WQ0043296_Application (FTSE)_20220425

State of North Carolina
Department of Environmental Quality
Division of Water Resources
DWF.
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number: W d OON 3 Z 16 (it) be comnlaed by DW R►
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Hillsborough Dealership Property 11, LLC (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: Tony Fisher per 15A NC AC 02T .0106(h)
Title: Member Manager
4. Applicant's mailing address: 4900 Leigh Drive
City: Raleigh State: NC Zip: 27616-
5. Applicant's contact information:
Phone number: [phone] Email Address: tony.fishera.universityford.com
II. PROJECT INFORMATION:
1. Project name: Hillsborough CDJ i R
2. Application.-Troject status: ® Proposed (New Permit) ❑ Existing Perm it+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: Orange County
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.0563 ' Longitude:-79.0783
5. Parcel I (if applicable): 9873698536 (or Parcel ID to closest downstream sewer)
Ili. CONSULTANT INFORMATION:
I. Professional Engineer: Timothy A. Smith License Number: 30517
Firm: Summit Design & Engineering Services
Mailing address: 320 Executive Court
City: Hillsborough State: NC Zip: 27278-
Phone number: [phone] Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
I. Facility Name: Hillsborough WWTP Permit Number: NCO026433
Owner Name: Town of Hillsborough
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ 0037048
2. Downstream (Receiving) Sewer Information: 3 inch I 1 Gravity N Force Main
3, System Wide Collection System Permit Number(s) (if applicable): WQCS NIA
Owner Name(s): Paliouras Enterprises, LLC
FORM: FTA 06-21 Page I of 5

VI. GENERAL REQUIREMENTS
L If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑ No ® N.:A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DI:V) been attached?
❑ Yes ❑ No ON. -A
3. If the Applicant is a Homer Property Owners Association, has an I.IOArPOA Operational Agreement (FORA: HOA) and
supplementary documentation as required by 15A NCAC 02T.0I 15(c) been attached?
El Yes El No ®NA
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 1 day care ❑ Medical ' dental i veterinary facilities ❑ Swimming Pool "Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool?Filter Backwash
❑ Businesses i offices factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: % Domestic 100 % Commercial % Industrial (See 15A NCAC 02T .0103(20))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes[] No
G. Has a flow reduction been approved under 15A NCAC 02T .011411)? ❑ Yes ® No
:p If yes, provide a copv of flow reduction approval letter with this anplication
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow 2�b
No. of Units
Flow
Grocery Store
1,500 gal?DAY
12
1,500 GPD
gala
GPD
gaV
GPD
gal?
GPD
gall
GPD
gal?
GPD
Total
3,000 GPD
a See 15A NCAC 02T .01 14(b), (d), (e)(i) and (e)(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 G.S. 42A-4).
b Per 15A NCAC 02T .01 14(c), design flow rates for establishments not identified [in table 15A NCAC 02T.01 14] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 1,500 GPD (per 15A NCAC 02T .01 14)
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

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) -02T .0305 & NIDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 243 PVC
b 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
Vlll. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & NIDC (Pump StationslForce .Nlainsl:
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)
i 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 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 method of solids reduction per
MDCPSFM Section 2.01C.I.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NNCAC 02T .0305(h)(1):
❑ Standby power source or ❑ Standby pump
Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(1)(B);
7 Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
Y 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:
r� Include documentation that the portable source is owned or contracted by the applicant and is compatible with the .station.
Y if the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations storage
capacities and the rotation schedule of the portable power source or pump, including travel timeframes, shall be provided
as part of this permit application in the case of a multiple station power outage.
FORM: FTA 06-21 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
I. Does the project comply with all separations/alternatives found in 15A NCAC 02 r .0305 & .! ®Yes [:)No
15A NCAC 02T 0305(f) contains minimum separations that shall be nrovided 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
2Water 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 11 impounded reservoirs used as a source of drinking water, and associated wetlands.
100 feet
*"Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or SB from normal
high water (or tide elevation) and wetlands associated with these waters (see item IX.2)
50 feet
"Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches, as well as wetlands associated with these waters or classified as WL.
10 feet
Any building foundation (horizontal)
5 feet
Any basement (horizontal)
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
If noncompliance with 02"r.0305(f) or (g), see Section X.I of this application
*15A NCAC 02'r.0305(0 contains alternatives where separations in 02T.03051 0 cannot be achieved. Please check '} es"
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 N%eh ai=e
2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ N :A
D 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.
io 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: Neuse ❑ No
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ® Yes ❑ No
This includes Trout Buffered Streams per 15A NCAC 213.0102
5. Does the project require coverage. -authorization under a 404 Nationwide/individual permits ❑ Yes ® No
or 401 Water Quality Certifications?
Please provide the permit numberipermitting status in the cover letter if coverage/authorization is required.
6. Does project comply with 15A NCAC 02T_0105(c)(6) (additional permits certifications)? ® Yes ❑ No
Per 15A NCAC 02T.0105(c)(6), directly related environmental permits or certification applications must he 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 sc%ver collection lines that are deemed "high -priority?" ❑ Yes ® No
Per 15A NCAC 02T.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.
> If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at least once every six -months and
inspections documented per 15A NCAC 02T.0403(a)(5) or the permittee's individual System -Wide Collection permit.
FORM: FTA 06-21 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 1 5A ;NCAC on. the ;\iinin, um Dc iyn Criicriu_for Ili c_I'erridittn , o1' 1'uml-St;tuon�
acid Force Nlam, (Wen 6t version), and the (drat ilv Sewer Mintrnurri Design Csitcria (latest tiersion) as applicable?
® Yes ❑ No
If no, for prujecta requiring a single variance, complete and submit flit Variance/Alternative Design Request apphcation
(VADC 10-1 ) and supporting docurnenis for review to the Central Office. Approval of the request will be issued
concurrently with the approval of the permit, and „p,roiects,requiring a variance approval may be subfcet to Ioniser
review times. For protects requiring I%vo o_r_ino_re variances or where the variance is determined by the Division to be a
si nificant portion of the proiect, the full technical review is required.
2_ Professional Fmigincei :, Certification:
I, Timothy A_ Smith , attest that this application forT ilillsborouah CDJ - R
ll'rutCssinnat rngincer's name cram Application item 111.1.) i i'rotcci Namc from :1pp .ca(ion Item It. [ f
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 hest 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,
ivlsiinitun QC.Mgn Cryciia for firavit", Sewers (latest version), and the Minimum Dcsiun Criteria for (tic Cast -Track Perntinin«
Of PUMP Stations and force \taro,; f hitest Although other professionals may have developed certain portions of this
submittal package, inclusion of these material,, 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 told 143-215.613, any person who knowingly snakes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which inay
include a fine not to exceed $10,000. as well as civil penalties up In $25,000 per violation. Misrepresentation of the application
information, ircluding failure to disclose any design non-compliance with the applicable Rules and design criteria. may subject
the North Carolina-hcenccd Professional Engineer to referral to the licensing board. (21 NCAC 56.0701)
North Carolina Professional Engineer's seal, signature, and date:
3/7/2022
Applicant's Certification per 15A NCAC 02T .01061h):
I, Ton- Fisher-_ attest that this application tot . Hillsborough C'DJ -R
{51gW1ltJ1e Audi,+rily Name from Application [rein 1.3.) tN(UC�r beanie from Appricaoon Item It 11
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 noel -discharge systent to surface waters or the land will result in an immediate enforcement
action that niay include civil penahies, injunctive relief, andlor criminal prosecution. I will make nu claim against the D vision
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, tilts application
package will be returned to me us incomplete.
(VOTE In at:cordancc: with Cicricra- Statutes 113-217,.(,A and any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which ma}
iaLlude a fine not to exceed S 10.000 as well as civil pcnuhic5 up to S25,000 per violation.
Signature: _ Date: Z
FORM: FTA 06-21 Page 5 of 5

