WQ0043522_Application (FTSE)_20220531

NC Dept of Environmental Quality
DocuSign Envelope ID. DC68EFDF-C94C-430E 80CB-25830449E476
DWR
Division of Water Resources
HAY 3 1 2022
Raleigh Regional Office
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 W c0 4✓ J aa, (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Town of INN Spring
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ® Municipal ❑ Other
3. Signature authority's name: Kendra P .Parrish, PE . per I5A N 'MC 02T .0iEgtal
Title: I<:xecutive Director of Utilities & Infrastructpre Service
—
4. Applicant's mailing address: 128 South Main Street, PO Box 8
City: Holly Springs State: tdt<' Zip: 27540
5. Applicant's contact information;
Phone number: [phone] Email Address: Kendra.pttrrishiiilholllyspli snc.gov
I1. PROJECT INFORMATION:
I. Project name: Friendship Innovation Park Infrastructure
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: 35.6750 Longitude; _ 78.9028
5. Parcel ID (if applicable) : (or Parcel ID to closest downstream sewer)
111. CONSULTANT INFORMATION:
I. Professional Engineer: Brandon McLamb License Number: 34373
Firm: Timmons Group
Mailing address: 5410 Trinity Road, Suite 102
City: Raleigh
Phone number: [phone]
State: NC Zip: 27607
Email Address:: brandon.mclamb a,timmons.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
I. Facility Name: Utley Creek Water Reclamation Facility Permit Number: NC0063096
Owner Name: Town of Holly Springs
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ00 Downstream sewer being permitted concurrently - Holly Springs Industrial Site permit modification
WQ0034579 - aka Friendship Public Utilities Extension Projects A, B, and Sanitary Pump Station
2. Downstream (Receiving) Sewer Information: 24 inch ® Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable):
Owner Name(s): Town of Holly Springs
FORM: FTA 06-21
W QC S00192
Page 1 of 5

DocuSign Envelope ID: DC68EFDF-C90C-430E-80CB-25830449E476
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 ®NfA
2. If the Applicant is a Developer of lots to be sold, has a Vevelgocr's Oncraiional Agrcemepl {CORM; DLVI been attached?
❑ Yes ❑ No ®N'A
3. If the Applicant is a Home/Property Owners' Association, has an I IOAIPOA Ot?eraiional Aerecrhent; FORM: BOAI and
supplementary documentation as required by I5A NCAC 02T.0115(c) been attachcd?
❑Yes ❑No (0 NIA
4. Origin of wastewater: (check all that apply):
❑ Residential (Individually Owned)
❑ Residential (Leased)
0 School / preschool / day care
❑ Food and drink facilities
❑ Businesses / offices / factories
❑ Retail (stores, centers, malls)
❑ Retail with food preparation/service
❑ Medical + dental 1 veterinary facilities
0 Church
❑ Nursing Home
❑ Car Wash
❑ Hotel and/or Motels
❑ Swimming Pool/Clubhouse
❑ Swimming Pool/Filter Backwash
❑ Other (Explain in Attachment)
5. Nature of wastewater : % Domestic % Commercial 100 % Industrial (SLR 5A NCA ' 027 .010300))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes❑ No
6. Ilas a flow reduction been approved under 15A NCAC 021' ,Q[114? ® Yes ❑ No
➢ If ves, provide a coin of flow reduction approval letter with this annlication
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(0)
Daily Design Flow
No. of Units
Flow
Unknown
0 gab' day. acre
237
0 GPD
gal?
GPD
gal.
GPD
gal.
GPD
gall
GPD
gal?
GPD
Total
0 GPD
a See 15A NCAC 02J .01 14(b), Idi. (el(JlA1814,l. = 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 I5A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15 ,NCAC 02T.,01 141 shall he
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 0 GPD (per 1'5,J'1QA(' 02'T .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 permits that connect to this line.
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:
❑ Rehabilitation or replacement of existing sewers with no new flow expected
❑ Other (Explain):
FORM: FI-A 06-21
Page 2 of 5

