ruck +t I, I,Iicatiou and supportinE doculue III
2. Professional Engineer' Certification;
Ronald B. Wilkins ancst that 11415 application for
{Professional Engineer's name from-\pplication Itcm totals
has been rexietxed by me and is accurate commplel. a-lul c011-6-0cm with th4 inl4mmimi snpplmcd in the plan; specifications.
enginecrin-, calculations, and all other S1lpp0rtimr C10CLInterit3601- to the hest of im kilt ledt- I furtlier attest that to the hest
of nil knottledgc the proposed design has been prepared ;n accrrdancc with the applicable regulations. Graxitx Setter
Mirtilnunt Desi&n Criteria for Gras its 5ct+crs t latest xersionl. and the Minimum Design C riteria for the F . -Track Pcnnittin_
of Pump Stations and Force Mains (latest %er.ionr. \lthough other pnil'essiottal; nla� hate dc'.elc)ped certain ponions ol'this
�ubrnilWl pa�1 age. iuclu,iun of thane nlatrri-ik under m., sicnal,ue and seal siu iilics 191a1 t has: retic%%cd this material and
hate judecd it to be condilcm txith the proposed design
NOTE - In accordance ttith General titatute, I a ,-? 15.6A and 1 -4 +-313.6B. am person ttho hnot4ineh make,-, am 1A
statement. representation. or certification in an% ,100CUti0rl package ;halt he g,rrlty of a (Loss'_ imidenieanor. %%hick mat
include a fine not to exceed S 10.000. as bell as :v l penalties up to 524.000 per t iolattuml-
North Carolina Pruressionul ISnt6neer's seal, si,nunlre, and date:
\pplicant's Certification per Ii \ \CAC 021, .0106thl:
1 attest that this applicatiurs for
(Signature Attthoritl'i mime & tttic from \pp'icafian Item 1-3.t
has been ref tested b% nee and is accurate and coiuplele to the hot of im kno%%ledgc- I under,tand that it'all required parts of
this application are not completed and that if all required supporting documentatiOn .tad attachments arc not inchidcJ. this
application package is subject to being returned as kwompicte. I undermand that anti di,charu of t%axte%%ater from tlris non -
discharge s} stem to surface haters or the land %till re,uh in an immediate nil'orccnicut acti+.n that may include cif it penalties.
injunctixe relief. and oreriminal prosecution. 1 u ill make no claim against the (lit is --on ai'\\,lter Resources should a condition
of this permit he %iolated. I alsu understand that if all required part., otthis applicadcn package are not completed and that if
all requited >uppiortin-, inl'omiation and altachsnmmitt
cti are includetL this applicAwl, paCkaYge %till he returned to rile as
incomplete.
NOTE - in accordance ttith Cienenll titdttrtei f It and am person tthn knottitigly stakes am tale
statement, representation, or cerliiic'alion in an} oppl-cation package ,hall he guilty of a Class 2 misdemeanor. tthich ilia}
include ;l fine not to exceed S 10.000 ai hell as cif it penaltie, up to 523.00 per t iolat`un
Cbacu5lgned 6y:
7C 44. P 7/21/2020
EA]SCBA13E63d6A
FORM.1: r.\ 04-1 G I'aitt ; of

DocuSign Envelope ID- DA557F4D-3887-4DD4-SE7F-C1EA33960831

DocuSign Envelope ID DA557F4D-38B7-4DD4-8E7F-C1EA33960831 -• • . } �� ".
. •. _ •S ` a� ' � � i... ?�.="1 'ice- \.l � �� �/
LL
��:",'��':-r •• j, 'r- - .- . vim,•• ' ��?•• _� _'' j �'-�jr
� F _ 4
/. { �c
p.� r, �� � y � •.--+�..,-��"[� /�� �' ;� � 11r it
-•�•t---� , f •�• `!ram=-��• �--•- =_ ' - Z-•,�;_- r 1 �•, '' ., {
•�� � :'may r,7,'�-�.�-.4 .r���1'��� .,,,1 �' �""__ i� _
' F �. ; � _ {, .,. a '• ,a .��.� r ..:.-r-•fy�1^}��!
ri r nr sC; Car= R, ,.: ✓ ag;
OIL-
Ao-
`F*• •! � t�•i t" ~! - � �� � '�.2 `', `fir .�
va