WQ0041933_Application (FTSE)_20200824

DocuSign Envelope ID:771DIB7E-EB6843E3-8EF4-9A4BAA8B3341
State of North Carolina
Department ofEnvironmental Quality
D\W� a Division of Water Resources
iSANCAC 02T.0300—FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources PTA 04-16 &SUPPORTING DOCUMENTATION
�
Application Number. W d 33 (1 o be completed by DWR) 'Ez
All items must be completed or -the npplication_nill be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Town of Holly Springs (company, municipality, IIOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ G:neral Partnership
❑ Federal ❑ State/County ER Municipal
3. Signature authority's name: Kendra D. Parrish. P.F per IiA NC'AC O2•I' .01061h)
Title: Director ofFngineering
4. Applicant's mailing address: 128 South Main Street
City: H 11X,s State: Imo. Zip: 27540-
5. Applicant's contact information:
3938
l Kce)'rtC-
❑ Privately -Owned Public Utility
❑ Other
14z--P
Phone number: (2U9 525-434 Email Address: kendra.12arri5h a hollyspring ns c.us and [e-mail]
II. PROJECT IlNMRMATION:
1. Project name: Children's Lighthouse Child Care Holly Springs •`
U � r
2. Application/Project status; Proposed (New Permit) sing en
If a modification, provide the existing permit number: WQOO and issued date:
If new construction but part of a master plan, provide thce:dsting permit number: WQ00
3. County where project is located: Wake
4. Approximate Coordinates (Decimal Degrees): Latitude: 35,737498 Longitude: 78.841245
5. Parcel ID (if applicable):
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
I. Professionalrngincer: Samuel Nye License Number:
Firm: Thr- .5 ke- 6&-aup
Mailing address: 1111 Oberlin Road
City: Raleigh Statc:NC Zip:27605-1136
Phone number: (gjj9 8354787 Email Address: [e-mail]
1V. WASTEWATER TREATMENT FACILITY (1VWT1) INFORMATION:
I. Facility Name: Utlgv trek WastewaterTreatmcnt Plan Permit Number: NCO063096
Owner Name: Town of Holly S ritz nas
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
I. Permit Numbers): WQ 0 0034078 Downstream (Receiving) Sewer Sic: 8 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS00192
Owner Name(s): Town of Holly Springs
tt
FORM:FTA 04-I6 Page 1 of

DocuSign Envelope ID: 771131 B7E-EB68-43E3-8EF4-9A4BAA8B3341
VI. GENERAL REQUIREMENTS
I. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
CgYcs ❑No �&A St' try\
2. If the Applicant is a Developer of lots to be sold, has a Developer's Qncrati�inI1J 6vNemenl (FORM: DM been attached?
❑ Yes ❑Na ®N/A
3. If the Applicant is a I lore•/l'ninerty Qwnets' Associalion.has an Onenalional Anreemenl (FORM: I10A) been attached?
❑ Yes ❑ No m N/A
4. Origin of wastewater: (check all that apply):
❑ Residential Owned ® Retail (stores,centcrs,malls) ❑ Car Wash
❑ Residential l.eascd ❑ Retail with food preparation/service ❑ I•Iotel and/or Motels
0 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 (&plain in Attachment)
5. Nature of wastewater: jo 0 */a Domestic/Commercial %Commercial
O % Industrial (ties I iA NCAC 02T .0103(2(ji)
>Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under I SA NC'A C 02'I' .0114(1)? ❑ Yes ® No
D );f ves:lirovisl�n_c�py of flow reduction nlyfrovnl letter
7. Summarize wastewater generated bypmjcct:
Establishment Type (see 02T.01 14(n)
Daily Design ilow'•b
No. of Units
Clow
Cirri kA COrYt Ctrs fie,✓
5,0 o D gall oia
4
5, p8Q GPI)
2, 3o o gav du
l
2 aot) GPD
gall
GPD
gay
GPD
gall
GPD
gall
GPD
,
Total
"l! 300 GPD
e1Jj� n
a See 1 t a o caveats to wastewaterdcsign flow rates (i.c., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use areas;
and residential property located south oreastofthcAtlantic Intracoastal Watcnizy to be used as vacation rentals as defined
in G.S. 42A-4 .
b Per 15A NCAC 071' .0114(c), design flow rates for establishments not identified (in table 1SA NCAC 02'1',01141 shall be
deteimincd using available flow data, water using fixtures, occupancy or operation patterns, and other meas urcd data.
7 300
8. Wastewater generated by project: - GPD (per 15A NCAC 02T .0114)
Y 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:
❑ Rehabilitation or replacement of epsting sewer with no new flow e..pected
❑ Other (0plain):
FORM; FTA 04-16 Page 2 of 5

