WQ0043394_Application (FTSE)_20220408

DocuSign Envelope ID: A992C848-6E05-403E-92C9-8BA47C3133053
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: jAl(C j (to he complcled by DWNC Dept of Environmental Quality
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
Applicant's name: Town of Iloliy Springs
2. Applicant type; ❑ Individual
❑ Federal
3.
4.
5.
❑ Corporation
❑ State•County
❑ General Partnership
® Municipal
Signature authority's name: Kendra D. Parrish. PE
Title: Executive Director of Utilities & Infrastructure Service
APR 0 8 2022
alcigh Regional
El Pnvately-OwnePu tc > t i4
❑ Other
per ISA NC AC 021 .UIUhih1
Applicant's tnailing address: 128. South Main Street, PO Box 8
City: Holly Springs State: NC
Applicant's contact information:
Phone number: [phone]
1l. PROJECT INFORMATION:
1. Project name: South Main Office
2. Application.Project status:
Zip: 27540
Email Address: Kendra.parrish(a hollyspnngsnc.gov
® 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:
3. County where project is located: Wake
4. Approximate Coordinates (Decimal Degrees):
5. Parcel ID (if applicable) : PIN No. 0648-98-7588
WQ00
Latitude: 353903.0( Longitude: -785000.0
(or Parcel ID to closest downstream sewer)
I11. CONSULTANT INFORMATION:
1. Professional Engineer: Thomas Spaulding License Number: 19375
Firm: The Spaulding Group
Mailing address: 5318 Burning Oak Ct
City: Raleigh
State: NC .
Zip: 27606
Phone number: [phone] Email Address: : tom(a,spaulding-group.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Utley Creek Water Reclamation Facility
Owner Name: Town of Holly Springs
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ00 3790•1
2, Downstream (Receiving) Sewer Information: -8 inch ® Gravity
3. System Wide Collection System Permit Number(s) (if applicable):
Owner Name(s): Town of Holly Springs
FORM: FTA 06-21
Permit Number: NC0063096
0 Force Main
WQCS00192
Page 1 of 5

DocuSign Envelope ID: A992C848-6E05-403E-92C9-8BA47C3B3053
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 ®N/A
2. If the Applicant is a Developer of lots to be sold, has a I)eNcIt, er:Igpyratwnal.Agrgcment.(FUR111: DL\) been attached?
❑Yes ❑No ®NiA
3 If the Applicant is a Home/Property Owners' Association, has an 1 IOA'POA Operational Alamein { I ORM; ! IOAI and
supplementary docutnentation as required by I5A NCAC 021_01 15(c) been attached?
❑Yes No ®N.A
4. Origin of wastewater: (check all 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
0 Nursing Home
❑ Car Wash
0 Hotel and/or Motels
❑ Swimming Pool/Clubhouse
❑ Swimming Pool/Filter Backwash
❑ Other (Explain in Attachment)
5. Nature of wastewater : % Domestic 100 % Commercial % Industrial (See 1 iA NC A(: 02 I_.1i l R t2t11)
If Industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No
b. Has a flow reduction been approved under 15A NC AC 02T ,01 I4(f)? ❑ Yes ❑ No
If ves, provide a copv of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow a'b
No. of Units
Flow
Medical Office
250 gal/ doctor
5
1,250 GPD
gal:
GPD
gal/
GPD
gal!
GPD
gall
GPD
gal?
GPD
Toial
1,250 GPD
a See 15A NCL\ 02'I .01 I4jbb,, „}d ,.,(rcN I) and lek2) 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.
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 021.0114) shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
R. Wastewater generated by project: 1.250 GPD (per 15A NCAC 921.0114)
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 pennits that connect to this Zinc
Please provide supplementary information indicating the approximate timeframe for permitting upstream sewers with flow.
0 Flow has already been allocated in Permit Number: Issuance Date:
0 Rehabilitation or replacement of existing sewers with no new flow expected
❑ Other (Explain):
FORM: FTA 06-21
Page 2 of 5

