WQ0042845_Application (FTSE)_20210908 (2)

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:. Aid o y8 (co be compacted by nwR)
All Items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Town of Ftiquay-Varina, NC (company, municipality, €iOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ® Municipal ❑ Other
3. Signature authority's name: Matt Poling, PE per 15A NCAC 02T .0106(b)
Title: Engineering Director
4. Applicant's mailing address: 1415 Holland Road NCDept ofEnvironmental Qtlalt
City: Fu ua -Varina State: NC Zip: 27526-
5. Applicant's contact information: SEP 10
Phone number: 919 753-1035 Email Address: mpoling@fuqu§Y-varina.org Ralcl
h Regional Office It. PROJECT INFORMATION:
1. Project name: Lane Professional Park
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: Wake
4. Approximate Coordinates (Decimal Degrees): Latitude: 35:607' Longitude:-78.906'
5. Parcel ID (if applicable): 0657-76-7859
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Fnginecr: Mike Zaccardo, PELicense Number: 022321
Firm: Timmons Group
Mailing address: 5410 Trinity Road, Suite 102
City: Raleigh State: NC Zip: 27607-
Phone number: [phone] Email Address: mike,zaccardo(atimmons.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name. Terrible Creek WWTP Permit Number: NC000066516
Owner Name: Town of Fuquav-Varina
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ 0Q 37633 Downstream (Receiving) Sewer Size: 6 inch
System Wide. Collection System Permit Number(s) (if applicable): WQCS00193
Owner Name(s): Town of Fuquay_Varina
FORM: F I'A 04-16 Page I of 5

vi.
GENERAL REQUIREMENTS
I.
If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑No ®NrA
2.
If the Applicant is a Developer of lots to be sold, has a Developt-r's Operatloin A rreetttenI (FORK -.,DV been attached?
❑ Yes ❑No ®NIA
3.
If the Applicant is a HomelFroperty Clwners' &�ocia ion has.an OMr'�tional Agreement
(FORM: H(}, been attached?
❑ Yes ❑No ®NIA
4.
Origin of wastewater: (check all that apply):
❑ Residential Owned ® Retail (stores, centers, malls)
❑ Car Wash
❑ Residential [.eased ❑ 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.
w
Nature of wastewater: % Domestic/Commercial 100 % Commercial
% Industrial (eg..15A NCAC 02T.0103(20))
L e)
� I'�"1 .0
�Is there a Pretreatment Program in effect?
❑ Yes ❑ No coo C.
6.
Hasa flow reduction been approved under 15A NCAC t72T _01i 4 Q? ❑ Yes
®No VQC. spa
➢ if.yes, provide a copy of flow reduction approval letter
�v N
7.
Summarize wastewater generated by project:
0
Establishment Type (see 211.0114
Daily Design Flow " b
No. of Units
Flow 0
Dental / Medical
250 gal/practitioners
17
4250 GPD
General Office
25 gal/employee
71
1775 GPD
Shopping
125 gal1fixtrure
2
250 GPD
Deli
40 gal/100 sf
15.65
626 GPD
Restaurant
40 gal/seat
20
800 GPD
gal/
GPD
Total
7701 GPD
a See 15A NCAC 02T .01 l4 ft (d). L� .1 acid ej(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 G.S. 42A4).
b Per 15A NCAC 02T .01 14(c), design flow rates for establishments not identified [in table 15A NCAC 02T.01 141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 7701 GPD (per 15A NCAC 02T .Qi i4)
➢ 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): _
z
n
tv
FORM: FTA 04-16 Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
I . Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8
268
PVC SDR35
➢ Section lI & [H 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
l . 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 (rDl1)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
f
6. Power reliability in accordance with 15A NCAC 02T . 1305(h)(1):
❑ 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
D 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 a multiple station power outage.
FORM: FTA 04-16 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & I5A NCAC 02T .0305(f)):
I. Does the project comply with all separations found in 15A NCAC 02'r .0305 & ®Yes [:]No
D 15A NCAC 02T.0305{f) contains minimum separations that shall be provided for sewer systems,
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 11 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
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth rade vertical
36 inches
➢ SSA NCAC 02T0305 } contains alternatives where separations in 02T.0305(f} cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications web
igge
➢ If noncompliance with 02T.0305(f) or (Sh see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ®Yes [-]No [:]NIA
➢ 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 perms NCAC 026.0200? ®Yes ❑ No ❑ NfA
➢ This would include Trout Buffered Streams per I SA NCAC 2B.0202
4. Does the project require coverage/authorization under a 404 Nationwide or ❑ Yes ® No
individual permits or 401 Water Quality Certifications?
➢ Information can be obtained from the 40 & Buffer Permiti 91 Branch
5. Does project comply with I SA NCAC 02UI05(cXo) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 027.0t 51pX6), 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 IAA RiCA(_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 ❑ 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 I5A NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit.
FORM: FTA 04-16 Page 4 of 5

i
i
CERTIFICATIONS:
I. Does the submitted system comply with 15A!QAC T, the Minimum Design Criteria for the Pernih iggrgf PumSiations
and ±orqg_Mains test version and the Gravity -ewer Aginimum Des�Cri]eria {latest version) as applicable?
® Yes ❑ No
[fNo, complete and submit the Variance+Alternative Design Request application (VADC 10-14) and supporting documents for
review. Approval of the re uest is re wired prior to submittal of the East Track Application and supporting documents.
2. Professional Enng%in�eces Certification:
I, rV�{ _ _ attest that this application for
(Professional name Applicati n Ite IILI.
Z Sio0t.
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. [ 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 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. a 0
North Carolina Professional Engineer's seal, signature, and date:
...... — ........-....... .
%%k t% k' 1CAt F f i i
�H R
Oo S8
E y
IN�Q�
3. Applicant's Certification per 15A NCAC 02T .0106(b): t�� l7o4
Matthew B. Poling _ Engineering Director _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 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- 1 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 143143-215,6613, 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: 0W07/2021
FORM: F'TA 04-16 Page 5 of 5

