WQ0043299_Application (FTSE)_20220314

DocuSign Envelope ID: 650381F3-4137-4197-BF23-CF8FAC4967EA
"WO iV1145123)1 112101111
DWR
Division of Water Resources
ZZOZ L kiYv
State of North Carolina
Department of Environmental Quality
Division of Water Resources
FAIT TRACK SEWER SYSTEM EXTENSION APPLICATION
Mtleoa pt3luausuolttua jo } lies FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number: we (YJ \ 154C-k (to be completed by DWR)
All items must be completed or the application will be returned
1. APPLICANT INFORMATION:
1. Applicant's name: Town of Holly SprEny s
2. Applicant type: ❑ individual ❑ Corporation ❑ General Partnership
0 Federal ❑ State/County ® Municipal
3. Signature authority's name: Kendra D. Parrish PE
Title: Executive Director of Utilities & Infrastructure Service
❑ Privately -Owned Public Utility
❑ Other
per I SA NC..V. 021 0itl[,
4. Applicant's mailing address: 128 South Main Street, PO Box 8
City: Holly Springs
5. Applicants contact information:
Phone number: [phone]
State:1C=.....—.
Zip: 27540
Email Address: Kendra.parrish(alhollysprinesnc.gov
11. PROJECT INFORMATION:
1. Project name: Sutton Property Phase 2
2. Application,Prolect status: ® Proposed (New Permit)
fl Existing Permit/Project
If a modification, provide the existing permit number: WQ00 and issued date:
For modifications, also attach a detailed narratise 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: 153815 el Longitude-7R5057i2
5. Parcel ID (if applicable) : PIN No. 0648-49-6146 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
I. Professional Engineer: .1 hoinak Snau.tEng
Firm: The Sttaulding Grtgp
Mailing address:
City: Raleigh
5318 Burning Oak Ct
Phone number: [phone]
License Number: 19375
State: NC Zip: 27606
Email Address:: tom(a spaulding-group.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
Facility Name: Utley Creek Water Reclamation FFcjlity
Owner Name: Town of Holly Springs
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ00 40507
2. Downstream (Receiving) Sewer Information: -8 inch ® Gravity
1. System Wide Collection System Permit Number(s) (if applicable):
Owner Name(s): Town of }lolly Springs
FORM: FTA 06-21
Permit Number. NC0063096
L7 Force Main
WQCS00192
Page I of 5

DocuSign Envelope ID: 650381F3-4137-4197-BF23-CF8FAC4967EA
Vl. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility. has a Certificate of Public Convenience and Necessity been attached'?
❑ Ycs ❑ No ®N?A
2. tithe Applicant is a Dewefoper of lots to be sold, has a Developer's Operational Agreement {I t.r'Rki I}t_k I been attached?
❑ Yes ❑ No
3. If the Applicant is a IlomefProperty Owners' Association, has an i lOA. POA Operational Agreement I FORM: f 1OA.} and
supplementary documentation as required by 15A NCAC 02T.0115(c) been attached'?
❑Yes ❑No ®NIA
4. Origin of wastewater: (check a?I that apply):
® Residential (Individually Owned)
❑ Residential (Leased)
❑ School , preschool / day care
❑ Food and drink facilities
❑ Businesses / offices / factories
❑ Retail (stores, centers, malls)
❑ Retail with food preparation/service
❑ Medical / dental / veterinary facilities
❑ Church
O Nursing Horne
0 Car Wash
❑ Ilotc1 and/or Motels
❑ Swimming Poul:Clubhouse
❑ Swimming Pool/Filter Backwash
❑ Other (Explain in Attachment)
5. Nature of wastewater : 100 % Domestic %Commercial % Industrial (See 15A NCAC 021 91131-t ?)
If Industrial, is there a Pretreatment Program in effect? 0 Yes❑ No
6. Has a flow reduction been approved under t 5A N • C j) 1. ,{}I I !(. )? ® Yes ❑ No
r If yes, provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(0)
Daily Design Flow o.b
No. of Units
Flow
Residential single family home
255 gal/ home
13
3,315 GPD
*Phase 1 (3 Tots) was connected
gal/
GPD
1 to existing infrastructure and is
not included in this wastewater
l
gal/
GPD
extension permit application.
gal/
"
GPI)
gale
GPD
gals
GI'D
Toro/
3.315 GPD
a See 155 N .•\(" *,.I..tl)J 4(71). tdi. tc)[ 1 } ani tc)t_'1 for caveats to wastewater des gn 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.
b Per 15A NCAC 02T .01 14(c), design flow rates for establishments not identified [in table 1.SA N( A( rJ2:1. t1t .a j shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
ii. Wastewater generated by project: _ 3,315. GPD (per 1 5A N(,,'lt. ctt t .t11 1 4)
r Do not include future !lows or previously permitted allocations
If permitted flow is zero, please indicate why:
0 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
L] Mow has already been allocated in Permit Number Issuance Date:
❑ Rehabilitation or replacement of existing sewers with no new flow expected
Q Othe (Explain). -
FORM: ETA 06-21
Page 2 of 5

