WQ0042941_Application (FTSE)_20211013

State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 - FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Olvislon of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: �1Q r-qC'k-k1-" l (to be completed by nwR)
All items must be com leted or 1he aRplication will be returned
1. APPLICANT INFORMATION:
1. Applicant's name. City of Oxford (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: Amy L. Ratliff per 15A_NCAt: 021 .0106(b}
Title: City y Engineer NC Dept of Environmental Quality
4. Applicant's mailing address: P.O. Box 506
City: Oxford State: N.C.. Zip: 27565- OCT 1 021
5. Applicant's contact information:
Phone number: (9I9) 603-1113 Email Address: [e-mail] Raleigh Regional Office
II. PROTECT INFORMATION:
1. Project name: Ivy Meadow
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: Granville
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.19'070 Longitude: -1136' 3°
5. Parcel ID (if applicable): 191310456394 Coll
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION,
1. Professional Engineer: Michael Stewart License Number: 22024
Firm: Stewart -Proctor #P-0148
Mailing address: 319 Chapanoke Road
City: Roleigh State: NC Zip: 27603-
Phone number: 919 77 -1855 Email Address: stewartpenaol.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: City of Oxford WW_TP Permit Number: NC - oo 250N
Owner Name: City of Oxford
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ Downstream (Receiving) Sewer Size: _ inch
SystemW Coiiggion. ystem Permit Number(s) (if app igatsle): WQCS - ovokb
Owner Name(s): City of Oxford
FORM: FTA 04-16 Page] of 5

V1. 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 - - t nal Agreement f EOil : DI VJ been attached?
[-]Yes [:]No ®NIA
3. If the Applicant is a do eE ProW(ly { w!Wrs` Association, has an.Operational Agreem nt R : H A) 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 preparation/service ❑ Hotel and/or Motels
❑ School / 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 Attachme )
NC Dept of Environmental �uality
5. Nature of wastewater: 100 % Domestic/Commercial % Commercial
% Industrial (ee.0A. 'AQ92TYO19IJ20 OCT 13 2021
'.Is there a Pretreatment Program in effect? ❑ Yes [:]No
6. Hasa flow reduction been approved under 15A NCAC 02T.01 14(t)? ❑ Yes ®No Raleigh Regional Office
➢ If yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(fl)
Daily Design Flow °'b
No. of Units
Flow
Residential
360 gal/units
121
43,560 GPD
all
GPD
gall
GPD
gal/
GPD
gall
GPD
gal/
GPD
Total
43,560 GPD
a See 15A NCAC 02T .0114(b). (d). (e)(1) and {c)(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 Q,$
b Per 15A NCAC 02T-0114(c), design flow rates for establishments not identified [in table 15,1� NC;, T:9tW shall
be determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 43.560 GPD (per i 5A NCAC 42'C.01 14)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
❑ Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit Number:__ .
❑ Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain):
FORM: FTA 04-16 Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T�0305 & MDC fCravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8
4,318
PVC
8
840
DIP
➢ Section II & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section III contains information related to minimum slopes for gravity sewer(s)
➢ Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T..0305 & MDC tPump St t'on rye Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: -
3. Design flow of the pump station: millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): gallons per minute at
5. Summarize the force main to be permitted (for this Pump Station):
feet total dynamic head (TDH)
Size (inches) Length (feet) Material
6. Power reliability in accordance with 15A NQAC 02T .0305(h)(i]:
NCbeptOfEnvironmental Qualit,
nCr j3 2U21
Raleigh Regionaj ()ffee
❑ 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 a multiple station power outage.
FORM: FTA 04-16 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations found in .k .IA NCAC.Q2T _03050) &.(g) ® Yes ❑ No
➢ 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 It 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 Ksee 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 hei t
10 feet
Drainage s stems and interceptor drains
5 feet
Any swimming ools
10 feet
Final earth grade vertical
36 inches
➢ 15A NCAC 02T.0305(g) contains alternatives where separations in 021.0305M cannot be achieved.
➢ "Stream classifications can be identified using the Division's NC Surface_ ater_ClassifiCati4ns wcbvag
➢ If noncompliance with 02�Qg}, 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 per 156 NC,AC JZD .0200? ❑ Yes ❑ No ® NIA
➢ This would include Trout Buffered Streams per I SA NCAC.21_9202
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 401 &. I3c1Ter Permitting Brau�h
5. Does project comply with 15A Nq6r, 02T_0105(clfb) (additional permits/certifications)? ® Yes ❑ No
Per 15A..�.'.!1C 02T.0105(c)(6), directly related environmental permits or certification applications are being prepared, have
been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion and
sedimentation control plans, stormwater management plans, etc.).
6. Does this project include any sewer collection lines that are deemed "high -priority?"
Per IAA NAAC ` NO2, "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes ® No ❑ NIA
➢ If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at least once every six -months and
inspections documented per 15A NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit.
FORM: FTA 04-16 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum U"ign Criteria ferltinog_of Pumptations
arrd 1-orcC MAiT_s.(lat{st versipt:), and the GmviN Sewer Minimum Dexign Criteria(latest ver$io as applicable?
® Yes ❑ No
If No, complete and submit the Variance/Alternative Design Request application (VADC 10-14) and supporting documents
for review. Approval of the_ request is required prior to submittal of the Fast Track Application and supporting
documents.
2. Professional
1, �— / attest that this application for
ssional Engineer's name from Application Item 1I1,1.)
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, Gravity Sewer
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the East -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 143-215.68, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a CIass 2 misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation.
North Carolina Professional Engineer's seal, signature, and date:
NC Dept of Environmental Quality
OCT 13 2021
Raleigh Regional O
3. Applicant's Certification per 15A NCAC
.0106(b):
1, m (.. 1 A- i L, 1:7f-- & +, (L 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. 1 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 ,JAR, 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: f Date:
FORM: FTA 04-16 Page 5 of 5