DocuSign Envelope ID: 771DiB7E-E868-43E3-8EF4-9A4BAABB3341
Vli. GRAVITY SEWER DESIGN CRITiMIA (if Applicable) - 02T.0305 & AJDC (G -mitt' Se%%rrs):
I. Summarize gravity sewer tobc permitted:
Size(incites)
Length (feet)
Material
811
1-1 W S 1�f
Pic
q9 LIF
n�
D Section II & iiI of the MDC for Permitting of Gravity Sewers contains information related to design criteria
D Section III containsinfonnation related tontinimum slopes for gravity sewer(s)
D Oversizing lines to meet minimum slope requirement is not allantd and a violation of the MUC
Vlll. PUNIP STATION DESIGN CRITERIA (If Applicable)—112T.030S& NWC (Pump Stntinrt lForce Mainst: N
C9MPLE1' FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
I. Pump station number or name:
2. Appro)amate Coordinates (Decimal Degrees): latitude: ° Longitude: - °
3. Design flow of the pump station: millions gallons per day (firm capacity)
4. Operational point(s) or the pump(s): gallons per minute at feel total dynamic hcad (TDII)
5. Summariize the force main to be permitted (for this Pump Station):
Slze(Inches) Length (feet) 1Vbrterial
6. Power reliability in accordance with 15A NCAC 03T .0305(h)f 1):
❑ Standby power source or pump with automatic activation and telemetry - 15A NCAC 0117 .0305(h)(1)(13):
➢ Required for all pump stations with an averagedaily flow greater than or equal to 15,000 gallons perday
➢ 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):
D 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.
D if the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump slalions'stmuge
capacities and the rotation schedule of the portable power source or pump, including travel tirieframes, shall be provided
in the case of a multiple station power outage.
FORM:I-rA 04-16 Page of

Docu5ign Envelope ID: 771D1B7E-EB68-43E3-8EF4-9A4BAA8B3341
Ix SUBACKS &SEPARATIONS—(02B.0200& ISANCAC 02T.0305(f)):
1. Does the project comply with all separations found in 15A NCAC 02T .0305(1) & (g)
➢ 15A NCAC 0271'.0305 contains minimum se arations that shall be provided for sewers sterns:
® Yes ❑ No
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below vertical
24 inclics
Watermains vertical -water over sewer including in ben ch cd trenches)
18 inches
Water mains (horiznntal)
10 feet
Reclaimed water lines vertical -reclaimed oversewer)
t8 inches
Reclaimed water lines hori7nntal-rclaimed over sewer
2 feet
**Any private or public water supply source, including any wells, W S-I waters of Class t or
Class IT impounded reservoirs used as a source of drinking water
100 feet
**Waters classified WS (except WS-I or WS-V), B, SA, ORW, IIQW, orSB from normal
high water (or tide elevation) and wetlands (see item IX.2)
50 feet
**Any otherstream, lake, impoundment, or ground water lowering and surface drainage
ditches
10 feet
Any building foundation
5 feet
Any basement
10 feet
Top sla eof embankment orcuts of 2 feet ormorc vertical height
t0 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth gradc (vertical)
36 inches
➢ 15A NCAC 021'.030(a) contains alternatives where separations in 02T 305(f) cannotbe achieved.
➢ **Stream classifications can be identified using the Division's NC Surlacc W:uerClassitic_ations %aghpage
➢ If noncompliance with 027110 0i or see Section X ofthis application
2. Does thcproject comply with separation rcquirements for wetlands? (50 feet of separation) B Yes ❑ No
➢ See thcDivision's draft separation requirements for situations where separation cannotbe meet
➢ No variance is required if thealtemative design criteria specified is utilized in design and construction
➢ As built documents shouldrefrrence the location of areas cfTcctcd
3. Does thcproject comply with all setbacks found in the river basin rules per 15A NCAC 0211 ,0200? [?]Yes ❑ No
➢ This would include Trout Buffered Streams per 15A NCAC 2H.0202
4. Does the project comply with an individual 404 Permit or any 401 Certifications? h1 aNE AF.Ot , D ❑ Yes ® No
➢ Wetiand-related permits shall be requested, obtained, and adhered to for projects that impact wetlands or surface waters
➢ Information can be obtained from the 401 & Bui1'cr Periniltinn Itrunch
5. Does project comply with 15A NQAC ),)T 1105 c 0) (additional pennits/certifications)? ® Yes ❑ No
Per 15A NCAC 02'17.0 05 c 6. , directly related environmental pennits or certification applications are being prepared, have
been applied for, orhave been obtained. lssuanceofthis permit is contingenton issuance of dependentpennils (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 fh102, "high -priority sewer" means "any acrial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streambanks that is subject tocros!on that undermines or deteriorates the sewer.
❑ Yes ® No
➢ if yes, include an attachment with details for each line, including type (acrial line, size, material, and location).
High priority lines shall be Inspected by the lrermillee 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: tTA 04-16 Page 4 of 5

