WQ0042354_Application (FTSE)_20210226

State of North Carolina
DWR 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: tll, UD J A 3 S r (to be completed by DWR)
All items must be completed or the application will be returned r
I. APPLICANT INFORMATION:
1. Applicant's name: Orange Water and Sewer Authority (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utilty
❑ Federal ❑ State/County ❑ Municipal ® Other y A �,,t
3. Signature authority's name: Todd Taylor. PE per 15A NCAC 02T .0106N
Title: Executive Director NC Dept of Environmental OUR1 y
4. Applicant's mailing address: 400 Jones Ferry Road
FEB 2 fi 2021
City: Carborro State: NC Zip: 27510-
5. Applicant's contact information: weigh Regional Office
Phone number: (2L9) 5374216 Email Address: ttaylorQowasa.org
II. PROJECT INFORMATION:
1. Project name: Jones Ferry Road WTP Finished Water Distribution Resiliency Improvements
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: WQ00
3. County where project is located: Orange
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.909083 Longitude:-79.078492
5. Parcel ID (if applicable): 9778656581
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Jason Cook License Number: 036851
Firm: Hazen and Sawyer
Mailing address: 4011 WestChase Blvd, Suite 500
City: Raleigh State: NC Zip: 27607-
Phone number: [phone] Email Address: jcookAhazenandsawyer.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Mason Farm WWTP Permit Number: NCO025241
Owner Name: Orange Water and Sewer Authority
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1, Permit Number(s): WQ Downstream (Receiving) Sewer Size: 8 and 16 inch
4P
System Widc.Collection Svsteni Permit Number(s) (if a liotLel: WQCS 7 r
Owner Name(s): Orange Water and Sewer Authority
FORM: FTA 04-16 Pagel of 5

Vl. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
[:]Yes (:]No OMA
2. If the Applicant is a Developer of lots to be sold, has a Dcvcluper's Operational Agrccment (FORM: DEV) been attached?
[]Yes ❑No EN. -'A
3. If the Applicant is a HomoiPr❑norty Owners' Association, has an Operational Agrpement €F{)RM;li¢A] 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 I 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
0 % Industrial (See 15A NC'AC 02T .0103 f 20i)
Its there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under J 5A NCAC 021 .0114(f)? ❑ Yes ❑ No
➢ If yes, grovide a copy of flow reduction aPDroval letter
7. Summarize wastewater generated by project:
Establishment Type (see 011.01140
Daily Design Flow "°
No. of Units
Flow
NA - Replacement of existing sewer
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gall
GPD
Total
GPD
a See 15A NCAC 02T .011 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 east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in C.S. 42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NC'AC 02T.01141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 0 GPD (per 15A NCAC 02T .0114)
➢ 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 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 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (itches)
Length (feet)
Material
16
174
PC 250 DIP
8
15
➢ Section II & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section III 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
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: 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 l 5 A KC AC02T .0.105f1i.if l y
❑ Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(h)(1)(B)_
➢ 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 - 15A NCAC 02T
A305(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 & SEPARATION,S — (02B .0200 & 15A NCAC 02T .0305(t)):
1. Does the project comply with all separations found in 15A NCAC 02T _0305(f) & (LP
)0- 15A NCAC 02T.0305 contains minimum separations that shall be provided for sewers stems:
[:]Yes ® No
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, 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 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
Drains e systems and interceptor drains
5 feet
Any swimming ools
10 feet
Final earth grade vertical
36 inches
➢ 15A NCAC 02T.0305f 4l contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ "Stream classifications can be identified using the Division's NC Surface Water Classifications webnaee
➢ If noncompliance with 02T,0305(f) or (a). see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ❑ Yes ❑ No Z MA
➢ 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 ❑ NFA
➢ This would include Trout Buffered Streams per 15A NCAC' 2B.0202
4. Does the project require coveragetauthorization under a 404 Nationwide or ❑ Yes ® No
individual permits or 401 Water Quality Certifications?
➢ Information can be obtained from the 401 & Buffer Permitting Branch
5. Does project comply with 15A NCAC 02T.0105M(6) (additional permiWcertifications)? ® Yes ❑ No
Per 15A NCAC02T.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 02T.0402, "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 ❑ NIA
➢ 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. FTA 04-16 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Qrsign Critcria for the Permitting of Pump Stations
and Force Mams (larest version)_ and the Qraviry Sewer Minimum Design Criteria flatest version! 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 re nest is re uired prior to submittal of the Fast Track Application and supportine documents.
2. Professional Engineer's Certification:
I, Jason Cook, PE attest that this application for
(Professional Engineer's name from Application Item IIL 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 furlher 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 be 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:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I,
Todd Taylor, Executive Director
(Signature Authority's name & title from Application Item I.3.)
� N\ CAROM
SEAL
�• 3ss5� -
v
-SO P "o- o
.............................. ..........Il, .,:, 5.2 '�
attest that this application for
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 143-215.6B, 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.
Signature: Date. 1 /28/2021
FORM: FTA 04-16 Page 5 of 5