DoeuSign Envelope ID: A992C848-$E05-403E-92C9-8BA47C3B3053
V II. GRAVITY SEWER DESIGN CRITERIA (If Applicable) -112T .0305 & AMI)C IGravft Sewers)=
1. Summarize gravity sewer to be permitted:
Size (inches)
IIIIIIIIMIIIIMMM
8-inchMEM
Length (feet)
MEM
DIP
11111111111111
IIII
Section II & II1 of the MDC for Permitting of Gravity Sewers contains information related to design criteria
r Section I1I 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) — 02T .0305 & MDC (Pump Stations/Force 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 puntp(s): -�
gallons per minute (GPM) at: feet total dynamic head (TDU)
5. Summarize the force main to be permitted (for this Pump Station):
lSize (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,1.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify) _
6. Power reliability in accordance with 15A NCA(' 02 I. .0}05lh)Llj:
❑ Standby power source or ❑ Standby pump
Must have automatic activation and telemetry • 15A NCAC 02T.0305(h)(I)(13)_
• Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
r Must be permanent to facility and may not be portable
Or if the pump station has an average daily flow Tess than 15,000 gallons per day I5A NCACO2T,0305(h)(1)(C):
❑ Portable power source with manual activation. quick -connection receptacle and telemetry
OF
❑ Portable pumping unit with plugged emergency pump connection and telemetry:
i Include documentation that the portable source is owned or contracted by the applicant and is compatible with the station.
lithe 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 06-2 I Page 3 of 5

DocuSign Envelope ID: A9922C848-6E05-403E-92C9-8UA47C3B3053
IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separationslaltematives found in 15A.?j(AC 02I ..030510_4_1.UP
15A NCAC 02T.0305(fl contains minimum separations that shall be provided for sewer systems:
® Yes 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
2Water mains (horizontal)
10 feet
Reclaimed water lines (vertical - reclaimed over sewer)
18 inchess
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 II 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, 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.
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.0305f fl or (gl+ see Section X.1 of this application
* 15A NCAC 02.1.0395W contains alternatives where separations in 02T,0M05t11 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 webjruge
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 drift separation Tectuirements 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 15.1 NCAC 0213 .0200 ❑ Yes ❑ No
> This includes Trout Buffered Streams per 15A NCAc 2B4O202
5. Does the project require coverage/authorization under a 404 Nationwide. individual permits ❑ Yes ® No
or 401 Water Quality Certifications?
Y Please provide the permit number/permitting status in the cover letter if coverage/authorization is required.
6. Does project comply with I5A N.C'A( 02T.010; e 6) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T 0105(t 1(6), 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 ISA NCAC 02 I .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).
Iligh priority lines shall be inspected by the permittee or its representative at least once every six -months and
inspections documented per I5A 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: A9g2C849-6E05-403E-92C9-8BA47C3B3053
X. CERTIFICATIONS:
Does the submitted system comply with 15 NC A( 02I , the Minimum Desit<n Criteria for the Permitting of Pump Station,
and I orce Mains j latesty: erston3, and the Gravity Sewer Minimum Design Criteria (latest Venlun1 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 approval of the permit, and protects 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
1, Thomas Spaulding , attest that this application for South Main Office
(Professional Engineer's name from Application Item II1.1.) (Project Name from Application Item 11 I )
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,
1Iinipt n I}e.'.ign ('rtieria forlir;tvi wirrs () lSs1 vsrsion), and the Minimum De Sigp Crites for the 1 ast-1 rack !°erin�tt»s
of Pump Stations and Force Mains (latest version'. Although other professionals may have developed certain portions of:his
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 I43-215.6B, 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+datp:
DocuSIpned by:
Sr tit'r. •
F330cea1aA7495
3/31/2022
•
lr
r(
[.J
3. Applicant's Certification per 15A NCAC 02T .0t06(b):
I, Kendra D. Parrish, PE , attest that this application for South Main Office
(Signature Authority Name from Application Item 13.i (Project Name from Application Item 11.11
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 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 nut 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 143-2I5,6A 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 S25,000 per violation.
Signature:
oocuSgnw by:
Date:
4/4/2022
03c05e69FC3L10
FORM: FT.A 06-21 Page 5 of 5

