WQ0043007_Application (FTSE)_20211110

DocuSign Envelope ID. 680593C4-2011-49D9-8AA0-584CD4153E49
State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number:4a LQ�Qgj(to be completed by DWR) >J30 puoi ag qialt,2I
All items must be completed or the application will be returned 90G Q 1 AON
1. APPLICANT INFORMATION:
1. Applicant's name: Tpu� of Holly Springs �C;il1:Ra IslUauiuollAu3Jo ldaQ �H
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ® Municipal ❑ Other
3. Signature authority's name: Kendra D. Parrish, per 51 A NCAC CPU-
Title: Executive Director of Utilities & Infrastructure Service
4. Applicant's mailing address: 128 South Midn Street_ PQ Box It _.
City: Holly Springs _ State: NC Zip: 27540
5. Applicant's contact information;
Phone number: ( 19) 577- Email Address: Kcndra.parrish holly. ringsnc.zov
II. PROJECT INFORMATION:
1. Project name: Regenay Subdivision - Phase 1 __ y
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: Wake
4. Approximate Coordinates (Decimal Degrees):
Latitude: 35.6524 U
Longitude:-78.8887 :'
5. Parcel l I) (if applicable) : 0639311837
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Jeremy V. Finch
License Number: 31452
Firm: McAdams
Mailing address: 2905 Meridian Parkway
City: Durham
State: NC
Zip: 27713
Phone number: 919 361-5000
Email Address:: ifinchgmcadamsco.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: kticy Crock Water RNIamption Facility
Permit Number: NC0063�1¢
Owner Name: 'town of Holly S rip s
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s):WQ0040668,
2. Downstream (Receiving) Sewer Information: -8 inch
® Gravity
❑ Force Main
3. System Wide Collection System Permit Nurhb~a*&nmental Quality
WQCS00192
Owner Name(s): Town of Holly Springg
NOV}�
FORM: FTA 06-21 N
201
Pagel of 5
kaicigh Regional Office

DocuSign Envelope ID, 680593C4-2011-4909-8AA0-584CD4153E49
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 ON. -A.
2. If the Applicant is a Developer of lots to be sold, has a JX-y0Qper's 0-,kl+++nal Agrccn5 mi t 1 • } =%' been attached?
❑ Yes ❑ No ON -'A
3. If the Applicant is a Home/Property Owners' Association, has an HOA/POA er�tand
supplementary documentation as required by 15A NCAC 02T.0I 15(c) been attached?
❑ Yes ❑ No ® N,'A
4. Origin of wastewater: (check all that apply):
® Residential (Individually Owned) ❑ Retail (stores, centers, malls) ❑ Car Wash
❑ Residential (Leased) ❑ Retail with food preparation/service ❑ Hotel and/or Motels
❑ School / preschool I day care ❑ Medical / dental I veterinary facilities ❑ Swimming Pool/Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 % Domestic % Commercial % Industrial (�5&m L5&po' 02]' ,Q I Q3 ())
If Industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under J NCAC 02T ,01140)? ® Yes ❑ No
➢ If yes, provide a cony of flow redaction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(9))
Single Family Home
Daily Design Flow'-b
266 gall unit
gall
gal/
gal/
gaV
gall
No. of Units
Flow
45
11,4750PD
GPD
GPD
GPD
GPD
GPD
Total
11,4750PD
a See [5 'A(' 02T ,01 l4[hj, J&(a1JA d (_cj(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 S_ 4A-4).
b Per 15A NCAC 02T .0l 14(c), design flow rates for establishments not identified (in table I5A NCAC02T 14] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: _ 11,475 GPD (per ,y{ i' q 4)
➢ 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: F-rA 06-2 t Page 2 of 5