DocuSign Envelope ID. DC68EFDF•C90C-430E-BOCB-25830449E476
Vll. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers)
I. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8-inch
1
192
PVC
a
I 2-inch
Q
105
PVC
El
I8-inch
2,122
PVC
0
18-inch
203
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) — 02T .0305 & MDC (Pump Stations/Force Mains):
PROVIDE A SEPARATE COPY OF TIIIS PAGE FOR EACH PUMP STATION INCLUDED IN TIIIS 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 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 Icss than 4-inches in diameter, please identify the me hod of solids reduction per
MDCPSFM Section 2.01C.I.b. ❑ Grinder Pump ❑ Mechanical liar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A N._UT 02T _03(15(h1l I):
❑ Standby power source or ❑ Standby pump
➢ Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(I)(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 Icss than 15,000 gallons per day l5A 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 Enve ope ID DC68EFDF.C90C-4 XF-80CB-25830449E476
IX. SETBACKS & SEPARATIONS • (02B .0200 & I5A NCAC 02T .0305(f)):
1. Does the project comply with all separations''alternatives found in I5A NCAC O2T .0305t f1. jam? ® Yes ❑ No
I5A NCAC 02T,0305(f} contains minimum separations that shall be provided for sewer systems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
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 inches
Reclaimed water lines (horizontal - reclaimed over sewer)
2 feet
**Any private or public watcr supply sourcc, including any wells, WS-I waters of Class 1 or
Class II impounded reservoirs used as a source of drinking watcr, and associated wetlands.
100 feet
**Waters classified WS (except WS-I or WS-V), B, SA, ORW, 11QW, or S13 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 02.1";b](ll pr (g), sec Section X.1 of this application
*1$A TV A(' 021_0305(g) contains alternatives where separations in 021'.030541l 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 Classificatigg
2. Does this project comply with the minimum separation requirements for water mains? CI 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?
> Please provide supplementary information identifying the areas of non-conformance.
➢ See the Division's draft selaratign requirements for situations where separation cannot be met.
➢ No variance is required lithe 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:Cape Fear ❑ No
If yes, does the project comply with setbacks found in the river basin rules per I5A NCAC 02B .0200? ® Ycs ❑ No
> This includes Trout Buffered Streams per 15A NCAC 2B..0_202
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ® Yes ❑ No
or 401 Water Quality Certifications?
➢ Please provide thc permit numberfpermitting status in thc cover letter if coverage/authorization is required.
6. Does project comply with 15A NCAC WT.0105(016) (additional permits/certifications)? ® Yes ❑ No
Per I5A NCAC 9 _0105(cX6), directly related environmental permits or certification applications must be being prepared,
have bccn 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 15A NCAC 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.
➢ 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
® Ycs
❑ No ❑ N/A

DocuSign Envelope ID: DC68EFDF-C9OC-430E-80CB-25830449E476
X. CERTIFICATIONS:
Does the submitted system comply with ISA j AC 021', the Minimum Design Criteria for the Pemuilit%of Pump Stations.
and Force Iv anti (latest version), and the graiiv Scwcr 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. Approval of the request will be issued
concurrently with the approval of the Hermit, and projects requiring a variance approval may be subiect to longer
review times. For projects requiring two or more variances or where the variance is determined by the Division to be a
sienifjcant portion of theproiect, the full technical review is required.
2. Professional Engineer's Certification:
Brandon McLamb , attest that this application for Friendship Innovation Park Infrastructure
(Professional Engineer's name from Application Item III 1) (Project Name from Application Item 11.1)
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans,
specifications, engineering calculations, and all other supporting documentation to the best of my knowledge. I further
attest that to the bcst of my knowledge the proposed design has been prepared in accordance with the applicable regulations,
Minimum Design Criteria "pi Grg,vil y Scuers.{Iptesl version), and the Mbimum Design Criteria for iI Fat l-1 rack Permitting
of PurFip Stations and Force Mains /latest version). Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies That 1 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 $I0,000, 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:
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3. Applicant's Certification per 15A NCAC 02T .0106(b):
1, Kendra D. Parrish, PE , attest that this application for Friendship Innovation Park Infrastructure
(Signature Authority Name from Application Item 1 3) (Project Name from Application Item 11.1)
attest that this application has been reviewed by me and is accurate and complete to the best of my knowledge.
understand that if all required parts of this application arc not completed and that if all required supporting documentation
and attachments are not included, this application package is subject to being returned as incomplete. 1 understand that any
discharge of wastewater from this non -discharge system to surface waters or the land will result in an immediate enforcement
action that may include civil penalties, injunctive relief, andfor 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 accordancc 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:
E4DocuSigned
by:
aNi`}"JC9rC H 44
Date:
5/26/2022
FORM: FTA 06-21 Page 5 of 5

