WQ0041837_Application (FTSE)_20200714

State of North Carolina
nWR
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: AlON� Ito be sompleIed by DWR)
All items must he completed or the application will be returned
1. APPLICANT INFORMATION: 9--a ytlE''v� `
iM �� r
1. Applicant's name: Orange Water & Sewer Authorit-, (company, municipalitN, I-IOA, utilit}. etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Pri�atcly-Onncd Public Utility
❑ Federal ❑ State County ❑ Municipal ® Other
3. Signature authority's name: S44�t� per 15A NCAC 02T ,tilt?6(h) Todd Taylor, P.E. as of 7/1/2020
Title: Executive Director
4. Applicant's mailing address: 400 Jones Fem Road
City: Carrboro State: NC Lip: 27510-
5. Applicant's contact information:
Phone number: (919) 5374201 Email Address: n arkerir'owasa_nr
11. PROJECT INFORMATION:
I. Project name: Tar Heel Lodging Redc%elopment Phase 'iB & 2
2. Application/Project status: ® Proposed (New Permit) ❑ Uxisting 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: Orange Countv
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.939879' Longitude:-79,020307-:
5. Parcel ID (if applicable): 9799-36-8876 9799-46-0556
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Justin Brown License Number: 042486
Firm: Pennoni
Mailing address: 5430 Wade Park Blvd. Suite 106
Citv: Raleigh State: NC Zip: 27607-
Phone number: [phone] Email Address [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) 1NFORNIATION:
1. Facility Name: Mason Farm Wastewater Treatment Plant Permit Number: NC 0025241
Owner Name: OWASA
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ0039713 Modification Downstream (Recei%ing) Sewer Size: S inch
Svstem Wide Collection Svstem Permit Number(s) (if applicable): WQCS_=31
Owner Namc(s): Orange Water and Sewer Authority
FORM: FTA 04-I6 Page I of 5

THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional Office
2090 US Highway 70
Avery, Buncombe, Burke, Caldwell, Cherokee,
Water Qualily Section
Swannanoa, North Carolina 28778
Clay, Graham, Haywood, Henderson, Jackson,
[phone]
Macon, Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Harnett, Hoke,
Water Quality Section
Fayetteville, North Carolina 28301-5094
Montgomery, Moore, Robeson, 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,lredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
Raleigh Regional Office
1628 Mail Service Center
Chatham, Durham, 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 Re tonal Office
943 Washington Square Mall
Beaufort, Bertie, Camden, Chowan, Craven,
Water Quality Section
Washington, North Carolina 27889
Currituck, Dare, Gates, Greene, Hertford, Hyde,
[phone]
.cones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
Wilmington Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
Water Quality Section
Wilmington, North Carolina 28405
Hanover, Onslow, Pander
[phone]
[phone] Fax
Winston-Salem Regional Office
450 W. 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 FORNI: FTA 04-16 & SUPPORTING DOCUivIEN I'ATION Page 3 ol'3

Vl. GENERAL REQUIREMENTS
1. Ifthe Applicant is a Privately-Ovvned Public Utility. has a Certilicatc ol'Public Convenience and Necessity been attached?
❑ Yes ❑No ®NIA
2. If the Applicant is a Developer of lots to be sold. has a Develoner's_Operational Agreement (rOR141: Df:VI been attached?
❑ Yes ❑No ®NIA
3. If the Applicant is a f lome-Tro em 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 i veterinary facilities ❑ Swimming Pool .'Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool,Filter Backwash
® Businesses � offices? factories ❑ Nursing I lome ® Other ( Explain in Attachment)
Fitness room for development
5. Nature of wastewater: 100 % Domesticr"Cornmercial % Commercial
% Industrial (See 15A NCAC 02'r .0103120))
bIs there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a floe reduction been approved under 15A NCAC 02T .01 14(i)? ❑ Yes ®No
If ves, provide a cony or now reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 021.01140
Daily Design Flow A a
No. of Units
Flow
gall'
GPD
Residential (2-Bedrooms and below)
240 gal/ Unit
234
56,160 GPD
Office
25 gal{ Employee
340
8,500 GPD
Fitness
50 gall 10010
112
5,600 GPD
gal/
GPD
gal;
GPD
Total
70,260 GPD
a See 15A NCAC 02T .01 i4[b). td). (c)I 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 cast ofthe Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in G.S. 42A-4).
b Per 15A NCAC 02T .0l 14(c), design flow rates for establishments not identified [in table 15A NCAC 02T.0114] shall be
determined using available flow data, r%m
using Fixtures. occupancyor operation patterns, and other measured data.
8. Wastewater generated by projecO -1�60 Gper 15A NCAC 021 .(i I l a)
i Do not include future flows or previously pemnitted allocations
II'permitted Ilow is zero, indicate why:
❑ Pump Station or Gravity Sc%%cr where tlow will be permitted in subsequent permits (hat connect to (his 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 & 1IDC (Gravity Sewer:
l . Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 452 DIP
Section 11 & Ill of the MDC for Permitting ol'Graiity Sewers contains information related to design criteria
Section III contains information related to minimum slopes fir gray ity sewer(s)
Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
Vill. PUMA STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & NIDC Pum Stations/Force ivlains :
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: NIA
2. Approximate Coordinates (Decimal Degrees). Latitude: Longitude: -. -
3. Design flow of the pump station: millions gallons per da) (firm capacit) )
4. Operational point(s) of the pump(s): gallons per minute at feet total dynamic head (TDI-1)
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 02l' .0305(h)(l ):
❑ Standb) power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(h)(1)(D)_
Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
i 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 - I SA NCAC 02T
.0305(h)(1)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry - I5A NCAC 02'f .0305(h)(l)(C):
i It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant (drali agreement)
and is compatible with the station.
i- 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 pcnyer 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

