WQ0042872_Application (FTSE)_20210927

DocuSign Envelope ID- FBC89063-BC7C-405E B35D-42F4E1537FF0
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:
4112,8 (oo be completed by DWI4WDept of Environmental Quality
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Town of FIol3Y_l>ann �� ii� 2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Private y- ed u c I t C'e
❑ Federal ❑ State/County IN Municipal ❑ Other
3. Signature authority's name: Kendra D. Parrish. PE per 15A NCAC 02T .0106(b)
Title: Executive Director of Utilities & Infrastructure Service
4, Applicant's mailing address: 128 South Main Street. PO Box 8
City: Jio1Iy Springs State: NC Zip: 27540
5. Applicant's contact information:
Phone number: (19) 571-3150 Email Address: Kendra,narrishahollvsorinesne.gov
II. PROJECT INFORMATION:
1.
Project name: Oakview Innovation Park
;EP 2 7 2021
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.
If new construction, but part of a master plan, provide the existing permit number: WQ00
3. County where project is located: Wilke
4. Approximate Coordinates (Decimal Degrees): Latitude: 35,6569 ° Longitude: -78.8664 °
5. Parcel ID (if applicable) : (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Blake Hall License Numbcr: 38616
Firm: Timmons Group
Mailing address: 5410 Trinity Road. Suite 102
City: Raleigh
Phone number: [phone]
State: NC Zip: 27607
Email Address:: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
I. Facility Name: Utley Creek Water Reclamation Facility
Owner Name: Town of Holly Springs
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ00 31620
Permit Number: NC0063096
2. Downstream (Receiving) Sewer Information: 24 inch Gravity D Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS00192
Owner Name(s): Town of Holly Springs
FORM: FTA 06-21 Page 1 of 5

DocuSign Envelope ID: FBC89063-8C7C-405E-B35D-42F4E1537FF0
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 NiA
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational ggregltlgni {FORM: DEVI been attached?
❑ Yes ❑ No ®N+A
3. If the Applicant is a Home/Property Owners' Association, has an HQA/POA Operational Aereement (FORM: HOA1 and
supplementary documents Lion as required by 15A NCAC 02T.0115(c) been attached?
❑ Yes ❑ No ® NIA
4. Origin of wastewater: (check all that apply):
❑ Residential (Individually Owned)
❑ Residential (Leased)
❑ School l preschool 1 day care
❑ Food and drink facilities
® Businesses / offices / factories
® Retail (stores, centers, malls)
® Retail with food preparation/service
❑ Medical I dental / veterinary facilities
❑ Church
❑ Nursing Home
❑ Car Wash
❑ Hotel and/or Motels
❑ Swimming Pool/Clubhouse
❑ Swimming Pool/Filter Backwash
❑ Other (Explain in Attachment)
5. Nature of wastewater : % Domestic 24 % Commercial 76 % Industrial (See ISA NCAC 02T .0103(201)
If Industrial, is there a Pretreatment Program in effect? ® Yes ❑ No
6. Has a flow reduction been approved under I5A NCAC 02T ,01 I4(f1? X❑ Yes ❑ No
gm, provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by projec
Establishment Type (see 02T.0114(1)) 1
Daily Design Flow'.b
No. of Units
Fiow
Oakview Phase I- Crescent
1500 gal/ acre
25.5
38,250 GPD
Shopping centers wf & w..,o food services
115 gal/ 1000 sf
148,000
33,200 GPD
FUJI Film site
gal/
400,000 GPD
Future Development
1500 gal/ acre
197.2
295,800GPD
gal/
GPD
gal/
GPD
Total
767,250 GPD
a See ISA NCAC 02T .01 I4(b), (d). (cl(I 1 and (0(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 S,.S, 42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table ISA NCAC 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: 767,250 GPD (per ISA NCAC 02T .0114)
> Do not include future flows or previously permitted allocations
If 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