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DocuSign Envelope ID DC68EFDF-C9OC-430E-BOCB-25830449E476
THE TOWN OF t
May 26, 2022
Director, Division of Water Resources
Raleigh Regional Office
Water Quality Operation Section
3800 Barrett Drive
Raleigh, NC 27609
qfolly c5prings
NC Dept of Environmental Quality
MAY 312022
Raleigh Regional Mee
Re: Application for Sewer Extension Permit
Project: Friendship Innovation Park Infrastructure
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 $480.00
o One original and one copy of the State of North Carolina Fast Track Sewer System
Extension Application (FTA 04-16)
0 Two copies of FTSE 04-16 Flow Tracking/Acceptance Form
o Two color copies of a 8.5-inch by I 1-inch portion of a 7.5 minute USGS Topographic
Map showing project area
o Two copies of a street level map showing all relevant project areas
o One copy of the locally -required Design and Application Certification
Feel free to contact me at 919-577-3150 should you have any questions or need additional
information in order to process this application.
Sincerely,
DceuSgned by
Kendra L f9 Sf$ Pf,` 44.E., CFM
Executive Director of Utilities and Infrastructure
KP/tr
cc: Project Consultant Engineer, W. Jordan Brewer
Rachel Ingham, Utility Engineer
Drew Johnson, Development Construction Manager
Theresa Randall, Utility Permitting Specialist
Project file/Correspondence #41995
3002
04 172018
, DS
F3
Rachel Ingham
utility Engineer
Utilities and Infrastructure Services
P.O. Box 8 • 128 S. Main Street • Holly Springs, NC 27540 • www.hollyspringsnc_gov

NC Dept of Environmental Quality
DocuSign Envelope ID: DC68EFDF-C90C-430E-80CB-25830449E476
HAY 312022
-WO Passional Urges
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 thc Fast Tract Application for extension to the Town of
Holly Springs Sewer System
Project:
Design Engineer:
Address:
Friendship Innovation Park
Brandon McLamb
5410 Trinity Road. Suite 102
Phone Number: (9191 866-4935 Email: brandon.mclambetimmons.com
Date Complete Application Package Received by Town:
Date Approved: 5/26/2022 (by R1 t'r' 5/26/2022 (by KDP = (by DJ)
f26/2022
As design engineer for this project, I certify thc following (please check (x) each applicable box):
I l That the design of the project is in complete conformance with the Town of Holly
Springs Engineering Dcsign and Construction Standards and NC DEQ Sanitary Sewer
Design Regulations;
❑ That each of the following items arc completed and enclosed for submittal to the State for
a sewer extension permit:
❑ One cover letter that includes a projcct narrative
o A check in the amount of $480.00 to NC DEQ
o 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
o One FTSE 10- 1 8 Flow Tracking for Sewer Extension Applications
o 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 Date 12/09/21
Please contact Theresa Randall at [phone] or theresa.randall cr hollyspringsilc,zov if you
have any questions.
2003 Scwcr Dcxign Appkicauon C .rli ication
01 14.21
Utilities and Infrastructure Services
P.O. Box 8 • 128 S. Main Street • Holly Springs, NC 27540 • www.hollyspringsnc.gov