WQ0042864_Application (FTSE)_20210917

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number: (A/Q 00 6t 8C ! (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Jordan Lutheran Church (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: Wendy Robertson per 15A NCAC 02T .0106(b)
Title: Trustee
4. Applicant's mailing address: 1031 Pemberton Hill Rd.. Suite 202
City: Apex State: NC Zip: 27502-
5. Applicant's contact information:
Phone number: [phone] Email Address: [e-mail]
la• Lfl 4,
II. PROJECT INFORMATION: cra'p-
1. Project name: Jordan Lutheran Church c, �s
§ ?s•
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ00 and issued date:
For modifications, also attach a detailed narrative description as described in Item G of the checklist 0
If new construction, but part of a master plan, provide the existing permit number: WQ00
o
3. County where project is located: Wake
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.743222; Longitude:-78.889249`
5. Parcel ID (if applicable): 0165055 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Trenton.D. StewartLicense Number: 024454
Firm: Arcadia Consulting Engineers. PLLC
Mailing address: P.O. Box 2077
City: Apex State: NC Zip: 27502-
Phone number: [phone] Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Western Wake Regional WRF Permit Number: NC0088846
Owner Name: Town of Cary
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ._
2. Downstream (Receiving) Sewer Information: BCXing Pump Station inch ❑ Gravity IA Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS00064
Owner Name(s): Town of Apex
FORM: FTA 06-21
Page 1 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 Developer's Operational Agreement (FORM: DEV) been attached?
❑ Yes ❑ No ® N/A
3. If the Applicant is a Home/'Property Owners' Association, has an HOA/PQA ]p rational Ag ment (FORM: ! {0A) and
supplementary documentation as required by 15A NCAC 02T.01 15(c) been attached?
❑Yes El No ®N.A
4. Origin of wastewater: (check all that apply):
❑ Residential (Individually Owned) ❑ Retail (stores, centers, malls)
❑ Residential (Leased) ❑ Retail with food preparation/service
❑ School ;` preschool l day care ❑ Medical / dental / veterinary facilities
❑ Food and drink facilities ® Church
❑ Businesses r offices factories ['Nursing Home
['Car Wash
LI Hotel and/or Motels
❑ Swimming Pool/Clubhouse
['Swimming Pool/Filter Backwash
❑ Other (Explain in Attachment)
5. Nature of wastewater : % Domestic 100 % Commercial ° o Industrial (See 1 S A NCAC 02T .O 103(2O))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes❑ No
6. Has a flow reduction been approved under 15A NCAC 02T .011411)? ['Yes ® No
➢ If yes. provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow',6
Church with Kitchen
5 gal/seat
gal/
gall
gall
gall
gal/
No. of Units
Flow
172
860 GPD
GPD
GPD
GPD
GPD
GPD
Total
GPD
a See I5A NCAC 02T .01140101 (e)if 1) and (e1(21 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).
b Per I5A NCAC 02T .01 I4(c), design flow rates for establishments not identified [in table 15A 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: 860 GPD (per 15A NCAC 02T .0114)
> Do not include future flows or previously permitted allocations
1f permitted flow is zero, please indicate why:
❑ Pump Station/Force Main or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line.
Please provide supplementary information indicating the approximate timeframe for permitting upstream sewers with flow.
❑ Flow has already been allocated in Permit Number: Issuance Date:
❑ Rehabilitation or replacement of existing sewers with no new flow expected
['Other (Explain):
FORM: FTA 06-21
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
➢ 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 requirements is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: Jordan Lutheran Church sewer service
2. Approximate Coordinates (Decimal Degrees): Latitude: 35.743222° Longitude: -78.889249
3. Total number of pumps at the pump station: 2
3. Design flow of the pump station: .056I6 millions gallons per day (firm capacity)
➢ This should reflect the total GPM for the pump station with the largest pump out of service.
4. Operational point(s) per pump(s): 39 gallons per minute (GPM) at 22.4 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
2
312.7
SDR 21 PVC
If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2,01C.1.b. ® Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(1):
❑ Standby power source or ❑ Standby pump
➢ Must have automatic activation and telemetry - I5A 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 and may not be portable
Or if the pump station has an average daily flow Tess than 15,000 gallons per day 15A NCACO2T.0305(h)(1)(C):
® Portable power source with manual activation, quick -connection receptacle and telemetry -
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry:
➢ Include documentation that the portable source is owned or contracted by the applicant 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
as part of this permit application in the case of a multiple station power outage.
FORM: FTA 06-21 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations/alternatives found in l5A NCAC 02T .03050} & (g)? ® Yes ❑ No
1 5A 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)
18 inches
'Water mains (vertical - water over sewer preferred, 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-I waters of Class I or
Class 11 impounded reservoirs used as a source of drinking water, and associated wetlands.
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 associated with these waters (see item IX.2)
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches, as well as wetlands associated with these waters or classified as WL.
10 feet
Any building foundation (horizontal)
5 feet
Any basement (horizontal)
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 grade (vertical)
36 inches
➢ If noncompliance with 02T.0305(f) or (g), see Section X.1 of this application
*I 5A NCAC 02T.0305{0 contains alternatives where separations in 02T.0305(fl cannot be achieved. Please check "yes"
above if these alternatives are used and provide narrative information to explain.
**Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ N.A
)> If no, please refer to 15A NCAC 18C.0906(f) for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands?
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ See the Division's sfraft,stparigion rgoircmcnts for situations where separation cannot be met.
➢ No variance is required if the alternative design criteria specified is utilized in design and construction.
® Yes ❑ No ❑ MA
4. Is the project located in a river basin subject to any State buffer rules? ❑ Yes Basin name: _ ® No
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAc 92B .0290? ❑ Yes ❑ No
➢ This includes Trout Buffered Streams per 15A NCAC 2B.0202
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ❑ Yes ® No
or 401 Water Quality Certifications?
➢ Please provide the permit number/permitting status in the cover letter if coverage/authorization is required.
6. Does project comply with 15A NCAC 02T.0105(c,6) (additional permits/certifications)? ® Yes ❑ No
Per ] 5A NCAC 02T.0I05(c(61, directly related environmental permits or certification applications must be 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.).
7. Does this project include any sewer collection lines that are deemed "high -priority?" ❑ Yes No
Per j5A NCAC 02T.040 , "high -priority sewer" means any aerial sewer, sewer contacting surface waters,
siphon, or sewers positioned parallel to streambanks that are subject to erosion that undermines or deteriorates the sewer.
Siphons and sewers suspended through interference/conflict boxes require a variance approval.
➢ 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 permittee's individual System -Wide Collection permit.
FORM: FTA 06-21 Page 4 of 5

