wq0042353_Application (FTSE)_20210223

Dwp
Division of Water Resources
11
St 1—C of North Carolin..
Depat•trttent of Earonmcntaf Qu;3litr•
Dil'ision of Water Resources
IiA SCAC 02T.03oo— FAST TR %CK SMER SYSTEM EXTENSION APPLICATION
FTA 04-16 & SUPP011TING DOCUMENTATION
i
Application Nilinber: LAIR 00 ` d 3 3 �� 3 Uo he eomtrlMd hx 1AVIj t
.11! items must lac cum lrtcti nr thr at t Neatjon �►il! he return -�
1. APPLICANT INFOI211IATION:
1. Applicant's name: Qrtnzc LYatcr,±; Seuer_.._�Authority (company Fit unicipaf;t•., ilOA, utill t%,
�. Applicant type: ❑ litdividual n�
Corttnr n [] General Partncrshi
p ❑ ❑ Federal Pritateh-0%k led Public
� 'Cnun[} [� Municipal
3. Signature' � , rtamc: !'add Ta.lor P.E. u' 1
Tllle: hNCCutite DlreCtol'
4. Applic,tttt's milling address: 1001n` ite; Fern 1Znad NC Dept of Environmental Quality
City: ci!'!! orn State: NC zip: 27; 10-
5. Applicant's contact information: FEB 2 3 20?1
I'luone number. (919) ;37-JI.O1 Email Ad(ir,.,,,. ,ip j er• it 1•.,
=' Raleigh Regional Office
11, PROJECT l,\ F'[ 3 i,Z 1 t:r•1'1pK:
I. Project name: (';�rol'ma lhtnor.es
?. APplicatitrn'Prnjcct status:
® Proposed Permit) ❑ F\istim—' Penr,it/Project
ide the existin., permit :turrth: LL f�00 and j,cued date: _
[file". con,:)t .(tun bu, _;; :; : C: ,ar pl, r 'Je the c%'lstin', perrtut i.t:ntb, r: IVQOO
�. Count} %%here prOJect is located- Or—rann, ee
4. Approximate Coordinates (Decimal Degrees) 1 atatide ;;•97440S Longitude. 7
r. Parcel ID (if applicable): 9870-g9. Lon nude.-_9.{a7;7+73
�fi76
(or Parcel 11) 10 closest downstream seuerl
ill. CONSULTANT INFOR1,1.17'Jt:.)\':
I. Prolcssional Fnllinecr. Chuc4__1 sill P E. license Nuinbcr 23461
Firm: C'rtC cr__ hL %Cll 7
Mailing address:.1 1 I West Main St
C'il'.- Durham S(ate: NC
Zip: '7701-_
Phone number: (919) bU� 1'63 Email Address chill
IV. 11°ASTEWATER TREATMENT FACILITY M-WTF) INFORMATION:
i. Facility C\amc: 1-ilson Farm Mlstewater Treattncrtt Plant
P;!rntit,hutnbcr \C 0023741
Owner Name: 0 %SA
V. RI•:CEIVING I)OWNSTUAA1 SEWER INFOICNIAT10,N (if different than WAYTF):
III
I . perntit Number{s}; k>'Q29204 Downstream (Itcccn ins,) Sewer Sipe
System Wide Collection System Permit Nuinber(s) (if applicable). WQCS00031
0"ner Narne(s): Oran<<c Walcr & Sqi. er Authority
FOR,iI: l"TA 04-16
I'a,e I n1' i