DocuSign Envelope ID: 771D1B7E-EB66-43E3-8EF4-9A4BAA883341
KW
JI�
MWfw of 4YMw RtiaarcM
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: Town of Holly springs
Project Name for which flow is being requested: Children's Lighthouse Child Care Molly Springs
Afore than one FTSE may be required for a single project if the owner of the tYlVTP is not responsible for all pump
stations along the route of the proposed ivastcu,aterfloiv.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Utley Creek Wastewater Treatment Plant
b. WWTP Facility Permit W. NC 0063096
A11 flows are in MGD
c. WWTP facility's permitted flow 6.0
d. Estimated obligated flow not yet tributary to the WWTP 0.823
e. WWTP facility's actual avg. flow 2.495
f. Total flow For this specific request 0.007
g. Total actual and obligated flows to the facility 3.325
h. Percent of permitted flow used 55%
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)
(p)
(C)
(D)=(B+C)
()Ei)—(A-D)
Design
Obligated,
Pump Average Daily
Approx.
Not Yet
Total Current
Station Firm Flow**
Current Avg.
Tributary
Flow Plus
(Name or Capacity, * (Firm / pf),
Daily Flow,
Daily Flow,
Obligated
Available
Number) MGD MGD
MGD
MGD
Flow
Capacity***
Avent Ferry 1.954 0.782
0.243
0.005
0.249
0.553
* TI he 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 WNVTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): Avent Ferry Pump station
Downstream Permit Number: W00028810M
Page l of 6
FTSE 04-16

DocuSign Envelope lD:771D1B7E-EB68-43E3-8EF4-9A4BAABB3341
X. CERTIFICATIONS:
1. Does the submitted systemcomply with 15A NCAC 02T, the Minimum Design Crites is for the Permitting orPump s Slatiort
d nr • v io and the tnavit)• Sewer Minimum Design Criteria (latest version) as applicable?
& Yes ❑ No
if No, complete and submit the Vadance/AItem ative Design Request applicatirn (VADC 10-14) and supportingdocumcnts for
review. A r vnl or the request is re uired prior to submittal of the Fast Track AVILlicatioit andsuMmirting documents.
2. Professional Engineer's Certification:
I, Samuel Nye attest that this application for
(Professional Fngincer's name from Application Item III,I.)
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans, specifications,
engineering calculations, and ail othersupporting documentation to the bestof 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 materinls under my signature and seal signifies that I have reviewed this material and
have judged it to be consistentwith 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 notto exceed $10,000, as well as civil penalties up to $25,000 per violation.
..------- -
North Carolina Professional Digineer's seal, signature, and date: tiCAR0�//,/�
4� •F D•hiss/ • • �2�i
�2.•py• y
SEAL �,-• �_
34981
3. Applicant's Certification per 15A NCAC 02T .0106(b);
Kendra Parrish
...-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 thatif 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 subjectto being returned as incomplete. I understand thatany discharge ofwastewaterfrom this non -
discharge systemto surface waters or the land will result in an immediate enforcement action thatmay include civil penalties,
injunctive relief, and/orcriminal prosecution. I will make no claim against the Division of Water Resources should acondition
of this permit be violated. I also understand that if all required parts of this application package are not completed and t hat if
all required supporting inrorrnation and attachments are not included, this application package will be returned to me as
incomplete.
NOTE -- In accordance with General Statutes 143-215.0A and 14-1-215.0B, 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 fmc not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
igned by:
Signature: DocuS
A4
Date: 8/17/2020
FORM; FTA 04-16 Page 5 of 5

DocuSign Envelope ID: 771D1B7E-EB68-43E3-8EF4-9A4BAABB3341
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 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 II plus all
attached planning assessment addendums for which I am the responsible party. Signature of this
form indicates acceptance of this wastewater flow.
—DOCUSIgned by:
K"."" Pik
Signature
8/17/2020
Date
Page 2 of 5
FTSE 04-16

