WQ0034579_Application (FTSE)_20220531

DocuSign Envelope ID E71BACFD-555A-4850-83E0-F1CC3113447F0
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 Nu;. 1.•*: W ti°Q 51 to0bcompleted by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Town of 1-lolly Springs (company, municipality, I-iOA. utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ® Municipal ❑ Other
3. Signature authority's name: Kendra D. Parrish. PE per 15A NCAC 02T .OIO&bj
Title: Executive Director of Utilities and Infrastructure Service
4. Applicant's mailing address: 128 South Main Street, PO Box 8
City: Flolty Springs State: NC Zip: 27540-
5. Applicant's contact information:
Phone number: [phone] Email Address: Kendrp arrishi hollyspriogsnc.gov
Raleigh Regional Office
11. PROJECT INFORMATION:
I. Project name: Friendship Public Utilities Extension (formerly known as Holly Springs Industrial Site)
2. Application/Project status: ❑ Proposed (New Permit) ® Existing Permit/Project
Ka modification, provide the existing permit number: WQ0034579 and issued date: March 17, 2010
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 RECEIVED
4. Approximate Coordinates (Decimal Degrees): Latitude; 35.66956Z Longitude: - 78.906069°
5. Parcel ID (if applicable): WA (or Parcel ID to closest downstream sewer)
NC Dept of Environmental Quality
MAY 3 1 2022
111. CONSULTANT INFORMATION:
1. Professional Engineer: Christopher R. Pctree
Firm: Timmons Group
Mailing address: 5410 Trinity Road, Unit 102
City: Raleigh State: NC Zip: 27607-
Phone number: [phone] Email Address: chris.petre a timmons.com
License Number: 041935
JUN--2 2022
?yQ-FAYETTEtlIL L E P,EG',O ALOFF ICE
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
I. Facility Name: Holly Springs Utley Creek WRF Permit Number: WQ0032289
Owner Name: Holly Springs, NC
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Numbcr(s): WO Downstream sewer is a force main at the Utley Creek WRF
2. Downstream (Receiving) Sewer Information; 24-inch El Gravity El Force Main
3. System Wide Collection System Permit Numbcr(s) (if applicable): WQCS00192
Owner Name(s): Town of Holly Springs. NC
FORM: FTA 06-21
Page 1 of 5

DocuSign Envelope ID: E71BACFD-555A-4850-83E0-F1CC31B447F0
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 ® N.fA
2. If the Applicant is a Developer of lots to be sold, has a Developer' g (gerational Agreement 1OORM: DEN!) been attached?
❑ Yes ❑ No ® NfA
3. If the Applicant is a Home/Property Owners' Association, has an HOA.FOA Operational Agreement (FORM: HOAR and
supplementary documentation as required by I5A NCAC 02T.01 I5(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
❑ Nursing Home
❑ Car Wash
❑ Hotel and/or Motels
❑ Swimming Pool/Clubhouse
❑ Swimming Pool/Filter Backwash
❑ Other (Explain in Attachment)
5. Nature of wastewater : 33% Domestic 33% Commercial 33% industrial ( j5A NCAC 02T .0103(701)
If Industrial, is there a Pretreatment Program in effect? ® Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 02T .0114L0? ® Yes ['No
If ves, Provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow'"
No. of Units
Flow
NIA
N/A
N/A
NIA
Total
0
a Sec 1 A N AC 02T 9.114b1, {dl, iel{ 11 and fclt21 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 lin table 11A NCAC 02T )114j shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 0 GPD (per 15A NCA(' 02T .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.
❑ 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 06-2 i
Page 2 of 5

DocuSign Envelope ID: E71BACFD-555A-4850-83E0-F1CC31B447F0
VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
I. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
24"
6
C-900 PVC
➢ Section 1I & I11 of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section 11I 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 & 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: Friendship Pump Station
2. Approximate Coordinates (Decimal Degrees): Latitude: 35.67516° Longitude: 78.90923'.
3. "Total number of pumps at the pump station: 2
3. Design flow of the pump station: 2.088 million 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): 1,460 gallons per minute(GPM) at 155 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
I6"
26,390
C-900 PVC
20"
1,300
C-900 PVC
If any portion of the force main is less than 4-inches in diameter, please idcntify the me hod of solids reduction per
MDCPSFM Section 2.0IC.l.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with i i :1SC' J2•1' .0305(h)( I):
CI
Standby power source or ❑ Standby pump
➢ Must have automatic activation and telemetry - I5A NCAC 02T.0305(h)(I)(B)_
➢ Required for ail 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 E71BACFD-555A-4850-83E0-FICC31B447F0
1X. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations/alternatives found in J5A NCAf 02T -0305( C} & iv.)? ® Ycs ❑ No
15A 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
'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-I waters of Class I or
Class II impounded reservoirs used as a source of drinking water, and associated wetlands.
100 feel
**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 02T.0305(ff Qr IA see Section X.1 of this application
*15A NCAC 02T.0305(g) contains alternatives where separations in 02Ty0/05jf] cannot be achieved. Please check "yes"
above if these alternatives arc used and provide narrative information to explain.
** Stream classifications can be identified using the Division's NC Surface Water Classilkgions webpage
2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No 0 NSA
➢ 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? Z Yes ❑ No 0 NIA
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ See the Division's dint). SC.PairaIion requirements 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 I5A N {}200? ❑ Yes ❑ No
➢ This includes Trout Buffered Streams per I5A NCAC 2B-0202
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ® Yes El No
or 401 Water Quality Certifications?
➢ Please provide the permit number/permitting status in the cover letter if coverageiauthorization is required.
6. Does project comply with 15A NCAC OWT.0105(e)(6) (additional permits/certifications)? ® Yes 0 No
Per ISA NCAC 02T,01I1:5 eK6), 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 I,1'AC 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