X. CERTIFICATIONS:
Qoes the submitted system compk with I SA NCAC Q2 r, the ,Minimum Deno CI iteria for the I'rrmrurng ul_I'ump ti •.,
and 1 Dice darn: •latest ►croon). and the (ira►tie►►er \Iminiontiie►tgn cnet ra 11,rtest version ab applicable'
® Yes ❑ No
If no. for projects requiring a single variance, complete and submit the Variance. Alternative Design Request application
(VADC 1044) and supporting docutnents for review to the Central Office. Annroval of the reoucst will be issued
concur n I• wi v a i v a 1 t I n r
review times. For aroiects requiring two or more variances or where the variance is determined by thc Division to be a
sienificarrfportion of the nrolect. She full technical review is required,
2. Professional Engineer's Certification:
1. Trenton A. Stewart PE , attest that this application for Jordan Whew Church
'Professional tmmett%name limn Apphcanu n Item ill I I (Prn$d \ame from Application Item II I!
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 know ledge the proposed design has been prepared in accordance with thc applicable regulations.
Minimum Design Cnterra tor Graity Sel,eri (latest %up-5 inn I, and the Minimum Design CntertafMlhe last- LracILPermitlirng
of Puma Stations and Force Mails tiniest version). Although other professionals may have developed ccrtam 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 143.215.6B. any person who knowingly makes an) 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 510.000, as well as civil penalties up to S25,000 per violation. Misrepresentation of the application
information. including failure to disclose any design non-compliance with the applicable Rules and design criteria, ma) subject
the North Carolina -licensed Professional Engineer 10 referral to the licensing board. (2 I NCAC 56.0701)
nth, r, w
North Carolina Professional Engineer's seal, signature, and date: 9..H CAjq
3. Applicant's1Certification per ISA NCAC 02T .0106(b):
1, INs dy RobertSOn r , attest that this application for
(Swage Authority Name from Application Item 1.3.)
Jordan Lutheran church
(Project Name from Application Item II I )
attest that this application has been reviewed by me and is accurate and complete to the best or 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. 1 understand that any
discharge of wastewater from this non -discharge system to surface waters or the land will resuh 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 510,000 as well as civil penalties up to S25,000 per violation.
Signature:
Date, 918/Z
FORM: FTA 06-21 Page 5 of 5

Pump
Station
(Name or
Number)
BeaverCrk
I)hrIslnn of Waster Rcsuurce4
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: Arcadia Consulting Engineers, PLLC
Project Name for which flow is being requested: Jordan Lutheran Church
More than one FIST may be required for a single protect (f7he owner of the WWTP is not responsible for all pump
stations along the route of the proposed wastewater flow.
1.
Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Western Wake Regional WRF
b, WWTP Facility Pennit #: NC0088846
All flows are to MGD
c. WWTP facility's permitted flow 18.0
d. Estimated obligated flow not yet tributary to the WWTP 1.95
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
6.74
0.00860
8.70
48%
II. 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) (C) (D)-93+C?
Design Obligated,
Average Daily Approx. Not Yet
Flow** Current Avg. Deming
(Finn / pf), Daily Flow, Daily Flow,
MGD MGD MGD
Firm
Capacity, *
MGD
39.4 12.71 6.83
BCXing 1.008 0.403 0.119
(EMA-D)
Total Current
Flow Plus
Obligated Available
Flow Capacity***
1.74 8.57 4.14
0 0.119 0.284
* The Firm Capacity 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 pealdng
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 < O.
Downstream Facility Name (Sewer): Towle of Apex
Downstream Permit Number: WQCS00064
Page l of 6
PTCR Act_11S

