WQ0042680_Application (FTSE)_20210712

DocuSign Envelope ID. F59A9302-188A-4C39-9AC6-A56E32104A60
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 FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: W 0 00112(p,50 ;to be completed by DWR;
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Town of Holly Springs (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ® Municipal ❑ Other
3. Signature authority's name: Kendra D. Parrish, P.E. per 13A NCAC 02T .0106(bl
Title: Executive Director of Utilities & Infrastructure Services
4. Applicant's mailing address: 128 South Main Street y�
City: Holly Shrines State: NC Zip: 27540-
01
5. Applicant's contact information:
Phone number. [phone] Email Address: kendra.parrishohollyssprin sg nc.us 0
& _
II. PROJECT INFORMATION: o
I. Project name: Village Gate Tract 3 q
2. Appiication/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project47
If a modification, provide the existing permit number: WQ00 and issued date: wtto
If new construction but part of a master plan, provide the existing permit number: WQ00
3. County where project is located: Wake
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.634284-' Longitude:-78.835850"
5. Parcel ID (if applicable): 0648-95-0812, 0648-85-4727
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
I. Professional Engineer: Chris Allen License Number: 023029
Firm: Allen Consulting PLL
Mailing address: 10609 Old Pine Court
City: Raleigh State: NC Zip: 27613-
Phone number: [phone] Email Address: callena,allencm.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
I. Facility Name: Utley_ Creek Wastewater Treatment Plant Permit Number: NC0063096
Owner Name: Town of Holly Springs
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ0039999 Downstream (Receiving) Sewer Size: 8 inch
System Wide Collection System Permit Number(s) (ifapplicable): WQCS00192
Owner Name(s): Town of Holly Shrines
FORM: FTA 04-16 Pagel of 5

DocuSign Envelope ID: F59A93D2-78BA4C09-9AC6-A56E32104A60
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 De�elooer's O, erational A&ecment (FORM; DI: V1 been attached?
[-]Yes ❑No ®N;'A
3. If the Applicant is a I lame.. Pronert� ners' Assoc ulio has an 0 ational Ajreement f Fol?M_ I I(...)A1 been attached?
❑ Yes ❑No ®NIA
4. Origin of wastewater: (check all that apply):
❑ Residential Owned ❑ Retail (stores, centers, malls) ❑ Car Wash
® Residential Leased ® Retail with food preparatiorVservice ❑ Hotel and/or Motels
® School! preschool! day care ® Medical! dental 1 veterinary facilities ❑ Swimming Pool [Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming PoollFilter Backwash
® Businesses 1 offices/ factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 % DomestiUCommercial % Commercial
% Industrial (See 15A NCAC 02T .01031201)
bIs there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 02'1 .011411)? ❑ Yes ❑ No
➢ Ifyes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(_q)
Daily Design Flow',b
No. of Units
Flow
Shopping Center with Food Service
130 gaVday/1000sf
13
1690 GPD
Apartments 117 (1 and 2 bedrooms)
240 gal/day/apartment
117
28080 GPD
Apartment 6 (3 bedrooms)
360 gal/day/apartment
6
2160 GPD
Pre-school 160 students_25 staff
25 gal/day/student
185
4625 GPD
gall
GPD
gall
GPD
Total
36555 GPD
a See 15,1 NCAC 02 I .01 14 b_Lept lJ andLq1L2j 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 6.S. 42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table I5A NCAC 02T.0114] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 36,555 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

DocuSign Envelope ID. r59A93D2-78BA-4C09-9AC6-A56E32104A60
VI1. GRAVITY SEWER DESIGN CRITERIA (If Applicable) -02Td & MD[: (Graxil� Sewersl,
I. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 1,437.96 PVC
➢ Section [I & [I[ 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) — 20 r .o3o5 & NIDC (Pump Stations/Force Mainsl:
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 ISA NCAC 021 .0305(h)111:
❑ 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
.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 multiple station power outage.
FORM: FTA 04-16 Page 3 of 5

DocuSign Envelope ID F59A93D2-78BA4CO9-9AC5-A56E32104A6C
IX. SETBACKS & SEPARATIONS — (02B .0200 & I5A NCAC 02T .0305(f)):
I. Does the project comply with all separations found in 15A NCAC 021 .0305ftlt. j}
➢ 15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
® Yes ❑ No
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below vertical
24 inches
Water mains verticakwater 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 11 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
Draina e systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade vertical
36 inches
➢ I SA NCAC 02I .0 xU contains alternatives where separations in U2'f.U305 t cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications %%L:bi,a_r
➢ If noncompliance with 02 f.03050or 1gi, see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ® Yes ❑ No
➢ 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 all setbacks found in the river basin rules per 15A NCAC 02B .0200? ® Yes ❑ No
➢ This would include Trout Buffered Streams per 15A NCAC 213.0202
4. Does the project comply with an individual 404 Permit or any 401 Certifications? ® Yes ❑ No
➢ Wetland -related permits shall be requested, obtained, and adhered to for projects that impact wetlands or surface waters
➢ Information can be obtained from the 401_k. Buftcr Permitting Branch
5. Does project comply with 15A NCAC 02T.W05(06) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCA, 021.4105tc ItGI, 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
➢ 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 l5A NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit.
FORM: FTA 04-16 Page 4 of 5

