WQ0042170_Application (FTSE)_20201221

Central Files: APS _ SWP
12/17/2020
Permit Number W00042170
Program Category
Non -discharge
Permit Type
Gravity Sewer Extension, Pump Stations, & Pressure Sewer Extensions
Primary Reviewer
dean.hunkele
Coastal SWRule
Permitted Flow
Faci
Facility Name
Elderhaus Public Sewer
Location Address
Owner
Owner Name
Cape Fear Public Utility Authority
Dates/Events
Scheduled
Orig Issue - App Received Draft Initiated Issuance
12/10/2020

CSD
ENGINEERING
December 10, 2020
Dean Hunkele
North Carolina Department of
Environmental Quality
Division of Water Resources
127 Cardinal Drive Extension
Wilmington, North Carolina 28405
Re: Elderhaus
Fast Track Sewer System Extension (public)
New Hanover County
CSD Project No. 19-0481
Dear Mr. Hunkele:
DEC 10 2021)
Per your phone conversation with Mike Broyhill on Dec. 4, 2020, we are submitting this application to resolve the issue
of private sewer within the NCDOT right-of-way of Kings Grant Rd. The site was already granted a private permit
(WQ0041630) on April 24, 2020. Per our discussion, please modify this existing private permit to change the permitted
length to 211 LF of 8" gravity sewer (191 LF of 8" C-900 & 20 LF of 8" DIP). If possible, we also request that the modified
private permit be placed in the name of United Church Homes and Services (instead of Elderhaus, Inc.) as the property
has changed ownership. Elderhaus will now be leasing the property from UCHAS, so we would like to get the permit in
the name of the actual property owner.
The enclosed public permit application is for+/- 29 LF of 8" DIP public gravity sewer main to serve Elderhaus, a proposed
adult day-care facility in New Hanover Co. This public line will connect to an existing CFPUA manhole located on Kings
Grant Rd. The main will be installed by the developer and owned and maintained by CFPUA. Enclosed please find:
- One (1) original Fast Track Sewer Application (FTA 04-16)
- $480.00 application fee, check #9128
- Street view map
- USGS map
If you have any questions or comments, please feel free to contact us. Thank you for your assistance.
Sincerely,
Jeremy Martin
Encl.: As noted above
Cc: Elderhaus, Inc., United Church Homes and Services
3805 Cherry Avenue - Wilmington, NC 28403 - 910 7914441- www.csd-engineering.com — License # C-2710
ED"o

State of North Carolina
Department
Division vof Water Quality erRe Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources ' r FTA 04.16 & SUPPORTING DOCUMENTATION
W Application Number: O0 4A913 (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: CFPUA (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ® Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ❑ Municipal ® OtherAuthority
3. Signature authority's name: Jeff Theber fe. PE per 15A NC.AC 021'.01061hj
Title: Engineering Manager
4. Applicant's mailing address: 235 Government Center Dr.
City: Wilmington State: NC 'Zip: 28403
5. Applicant's contact information:
Phone number: (90) 332-6560 Email Address: [e-mail]
II. PROJECT INFORMATION:
1. Project name: Elderhaus
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ00_ and issued date:
If new construction but part of a master plan, provide the existing permit number: W000_
3. County where project is located: New Hanover
4. Approximate Coordinates (Decimal Degrees): Latitude: 34.1229' Longitude:-77.891820'
5. Parcel ID (if applicable): R04200-004-001-000
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Howard Resnik License Number: 25483
Firm: CSD Engineering
Mailing address: PO BOX 4041
City: Wilmington State: NC Zip: 28406-
Phone number: [phone] Email Address: howard@csd-en ing eerieg com
IV. WASTEWATER TREATMENT FACILITY (W WTF) INFORMATION:
1. Facility Name: Northside W WTP Permit Number: NCO023965
Owner Name: CFPUA
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ_ Downstream (Receiving) Sewer Size: 8 inch
Svstem Wide Collection SNsteln Permit Number(s, iil'applica.ble): WQCS
Owner Name(s): CFPUA
FORM: FTA 04-16 Page l of 5