DocuSign Envelope ID: E7IBACFD-555A-4850-83E0-FiCC31B447F0
X. CERTIFICATIONS:
Does the submitted system comply with I$A NCAC 02T, the Minimum Design Critcri. for the P 1mittir,g i f I'urttp Stations
and Force Mains (latest version', and the Crravih+.5. wer Minim r�rr .Design Criteria glakesLymionl as applicable?
® Ycs ❑ No
If no, for projects requiring a single variance, complete and submit the Variance/Alternative Design Request application
(VADC 10-14) and supporting documents for review to the Central Office. Approval of the request will be issued
concurrently with the approval of the permit. and projects requiring a variance approval may be subject to longer
review times. For projects requiring two or more variances or where the variance is determined by the Division to be a
significant portion of the project, the full technical review is required.
2. Professional Engineer's Certification:
I, Christopher R. Petree , attest that this application for Friendship Public Utilities Extension (formerly known as Holly SDnngs Industrial
Site) (Professional Engineer's name from Application Item 111 I ) (Project Name from Application Item lI 1)
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans,
specifications, engineering calculations, and all other supporting documentation to the best of my knowledge. I further
attest that to the best of my knowledge the proposed design has been prepared in accordance with the applicable regulations,
Minimum Design Criteria fqr Gr$vits Sewers Slate t version), and the Minimum Desimn Criteria for LK Fist - fnek Permitting
pf Punn Stations and Force Mans j atcst version). Although other professionals may have developed certain portions of this
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 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 tine not to exceed $10,000, as well as civil penalties up to $25,000 per violation. Misrepresentation of the application
information, including failure to disclose any design non-compliance with the applicable Rules and design criteria, may subject
the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NCAC 56.0701)
North Carolina Professional Engineer's seal, signature, and date:
Q'ftiSSrp..ti ;
• ;tU p
a SEAL
041935
lEti�• ,``
i i,gwk;-2O 22
DocuSigned by:
3. Applicant's Certification per 15A NCAC 02T .0106(b): fr is 5/26/2022
Kendra Parrish U�� nuo2�
1, , attest that this application for Fiieni$ upLrnrie3 F.ktensron tforrplg : known as
Holly Springs Industrial Site) (Signature Aulhonty Name from Application Item I.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.
1 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. 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 1V3-215.6A 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 $I0,000 as well as civil penalties up to $25,000 per violation.
Signature:
LDa...aid
ocuslgned by
Date:
5/26/2022
FORM: FTA 06-21 Page 5 of 5

DocuSign Envelope ID. E71BACFD-555A-4850 83E0-FiCC34B447F0
�•••
•
ci.
TIMMONS GROUP
May 12, 2022
Scott Vinson — Regional Supervisor
Raleigh Regina! Office
3800 Barrett Drive Ra ieigf>' Regional Office
Raleigh, North Carolina 27609
RE: Holly Springs Industrial Site (WQ0034579), March 17, 2010 — Permit Modification
aka - Friendship Public Utilites Extension Project A, Project 8, and Sanitary Pump Station
5410 Tnnity Road P 919 866.4951
Suite 102 F 919 859 5663
Raleigh, NC 27607 www.tknmons.com
NC Dept of Environmental QuAlity
Dear Mr. Vinson,
MAY 312022
Timmons Group is pleased to submit the following Fast Track Sewer System Extension Application
permit modification package on behalf of the Town of Holly Springs for the Friendship Offsite Utilities
Extension project. The following Fast Track Sewer System Extension Application permit package
includes one original of the following:
1. A Fast Track Sewer System Extension Application (FTA 06-21),
2. A check for $480.00 payable to NCDEQ,
3. A copy of the Flow Reduction Approval Letter,
4. A USGS Topographic Site Map,
5. An aerial map showing the general project location, and
6. The existing permit WQ0034579.
This application is a modification to existing permit WQ0034579 (Holly Springs Industrial Site). The
existing permit includes 13,850 LF of 12" force main. This project replaces all of the previously
permitted force main with 26,390 LF of 16" C-900 PVC force main (12,645 LF Project A;13,005 LF Project B;
740 LF Pump Station); 1,300 LF of 20" C-900 PVC force main (Pump Station); a 1,460 GPM Pump Station;
and 6 LF of 24" C-900 PVC gravity sewer (Pump Station). This application does not request acceptance of
generated wastewater. Wastewater is generated by future projects beginning in late 2022, therefore no
Flow Tracking for Sewer Extension Application is included with this submittal.
This project has received approval of an Individual 401 Water Quality Certification on February 17,
2022 (individual certification #WQC004655).
If you have any questions or need any additional information, please don't hesitate to contact
me at 919.532.3234 or c sis.petreeatimmons.com at your convenience.
Sincerely,
Christopher R. Petree, PE, DBIA
Manager, Water Infrastructure Carolinas
ENGINEERING I DESIGN I TECHNOLOGY