DocuSign Envelope ID: FBC89063-8C7C-405E-B35D-42F4E1537FF0
VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers);
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
a
1,043
DI
8
170
PVC
12
552
DI
12
332
PVC
16
1,720
DI
16
760
PVC
20
1,516
DI
> 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)
D Overdoing 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 StatlonslForee Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: • Longitude:
3. Total number of pumps at the pump station:
3. Design flow of the pump station: 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): gallons per minute (GPM) at:
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
feet total dynamic head (TDH)
If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.01 C.1.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NCAlti 02T .03051h1(11:
❑ Standby power source or ❑ Standby pump
➢ Must have automatic activation and telemetry - l5A 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 less than 15,000 gallons per day 15A NCACO2T.0305(11)(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

DoccuSign Envelope ID: rBC89063-8C7C-405E-B35D-42F4E1537FF0
IX. SETBACKS & SEPARATIONS — (02B .0200 & I5A NCAC 02T .0305(f)):
1. Does the project comply with all separations/alternatives found in 15A NCAC 02T .03051fl & (tt)?
i 5A NCAC 02T_0305(ft contains minimum seoarations that shall be Drovided for sewer systems:
®Yes El No
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
2Water mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
ZWater 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 1 or
Class I1 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(fl or fig), see Section X.1 of this application
*1 5A NCAC 02T.0305ts'i contains alternatives where separations in 02T.0305m 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 wcbnagc
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? ® Yes ❑ No ❑ N/A
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ See the Division's draft separation requirements for situations where separation cannot be met.
➢ No variance is required if the alternative design criteria specified is utilized in design and construction.
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 0213.0200? ® Yes El No
➢ This includes Trout Buffered Streams per 15A NCAC 28.0202
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 l5A NCAC 02T.0105(c116) (additional permits/certifications)? ® Yes ❑ No
Per I SA NCAC 02T.0105(0(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?" ❑ Ycs ® No
Per I5A NCAC 02T.0402. "high -priority sewer" means any aerial sewer, sewer contacting surface waters,
siphon, or sewers positioned parallel to strcambanks 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(aX5) or the permittee's individual System -Wide Collection permit.
FORM: FTA 06-21 Page 4 of 5

DocuSign Envelope ID. FBC89063.8C7C-405E-B35D-42F4E1537FF0
X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Dcsian Criteria for ilia Pennittinit of Pump gtations
anst_Forcc Mains (latest version) and the Gravity Sewer Minimum Design Criteria (latest version) as applicable?
Yes ❑ No
If no, for projects requiring a single variance, complete and submit the Vanance/Alternative Design Request application
(VADC 10-14) and supporting documents for review to the Central Office. Auproval of the request will be issued
concurrently with the approval of the permit, and nroIects requiring a variance approval may be sublect to longer
review times. For proiccts requiring two or more variances or where the variance is determined by the Division to be a
sienificantportion of the protect, the full technical review is required.
2. Professional Engineer's Certification:
I, Blake Hall , attest that this application for Oakview Innovation Park _
(Professional Engineer's name from Application Item W.I.) (Project Name from Application Item 11.1)
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 further
attest that to the best of my knowledge the proposed design has been prepared in accordance with the applicable regulations,
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum pesign Cnteria for the Fast -Track Permitting
of Pumn Stations and Force Mains (sates 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 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Cass 2 misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation. Misrepresentation of the application
information, including failure to disclose any design non-compliance with the applicable Rules and design criteria, may subject
the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NCAC 56.0701)
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
` 0%t[ttrrIN, ./
.•GAS p��.
,`•C 4,,
O�QEssip- ti
:
�.9z?;- I..
_ SEAL
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H4A4► -g/ 1/2021
�1ilye raiski 10.1... ...... Hall
• :2L'•
..!/R•BIA�\t"
I1llttltlttO
I, Kendra D. Parrish. PE , attest that this application for Oakview Innovation Park
(Signature Authority Name from Application I'em 1.3.) (Project Name from Application Item II. l l
attest that this application 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 143-2I5 6a, 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 S25,000 per violation.
1-Docu Signed by:
Signature:
Date:
9/21/2021
FORM: FTA 06-21 Page 5 of 5