DocuSign Envelope ID: 771D1B7E-EB6843E3-SEF4-9A4BAA853341
PLANNING ASSESSMENT ADDENDUM (PAA)
Submit a planning assessment addendum for each pump station listed in Section li where Available
Capacity is <0.
Pump Station (Name or Number):
Given that:
a. The proportion and amount of Obligated, Not Yet Tributary Daily Flow (C) accounts for
% and MGD of the Available Capacity (E) in Pump Station
; and that
b. The rate of activation of this obligated, not yet tributary capacity is currently approximately
MGD per year; and that
c. A funded Capital Project that will provide the required planned capacity, namely
_ is in design or under construction with
planned completion in ; and/or
d. The following applies:
Therefore:
Given reasonably expected conditions and planning information, there is sufficient justification to
allow this flow to be permitted, without a significant likelihood of over -allocating capacity in the
system infrastructure.
I understand that this does not relieve the collection system owner from complying with G.S. 143-
215.67(a) which prohibits the introduction of any waste in excess of the capacity of the waste
disposal system.
Signing Ofcial Signature
}Dale
Page 3 of 6
FTS C 04-16

DocuSign Envelope ID: 771D1B7E-EB68-43E3-8EF4-9A4BAABB3341
Instructions for Flow Tracking/Acceptance form (FTSE) and Planning Assessment Addendum (PAA)
Section I
a. WWTP Facility Name: Enter the name of the WWTP that will receive the wastewater flow.
b. WWTP Facility Permit 11: Enter the NPDES or Non -Discharge number for the WWTP receiving the
wastewater flow.
c. WWTP facility'spermitted flow, MOD: From WWTP owner's NPDES or Nan -Discharge permit.
d. Estimated obligated flow not yet tributary to the WWTP MGD: This includes flows allocated to other
construction projects not yet contributing flow to the collection system. Flows allocated through
interlocal agreements or other contracts not yet contributing flow to the collection system are also
included. For POTWs that implement a pretreatment program, include flows allocated to industrial
users who may not be using all of their flow allocation. Please contact your Pretreatment Coordinator
for information on industrial flow tributary to your WWTP.
As of January 15, 2008 the POTW should have reviewed flow allocations made over the last two years
and reconciled their flow records, to the best of their ability, so it is known how much flow has been
obligated and is not yet been made tributary to the WWTP, in accordance with local policies and
procedures employed by the reporting entity.
e. WWTP facility's actual avg.-flow, MGD: Previous 12 month average,
f. Total flow for this specific request, MGD: Enter the requested flow volume.
g. Total actual and obligated flaws to the facility„ MGD Equals [d + e + fj
h. Percent of permitted flow used: Equals ((g / c)* 100)
For example:
On January 15 a POTW with a permitted flow of 6.0 MGD, reported to the Regional Office that there
is 0.5 MGD of flow that is obligated but not yet tributary. The annual average flow for 2007 is 2.7
MGD. There is a proposed flow expansion of 0.015 MGD.
The first Form FTSE submitted after January 15, 2008 may have numbers like this:
c. = 6.0 MGD
d. = 0.5 MOD
e. = 2.7 MGD
f. = 0.015 MGD
g. = 3.215 MGD
h. = 53,6 %
The next Form FTSE may be updated like this with a proposed flow expansion of 0.102 MGD:
c. = 6.0 MGD
d. = 0.515 MOD
e. = 2.73 MGD
E = 0.102 MGD
g. = 3.349 MGD
h. = 55.8 %
Each subsequent FTSE form will be updated in the same manner.
Page 4 of 6
FTS E 04-16

DocuSign Envelope ID; 771D1B7E-EB68-43E3-BEF4-9A4BAA8B3341
Section lI
List the pump station name or number and approximate pump station firm capacity, approximate design
average daily flow (A) approximate current average daily now (a), and the obligated, not yet tributary flow
through the pump station (C) for each pump station that will be impacted by the proposed sewer extension
project. Calculate the total current flow plus obligated flow (D=B+C) and the available capacity (E—A-D).
Include the proposed flow for this project with other obligated flows that have been approved for the pump
station but are not yet tributary (C).
Firm capacity is the maximum pumped flow that can be achieved with the largest pump out of service as
per the Minimum Design Criteria.
Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor (pf) of not
less than 2.5.
If the available capacity (E) for any pump station is < 0, then prepare a planning assessment for that pump
station if the system has future specific plans related to capacity that should be considered in the permitting
process.
(A)
(B)
(C)
(D)=(B+C)
(E)=(A-D)
Obligated,
Design
Approx.
Not Yet
Total Current
Firm
Average
Current Avg,
Tributary
Flow Pius
Pump Station
Capacity
Daily blow
Daily Flow,
Daily Flow,
Obligated
Available
(Name or Number)
MGD
(Firm / pf)
MGD
MGD
Flow
Capacity*
Kaw Creck PS
0.800
0.320
0.252
0.080
0.332
-0.012
Valley Road PS _
1.895
0.758
0.472
0.135
0.607
0.151
Page 5 of t;
FTSE 04-16