DocuSign Envelope ID: A992C848-6E05-403E-92C9-813M7C3133053
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: Sutton Property Phase 2
More than one FTSE may he 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 1.552
e. WWTP facility's actual avg. flow 2.828
f. Total flow for this specific request .001250
g. Total actual and obligated flows to the facility 4.381
h. Percent of permitted flow used 73.0
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 Currcnt 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***
BassLake WQ0013069 1.728 0.691 0.439 0.035 0.474 0.217
* 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): Bass Lake
Downstream Permit Number: NC0013069
Page 1 of 6
FTSE 10-18

DocuSign Envelope ID: A992C848-6E05-083E-92C9-8BA47C3B3053
III. Certification Statement:
1 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 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.
Signing lUF Signature
Exec Director of utilities and Infrastructure
Title of Signing Official
4/4/2022
Date
Page 2 of
FTSE 10-18

DocuSign Envelope ID: A992C848-6E05-403E-92C9-8BA47C3B3053
South Main Office
Project Narrative:
Please see attached submittal package for the South Main office containing a fast -track
application, flow tracking form, USGS map, street level map and fee. The proposed
South Main Office project is located at the 851 South Main Street in the Town of Holly
Springs, North Carolina. The South Main Office development is 14,400 Sf medical office
building. The proposed sewer will be public with a proposed flow of 1,250 GPD
(5 doctors @ 250 GPD/ Doctor).
Project Schedule:
The construction of Sutton Subdivision will begin in June 2022 and should be completed
by August of 2023

O-
a
DocuSign Envelope ID: A992C848-6E05-403E-92C9-8BA47C3B3053
1 inch equals 400 feet

DocuSign Envelope ID: A992C848-6E05-403E-92C9-8BA47C3B3053
''
ff

OocuSign Envelope ID: A992C848-6E05-403E-92C9-8BA47C3B3053
THE TOWN OF
3/31/2022
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: South Main Office
Dear Sir or Madam:
oily e)rings
APR 2222,
rweigh Regional Offie
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
O One original and one copy of the State of North Carolina Fast Track Sewer System
Extension Application (FTA 04- 1 6)
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
o 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,
4414—
wcO6Mb r:.,an
Kendra D. Parrish, P.E., CFM
Executive Director of Utilities and Infrastructure
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 #41966
3002
04.17.2018
DS
r-2M
DS
Utilities and Infrastructure Services
P.O. Box 8 • 128 S. Main Street • Holly Springs, NC 27540 • www.hollyspringsnc.gov

aocuSign Envelope ID: A992C848-6E05-403E-92C9-8BA47C3B3053
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:
Design Engineer:
Address:
South Main Office
The Speol .ng Groan
5318 Burning Oak Ct.. Raleigh, NC 27606
Phone Number: 919.66g.1016 Email: tom spaulding-group.com
Date Complete Application Package Received by
Date Approved: (by RI)
4/4/2022
(by KDP)
As design engineer for this project, I certify the following (please check (x) each applicable box):
ID 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
Dcsign Regulations;
m That each of the following items are completed and enclosed for submittal to the State for z
C
o One cover letter that includes a project narrative Ca b
o A check in the amount of $480.00 to NC DEQ —
rro D
o A check in the amount of $200.00 to the Town of Holly Springs :X3
ID One State of North Carolina form FTA 04-16 Fast Tract Sewer Sy in r.= 5.
Extension Application o• 00 0
ElOne FTSE I0-18 Flow Trackingfor Sewer Extension Applications g.- ,
o One color copy of an 8.5-inch by 11-inch portion of a 7.5-minute 0
USGS Topographic Map showing project area •-i, r0
t i One copy of a street level map showing all relevant project areas 8 0
o One copy of the locally -required Design and Application Certification
(this form)
a sewer extension permit:
Design Engineer's Signature
Date 03/11.22
Please contact Theresa Randall at [phone] or tlleresa.randall dFhollyspringsne.gov if you
have any questions.
2003 Sewer Design Application Certification
01 14.21
Utilities and Infrastructure Services
P.D. Box 8 • 128 S. Main Street • holly Springs, NC 27540 • www.lrallyspringsrrc.gov