VI.
I
2.
3.
4.
GENERAL Rr•.QUIRf:MEN'l S
if the Applicant is a Privarely-O%%ned Public UtiIity. has a C'ertificale of Public Convenience and Necessity been attached'
❑ Yes ❑tip ©ti`rA
If the Applicant is a Developer Hilo;( d% ht sold, has a t7cielu�!; r-5 t?j��r.�rinn3l ,1�rcclttcnt.�fI )!t �.1_ {tf=1- } been attached'
❑ )Yes ❑NO EIN!r1
lf'the Applicant is a [f{tnlc;'Propert% [l�inLF•.4�1�s,,�r�rlit+n, has an. ()nc.r.itiunaE-;1�rc•cnicrlt i FOR 1l:-I bcLn attached`'
❑ Yes ❑No RINIA
Origin of %%asimater: (check all the;t a{ ply);
❑ Residential [h%ned ❑ Residential l.cas,d detail (stares. centers. malls)
❑ Retail with food preparationiservice
❑ School / presc%:oat ;' day care Z hIedical i dental vQterinary facilities
❑ Food and drink facilities ❑ Church
❑ Bus'llesses i Offices; factories
❑ Nursine 1lome
5. Nawre of %vaste%sater
❑ Car Wash
❑ Hotel andAir iotels
❑ SWinlining Pool iClubhuuse
❑ 5%%immina POOI/Filter Back%%ash
El Other (Explain it) Attachment)
°b Domestic Commercial 50 "G Commercial
0 industrial (See 1S,A q AC
1-->ts there a Pretrcttment Prof*rain in effect:'
6. Flas a flow reduction been anproved under I>.� `(',1t i,w i , ❑ } rs ® NO
tP ves. roe ide a a n n' of tTnw reduction a 1 rural letter i ❑ 1'rs ❑ Nu
7. Salmmarire waste%%aier -generated by prow' m
Establishment Type (sec 02T'.I)i 1a{fl)�
Dail) Design Flo►('ry
i E c�+t+}cite= �—-- _'No. of Units Flow
_ tilrr�l
r 4--1=
I General Business and
2 w=al EmArayeelsh;N 133 3325 GPD NLP
GPD
_ --GPD
gal:` CPD
4Y 11 -
GPD
7< lcrl 3325 GPD
a See :l`C'1C'i}'T ,[iE{1.to cI}a
E—b�--fdi —1 z t for ca%�ats to %waste+%atrr desi��n tlo%% rates (i.e•, rnininlum lio%% per
d%%clling: proposed alnkno%vn non-residential de%elopment tlscs: public access t cilities located near hid=il public use areas;
and residential property located south or east nfthe Atl lntic Intracoastal �l'atem a% to be used as vacation re Heals as defined
b Per 15A NC,NC 02-1' .01 1-l(c), desi�+n flo%% rates for estabttslirnerlts I'M identified jrn table 1 �. i}?'1 t3 j ; ; ]shall he
determined using available t7o%% data, %%aleF' ll>Irt�= fixtures, occupancy or operation patterns, and other lneasurcd data.
8. 1l aste+hater generated by project: 3325 Gl'D f per " �, �: r t? 1 4)
Do not include future flows or previously perrnrttcd allocations
]f permitted flat%v is zero, indicate why:
❑ Pump Station or Gravity Sewer %%here flow will be permitted in subsequent permits that connect to tills line
❑ Flo%v has already been allocated in Permit Number:
❑ Rehabilitation or replacement of existing sewer %%ith no nen• ila%v e.Npected
❑ Other (Explain);
rORrNI: FTA 04-16
Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - I)_ r .03t)5 & lII}C (1,
I. Summ2rirt r�rav t}• so3ucr to be permitted
Size (inches} Length (feet) itI;tterlal
-----..._— _i
93 DIP
Section 1[ & I1! ufthe i�lf)C ti,r Pernritri„ of C;rttviEy Sck%er'S contains information rclatcd to desi"n criteria
Section 1i1 contains information relaie,t to minimum slopes Fur gavit+' sewer(,.,)
Oversizinh lines to meet minimum, %lope requirement is not allowed and a violation of the i�1DC
NAIL PUMPSTATIO. DESIGN CR!TLRIA (if Applicable)—!)j,r ()3il5 cd :`I!){' Pur,, Stations Farce 2.,ri„
CO:III'LL -T FOR fACll PUNIP STATION INCLUD f) 11 THIti PRO.IECT
I. Pun,p station nurnber or „an,r NA
2. Approm,n3,e Coordinates (Decimal Degrees). Lat"!ude:
. Lon��irtitle: -
3. Des, -or, tlOk% .: purnp station millions gallons pe, day (firm capacity)
4, Operational poimt(;) r ,',,,, purnp(s)- gallons per n,-nute at — feet Iotal dv narnic head ([ DH)
5. Suminarire the force main to be pert -titled (for this Purnp Station)
Size (inches) I Length (feet) Material 1
G. Powerrel'tability in accordance with fa�',_tCAt 0?T
❑ Standby power source or l,tunp with aalnmatiC actry atran and telemetry - I iA +NCAC 02-f .0305(h)( 1)(I3)
Required for all purnp stations with an average daih )low vreater than or equal to 15.000 gallons per day
A•lust be permanent to facility
Or ifthe purnp station has an average daily flow less than ! 5,000 L-al Ions per da%.
❑ Portable power source kv ith manual activation, quid. -connection receptr,cle aril lelemetry - ! -;A tiC:1C 02'C
.0305(h)(1)(C)
or
❑ Portable pumping unit with plugged emergency purnp connection and tele,retry - [;A NC:AC 02-f .0305(h)(1)(C)-
It shall be demonstrated to the Division that the portable source is owned or conlracled by the ap and is compatible with the stplicant (drati a��reement)
ation.
If the portable power source or pump is cicdiCated to multiple pump stations, an evahiation ofall the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, includur,,4 travel tinleframes- sh elf o prov ided
in the case of a multiple station power oulaac.
FORM- FTA 0.1-I6
Page 3 of 5