DocuSign Envelope ID: F5gA93D2-T8BA-4C09-9AC6-A56E32104A60
X. CERTIFICATIONS:
1, Does the submitted system comply with,15A NCAC 021, the tldiai-murn I7oLgit CriNna for the Nrnlattine of P llnp Stadon5
and Forst Maim tlatcst ycrsiom. and the as applicable9
® Yes ❑ No
If No, complete and submit the Variance/Altemative Design Request application (VADC 10-14) and supporting documents for
reV ie►►. AnnroVal of the reauest is reauired prior to submittal of the Fast Track Application_aad su r in�documeMIL
2. Professional Engineer's Certification:
name from Application Item 1II,1 )
attest that this application for
has been reAie►ved 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. 1 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 Fore 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
haV a judged it to be consistent with the proposed design.
NOTE - In accordance with General Statutes 143-215.6A and 143-215.6H, 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 scat, signature, and date: ►tit t rltl�F
CARD
l- :4 SE4 �•
r3M9
1 Applicant's Certification per 15A NCAC 02T .0106(b):
I Kendra Parrtigb Director of utilities and Infrastructure 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 pans 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 ]d 2l- 5,,6and 144 6, any person who knowingly makes any false
statement_ representation, or certification in any application package shall be guilt' 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
ooeuny:
Signature: F Date:
7/7/2021
FORM: FTA 04-16 Page 5 of 5

DocuSign Envelope ID F69A93D2 78BA-4C09-9AC6-A56E32104A60
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: Town of Holly Springs
Project Name for which flow is being requested: Village Gate Tract 3
More than one FTSE may be required for a single project if the owner of the WWTP is not responsible for all pump
stations along the route of the proposed wastewaterflow.
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 #: NCO063096
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
A11 flows are in MGD
6.0
0.658
2.426
0.037
3.12
52.00
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)
(B)
Design
Average
Approx.
Pump
Pump
Daily
Current
Station
Station
Firm
Flow**
Avg. Daily
(Name or
Permit
Capacity, *
(Firm / pi),
Flow,
Number)
No.
MGD
MGD
MGD
HS Basal
0.184
L_ WQ0037350M
0.501
0.200
(C)
(D)=(B+C)
(E)=(A-D)
Obligated,
Total
Not Yet
Current
Tributary
Flow Plus
Daily Flow,
Obligated
Available
MGD
Flow
Capacity***
0.179
0.363
-0.163
* The Firm Capacity (design flow) 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
(po not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** 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): HS Basal Creek
Downstream Permit Number: WQ0037350M
Page I of 6
FTSE✓ 10-18

DocuSign Envelope ID- F59A93D2-78BA-4C09-9AC6-A56E32104A60
111. 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 certifies that the receiving collection system or treatment
works has adequate capacity to transport and treat the proposed new wastewater.
by:
Signing
Exec Director of Utilities and Infrastructure
Title of Signing Ogicial
7/7/2021
Date
Page 2 of 6
I' 'SE 10-18

DoouS gn Envelope ID- F59A93D2-78BA-4C09.9AC6 A56E32104A6.3
PLANNING ASSESSMENT ADDENDUM (PAA)
Submit a planning assessment addendum for each pump station listed in Section II where Available Capacity is
0.
Pump Station (Name or Number): HS Basal Creek PS
Given that:
a. The proportion and amount of Obligated, Not Yet Tributary Daily Flow (C) accounts for
49.3 % and 0.163 MGD of the Available Capacity (E) in Pump Station
HS Basal Creek PS ; and that
b. The rate of activation of this obligated, not yet tributary capacity is currently approximately
N/A MG per year; and that
c. A funded Capital Project that will provide the required planned capacity, namely
HS Basal Creek Phase 2A is in design or under construction with
planned completion in July 2021 ; and/or
d. The following applies:
An upgrade to the HS Basal Creek Pump Station will be completed in partnership with a
Developer on a contributing project. It is anticipated that the improvements will be
completed for expanded capacity by July 2021.
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.
by.
Signing
Page 3 of 6
7/7/2021
Date
F-I, S E 10-18