DocuSign Envelope ID: 680593C4-2011-49D9-8AA0-584CD4153E49
VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02.. T ,91QS & 1H, =((;raiity %ewers)
1. Summarize gravity sewer to be permitted:
Size (inches)
8-inch
8-inch
Length (feet) Material
4,349 PVC
1,478 DIP
➢ Section 11 & 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) - $2 .4 o & MI][ Erna? Stntic w0grce Mains}:
PROVIDE A SEPARATE COPY OF THIS PAGE FORE EACH PUMP STATION INCLUDED IN THIS P&QJECT
1. Pump station number or name: Regency Subdivision Pump Station - Permitted Under Separate Application
2. Approximate Coordinates (Decimal Degrees): Latitude: 35,6489 Longitude:-78,8914
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: feet total dynamic head (TDH)
5. Summarize the force train to he permitted (for this Pump Station):
d
o
'lot
c
b
a
71 If any portion of the force main is less than 4-inches in diameter, please identify the method of solideductgp per �GD
MDCPSFM Section 2.01C.l.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please spetfy) v
., cd
6. Power reliability in accordance with ILA N( AC U2T :4,3Q5 ":
ElStandby power source or [I Standbypump C.
7
➢ Must have 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 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(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

DocuSign Envelope ID: 680593C4-2011-49D9-8AA0-584CD4153E49
IX. SETBACKS & SEPARATIONS — (02B .0200 &. 15A NCAC 02T .0305(f)):
I. Does the project comply with all separations/alternatives found in I5ANCAC 02T .03QSifi & tat? ® Yes ❑ No
15A NCAC 02T.0305(Q 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-1 waters of Class 1 or
_
Class I impounded reservoirs used as a source of drinking water, and associated wetlands.
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 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
r it noncompnance wttn !ML.uMV(t] ,See Section X.1 of this application
• l 5A N€'AU 0Z'Ii0345€ - contains alternatives where separations in Q2T.03QStfl 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 webL►age
2. Does this project comply with the minimum separation requirements for water mains? ® Yes [-]No ❑ N/A
➢ If no, please refer to I5A 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.
D See the Division's r A se iy D FVQLJircments 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 028 .0200? ❑ Yes El No
➢ This includes Trout Buffered Streams per 15A NCAC 28.0202
5. Does the project require coveragetauthorization under a 404 Nationwidelindividual 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 NBC 02T.0105(c)(6) (additional permits/certifications)? ® Yes ❑ No
Per I S htC'AC' 02i.O105(j}, 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 15 A NCAC_02i'.0402, "high-pnority 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 loxes 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 permitee 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

DocuSign Envelope iD. 680593C4-2011-49D9-8AA0-584CD4153E49
X. CERTIFICATIONS:
I. Does the submitted system comply with 15A hK'A(' 02T, the Mmrwij un.Pg {',riteriu fQL& Permittin QfP1uBy Stalian
and FarceMOg$ ag_� and theCrtarvft Sewer Miim"U .r_igg ( atgys(yersian as applicable?
® Yes ❑ No
If no, for projects requiring a single variance, complete and submit the Variance/Alternative Design Request application
(VADC 10-14) and supporting documents for review to the Central Office. Approval of the request will be issued
concurrently with the aRgrovall 2f the Permit. andis re uirin v Hance rove be subject Iona
reviewtimes r ' cts reguiring two or more varian r where the variance is determinedhe Division to bea
significant portion of the proiect, the, full teghnical rc view is required.
2. Professional Engineer's Certification:
1, _ Jeremy V. Finch , attest that this application for Regency Subdivision - Phase 1
{Professional Engineer's name from Application Item 1I1.1 } (Project Name from Application Item II.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. 1 further
attest that to the best of my knowledge the proposed design has been prepared in accordance with the applicable regulations,
Minimum" Utxjgt C. ri4 ja (or QMitx .,e r t latest rcrsiun1, and the it ugll n Drsi n Critcr+� 4hr_ Fall -Track pvfm it ins
[ptgswcr!«ionl. Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that [ 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 Class 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)
1:8JVr� tl%9ielfa AJd9Q I,allllll,•• E
Nortn 's seal, signature, and date: CAR
ako�}••,,,
S
IZOZ Q 1 AON 452
4111una 1E)U3U1U01IAU'J J0 Id;)CI Dr,4•'•,�''' t ,, :
1+11,111111aa
Jeremy Finch
3. Applicant's Certification per 15A NCAC 02T .O1Q6{b}:
Sep 16201 5:47 PM
I, _Kendra D. Parrish, PE , attest that this application for Regency Subdivision - Phase 1
(Signature Authority Name rrom Application Item 13) (Project Name from Application Item II.1)
attest that this application has been reviewed by me and is accurate and complete to the best of my knowledge.
l understand that if all required parts of this application are not completed and that if all required supporting documentation
and attachments arc 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 143.215,613, 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.
Signature: Date: 11/4/2021
FORM: FTA 06-21 Page 5 of 5