DocuSign Envelope ID: 771D1B7E-EB68-43E3-BEF4-9A4BAABB3341
Planning Assessment Addendum Instructions
Submit a planning assessment addendum for each pump station listed in Section II where available capacity
is < 0.
A planning assessment for Kaw Creek PS (see example data above) may be performed to evaluate whether
there is significant likelihood that needed improvements or reductions in obligated flows will be in place
prior to activating the flows from the proposed sewer extension project.
If the system decides to accept the flow based on a planning assessment addendum, it is responsible to
manage the flow without capacity related sanitary overflows and must take all steps necessary to complete
the project or control the rate of flow to prevent sanitary sewer overflows.
The planning assessment may identify a funded project currently in design or construction, or a planned
project in the future not yet funded but in a formal plan adopted by the system. The system should carefully
weigh the certainty of successful timely project completion for any expansion, flow management diversion
or infiltration and inflow elimination projects that are the foundation of a planned solution to capacity
tracking and acceptance compliance.
For example:
Given that:
a. The proportion and amount of obligated, not yet tributary flow accounts for 24 % and 0.080
MOD of the committed flow in Pump Station Kaw Creek; and that
b. The rate of activation of this obligated, not yet tributary capacity is currently approximately 0.01
MOD per year; and that
c. A funded capital project that will provide the required planned capacity, namely
is in design or under construction with
planned completion in ; and/or
d. The following applies:
The master plan and ten year „capital plan contain recommended scope and funding for a capital project
entitled Kaw Creek Pump Station upgrade with funding planned in July, 2014. This project is planned to
add 0.100 MOD to the film capacity of the pump station by October 2015. Inclusion_of_this proposed
capital project as a condition of this Flow Trackin Acceptance for Sewer Extension Permit Application
elevates this project's priority for funding and construction to be implemented ahead of the activation of
obligated, not yet tributary flows in amounts that exceed the firm pump station capacities identified in
Section II above.
Therefore:
Given reasonably expected conditions and planning information, there is sufficient justification to allow
this flow to be permitted, without a significant likelihood of over -allocating capacity in the system
infrastructure.
Page 6 of 6
(:TSE 04-16

DocuSign Envelope ID: 771 DI B7E-EB68-43E3-8EF4-9A4BAA8B3341
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DocuSign Envelope ID. 771 D 1 87E-E86B-43E3-8EF4-9A4BAA8B3341
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T H E TO W N O F
August 14, 2020
Director, Division of Water Resources
Raleigh Regional Office
Water Quality Operation Section
1628 Mail Service Center
Raleigh, NC 27699-1628
.)7olly Sprin
1-- -
Re: Application for Sewer Extension Permit
Project: Children's Lighthouse Childcare Holly Springs
Dear Sir or Madam:
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 Fdst Ti ick Sewer System Extension
Applications (FTA 04-16)
0 One digital copy of FTSE 04-I6 Flow Tracking/Acceptance Form
0 One digital color copy of an 8.5-inch by I 1-inch portion of a 7.5 minute USGS
Topographic Map showing project area
0 One digital 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,
Da; Uftned by: DS
Affla t;Varrish, P.E., CFM 8/17/2020
Director of Engineering
KP/se
cc: Project Consultant Engineer, Samuel Nye, The Site Group
Administrative Manager (for addition to sewer permit log)
Rodney Campbell, Development Administrator
Project file/Correspondence #41825
3002
04.17.2018
Engineering Departinent
P.O_ Box 8 - 128 S. Main Street - Holly Springs, NC 27540 - www.hollyspringsnc.us