IX• SFTBACKS & SLPAlZA•i•I()N,.s - (0213.0200 & 15A'NCAC 02T.0305(t)):
1. Docs 1he project col;tpiv with all separations found in ' , 3
\r 40�lfl:. �tt� c� f
15A NCAC _I'")305(f) contains rnrnimu_m sM rations that sha—
ll b.ti
eprotiided for sc�tierlstcm.ti: ❑ }cs Cl No
Setback Parameter* _ -
Storm sowers and ocher utilities not listed bNfot+ tvertrcai) — — 5e oration Required
Water mains t vertical -water over sewer including iit bcnchc.-1 1 ;YeS} 'µ 24 inches
11-ater mains IhnrizonEaf) - -- — "� - �f t3 ]ache~
Reclaimed water lines (vcrlical-reclaimed; . ,ewer} _ —w—' — — — 10 feet
Reclaimed Seater fines (hr,-: ! S inches
..,.loed over sewer)
""Arty private or public v,ater supply source. including _ _ tctit
Class If n„ ounde' res_rvoirs used as a source ufdrinkimwwvata r �� 5 I `c`lZers o1'C'I?ss I or
"waters ciacsitie" WS (except W'S-1 or WS-V), B. S_1. ORW', I[(i11', or SB from normal fUU feet
fti;h «Grp fo- EWe elevation) and wetlands (see item IX ?)
Any other strcarn, lake, im oundrncnt, or „ , ---- - -- o feet
ditches p ,rc and «ater Iow Bring and surf cc draina�,c
building foundiwov
basement
•I-ap sl
Drain:
i
— —,.— 10 feet
' G inches
lC _ I' '� _;�, t:) conrkms tlhernalll'ej 51'heCe yen?Catlprl5 in lid]
r •"5tre,tnr cliNsificati(ins can be Identified using the C)kv ,1 .s cannir, be
fn� : c.vnr;:Il.. r i!h i) r _ _r C11.ti _
See sev1.:i i (it .. �) .-�117NiLation .••_
2, -Does the project comply vv^ith separation requirements for wetland;" (50 feel of separation)
%- See tite Division's draft separation ret]urrernents For situations where separation cannot 6e meet ❑ es ❑ No
No variance is required if the alternative design criteria specified is utifi�ed in design and construction
As built ducumenls should reference the location ofareas cffxted
3• Does ilae prOjl'C[ Comply LN'itlt all Setbacks luund in the river basin rilles per -1;; t
This would include Trout Buffered Streams per , _.1C _I�.ti�i), 0 Yes ❑ No
4, Does the pre ject coinply with an individual 404 Permit or anv 401 Celli fication.N? No
Yes ❑
r Welland -related permits shall be requeste�I, obtained. and adhered to for projects that iYmpact v4etland, orsurles waters
Information can be obtained from the 4()!. Ii lFicr�rutittin.> E3r.IncFi
;. Does project comply with 1,�.1 ['A(: ()'r.[t [ ;
I i. rcf�f j (additional permit 'certifica[lolls)°
Per ];,1 �C';'� 0 t•4t0:.i._JS �• ❑ Yes ❑ �Ia
' ` L b directly related ertviromncntrll permits or certification applications are beige prepared, have
been applied fur, or have been obtained. issuance of this permit is cantin"znt on issuance ofdependcnt perm
sedilneniation control plans, s(orrnwawr inanagernent pious, etc.). its (erosion and
10 fcet
of embankment or cuts of3 feet or — _ — 10 leer
�k rc vertu heir llt - -
•,stems and intcl--; -- 10
�lrt; s.vin�r�ir.•�,n
Fi:l l ccrtl' 'ra,f. (vertical) ---
6. Does this project include any sewer ct)!lcction fines that are deemed
Per ISA tiC'.4C' (h 1 l): U ^ 1 igh-priority sewer•' means "anv aerial sewer, sewer cuntactin��
positioned parallel to strearnbak's that is subject to erosion that undermines or deteriorates the se wet vvatLrs, siphon. or sewer
❑ Yes ® No
If yes, include an atiachrnellt with details for each line, including,
type (aerial line, size, material, and focatian).
High priori[} lines shalt he inspected lav the perraittee or its representative at least once every six ,months and ins ecti
documented per 15A i�CAC 02T.0-I(13(a)(55) or the permitees individual Srsteni-Wide Collection permit. p ans
FORE; FTA 04-16
Paue 4 of ;