State of North Carolina
Department of Environmental Quality
DWP Division of Water Resources
Division of Water ResoE:ices Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: The City of Oxford
Project Name for which flow is being requested: Ivey
Meadows
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: City of Oxford WWTP
b. WWTP Facility Permit #: NCO025054
_
All flows are in MGD
c. WWTP facility's permitted flow
3.50 CD _
d. Estimated obligated flow not yet tributary to the
0•
WWTP 0.12NJ
e. WWTP facility's actual avg. flow
I.16
f. Total flow for this specific request
0.04 p "`
g. Total actual and obligated flows to the facility
1.32
h. Percent of permitted flow used
37.7%
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)
(B)=(A-D)
Design
Obligated,
Pump
Average Daily
Approx.
Not Yet
Total Current
Station
Firm Flow**
Current Avg.
Tributary
Flow Plus
(Name or
Capacity, * (Firm 1 pfl,
Daily Flow,
Daily Flow,
Obligated
Available
Number)
MGD MGD
MGD
MGD
Flow
Capacity***
NIA
* 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 peaking
factor (pi) 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 < 0.
Downstream Facility Name (Sewer):
Downstream Permit Number: NC
Page 1 of 6
FTSE 04-16

III. Certification Statement:
I Amy+ L.RRatliff 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 indicates acceptance of this wastewater flow.
Signing Offi 'al Signature
Date -
NCbebf ofFnv�rpnfiental Qua1
Page 2 of 6
FTSE 04-16

Ivy Meadow Sewer Submittal Cover Letter
The purpose of this application submittal is to permit sewer for 85 lots and
36 townhome/units for Ivy Meadow subdivisions located in the City of
Oxford, Granville county.
Items included in application package:
1. FTA 04-16 Fast Track Sewer System Extension Application
2. Check $480.00
3. FTSE 04-16 Flow Tracking/Acceptance for Sewer Application
4. 8.5"x I I" USGS colored copy
5. Site plan map.
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