DocuSign envelope ID FBCB9063-8C7C-405E-B35D-42F4E1537FF0
Dtvislon 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: Oakview Innovation Park
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 wastewater flow.
I. 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 #: NC 0063096
All flows are in MGD
c. WWTP facility's permitted flow 6.0
d. Estimated obligated flow not yet tributary to the WWTP 0.644
e. WWTP facility's actual avg. flow 2.426
f. Total flow for this specific request 0.767
g. Total actual and obligated flows to the facility 3.837
h. Percent of permitted flow used 64.0
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)=(B+C) (E)=(A-D)
Design
Average Approx. Obligated,
Pump Pump Daily Current Not Yet Total Current
Station Station Firm Flow** Avg. Daily Tributary Flow Plus
(Name or Permit Capacity, * (Firm / pt), Flow, Daily Flow, Obligated Available
Number) No. MGD MGD MGD MGD Flow Capacity***
Business DL WQ0031620 2.506 1.002 0.095 0.803 0.898 0.104
* 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 < O.
Downstream Facility Name (Sewer). HS Business Park Pump Station
Downstream Permit Number: WQ0031620
Page 1 of 6
I•TSF 10-18

DocuSign Envelope ID FBC89063-8C7C-405E-B35D-42F4E1537FF0
III. Certification Statement:
I Kendra D. 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.
DocuSigned by:
Signing Ofcia tignaFtu e°."
9/21/2021
Exec Director of utilities and infrastructure
Title of Signing Official
Page 2 of 6
Date
l'ISE 10-18

DocuSign Envelope ID FBC89063-8C7C-405E-B35D-42F4Ei537FF0
••O� w
•• m
TIMMONS GROUP
Oakview Innovation Park
Date: 09-17-21 Job #: 47135
Items included in package:
5410 Trinity Road P 919.866.4951
Suite 102 F 919.859 5663
Raleigh, NC 27607 www.timmons.com
COPIES
DATE
NUMBER
DESCRIPTION
4
Full Size Civil Plan Set
1
Fast Track Sewer System Extension Application
1
Sewer Design Certification
Cover Letter:
The proposed project is in Town of Holly Springs, located at the intersection of New Hill Holly Springs
Road and Green Oaks Parkway. The scope of the project will include the construction of two Town of
Holly Springs roads, a water main, reclaimed water main and sanitary sewer main. The proposed sanitary
sewer system will serve the surrounding properties and run 10 the Town's existing pump station. The new
gravity sanitary sewer system will be owned, operated, and maintained by the Town of Holly Springs. The
sanitary sewer main is made up of:
Size (inches)
Length (feet)
Material
8
1,043
DI
8
170
PVC
12
552
DI
12
332
PVC
16
1,720
DI
16
760
PVC
20
1,516
DI
Associated 401/404 permits have been approved. Refer to permit numbers DWR# 20201873 and SAW-
2015-02137.
The sanitary sewer main is anticipated to provide capacity for the following wastewater flows below
Future development flows were determined using 1500 GPD per acre. Based on previous projects done,
1500 GPD rather than the state recommended follows more closely to what these developments need.
The Fuji Film site for phase 1 has been allocated 400,000 GPD available per the Development
Agreement with the Town of Holly Springs
ENGINEERING I DESIGN 1 TECHNOLOGY