X. CERTIFICATIONS:
Does t)te suhrnitted system comply ttith l;. p2 1, the .�liltrn,tnr, irs
LC
'rrleri,l tnr the P,n
z,ittii,_ ut pnlL 5 ,ttiuns
aec! f nrc� 1faiEts �IRncsf tersiun], and the tlr.,'Ir'. bLucr P�fii tntum ILLS e,ti �ritti'fa 11t«`fit �ry;itrl ES applicable?
Yes ❑ �u
1e ie cunnplete and submit the 1'ariarlcr.Alternative ❑esign Bequest application (V,1i)C' ! i}-I'I) and supl,nrtin�� doeunnents tier
review. A tint al of the re uesl it rec uiret! ryriur to suhr„Req csj ,,l, li ..
E�rnlessiorta! Engineer's Ccrtification-
(Prof., ...,,, Lngincer's name Cron, Application !h'm 1[L I,i _.-ativst that this application For
has been reviext•,i _ t me and is accurate, cortnplete and consistent with the information supplrcd in the plans• specificatium.
etneineerinc calculations, and all other supporting documentation to the best c,I-rm knotvle&,
Of my I }T,L• the proposed design has been prepared in accordance with the applicable further attest that to the best
Minimum Design Criteria fior Gravity Scttiers (latest version), and the �linimutn Desi��nCpr iteria fi r tluL f as[STraei,tl'L3 Ifttne
of Pump Stations and force 4lains (latest %ersion). Although other professionals nnat have developed certain portion; ortltis
submittal package. inclusion of Ihese materials under illy siwalatine and seal si_-niftes that I have reviewed this material and
haveludged it to be consistent with the proposed design.
NOTE •- In accordance t%ith General Statutes 143--2I i.6A a:r,! 1-13-215.613. ant person tt ho ktnott'inglt makes any rinse
statement, representation. or certificarr r , ;t, application package shall be ,uilty of a Class ? misdemeanor, which may
ir,; ittslr a rinc n to a; a, Cis it penaides up to S25.000 per violation.
North arolina Professionail Engineer's seal* signature, and date:
It
i
r
3. Applicant's Certification per 15A NCAC 02T .0106(b): 1
1, Todd Taylor, P.E., Executive Director _
(SiQ113ture Authority's name , �' - — attest that tlus application for
t,1L from Application Item I;.}
has been revietted by me and is accurate and con;pletc to the best of, mt knutvicdt}e. 1 understand that if all required parts of
thk application are not completed and that ifal'o required supportingdacuntentatiun and attachments ,tie not included, this
application Pack -age is subject to being returned a3 incomplete. I understand that an, dtschat-Le of nastetvater from this nor) -
discharge system to surface waters or the land wr;l result in all inninediate enforcement action that may include civil penalties.
injunctive relief. and:'or criminal prosecution. I wi'I make Ilk) claim against the Division of Water Resources should a condition
ol•this permit be violated. I also understand that Wall required parts of this appircation package are not completed and that if
al! r•_quired supportint< information and attachnl ms are not included. this application package will be retuned to ire as
incomplete,
MOTE - In accordance with Genera! Statutes 113__1�r,1 and �h_,(,, any person ttho knowingly makes an, litlse
statement, representation, or certification in any application package shall he ,tr,ity of a Class ?misdemeanor, which nt ty
include a tine not to eNceed 510,000 as ttell as civt: pettaltics tip so S?5.00ll per vli ;anion.
Si,natut� ! ) 1
Date
- 1/11/2021
FORt\1. FTA O.1-16
Page 5 of'5