DocuSign Envelope ID: 680593C4-2011-49D9-8AA0-584CD4153E49
L)WR
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: Regency Subdivision - Phase 1
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
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 #: NC 0063096
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
All flows are in MGD
6.0
0.644
2.426
0.011
3.081
51.35
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) (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 f pf), Avg. Daily Daily Flow, Obligated Available
Number) No. MGD MGD Flow, MGD MGD Flow Capacity***
Regency Not yet permitted -
=iviaion separate application
Pump a aon
* 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): Regency Pump Station
Downstream Permit Number: Not yet permitted - separate application
Page 1 of 6
FTSE 10- 18

DocuSign Envelope ID: 680593C4-2011-49D9 8AA0 584CD4153E49
Ill_ 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 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.
` 11/4/2021
Signing Official Signature Date
Exec Director of utilities and infrastructure
Title of Signing Official
Page 2 of 6
<~TSE 10-18

DocuSign Envelope ID: 680593C4 2011-49139 8AAO-584CD4153E49
'J McADAMS
October 29, 2021
NCDENR - DWR
Raleigh Regional Office
1628 Mail Service Center
Raleigh, North Carolina 27699-1628
Re: Regency Subdivision - Phase 1
Holly Springs, North Carolina
TOL-20030
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The accompanied Fast -Track Application (FTA 06-21) includes 4,349 lineal
feet of 8" PVC and 1,478 lineal feet of 8" DIP of gravity sanitary sewer
system and 1,773 lineal feet of 4" PVC force main for the proposed Regency
Subdivision - Phase I development located off New Hill Holly Springs Road
in Holly Springs, NC. The gravity sewer and force main systems will be
public systems owned and operated by the Town of Holly Springs. Phase 1 of
the project will consist of approximately 45 residential units. The total
wastewater flow generated by Phase 1 of the project is 11,475 GPD. Please
find the following attached information in support of this permit request:
• Cover letter with project narrative
• 401 permit #WQC0044841404 permit #SAW-2019-01637
• Fast Track Sewer System Extension Application (FTA 06-21)
• Flow Tracking for Sewer Extension Application (FTSE 10-18)
• USGS Topo Map
• Aerial Photo Map
• NRCS Soils Map
• FEMA Firm Map
Sincerely,
T E JOHN R. A MS COMPANY, INC.
the John R. McAdams
Company, Inc. Y.
Raleigh Durham, NC m V. Finch, P.E.
2905 Meridian Parkway Group Manager, Residential
Durham. North Carolina 27713
(919►361-M Enclosures
Charlotte, NC
113D1 Carmel Commons Blvd.
Suite 111
Charlotte Nonh Carolina 28226 s
(7041527-0800
t d&ff0A M Designing Tomorrow's Infrastructure & Communities