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
I. Does the project comply with all separations found in 15A NCAC 02T.0305(1) & (a) ® Yes ❑ No
15A NCAC 02T.0305(t) contains minimum separations that shall be provided I'or se►►er systems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (►ertical)
24 inches
Water mains (vertical -water over sewer including in benched trenches)
18 inches
Water mains (horizontal)
10 lect
Reclaimed water lines (vertical - reclaimed over sewer)
18 inches
Reclaimed water lines (horizontal - reclaimed o► er sewer)
2 feet
"Any private or public water supply source, including any ►veils. WS-1 waters of Class I or
Class II impounded reservoirs used as a source of drinking water
100 feet
**Waters classified WS (except WS-1 or WS-V). B. SA, ORW, HQW, or SR from normal
high water (or tide elevation) and wetlands (sec item IX.2)
50 Net
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches
10 Net
Any building foundation
5 feet
Anv basement
10 reel
To slo a of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage s►stems and interce for drains
5 feet
Any swimming pools
10 Icet
Final earth grade (vertical)
36 inches
15A NCAC 021.0305(e) contains alternatives "here separations in 02 f.0305(1) cannot be achieved.
**Stream classifications can he identified using the Division's NC Surface Water Classifications wehVage
If noncompliance with 02T.0305(f) or (.91 see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ® Yes ❑ No ❑ NSA
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 15A NCAC 02B .0200? ® Yes ❑ No ❑ NIA
S- This would include Trout Buffered Streams per 15A NCAC 213.0202
4. Does the project require coverage/authorization under a 404 Nationwide or ® Yes ❑ No
individual permits or401 Water Quality Certifications?
i- Information can be obtained from the 401 & Buffer Pennitting Branch
5. Does project comply with .15A NCAC 02T.0105(c)(6) (additional permits.+certifications)? ® Yes ❑ No
Per 13A 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 021'.0402, "high -priority server" 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 ❑ NSA
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: CTA 04-16 Page 4 of'5

X. CERTIFICATIONS:
1. noes the submitted system comply with 15A NCAC 02T, the Minimum D,:,;tgn Citeri,i for file Permitting of Pump Stations
ank! Fury; yl�iiis latest version and the Gravity tie%%cr 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, Awoval of the rer uer•t is required prior to submittal of the haxt "Track ApVlicalian and junportign documents.
2. Professional Engineer's Certification:
1, Justin J. Brown, PE
(Professional Engineer's name from Application Item 111.1.)
attest 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 he 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: i�1i C�
'L�Qaoc t s s,oy i! '
o � _
a SEAL mV.
.ct r 042486 - -
. U�
.........
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I,Fri Keewin,Pxeculive nire Todd Taylor, Executive Director attest that this application for
(Signature Authority's name & title from Application Item 1.3.)
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 ofwastewater 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 "ith Generd Statutes 14j-� 15,6A and 1.13 215.611. any person %%ho knowingly makes any lake
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $ I0,000 as well as civil penalties up to $25,000 per violation.
Signature: � Date. 7/10/2020
FORM: FTA 04-16 Page 5 of5

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: Orange Water & Sewer Authority
Project Name for which flow is being requested: Tarheel Lodging Phases 1 B and 2
.tlore than one FTSE ma - he re yuired for it single project if llte o+rner of the H IMI is not responvihle for all pump
stations along the roule of the proposed +rasletirwer. flow.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Mason Farm Wastewater Treatment Plant
b. WWTP Facility Permit #: NC 0025241
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
A11 flows are in MGD
14.500
0.608
7.600
0A59 (59,620 GPD)
8.267
_ 57.0%
11. 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)
Design
Pump
Average Daily
Station
Firm
Flo%%!**
(Name or
Capacity. *
(Firm / pl).
Number)
MGD
NIGD
Rogerson
n —c
18.5
7.4
(B)
(C)
(D)=(B+C)
(E)=(A-D)
Obligated,
Approx.
Not Yet
Total Current
Current Avg.
Tributary
Flow Plus
Daily Flow.
Daily Floi%,
Obligated
Available
MGD
MGD
Flow
Capacity***
3.5
0.36
3.86
3.54
* 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 (pi) 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): OWASA
Downstream Permit Number: WQCS00031
Pagel of 6
USE 04-16

111. Certification Statement:
I Todd Taylor. P.E. 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 11 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
7/10/2020
Dale
Page 2 of 6
PTSE 04-16

Cashion, Ted
From:
Cashion, Ted
Sent:
Saturday, August 8, 2020 9:00 AM
To:
Nick Parker ([e-mail]); Justin Brown
Cc:
Robinson, Jason
Subject:
Fast track sewer extension application for Tar Heel Lodging Redevelopment Phase 1 B &
2, WQ0041837
Hi Nick and Justin,
We are reviewing the subject application. Please submit a USGS topo map, street level aerial map showing the project
area, and a narrative of the project as required in the application instructions.
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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