DWR
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 Fuquay-Varina
Project Name for which flow is being requested: Lane Professional Park
More than one FTSE may be required for a single project if the owner of the WWTP is not responsible for all
stations along the route of the proposed wastewater flow.
i. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Terrible Creek WWTP
b. WWTP Facility Permit #: NCO066516
All flows are in MGD
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
3.000
1.192
1.152
.007
2.351
78.37%
FEE
1I. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
to
rn
0
c�
N
List pump stations located between the project connection point and the WWTP:
(A)
(B)
(C)
(D)=(B+C) (E)=(A-D)
Design
Obligated,
Pump
Pump
Average
Approx
Not Yet
Total Current
Station
Station
Firm Daily Flow**
Current
Tributary
Flow Plus
(Name or
Permit
Capacity, • (Firm 1 pf),
Avg. Daily
Daily Flow,
Obligated Available
Number)
No.
MGD MGD
Flow, MGD
MGD
Flow Capacity***
* 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
(pf) 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): Terrible Creek WWTP
Downstream Permit Number: NCO066516
Page l of 6
FTSE 10-18

III. Certification Statement:
I Matthew B. Poling 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 11 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.
mafkl ur 6_ P0-&ruL
Signing Official Signature
Engineering Director
Title of Signing Official
09/07/202 l
Date
Page 2 of 6
FTSE 10-18

PROJECT NARRATIVE
Project Name: Lane Medical Park
Location: Fuquay Varina, Wake County, NC
Owner: 1830 N Broad Street, LLC
15 Rawls Road, Suite 100
Angier, NC 27501
Developer: 1830 N Broad Street, LLC
15 Rawls Road, Suite 100
Angier, NC 27501
Consultant: Timmons Group
Mike Zaccardo, PE
5410 Trinity Road, Suite 102
Raleigh, NC 27607
Phone: [phone]
PROJECT DESCRIPTION AND NARRATIVE:
Nc�eAt Qf
�q yron�ent
goal,
eg jo�a� Off,-,
e
The proposed project is inside Fuquay Varina jurisdictional limits and is located along Highway 55, at
the intersection with Old Powell Road. The scope of this project will include the construction of 6
buildings (include medical office, general office, Retail and restaurants) and associated roads.
The proposed public sewer extension will provide service to Lane Medical Park on a 7.38-acre tract of
land in Fuquay Varina, NC.
Development Flow Rate: 7,701 gpd
Building A —1,750 gpd
Dental 2 Practitioners @ 250 gpd
Gen. Office 50 Employees @ 25 gpd
Building B & C -- 2,350 gpd
Medical 4 Practitioners @ 250 gpd
Gen. Office 7 Employees @ 25 gpd
Building D — 750 gpd
Medical 3 Practitioners @ 250 gpd
Building E —1,175 gpd
Medical
Gen. Office
4 Practitioners @ 250 gpd
7 Employees @ 25 gpd
500 gpd
1,25.0 gpd
1,750 gpd
1,000 gpd
175 gpd
1,175 gpd per building
750 gpd
750 gpd
1,000 gpd
175 gpd
1,175 gpd
Building F —1,676 gpd
Shopping 2 Fixtures @ 125 gpd 250 gpd
Deli(Bagel) 1,565 sf @ 40 g per 100 sf 626 gpd
Restaurant 20 seats @ 40 g per seat _ 800 gpd
1.676 gpd

USGS Map
Fuquay Varina Quadrangle
North Carolina
7.5-minute series
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NC Dept of Environmental Quality
TIMMONS GROUP
YOUR VISION ACHIEVED THROUGH OURS.
Raleigh Regional Office
TRANSMITTAL
TO: NCDEQ DWR - Raleigh Regional Office Date: 09/07/2021 Job #: 45185
3800 Barrett Drive Project: Lane Medical Park
Raleigh, NC 27609 Reference:
Copies Sent To:
❑ ENCLOSED PLEASE FIND:
❑ WE ARE SENDING UNDER SEPARATE COVER:
COPIES
DATE
NUMBER
DESCRIPTION
1
1
Fast Track Sewer Application (Incl. Flow Acceptance Form/
Certification Statement
1
2
Check for $480
1
3
Project Narrative
1
4
USGS ma
1
5
Vicinity Ma
THESE ITEMS ARE TRANSMITTED:
If enclosures are not as noted, please notify us at once.
COMMENTS -
Feel free to contact me with any questions at 919-866-4944 or dexter.howell(ctimmons.com
Thank you,
Dexter Howell
Project Manager
SIGNED:
F.A