DocuSign Envelope ID: FBC89063-8C7C-405E-B35D-42F4E1537FF0
Site
Method
Acres
Flow Factor
(GPD/ac)
Gallons per
Day
Peaking
Factor
Peak Flow
Rate
(GPM)
Green Oaks
Development/Green
Oaks Tech Center
1500 GPD/AC
1190
1 500
178,500
2.5
309 9
Crescent (Life
Science Buildings)
02T Rules
See Below
Calculations
N/A
N/A
13 00U
30
82 n
Add'I Property East
of Green Oaks
Pkwy
1500 GPD/AC
42 0
1 500
63 00C
2 5
10:-i 4
Other Properties in
Oakview Innovation
Park (West of
Green Oaks Pkwy)
1500 GPD/AC
36 2
1 500
54 3•;.:
2 5
94 3
Oakview Corner
Piece
02T Rules—
See Below
Calculations
N/A
N/A
33 2„..r
2 5
58 7
Fuji Film (Galaxy)
Flow shared by
Jacobs
Engineering
N/A
N/A
400,000
N/A
115$.
Crescent Calculations
Flows for the Oakview Phase 1 development were calculated using North Carolina 02T rules, which
specify the sewer usage for general office facilities and factories as 25 GPD per employee per shift.
Assuming 520 employees, 8 hours of daily operation, and a 3.0 peaking factor (PF), the peak flow from
Oakview Phase 1 is as follows:
S20 employees x Z5 gal/day 24 hrs 24 hrs
24 hrs x 8 hrs operation x 1440 min x 3.0 PF = 81.25 GPM -' 82 GPM
Oakview Corner Piece Calculations
Flows for the Oakview corner piece were also calculated using North Carolina 02T rules. The current plan
of development consists of 148,000 square feet of retail space and a hotel with 135 beds. State rules specify
that shopping centers with food service be designed for a daily sewage flow rate of 130 gallons (gal)/1000
square feet (sf). Because shopping centers without food service have an assumed daily flow of 100
ga1/1000 sf, the average between the two values (115 gal/1000 sf) was be used. This value is conservative
because Tess than half of the retail space is currently planned to serve food,
Hotels without in -room cooking facilities are estimated by the 02T rules to discharge 120 gal/room.
Accounting for all the above, the estimated flow rate from the Oakview corner piece is as follows:
115 gal 120 gal
x 148,000 sf retail + x 135 rooms = 33,220 GPD
1000 sf retail 1 room
1 day
33,220 GPD x 1440 min x 2,5 PF = 58 GPM

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DocuSign Envelope ID. FBC89063-8C7C-405E-B35D-42F4E1537FF0
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DocuSign Envelope ID: FBC89063.8C7C-405E-1335D-42F4E1537FF0
THE TOWN OF Y7511,Springs
September 20, 2021
Director, Division of Water Resources
Raleigh Regional Office
Water Quality Operation Section
3800 Barrett Drive
Raleigh, NC 27609
Re: Application for Sewer Extension Permit
Project: Oakview Innovation Park
Dear Sir or Madam:
NL'D
epr pf.8nvrronmenral
Quality
$EP 2 7 2021
{utlel
gh Region,ce
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
o Two color copies of a 8.5-inch by 11-inch portion of a 7.5 minute USGS Topographic
Map showing project area
0 Two copies of a street level map showing all relevant project areas
o 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,
�Gpocu3gmd M Y'T"�yY}1^
ien r04"iarrish, P.E., CFM
Executive Director of Utilities and Infrastructure
KP/tr
cc: Project Consultant Engineer, Blake Hall, PE
Rachel Ingham, Utility Engineer
Drew Johnson, Development Construction Manager
Theresa Randall, Utility Permitting Specialist
Project file/Correspondence #41920
3002
04.17 2018
r DS
9/21/2021
Rachel Ingham
utility Engineer
Utilities and Infrastructure Services
P.Q. Box 8 • 128 S. Main Street • Holly Springs, NC 27540 • www,hollyspringsnc.us

Dom'Sign Envelope ID. FBC89063-8C7C-405E-835D-42F4E1537FF0
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: 0akview Innovation Park
Design Engineer: Timmons Group; Blake Hail
Address: 5410 Trinity Rd, Suite 102, Raleigh, NC 27607
Phone Number; 919-866 4933 Email: [e-mail]
Date Complete Application Package Received by Town:
Date Approved;{ 9/21/2021 (by R 9/21/2021 (by KDP �9 (by DJ)
9/21/2021
As design engineer for this project, I certify the following (please check (x) each applicable box):
® 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 S480.00 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 a 7.5-minute USGS
Topographic Map showing project area
o One copy of a street level map showing all relevant project areas
o One copy of the locally -required Design and Application Certification (this
form)
Design Engineer's Signature �� Date 5/18/21
Please contact Theresa Randall at [phone] or iliemMa,tunclail(gi holl}springmric. gie if you
have any questions.
2003 Sewer Design Application Certification
01.14.21
Utilities and Infrastructure Services
P.O. Box 8 • 128 S. Main Street • Holly Springs, NC 27540 • noww.hollyspringsnc.gov