DocuSign Envelope ID:771DlB7E-EB6843E3-8EF4-9A4BAA8B3341
DO NOT SUBMIT SEWER EXTENSION APPLICATIONS UNTIL
CONSTRUCTION DRAWINGS HAVE BEEN APPROVED BY STAFF!
Sewer Design and Application Certification
Note: This form must be submitted with the Fast -Tract Application for Gravity Sewers Pump
Stations, and Force Mains for extension to the'rown of Holly Springs Sewer System
Project:
Design Engineer:
Children's Lighthouse Child Care Holly Springs
Samuel R. Nye
Address: 1111 Oberlin Road Raleigh, NC 27605
Phone Number: 919-835-4787 Email: [e-mail]
Date Complete Application Package Received by Town: 03/11/2020 2—f
0S 8/17/2020 03 8/17/2020
Date Approved: C (by RLC) I Kr {by KDP) 8/17/2020
As design engineer for this project, I certify the following (please check (x) each applicahle hox):
• That the design of the project is in complete conformance with Town of Holly Springs
Engineering Design and Construction Standards and NCDENR Sanitary Sewer Design
Reguiations;
0 That each of the following items are completed and enclosed for submittal to the State for
a sewer extension permit:
>, One original and one copy cover letter including a project narrative
.o A check in the amount of $480.00 to DENR
cy— A check in the amount of $200.00 Town processing fee
A- One original and one copy of the State of North Carolina Fast Track
Application far Gravily Sewers, Pump Stations, and Force Mains
4, Two copies of FTSE 08-13 Flow Tracking/Acceptance Form
Two color copies of a 8.5-inch by 1 I -inch portion of 7.5 minute USGS
Topographic Map showing project area
>� Two copies of a street level map showing all relevant project areas
;C One copy of the locally -required Design and Application Certification
Design Engineer's Signature
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 State for permitting. Please contact Sara
Emig at [phone] if you do not receive this confirmation or if you have any questions.
Enghteering Department - P.O. Box 8, Holly Springs, NC 27540
919-557-3938 - 919-552-9881 (fax)
2003 Sewer Design Application Certirwation
04 11.2018

THE_TOWN OF
August 24, 2020
NC Department of Environmental Quality
Division of Water Resources
Raleigh Regional Office
1628 Mail Service Center
Raleigh, NC 27699- I 628
To Whom It May Concern:
,�;90,11Y C Pfings
PVC nept o pin giro
nmental Quality
l��tl��l�li Rc.,blan
al 0friee
The enclosed check is for payment of the submittal fee for a fast -track sewer extension
application, which was recently submitted via email to Jason Robinson and Ted Cashion. Below
is information regarding the submittal associated with the enclosed payment.
Email submittal date: August 24, 2020
Name of Project: Children's Lighthouse Child Care Holly Springs
Applicant: Town of Holly Springs
Design Engineer for Developer: Samuel Nye, The Site Group
Check: 43445 from The Site Group, PLLC
Please feel free to contact me at sara.emi roa hollys rin xsnc.us or 919-557-3926 with any
questions.
Thank you,
Sara Emig
Administrative Manager
CC: Elizabeth Goodson, Utility Engineer
Project file/Correspondence # 10007
Engineering Depar bitent
P.O. Box 8 - 128 S. Main Street - Holly Springs, NC 27540 - www.hollyspringsnc.us

Robinson, Jason
From: Sara Emig <[e-mail]>
Sent: Thursday, September 24, 2020 10:14 AM
To: Sam Nye; Robinson, Jason; Kendra Parrish
Cc: Elizabeth Goodson; Cashion, Ted
Subject: RE: --[EXTERNAL]--RE: Children's Lighthouse Child Care Holly Springs fast track sewer
extension application
Esc mal email. Do not dick links or open attaefiments unless you verify- Send all suspicious email.as an attachment to
reiaort.spaul 22L.gov
Jason,
For item 1, please revise this item as suggested.
Thank you,
Sara Emig
;x JAdministrative Manager
Engineering Department
1 To%%n of l loll% Spring,
11.0. Box 81 t'_8 S. Main Street
E folh Springs, NC 27540
Direct 919-557-3926
For operational changes associated with the Town of Holly Springs - Engineering Department COVID-19 response please
visit: http.Z www.hollysorinasnc.us/1848/Development-Services
From: Sam Nye <[e-mail]>
Sent: Wednesday, September 23, 2020 5:08 PM
To: 'Robinson, Jason' <[e-mail]>; Kendra Parrish<[e-mail]>
Cc: Elizabeth Goodson <[e-mail]>; Sara Emig <[e-mail]>; 'Cashion,
Ted' <[e-mail]>
Subject: --[EXTERNAL]--RE: Children's Lighthouse Child Care Holly Springs fast track sewer extension application
Good afternoon Jason,
Kendra will have to answer the applicant type. I assume Municipal but this is our first job in Holly Springs in a long time.
The design flows were calculated per the 2T rules:
Proposed childcare was calculated at 25 gpd/person * 200 people = 5,000 gpd
Future retail was calculated at 130 gpd/1,000 SF * 4250 SF = 553 gpd
Future Restaurant (Deli) was calculated at 40 gpd/100 SF * 4250 SF = 1,700 gpd (the owner was thinking
about Subway)
7,253 gpd (rounded to 7,300
gpd)
This breakdown assumes %: retail %: restaurant which is conservative. I doubt the developer will get 4,250 SF of
restaurant/Deli for this project. If they do, we will need to amend the sewer allocation permit.