III. Certification Statement:
I Robert Hirt 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.
The Obligated Flow Not Yet Tributary reported in items I.d and Il.c include the Town of Apex
flows certified by the Town of Apex below. Signature of this form indicates acceptance of this
wastewater flow.
9/15/21
Signing Official Signature n a f Cary, Lead Agency Date
I Michael Deaton certify to the best of my knowledge that the total Estimated Obligated flow from
within the Town of Apex Jurisdiction not yet tributary to the WWRWMF (Item 1.d) is 0.98 mgd,
and that the total Estimated Obligated flow from within the Town of Apex Jurisdiction not yet
tributary to the BCPS - item (Tic) is 0.77 mgd.
q /S ./�
e - own of Apex U to
Signing Official gnature
2 of 6
FTSE 08-13

2i
CONSULTING ENGINEERS
September 17, 2021
Email: [e-mail]
N.C. Dept. of Environmental Quality — Division of Water Resources
Raleigh Regional
v Office Water Quality Section Dept
3800 Barrett of environmental Quaiit)
Raleigh, NC 27604 SEP r' 20
21
Re: Jordan Lutheran Church Raleigh 1611 Beaver Creek Commons Drive, Apex, N.C. Regional Office
Fast Track Sewer System Extension Application
Please find attached the Fast Track Sewer System Extension Application (FTA 06-21) and
supporting documents for the above referenced Project located in Apex, NC. The new Church
will be served by a Pump Station designed in accordance with the NC Division of Water
Resources' Minimum Design Criteria. The proposed Pump Station will be owned and
maintained by Jordan Lutheran Church.
Per 15A NCAC 02T .0114 (Wastewater Design Flow Rates), the Church will generate 860 gpd
of wastewater flow for the new 172 seat Sanctuary Building with kitchen @ 5 gal/seat. This
wastewater flow will be treated by the Western Wake Regional WRF — FTSE 04-16 attached.
The proposed Jordan Lutheran Pump Station will pump to the existing Beaver Creek and
BCXing Pump Station for conveyance to the Wastewater Treatment Plant.
Other documents included in the Permitting Package are as follows:
• Application Fee - $480.00
• USGS Topo and Aerial Map of Project Area
• Power Reliability Statement from Owner
• FTSE 04-16 Flow Tracking/Acceptance for sewer extension applications
Upon review of the attached, please advise if there are questions or additional information is
needed.
Sincerely,
Arcadia Consulting Engineers, PLLC
Trenton D. Stewart, PE
PO Box 2077 Apex, NC 27502 Telephone: [phone] Facsimile: 919 363-1477

September 17, 2021
To: N.C. Dept. of Environmental Quality - Division of Water Resources
Raleigh Regional Office — Water Quality Division
3800 Barrett Drive
Raleigh, NC 27609
From: Jason Buehring
Construction Committee, Treasure
Re: Jordan Lutheran Church
1031 Pemberton Hill Drive, Apex, N.C.
Fast Track Sewer System Extension Application
Power Reliability Plan
The above referenced Project in Apex will be served by a Pump Station designed in
accordance with the NC Division of Water Resources' Minimum Design Criteria. The
Pump Station will include a portable power generation unit and associated
appurtenances. Personnel will be available for the connection and operation of the
portable generator unit which as designed is a 12.5KW, 120/240 volts, 1 PH Generator
by Gillette GPE125EH-1-1 or Approved Equal. The generator will be stored on -site and
connection to the Pump Station will be via a Manual Transfer Switch.
JascyBuehring, o' struction mmittee, Treasure

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Arcadia Consulting Engineers, PLLC
PO Box 2077
Apex, NC 27502
To:
NCDEQ-Division Water Resources
Raleigh Regional Office-WQ Section
3800 Barrett Drive
Raleigh, NC 27604
LETTER OF TRANSMI' TAL
DATE: 9-17-21
PROJECT NO. 18031
ATTENTION: Staff
REFERENCE: Jordan Lutheran Church — Site Plan
Dept of Environmental Quality
SEP T f 2021
Raleigh Regional Office
We Are Sending:
® Attached ❑ Under Separate cover via Courier the following items:
❑ Bulletin Drawings ❑ Copy of Letter ❑ Equipment Cut -Sheets
❑ Shop Drawings ❑ Specifications ❑ Prints
❑ Plans ❑ Change Order 0
COPIES
DATE
DESCRIPTION
1
Cover Letter
1
FTA 06-21 Fast Track Sewer System Extension Application
1
USGS Except showing site
1
Location Map
1
Owner Power Reliability Plan Letter
1
FTSE 04-16 Flow Tracking and Acceptance Form
i
$480.00 application fee (Arcadia check no. 3832) and CD with combined documents
Transmitted as:
❑ For approval ❑ Approved as submitted
❑ For your use ❑ Approved as noted
❑ As requested ❑ Return for corrections
❑ For review and comment
Remarks:
❑ Resubmit copies for approval
❑ Submit copies for distribution
❑ Return corrected prints
Copy to
file
Signed: ��-'