Hazen
February 25, 2021
Hazen and Sawyer
4011 WestChase Boulevard, Suite 500
Raleigh, NC 27607 -919 833.7152
North Carolina Department of Environmental Quality
Division of Water Resources
Water Quality Section
1628 Mail Service Center
Raleigh, NC 27699-1617
Re: Fast -Track Application (FTA 04-16) and Supporting Information
Orange Water and Sewer Authority (OWASA)
Jones Ferry Road WTP Finished Water Distribution Resiliency Improvements
To whom it may concern,
Enclosed for review is an application and supporting documentation to replace approximately 174 LF of
existing sanitary sewer in Carborro, NC. The above referenced project is located by OWASA's Water
Treatment Plant off Jones Ferry Road and involves upsizing an existing 8-inch sewer with a new 16-Inch
DIP sewer.
A majority of the new sewer will replace an existing sanitary sewer in place, with a short parallel segment
being installed. All of the new sewer meets the minimum design criteria per 15A NCAC 02T .0305 except
for a 20-ft segment that is located less than 10-ft from the top of an existing stream bank. We have
submitted a variance reouest to Ms. Christyn Fertenbaugh on February 8, 2021 for consideration and this
fast -track submittal is being submitted with the assumption that the variance request will be allowed.
Accompanying this letter is additional supporting documentation required to be submitted as a part of
this permit submittal:
• $480 Application Fee
• Fast -Track Application FTA 04-16 with checklist
• Figure 1— Site Topography Map
• Figure 2 —Aerial Site Map
• Plan and Profile drawing of the proposed sewer extension
Please feel free to call [phone] or email me at icookhazenandsawyer_com if you have any
questions or require additional information.
Sincerely,
JaT6n Cook, PE, PMP
Senior Associate
hazenandsawyer.com

Ira nge Y1i<vr �
Sewer Authority
4
I
1
.-
Legend
Proposed Sanitary Sewer
Existing Sanitary Sewer
N )ONES FERRY ROAD WTP FINISHED WATER DISTRIBUTION RESILIENCY IMPROVEMENTS am.January 2W1
Hazen 1 inch = 58 feet ORANGE WATER AND SEWER AUTHORITY n.ZEMHo 32]
Figure 1 - Site Topography Map m"""�
Flr. Rt HP