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
® Yes ❑No ❑N/A
2. If the Applicant is a Developer of lots to be sold, has a Dc tcl_oper', 01,cranonal Ayrcement ( FORM: DIi V) been attached'?
❑ Yes ❑No ®N/A
3. If the Applicant is a Homc/futper?.j Owncrs' Associ anon_ has an.01mational Agreement i FORA; HOA, been attached?
❑ Yes []No ®N/A
4. Origin of wastewater: (check all that apply):
❑ Residential Owned ❑ Retail (stores, centers, malts) ❑ Car Wash
❑ Residential Leased ❑ Retail with food preparation/service ❑ Hotel and/or Motels
® School / preschool / day care ❑ Medical / dental / veterinary facilities ❑ Swimming Pool /Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 % Domestic/Commercial % Commercial
_ % Industrial (See I5A NCAC 02T .0103(201)
"Is there a Pretreatment Program in effect? []Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 02T .011.4U1? ❑ Yes ® No
➢ If yes, provide a cony of flow reduction approval letter
7. Summarize wastewater generated by project
Establishment Type (see 02T.0114(fa)
Daily Design Flow a,h
No. of Units
Flow
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
GPD
See 15A NCAC 02T .01 14(bi. ((I k. (e It I a and ,e)t2 a 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).
Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table I � A NCAC 021.01 141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
R. Wastewater generated by project: 0 GPD (per 15-A NCAC 02T 01 14)
➢ 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: W00041630
❑ 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) -112T .I1305 &'NIDC iGrm ih Sewcrsn
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
S 29 �.IDIP
➢ Section II & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section lit 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
VILL PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & NIDC (Pump Stations/f urce \Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: _
2. Approximate Coordinates (Decimal Degrees): Latitude: 0 Longitude:
3. Design flow of the pump station: millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): _ gallons per minute at ___ feet total dynamic head (TDH)
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 02`1 0305Qt1i I :
❑ Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(h)(1)(13)_
➢ 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 - I SA NCAC 02T
.0305(h)(1)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry - 15A NCAC 02T .0305(h)(1)(C):
➢ It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant (draft agreement)
and is compatible with the station.
➢ If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel timeframes, shall be provided
in the case of a multiple station power outage.
FORM: FTA 04-16 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
I. Does the project comply with all separations found in 15A NCAC- 02T .0305(fi & �g ®Yes ❑ No
➢ 15A NCAC 02T.0305(f) contains minimum separations that shall be Provided for sewers stems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
24 inches
Water mains (vertical -water over sewer including in benched trenches)
18 inches
Water mains (horizontal)
10 feet
Reclaimed water lines (vertical - reclaimed over sewer)
18 inches
Reclaimed water lines (horizontal - reclaimed over sewer)
2 feet
**Any private or public water supply source, including any wells, W S-I waters of Class I or
Class II impounded reservoirs used as a source of drinking water
100 feet
**Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal
high water (or tide elevation) and wetlands (see item IX.2)
50 feet
*"Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches
10 feet
Any building foundation
5 feet
Any basement
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainages stems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth radc (vertical)
36 inches
➢ 15A NCAC. 02T.005(0 contains alternatives where separations in (C'I 0305i f � cannot be achieved.
➢ **Stream classifications can be identified using the Divisions NC Surf tci Water Classifications Pv_ Jude
➢ If noncompliance with 027'.0305(f) or (g), see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ® Yes ❑ No ❑ N/A
➢ See the Division's draft separation requirements for situations where separation cannot be meet
➢ 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.0213 .02009 ❑ Yes ❑ No ® N/A
➢ This would include Trout Buffered Streams per 15A NCAC 213.0202
4. Does the project require coverage/authorization trader a 404 Nationwide or ❑ Yes ® No
individual permits or 401 Water Quality Certifications?
➢ Information can be obtained from the -it)I&But her Pei nntiine Branch
5. Does project comply with 15A NCAC 02T 0105(c)i 6) (additional permits/certifications)? ® Yes ❑ No
Per I5A NCAC 02T.0105(ch)), 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 NCAU 0210=402, "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes ® No ❑ N/A
➢ 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: PPA 04-16 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with I5.A NC AC 021, the Minimum Down Criteria for the Penniuing of Ptun;i Stations
and Force_ Maim (latest version). and the Cnav n. Sewn iligintmn_DcgLn Criteria tlatcal vcr.ionl 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 required prior to submittal of the Fast Track Application and supporting documents
2. Professional Engineer's Certification:
that this application for
Engineer's name from Application Item III.1.)
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 tinder my signatureand 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 143-215.6B, 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 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's Certification per 15A NCAC 02T .0106(b):
tlllntr/���
CARO��i�i
s;0'
SEAL 9
025483
I, - Jeff Theberge, P.E., Engineering Manager attest that this application for
(Signature Authority's name & title from Application Item I.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 of wastewater from this non -
discharge system to surface waters or the land will result in an immediate enforcement action that may include civil penalties,
injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water Resources should a condition
of this permit be violated. I also understand that if all required parts of this application package are not completed and that if
all required supporting information and attachments are not included, this application package will be returned to me as
incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.0% 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 tine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature:
Date: 12/9/2020
FORM: FTA 04-16 Page 5 of 5

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