DocuSign Envelope ID: 650381F3-4137-4197-BF23-CF8FAC4967EA
VI1. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 021 .0305 & NIDC (Gravity Seacrs):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8-inch
285
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 requirements is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 021 .0305 & MIK IP iti p Stat_ionsll•oscc Stainsl•:
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
I. 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: _-_- feet total dynamic head (TDII)
5. Summarize the force main to be permitted (for This Pump Station):
Size (inches)
Length (feet)
Material
If any portion of the force main is less than 4-inches in diameter, please identify the me hod of solids reduction per
MDCPSFM Section 2.0I C. I.b. 0 Grinder Pump 0 Mechanical Bar Screen 0 Other (please specify)
6 Power reliability in accordance with 15A NCAC 021 QM05;h2 IJ:
❑ Standby power source or 0 Standby pump
Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(1)(D):
Required for as 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):
O Portable power source with manual activation, quick -connection receptacle and telemetry -
or
❑ Portable pumping unit with plugged emergency putnp 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.
NORM: FTA 06-21 Page 3 of 5

DocuSign Envelope ID:650381F3-4137-4197-BF23-CF8FAC4967EA
l a,
SETBACKS & SEPARATIONS (02B .0200 & 15A NCAC 02T .0305(f)):
Does the project comply with all separations/alternatives found in 153 NCg- 02 1..(MJ1.4.igi.P ® Yes ❑ No
15A NCAC 02'f.0305t) contains minimum separations that shall beprovided for sewer systems:
Setback Parameter*
Storm sewers and other utilities not listed below (vertical)
Separation Required
18 inches
2Water mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
2Water mains (horizontal)
Reclaimed water lines (vertical - reclaimed over sewer)
Reclaimed water lines (horizontal - reclaimed over sewer)
10 feet
18 inches
**Any private or public water supply source, including any wells, WS-I waters of Class I or
Class iI impounded reservoirs used as a source of drinking water, and associated wetlands.
2 feet
100 feet
**Waters classified WS (except WS-I or WS•V), B, SA, ORW, HOW, 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.
Any building foundation (horizontal)
Any basement (horizontal)
Top slope of embankment or cuts of 2 feet or more vertical height
ti
Drainage systems and interceptor drains
Any swimming pools
Final earth grade (vertical)
10 feet
5 feet '.,
10 feet tro'_
10 feet
5 feet t_
10feet O'
36 inches
➢ If noncompliance with 921 t i i for dgje see Section X.I of this application Q
*15A NCAC 02'1..03(15(,i contains alternatives where separations in 02T 0305(f) cannot be achieved. Please the "yes"
above if these alternatives are used and provide narrative information to explain. :7
ra
**Stream classifications can be identified using the Division's fit(,' Sut'faet Water Classifications wchoin:e
2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ N.A
r If no, please refer to 15A NCAC 1 8C.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
Please provide supplementary information identifying the areas of non. conformance.
See the Division's draft laaration„ryytireo#s for situations where separation cannot be met.
i- 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 ruled ❑ Yes Basin name: ® No
Byes, does the project comply with setbacks found in the river basin rules per 15r1 NCAC 02f3 .11200 ❑ Yes ❑ No
v This includes Trout Buffered Streams per 15A NCAC 20.9.2.01
5. Does the project require coverageiauthorization under a 404 Nationwide/individual permits ❑ Yes ® No
or 401 Water Quality Certifications?
v Please provide the permit number.permitting status in the cover letter if coveragci'authorizatron is required.
s. Does project comply with 1 f ?I( 4(. 021.0I(}5(c4i) (additional permitsrcertifications)? ® Yes ❑ No
Per 15A NC'A( 021 0105(r 116), 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 and sewer collection lines that are deemed "high priority''' ❑ Yes ® No
Per 15A N('A( 021.0402, "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.
Y If yes. include an attachment with details for each line, including type (aerial line, size, material. and location).
arab
❑ No ❑ N,A
High priority lines shall he inspected by the permittee or its representative at least once every six -months and
inspections documented per ISA NCAC 02T.0403(a)(5) or the permittee's individual System -Wide Collection permit.
FORM: FTA 06-21
Page 4 of 5
NC Dept of Environmental Quality