State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION
This application is for sewer extensions involving gravity sewers, pump stations and force mains, or any combination that has been
certified by a professional engineer and the applicant that the project meets the requirements of 15A NCAC 02T and the Division's
Minimum Design Criteria and that plans, specifications and supporting documents have been prepared in accordance with, 15A
NCAC 02T, 15A NCAC 02T .0300 Division policies and good engineering practices.
While no upfront engineering design documents are required for submittal, in accordance with 15A NCAC 02T .0305(b), design
documents must be prepared prior to submittal of a fast track permit application to the Division. This would include plans, design
calculations, and project specifications referenced in 15A NCAC 02T _0105 and the applicable minimum design criteria. These
documents shall be available upon request by the Division.
Projects that are deemed permitted (do not require a permit from the Division) are explained in 15A NCAC 02T.0303.
Projects not eligible for review via the fast track process (must be submitted for full technical review):
➢ Projects that require an environmental assessment in accordance with 15A NCAC 1C .0100;
➢ Projects that do not meet any part of the minimum design criteria (MDC) document;
➢ Projects that involve a variance from the requirements of 15A NCAC 2T;
➢ Pressure sewer systems utilizing septic tank -effluent pumps (STEPS) or simplex grinder pumps;
➢ STEP or simplex grinder pumps connecting to pressurized systems (e.g. force mains);
➢ Vacuum sewer systems.
General — When submitting an application, please use the following instructions as a checklist in order to ensure all required items
are submitted. Adherence to these instructions and checking the provided boxes will help produce a quicker review time and
reduce the amount of requested additional information. Failure to submit all required items will necessitate additional
processing and review time, and may result in return of the application. Unless otherwise noted, the Applicant shall submit
one original and one copy of the application and supporting documentation.
A. One Original and One Copy of Application and Supporting Documents
® Required unless otherwise noted
B. Cover Letter (Required for All Application Packages):
® List all items included in the application package, as well as a brief description of the requested permitting action.
➢ Be specific as to the system type, number of homes served, flow allocation required, etc.
➢ If necessary for clarity, include attachments to the application form.
C. Application Fee (All New and Major Modification Application Packages):
® Submit a check or money order in the amount of $480.00 dated within 90 days of application submittal.
➢ Payable to North Carolina Department of Environmental Quality (NCDEQ)
D. Fast Track (Form: FTA 04-16) Application (Required for All Application Packages):
® Submit the completed and appropriately executed application.
➢ If necessary for clarity or due to space restrictions, attachments to the application may be made.
❑ If the Applicant Type in Item 1.2 is a corporation or company, provide documentation it is registered for business with
the North Carolina Secretary of State.
❑ If the Applicant Type in Item I.2 is a partnership or d/b/a, enclose a copy of the certificate filed with the Register of
Deeds in the county of business.
® The Project Name in Item II.1 shall be consistent with the project name on the flow acceptance letters, agreements, etc.
® The Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a North
Carolina licensed Professional En ig neer.
® The Applicant's Certification on Page 5 of the application shall be signed in accordance with 15A NCAC 021,0106(b).
Per 15A NCAC 02T .0106(c), an alternate person may be designated as the signing official if a delegation letter is
provided from a person who meets the criteria in 15A NCAC 02T .0106(b).
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 1 of 3