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State of North Carolina
Department of Environment,
Health and N,aturai Resources
Division of Environmental Management
James B. HOnt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard,.Jr., P.E., Director
March 31, 1995
Stepanie L. Sudan, P.E., Town Engineer
Town of Holly Springs
Post Office Box 8
Holly Springs, North Carolina 27540
RE: Town of Holly Springs
Request for Adjusted Daily Wastewater Flow
Wake County
Dear Ms. Sudn:
�EHNR
4n March 15,1995, the Division received your wastewater flow reduction request and supporting
documentation concerning wastewater flows associated with present residences within the Town of Holly
Springs. Your lettet requested the Division allow the reduction of wastewater flows froth 120 GPD per
bedroom as required in inquired by North Carolina Administrative Code to 255 GPD per household for
single family residential units. In support of your request, water.consumption data and wastewater
Information was supplied from households located in Holly Springs.
An evaluation was completed by the Division in accordance with 15A NCAC .0219(1)(3) using the
water consumption data submitted, twelve (12) months of data starting from January 1994. The peak.
month was determined to be January 1994 based on average wastewater generated per customer. Using
the upper 10% of the water consumption data for the month of January, eliminating industries, commercial
properties and several inaccurate residential readings, Division staff verified the flow rate of 255 GPD per
household.
In view of the information submitted, the Division. of Environmental Management hefeby approves
the lase of 255 GPD per single family residence in all applicable non -discharge permit applications for
future wastewater collection extenkons which will be made tributary to the Town of Holly Springs
Wastewater Treatment Plant (Permit No. NC0063096). This consideration applies to any applicable future
projects submitted to this Division as well as any projects which are presently under review, Wastewater
flows presently tributary to the wastewater treatment facilities can be adjusted upon negotiations between
the Town of Holly Springs and the Raleigh Regional Office.
If you have any questions or comments regarding this matter, please contact Mr. Michael D. Allan
at [phone] ext. 547.
4Y
/-- A.
Preston Howard, Jr., P.E.
w: Raleigh Regional Office, Water Quality Section
State Engineering Review Group
P.O. Box 29535, Raleigh, North Carolina 27620-0535 - Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 60% recycled/ 10% post -consumer paper

DocuSign Envelope ID: 680593C4-2011-49D9-8AAo-584CD4153E49
n Na n 5
s. THE TOWN OF �CL
November 3, 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: Regency Subdivision Phase I
Dear Sir or Madam:
!12gS
aou30 IrU010a-d t falol ; d
I oz o 1 AON
9111i2no 11R1u9wu04lnua3o;daQ DH
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 I I -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,
��a
Kendra D. Parrish, P.E., CFM
Executive Director of Utilities and Infrastructure
KP/tr
cc: Project Consultant Engineer, Jeremy Finch, PE
Rachel Ingham, Utility Engineer
Drew Johnson, Development Construction Manager
Theresa Randall, Utility Permitting Specialist
Project file/Correspondence 441933
DS
11/4/2021
Rachel Ingham
Utility Engineer
R02
04,17.2018
Utilities and Infrastructure Services
P.O. Box 8 - 128 S. Main Street - Holly Springs, NC 27540 - www.hollyspringsnc.us

DocuSign Envelope ID: 680593C4-2011A9D9-8AA0-584CD4153E49
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 Fas Tract_Agplication for extension to the Town of
Holly Springs Sewer System
PIoject: Rele;k.-_e Phase 1
Design Engineer: em,yfinc+
Address: 2905 Merdan Pencwa, Durham, NC 27713
Phone Number: 9iswi-saw _ Email: mncn wnswo-
Date Complete Application Package Received by Town: aa-3i-2021
11/4/2021 11/1./2021 a �
Date Approved. � (by Rl� _ _ (by KDP J {by D])
As design engineer for this project, I certify the following (please check (x) each applicable box):
O 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:
❑ One cover letter that includes a project narrative
❑ A check in the amount of $480.00 to NC DEQ
❑ A check in the amount of $200.00 to the Town of Holly Springs
❑ One State of North Carolina form FTA 04-16 Fast Tract Sewer System
Extension Application
❑ One FTSE 10- 18 Flow Tracking for Sewer Extension Applications
❑ One color copy of an 8.5-inch by 11-inch portion of a 7.5-minute
USGS Topographic Map showing project area
❑ One copy of a street level map showing all relevant project areas
❑ One copy of the locally -required Design and Application Certification
(this form)
Design Engineer's Signature A Date e- it
Please contact Theresa Randall4a674CO09 or ihrres;t_randullia.hullyslaringsnc•b{+w if you
have any questions, _ NC De t of Environmental Quality
2003 Scwcr Design Application Certification
01.14.21
NOV 10 2021
Raleigh Regional Office
Utilities and Infrastructure Services
P.O. Box 8 • 128 S. Main Street • M4 Springs, NC 27540 a www.hollyspringsnc.gov