SUMMIT
DESIGN AND ENGINEERING SERVICES
Project:
SDE Project #:
Information Provided by:
320 Executive Court, Hillsborough, NO 27278
Phone ?/ 919.732.3883 Web // www.summitde.net
Fast Track Sewer Application
Cover Letter
Hillsborough CDJR
19-0102.010
Timothy A. Smith, P.E.
April 24, 2022
Contents:
Cover Letter, wastewater flow calculations and project narrative, Division of Water Resources
Fast Track Sewer System Extension application and attachments.
Project Narrative:
Hillsborough CDJ+R consists of a 23,593 sq. ft. car dealership building, parking lots, private road,
and sidewalks on 5.98 acres of land. The building will be a one-story structure with office and
showroom space, service bays and other open areas. The site is located on NC HWY 86 S in
Hillsborough, North Carolina and identified with Orange County Parcel PIN #9873698536. The
development of this site will require a private sewer extension to connect to an existing private
pump station located on the parent development parcel. (Orange County Parcel PIN #873697321)
This private gravity extension is not required for the new dealership but is part of the approval
for the project by the Town of Hillsborough and will serve future development on the parent
parcel. For the new dealership, there will only be a new service line installed to connect to the
existing pump station. The private pump station has a private force main that discharges into the
Town of Hillsborough public sewer system. The proposed gravity sewer extension will consist of
1 new manhole and 243 If of 8" SDR-35 PVC pipe. This new sewer extension will provide service
for a future grocery store, with an anticipated daily wastewater flow of 1,500 gpd.
Wastewater Flows:
12 plumbing fixtures at 125 gpd/fixture (per 15A NCAC 027 .0114 Wastewater Flow Rates)
Total Wastewater Flow = 1,500 gpd
Items included with this submittal: (one original and one copy)
• Cover Letter
• Fast Track Form and $480 fee check
• Flow Tracking Forms (Two)
o One for private pump station
& One for Town of Hillsborough
• Site Maps (LISGS and Google Street Map)
4/24/2022

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USUMMIT
DESIGN AND ENGINEERING SERVICES
LETTER OF TRANSMITTAL
TO: LCDEQ -Division of Water Resources
3800 Barrett Drive, Suite 100
,Raleigh, NC 27609
Scott Vinson
ATTN:
1 919-791-4200
TRANSMITTED VIA: Fedex
WE ARE SENDING YOU:
320 Executive Court, Hillsborough, NC 27278
Phone // 919.732.3883 Web // www.summitde.net
DATE: 3/8/2022 PROD, Na.- 19-0102
RE: Hillsborough CDJ+R Dealgship
Fast Track Sewer Extension Applicafion
h
�r?/Qo
4�
COPIES
1
1
i
1
DRAWING_
C-1 thru A5.0
DATE
DESCRIPTION
2/22/2022
I Hillsborough CDJ+R Construction Drawings
Cover Letter
Fast Track Sewer Application
Flow Tracking From - Private Pump Station
Flow Tracking Form - Town of Hillsborough
Google Maps Site Location Map
NCGS Quad Map Site Location
$480 Fee Check
N/A
N/A
3/7/2022
1 / 13/2022
3/7/2022
1
N/A
I
N/A
2/25/2022
1
N/A
N/A
1
1!
N/A
N/A
N/A
1 / 13/2022
1
N/A
3/8/2022
CD Disk with Digital Files
TRANSMITTED
For Approval
COMMENTS:
COPY TO:
As Requested
For Your Use For Review and Comment
SIGNATURE: I Timothy A. Smith:�'°°�"°-°�°