DocuSign Envelope ID. F69A93D2-78BA4CG9-9AC6-A56F32104A60
Alien Consulting, PLLC
10609 Old Pine Court Raleigh, NC 27613 919-669-3635
Project Name: Village Gate Tract 3
Fast Track Sewer System Extension Application: FTA 04-16 and FTSE 10-18
A. INTRODUCTION
The subject property is a 7.65-acre tract of land located on South Main Street and Ralph
Stephens Road in Holly Springs. The project will consist of a mixed -use building housing retail
on the ground floor and apartments above. There will also be a pre-school located on the
property.
4 55]
r' 1
� 4a
A
0
L A�
y{k �Ra � 1� ►%
4
. 4 Rom' Shpyr. R
� n
ca Ra _
p Y�� R610 SMN- Rd
5 Rdph UCPP .'4 Rd
2

DocuSign Envelope ID: F59A93D2-78BA-4C09-9AC6-A56E32104A60
Village Gate Tract 3 0131/2021
S. PROJECT DETAILS
• Mixed -Use Building Size: 13,000 sf Retail and 123 Apartments
• Pre -School with 160 student capacity.
• Proposed sewer flow:
Shopping Center with Food Service (13,000 sf): 130 GPD/1000SF= 1690 GPD
Apartments (123 apartments)117 (1 and 2 bedrooms) at 240 GPD/bedroom and
6 (3-bedrooms at 360 GPD/Bedroom= 30,240 GPD
Pre -School 160 students + 25 staff: 25 GPD/PP= 4,625 GPD
• Total Peak Flow 63.46 GPM.
• Project to be served with 1,437 linear feet of 8" PVC sanitary sewer pipe minimum slope
of 1.05% which drains to the Southeast corner of the site.

DocuSign Envelope ID: F59A93D2-78BA-4C09-9AC6-A56E32104A60
+, THE TOWN OF
July 6, 2021
Director, Division of Water Resources
Raleigh Regional Office
Water Quality Operation Section
1628 Mai I Service Center
Raleigh, NC 27699-1628
,J�lly p1rings
Re: Application for Sewer Extension Permit
Project: Village Gate Tract 3
Dear Sir or Madam:
NC Dept ofEnvironmentai Quality
JUL122.51
Raleigh Regional Office
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 original and one copy cover letter including a project narrative
o A check in the amount of $480.00
0 One original and one copy of the State of North Carolina Fast Track Sewer System
Extension Application (FTA 04-16)
0 Two copies of FTSE 04-16 Flow Tracking/Acceptance Form
0 Two color copies of 8.5-inch by 11-inch portion of 7.5 minute USGS Topographic
Map showing project area
0 Two copies 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 919-577-3150 should you have any questions or need additional
information in order to process this application.
Sincerely,
effff '°Parrish, P.E., CFM
Executive Director of Utilities and Infrastructure
KP/tr
03
7/7/2021
Rachel Ingham
cc: Project Consultant Engineer, Chris Allen, PE
Rachel Ingham, Utility Engineer
Drew Johnson, Development Construction Manager
Theresa Randall, Utility Permitting Specialist
Project file/Correspondence #41896
Utility Engineer
3002
04 172018
Wilities and Infrastruchwe Services
P.O. Box 8 • 128 S. Main Street • Holly Springs, NC 27540 • www.hollyspringsnc.us

DocuStgn Envelope ID- F59A93D2-78BA-4C09-9AC6-A56E32104A60
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 extension to the Town of
Holly Springs Sewer System
Project -
Design Engineer:
Village Gate Tract 3
Chris Allen, P.E.
Address: 10609 Old Pine Court Raleigh, NC 27613
Phone Number: 919-669-3635 Email: [e-mail]
Date Complete Application Package Received by Town: 6.28.2021
Date Approved: {2z 7/7/2021 (by RI)I Kyl 7/7/2021 _ (by KDP VJ (by DJ)
As design engineer for this project, I certify the following (please check (x) each applicable box):
0 That the design of the project is in complete conformance with the Town of Holly
Springs Engineering Design and Construction Standards and NC DEQ Sanitary Sewer
Design Regulations;
® That each of the following items are completed and enclosed for submittal to the State for
a sewer extension permit:
0 One cover letter that includes a project narrative
o A check in the amount of $480.00 to NC DEQ
o A check in the amount of $200.00 to the Town of Holly Springs
0 One State of North Carolina form FTA 04-16 Fast Tract Sewer System
Extension Application
0 One FTSE 10-18 Flow Tracking for Sewer Extension Applications
0 One color copy of an 8.5-inch by 11-inch portion of 7.5-minute USGS
Topographic Map showing project area
0 One copy of a street level map showing all relevant project areas
0 One copy of the locally -required Design and Application Certification (this
form)
Design Engineer's Signature Date 6.28.2021
Please contact Theresa Randall at [phone] or theresa.randallfci:holl springsnc.gov ifyou
have any questions.
2003 Sewer Design Applical4on Certification
01 14.21
Utilities and Infrastructure Services
P.O. Box 8 • 128 S. Main Street • Holly Springs, NC 27540 0 www.hollyspringsncgov