Please call or write back if there are any additional questions for me.
Thank you, Sam
Samuel R. Nye, PE I Principal
[e-mail]
THE SITE GROUP
Civil Engineers ■ Landscape Architects
1111 Oberlin Road t: 919.835.4787
Raleigh, NC 27605 c: 919,996.9136
From: Robinson, Jason <'ason.t.robinson ncdenr. ov>
Sent: Wednesday, September 23, 2020 3:57 PM
To: Kendra Parrish<[e-mail]>; srn(@thesitegroup.net
Cc: Elizabeth Goodson <[e-mail]>; Sara Emig <sara.emig(@hollvspringsnc.us>; Cashion, Ted
<[e-mail]>
Subject: Children's Lighthouse Child Care Holly Springs fast track sewer extension application
Kendra and Samuel,
We are reviewing the referenced sewer extension application and have the following questions:
I. Item VIA is checked "Yes" for the applicant being a privately owned public utility. However, Holly
Springs is the applicant. This appears to be an error on the application. With the applicant's approval,
we can revise this item on the application.
2. Item VI.7 — Design flows should be estimated using 15A NCAC 02T .0114(c). Please explain how the
design flows in the application were estimated. This may need to be revised based on .0114(c).
Thanks,
Jason
------------
Jason T. Robinson, P.E.
Raleigh Regional Office
Water Quality Regional Operations
NC Division of Water Resources, DEQ
919-791-4200
"Subscribe to Collection System & Sewer Permitting Updates"
E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to
third parties.
Based on the current guidance to minimize the spread of COVID-19, the Department of Environmental Quality has
adjusted operations to protect the health and safety of the staff and public. Many employees are working remotely or
are on staggered shifts. To accommodate these staffing changes, all DEQ office locations are limiting public access to
appointments only. Please check with the appropriate staff before visiting our offices, as we may be able to handle your

requests by phone or email. We appreciate your patience as we continue to serve the public during this challenging
time.
From: Cashion, Ted
Sent: Monday, August 31, 2020 10:49 AM
To: Elizabeth Goodson <Elizabeth.Goodson0hollvspringsnc.us>; Kendra Parrish <[e-mail]>;
Sara Emig <sara.emis(@hollvsprinRsnc.us>; [e-mail]
Cc: Robinson, Jason <jason.t.robinson(ftcdenr.eov>
Subject: Re: --[EXTERNAL.]--Children's Lighthouse Child Care Holly Springs fast track sewer extension application
Thanks Elizabeth, we'll note it on the application.
Ted Cashion
Water Quality Regional Operations
Division of Water Resources
NC Department of Environmental Quality
Raleigh Regional Office
919-791-4254
ted.cashion cr ncdenr..,ov
1628 Mail Service Center
Raleigh, NC 27699-1628
3800 Barrett Drive
Raleigh, NC 27609
Subscribe to Collection System & Sewer Permitting Updates
Email correspondence to and from this adds-ess may be subject to the Nol'th Ca]'ohtra Public Records Law and
may be disclosed to third parties unless the content is exempt by statute or other regulation.