DocuSign Envelope ID: 650381F3-4137-4197-BF23-CF8FAC4967EA
X. CERTIFICATIONS:
I. Does the submitted system comply with 15A NCAC 021. the Minimttin Design Critena for the Pcriniiti:.;; i}r Nut? S1. it{9i.,
and Force (\lane.{Iatcst version), and the Grasity Sexcr Minimum Design Criteria (latest version.) 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. Annroval of the request will be issued
concurrently with the approval of the permit. and Projects requiring a variance approval may be subject to longer
review times. For projects requiring two or more variances or where the variance is determined by the Division to be a
significant portion of the Project, the full technical review is required.
2. Professional Engineer's Certification:
! _ Thomas Spaulding , attest that this application for Sutton Property Phase 2
(Professional l.nginecr's name from Application Item rit.t } /Protect Name Font Application hem II I
has been reviewed b) 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,
f.tiniinum Design Criteria for Gravity Sewers {latest version', and the Minimum/ i)csiel ijkt(r,i Is,t,IN I am- !Lid I.'cvinilting
of Pump St., tions,rnd For,:c.lains.(Iatest )yrtiitlq}. Although other professionals may have developed certain portions of this
submitta: package, inclusion of these materials under my signature and seal signifies that 1 have reviewed this material and
have judged it to he 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)
North Carolina Professional Engineer's seal, signature, and date: ,.. b
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3. Applicant's Certification per 15A NCAC 02T .0106(b): h
m
I, Kendra D. Parrish, PE , attest that this application for Sutton Property Phase 2
(Signature Authonty Name from Application Item i 3.) (Project Name from Application Rein II.1)
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. 1 understand that any
discharge of wastewater from this non -discharge system to surface waters or the land will rest-!t 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. 1 also understand that if all required parts of this application
package are not completed and that if all required supporting information and attachments arc not included. this application
package will be returned to me as incomplete.
NOTE • In accordance with General Statutes LI3-_15.6A and I43-215.613, 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;
DocuSigmd by:
(--
03005869FC34440.
FORM: FTA 06-21 Page 5 of 5
3/9/2022
Date;

DocuSign Envelope ID: 650381F3.4137-4197-BF23-CF8FAC4967EA
•.•
Division of Witt:, Resosntt�ti
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: Sutton Property Phase 2
More than one FTSE may be required for a single protect 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 Zi i
All flows are 1n 4WD oo v
c. WWTP facility's permitted flow 6.0 d" a 0
d. Estimated obligated flow not yet tributary to the WWTP 1.552f.Pzi Az 2
e. WWTP facility's actual avg. flow 2.828 Yz
0• i
g.
f. Total flow for this specific request .003315 3
g. Total actual and obligated flows to the facility 4.384 O co
h. Percent of permitted flow used I 73.1%
A
II. Complete this section for each pump station you are responsible for along the route of this proposed c'
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 / pf), Avg. Daily Daily Flow, Obligated Available
Number) No. MGD MGD Flow, MGD MGD Flow Capacity***
* The Firm Capacity (design flow) of any pump station is defined as the maximum pumped flow
that can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor
(pf) not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): Utley Creek Wastewater Treatment Plant
Downstream Permit Number: NC0063096
Page 1 of 6
FTSE 10-18

DocuSign Envelope ID: 650381F3-4137-4197-13F23-CF8FAC4967EA
I1I. Certification Statement:
1 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 1
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.
OocuSipned by:
ial Signature
Exec Director of utilities and Infrastructure
Title of Signing Official
Page 2 of 6
3/9/2022
Date
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FTSE 10-18