WWTP facility's permitted flow 14.5 A�f.1lO1-s are in 11-lGD
Estimated obligated flow not yet tributary to the WWTP 0.371
WWTP facility's actual avg. flow 7.600
f. Totaf flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
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: Orange Water and Sewer Authority
Project Name for which flow is being requested: Carolina Donor Services
Alore than one FTSE' ma"V he required far a single project if the owner of'the 11 117P is riot 1•esponvihle for all pmunp
stations along the route ofthe proposed wastewater• floti.
I. 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 #: NCO025241
d.
C.
0.004 (3325 GPD)
7,975
55%
I1. 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
Flow**
(Name or
Capacity, *
(Firm / po,
Number)
%lGD
MGD
Eubanks
0.43
0.17
L. Ellen
1,44
0.58
Rogerson
18.5
7.4
(B)
(C)
(D)=(B+C)
(E)=(A-D)
Obligated,
Approx,
Not Yet
Total Current
Current A%g.
Tributary
Flow Pius
Daily Flow,
Daily Flon,
Obligates!
Available
NIG17
MGD
Flow
Capacity***
0.077
0
0.077
0 .093
0.315�
0
0.315
0.265
3.711
0.241
3.952
3.448
* The Firm Capacity of any pump station is defined as the~ m puu a«• that
can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking
factor (pf) not less than 2.5.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): OWASA
Downstream Permit Number: WQCS00031
Page 1 of 6
FTSE 04-16

III. 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 If plus all
attached planning assessment addendums for which I am the responsible party. Signature of this
form indicates acceptance of this wastewater flow.
ug 0WICi(II SIZzliciture
1 /11 /2021
Arlc
Page 2 of 6
FTSE 04-16

0
COulter Jewell Thames, Pq
S T
1)L,RgII N-a1H LAZO. vx 2±r
a819 a 0.159 151
9 Biqa KG:5
�1ore= ' 1. 2020
Vick Parker
Orange Water and Server :A • thori13
-400.fones Ferry Road
trrboro. NC 27510
RE: Carolina Donor -Services
Pern-.1i C.0- Jr I -.:r
Mr. Parker.
rile Carolina ;?c`�} �- 'Ic,A ices protect i> ]octftil .
building. ' 't 7000
t�;t13 "'"OUSt 'Wad. f h_ Proposed project
ser�t,. as roc iatcd �r�;dif�<<. a. �.i=zu`,�, parking. and "4 Iter :ld
Public i'tilities. including Public Sealer. are proposed to be installed as a part Ofthis project to
sefve the new building. :�pprosimatcly 93 linear feet of s-, D11'sewer Line is proposed t0 serve
the addition. the proposed line k� ill c�tend from the rear of'the huildin�' to the; rear of the site.
and ►oil! connect t0 the e�istin&, sower manhole itt that location.
The reOU.'tc.-1 capacit} ltrr the project i4 3.325 GPD,
Ple{tsc contact file if there are anN questions regarding this application• and thanks for Four
assistance,
Sincerely.
Chuck 1-]ill P.Ej. V
Protect 1:nuineer

vocoNorY MAP

Im
USGS - CHAPEL HILL QUAD
1 =500'