„,-A7.
From: Elizabeth Goodson <[e-mail]
Sent: Monday, August 31, 2020 8:45 AM
To: Cashion, Ted <[e-mail]>; Kendra Parrish <kendra. arrish holl s rin snc.us>; Sara Emig
<sara.emie hollysprinssnc.us>; sm0thesitesroug.net <[e-mail]>
Cc: Robinson, Jason <[e-mail]>
Subject: RE: --[EXTERNAL]--Children's Lighthouse Child Care Holly Springs fast track sewer extension application
�• Ektfmal email. Do not•allalc links or oopen attac7wents unless you verify. Send'all suspicious ernail.as an attachmentfto
Oren' art.st�arnt�nc.c[ov �
Thank you for circling back to us. I believe this is a new permit and not a modification either. Let us know if you need us
to provide any type of updated application or if you can make a note on what has been submitted.
Thank you,
Elizabeth
i �Elizabeth C. Goodson, P.E. I Uti[ity Engineer• i F 'morn• c f liolly Springs I Engineering Department
P,O. lox 8 1 1•'8 S. Main Street
E lolly Spring;, NC _75-10
Direct 919-537-39:33
www.hol1Y_.9y ingsnc.uS ! Facebook , Twitter: insta_r� am
For operational changes associated with the Town of Holly Springs - Engineering Department COVID-19 response please
visit: http://www.hollysorinasnc.usLl84BIDevelopment-Services
From: Cashion, Ted <[e-mail]>
Sent: Saturday, August 29, 202011:34 AM
To: Kendra Parrish <[e-mail]>; Sara Emig <sara.emi holl s rin snc.us>; Elizabeth Goodson
<Elizabeth.Goodson@ hollysprinesnc.us>; [e-mail]
Cc: Robinson, Jason <[e-mail]>
Subject: --[EXTERNAL]--Children's Lighthouse Child Care Holly Springs fast track sewer extension application
Hi all,
We received the subject application via email 8-24-20. Item 11.2 of the application was marked that this project has an
existing permit, but no permit number was included that was to be modified.
Our records do not indicate we have issued a previous permit for this project.
Is this a proposed (new permit to be issued) project?
Or has a permit already been issued that needs to be modified? If so, please provide the permit number.
Thx
ted

Ted Cashion
Water Quality Regional Operations
Division of Water Resources
NC Department of Environmental Quality
Raleigh Regional Office
919-791-4254
ted.cash !on Concdenr.sov
1628 Mail Service Center
Raleigh, NC 27699-1628
3800 Barrett Drive
Raleigh, NC 27609
Subscribe to Collection Svstem & Sewer Permittina Updates
Email correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to
third parties unless the content is exempt by statute or other regulation.
l will be working away from the office most days_ 1 will be checking email periodically. If you need immediate assistance please
contact a water resources staff member at our main number, 919-791-4200.
Based on the current guidance to minimize the spread of COV1D-19, DEQ has adjusted operations to protect the health and safety of
the staff and public. Many employees are working remotely or are on staggered shifts. To occomodate these staffing changes, all
DEQ office locations are limiting public access to appointments only. Please check with the appropriate staff before visiting our
offices, as we maybe able to handle your requests by phone or email. We appreciate your patience as we continue to serve the
public during this challenging time.
Warning: This email is subject to disclosure under the North Carolina Public Records Law (NCGS 132-1).
Warning: This email is subject to disclosure under the North Carolina Public Records Law (NCGS 132-1).

Cashion, Ted
From: Cashion, Ted
Sent: Saturday, August 29, 2020 11:34 AM
To: Kendra Parrish([e-mail]); Sara Emig; Elizabeth Goodson;
[e-mail]
Cc: Robinson, Jason
Subject: Children's Lighthouse Child Care Holly Springs fast track sewer extension application
Hi all,
We received the subject application via email 8-24-20. Item 11.2 of the application was marked that this project has an
existing permit, but no permit number was included that was to be modified.
Our records do not indicate we have issued a previous permit for this project.
Is this a proposed (new permit to be issued) project?
Or has a permit already been issued that needs to be modified? If so, please provide the permit number.
Thx
ted
Ted Cashion
Water Quality Regional Operations
Division of Water Resources
NC Department of Environmental Quality
Raleigh Regional Office
919-791-4254
ted.cashion@ncdenrgov
1628 Mail Service Center
Raleigh, NC 27699-1628
3800 Barrett Drive
Raleigh, NC 27609
DE
!nw-i �-
Subscribe to Collection System & Sewer Perm ittin U dates
Email correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to
third parties unless the content is exempt by statute or other regulation.
I will be working away from the office most days. I will be checking email periodically. If you need immediate assistance please
contact a water resources staff member at our main number, 919-791-4200.
1

Based on the current guidance to minimize the spread of COVID-19, DEQ has adjusted operations to protect the health and safety of
the staff and public. Many employees are working remotely or are on staggered shifts. To accomodate these staffing changes, all
DEQ office locations are limiting public access to appointments only. Please check with the appropriate staff before visiting our
offices, as we maybe able to handle your requests by phone or email. We appreciate your patience as we continue to serve the
public during this challenging time.