E. Flow Tracking/Acceptance Form (Form: FTSE 04-16) (If Applicable):
❑ Submit the completed and executed FTSE form from the owners of the downstream sewers and treatment facility.
➢ Multiple forms maybe required where the downstream sewer owner and wastewater treatment facility are different.
➢ The flow acceptance indicated in form FTSE must not expire prior to permit issuance and must be dated less than one
year prior to the application date.
➢ Submittal of this application and form FTSE indicates that owner has adequate capacity and will not violate G.S. 143-
215-67(a).
➢ Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific FTSE.
F. Site Maps (All Application Packages):
® Submit an 8.5-inch x I 1-inch color copy of a USGS Topographic Map of sufficient scale to identify the entire project
area and closest surface waters.
➢ Location of the project (gravity sewer, pump stations & force main)
➢ Downstream connection points and permit number (if known) for the receiving sewer
® Include a street level map (aerial) showing general project area so that Division staff can easily locate it in the field.
G. Existing Permit (All Modification Packages):
❑ Submit the most recently issued existing permit.
❑ Provide a list of any items within the permit the Applicant would like the Division to address during the permit
modification (i.e., permit description, flow allocation, treatment facility, etc.).
H. Power Reliability Plan (Required if portable reliability option utilized for Pump Station):
❑ Per 15A NCAC 02T„0305(h)(1), submit documentation of power reliability for pumping stations.
➢ This alternative is only available for average daily flows less than 15,000 gallons per day
➢ It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant and is compatible
with the station. The Division will accept a letter signed by the applicant (see 15A NCAC 02T .0106(b)) or proposed
contractor, stating that "the portable power generation unit or portable, independently -powered pumping units, associated
appurtenances and personnel are available for distribution and operation of this pump 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. (Required at time of certification)
I. Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per 15A NCAC 02T .0115(a)(1) provide the Certificate of Public Convenience and Necessity from the North Carolina
Utilities Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served by
the sewer extension, or
❑ Provide a letter from the North Carolina Utilities Commission's Water and Sewer Division Public Staff stating an
application for a franchise has been received and that the service area is contiguous to an existing franchised area or that
franchise approval is expected.
J. Operational Agreements (Applications from HOA/POA and Developers for lots to be sold):
❑ Home/Property Owners' Associations
❑ Per 15A NC'AQ 021' .0115(cl, submit the properly executed Operational Agrucmcnt (FOE HOA1.
❑ Per 15A NCAC 02T .0115(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
❑ Developers of lots to be sold
❑ Per 15A NCAC 02T .0l 15(b), submit the properly executed Operational Agreement (FORM: DEVI,
For more information, visit the Division's collection systems website
INSTRUCTIONS FOR FORM: FTA 04- l6 & SUPPORTING DOCUMENTATION Page 2 of 3

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 Quality Section
Swannanoa, North Carolina 28778
Clay, Graham, Haywood, Henderson, Jackson,
[phone]
Macon, Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Favetteville 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 Reaional Office
610 E. Center Avenue
Alexander, Cabarrus, Catawba, Cleveland,
Water Quality Section
Mooresville, North Carolina 28115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
Ralelah 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
Washinaton Regional Office
943 Washington Square Mall
Beaufort, Bertie, Camden, Chowan, Craven,
Water Quality Section
Washington, North Carolina 27889
Currituck, Dare, Gates, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
Wilmington Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
Water Qualft Section
Wilmington, North Carolina 28405
Hanover, Onslow, Pender
[phone]
[phone] Fax
Winston-Salem Reaional 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 FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 3 of 3

V01 u0c� [am vu}v wQopL4z3sN
fr. rn pUl% L (, 0. 124 INTO -R,kd U/
Cover Page Language:
Condition 1.1: An alternative design is granted for the installation of portions of the gravity
sewers permitted herein in accordance with 15A NCAC 02T.0105(n). Please see
Condition 1.1 for more details
Special Condition Language:
Per the submitted variance request as received on February 8, 2021 by Hazen and Sawyer on
behalf of Orange Water and Sewer Authority for the subject project, along with additional
information received on July 13, 2021, the Division will grant the variance request for the
construction and operation of approximately 25 linear feet of 16-inch DIP gravity sewer located
within the 10-ft minimum separation from the top of an existing stream bank in accordance with
the provisions of 15A NCAC 02T.0105(n), and subject to an the following conditions:
As specified in the provided plans, where the gravity sewer does not meet separation
requirements for stream banks, rip rap protection shall be implemented in accordance with the
plans, general notes, and cover letter as submitted to and approved by the Division as part of this
variance request.
Regardless of the variance approval, in the event that the wastewater collection facilities fail to
perform satisfactorily, including the creation of nuisance conditions, the Permittee shall take
immediate corrective action, including those as may be required by this Division, such as the
construction of additional or replacement facilities.
All other elements of this project shall be constructed in accordance with all applicable rules and
statues including, 15A NCAC 2T; the Division of Water Resources' (Division) Gravity Sewer
Minimum Design Criteria adopted February 12, 1996 as applicable; and the Division's Minimum
Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains adopted June 1,
2000 as applicable. Approval of the variance request does not constitute approval of the permit.