DocuSign Envelope ID: 650381 F3-4137-4197-BF23-CF8FAC4967EA
Sutton Property Subdivision
Project Narrative:
Please see attached submittal package for the Sutton property subdivision containing a
fast -track application, flow tracking form, USGS map, street level map and fec. The
proposed Sutton property Subdivision is located at the intersection of Martingale Drive
and Utley Bluff Drive in the Town of Holly Springs, North Carolina. The Sutton
Subdivision includes 13 residential units and will be served by both existing sanitary
sewer that was constructed as part of permit number WQ0040507 and 285 LF of
proposed 8" sanitary sewer. The proposed sewer will be public with a proposed flow of
3,315 GPD (13 single family units x 255 gpd/ unit).
Project Schedule:
The construction of Sutton Subdivision will begin in May 2022 and should be completed
by August of 2022

DocuSign Envelope ID: 650381F3-4137-4197-BF23-CF8FAC4967EA
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DocuSign Envelope ID: 650381F3-4137-4197-BF23-CF8FAC4967EA

e{i
State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Environmental Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
March 31, 1995
z
Stepanie L. Sudano, P.E., Town Engineer gC
Town of Holly Springs co .a
Post Office Box 8 Oaf
o
Holly Springs, North Carolina 27540 Pc' tri
(D <
OR RE: Town of Holly Springs ... o'
Request for Adjusted Daily Wastewater Flow w
Wake County g
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fo w
On March 15,1995, the Division received your wastewater flow reduction request and supportingr•
documentation concerning wastewater flows associated with present residences within the Town of Holly
Springs. Your letter requested the Division allow the reduction of wastewater flows from 120 GPD per
bedroom as required in required 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.
Dear Ms. Sudano:
In view of the information submitted, the Division of Environmental Management hereby approves
the use of 255 GPD per single family residence in all applicable non -discharge permit applications for
future wastewater collection extensions 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. Allen
at [phone] ext. 547.
Since y
A. Preston Howard, Jr., P.E.
cc: Raleigh Regional Office, Water Quality Section
State Engineering Review Group
P.O. Box 29535, Raleigh, North Carolina 27826-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

DocuSign Envelope ID: 650381 F3-4137-4197-BF23-CF8FAC4967EA
THE TOWN OF W5lly rings
03-08-22
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: Sutton Property Phase 2
Dear Sir or Madam:
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
0 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
0 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, DocuSigned by:
EPt
03CO5B6SFC34440
Kendra D. Parrish, P.E., CFM
Executive Director of Utilities and Infrastructure
r DS
L
KP/tr
cc: Project Consultant Engineer, Tom Spaulding
Rachel Ingham, Utility Engineer
Drew Johnson, Development Construction Manager
Theresa Randall, Utility Permitting Specialist
Project file/Correspondence #41961
3002
04.17.2018
Utilities and Infrastructure Services
P.O. Box 8 • 128 S. Main Street • Holly Springs, NC 27540 • www.hollyspringsnc.gov

DocuSign Envelope ID: 650381F3-4137-4197-BF23-CF8FAC4967EA
DO NOT SUBMIT SEWER EXTENSION APPLICATIONS UNTIL
CONSTRUCTION DRAWINGS HAVE BEEN APPROVED BY STAFF!
Sewer Design and Application Certification
Note: This torn must be submitted with the Fast Traci Application for extension to the Town of
Holly Springs Sewer System
Project: Sutton Properly Phase 2
Design Engineer:
Address:
The Spaulding Group
5318 Burning Oak CI., Raleigh, NC 27608
Phone Number: 919-669-1078 Email: tamgspauksing.group.com
Date Complete Application Package Received by Town:
Date Approved;(by(by KDP)
As design engineer for this project, I certify the following (please check (.e) 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;
Ga That each of the following items are completed and enclosed for submittal to the State tbr
a sewer extension permit:
o One cover letter that includes a project narrative
o A check in the amount of $480.00 to NC DEQ
i A check in the amount of $200.00 to the Town of Holly Springs
o One State of North Carolina form FTA 04-16 Fast Tract Server System
Extension Application
o One FTSE 10-18 Flow Trackingfor Sever Extension Applications
o One color copy of an 8.5-inch by 1 I -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
• One copy of the locally -required Design and Application Certification
(this form)
Design Engineer's Signature
Date 02028/22
Please contact Theresa Randall at [phone] or teresa; randal l@Il of lyyringsnc,su ' if you
have any questions.
2003 tieWei IlcsiEtF App,n dlton Ccniticalinn
111 14 21
Utilities and Infrastructure Services
P.O. BOX 8 • 128 S. Alain Street • Holly Springs. NC 27540 • www.hollyspringsnc.gov