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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
Stepanie L. Sudano, P.B., 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. Sudano:
A11:411p1C.A
dEHNR
On 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 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.
In vie* 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.
SinCey
cc: Raleigh Regional Office, Water Quality Section
State Engineering Review Group
iA. Preston Howard, Jr., P.E.
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: E71BACFD-555A-4850-83E0-F1CC31B447I-ci
&NR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Govemor Director Secretary
March 17, 2010
Ms. Stephanie Sudano, PE
Director of Engineering
Town of Holly Springs
P. O. Box 8
Holly Springs, NC 27540
Subject: Permit No. WQ0034579
Holly Springs Industrial Site
Wastewater Collection System Extension
Wake County
Dear Ms. Sudano:
RECEi VE
MAR 2' VfV
ENONEERiNC1
In accordance with your permit application received February 2, 2010, we are forwarding herewith
Permit No. WQ0034579 dated March 17, 2010, to the Town of Holly Springs for the construction and
operation of the subject wastewater collection system extension. This permit shall be effective from the
date of issuance until rescinded and shall be subject to the conditions and limitations as specified
therein. This cover letter shall be considered a part of this permit and is therefore incorporated therein
by reference.
Please pay particular attention to:
a) Permit Condition 3 that requires that the wastewater collection facilities be properly operated
and maintained in accordance with 15A NCAC 02T .0403 or any individual system -wide
collection system permit issued to the Permittee, and
b) Permit Condition 6 that requires Engineering Certification prior to operation of this collection
system extension, and
c) Permit Condition 12 which requires abandonment of private water wells, and
d) Permit Condition 13 regarding permit modification.
Permitting of this project does not constitute an acceptance of any part of the project that does not meet
15A NCAC 02T; the Division of Water Quality's (Division) Gravity Sewer'Minimum Design Criteria
adopted February 12, 1996 as applicable; and the Division's Minimum Design Criteria for the Fast -
Track Permitting of Pump Stations and Force Mains adopted June 1, 2000 as applicable, unless
specifically mentioned herein. Division approval is based on acceptance of the certification provided by
a North Carolina -licensed Professional Engineer in the application. It shall be the Permittee's
responsibility to ensure that the as -constructed project meets the appropriate design criteria and rules.
Failure to comply may result in penalties in accordance with North Carolina General Statute §143-
215.6A through §143-215.6C, construction of additional or replacement wastewater collection facilities,
and/or referral of the North Carolina -licensed Professional Engineer to the licensing board.
N°4Caro �' a
A/already
North Carolina Division o1 Water Quality Raleigh Regional Office Surface Water Protection Phone [phone] Customer Service
Internet: www.ncwaterquality.org 1628 Mall Service Center Raleigh. NC 27699-1628 FAX [phone]
An Equal Opportunity/Affirmative Acton Employer — 50% Recycled/10% Post Consumer Paper

DocuSign Envelope ID: E71BACFD-555A-4850-83E0-F1CC31B447F0
„*vat, THE TOWN
May 26, 2022
O F
Director, Division of Water Resources
Raleigh Regional Office
Water Quality Operation Section
3800 Barrett Drive
Raleigh, NC 27609
bily c)frings
NC Dept of Environmental Quality
MAY 312022
Raleigh Regional Office
Re: Application for Sewer Extension Permit
Project: Holly Springs Industrial Site permit modification; WQ0034579; March 17, 2010
Friendship Public Utilities Project A, Project B, and Sanitary Pump Station
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:
One original and one copy cover letter including a project narrative
o A check in the amount of $480.00
One original and one copy of the State of North Carolina Fast Track Sewer System
Extension Application (FTA 04-16)
0
o Two color copies of a 8.5-inch by i l -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
0 The existing permit WQ003457
Feel free to contact me at 919-577-3150 should you have any questions or need additional
information in order to process this application.
Docuspn•u by:
Sincerely,
Kendra D. a691sr`-°•CFM
Executive Director of Utilities and Infrastructure
KP/tr
cc: Project Consultant Engineer, Chris Petree, PE
Rachel Ingham, Utility Engineer
Drew Johnson, Development Construction Manager
Theresa Randall, Utility Permitting Specialist
Project file/Correspondence #41994
3002
04 17 2018
{ Ds
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
Project:
Design Engineer:
5410 Trinity Rd, Suite 102, Raleigh, NC 27607
Address:
DocuSign Envelope ID: E718ACFD-555A-4850-83E0-F1CC31B447F8
MAY 312022
fdaasigh)(ln beat
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
Holly Springs industrial Site permit modification; W00034579; March 17, 2010
aka: Friendship Public Utilities Extension Projects A, B and Sanitary Pump station
Chris Petree
[phone] [e-mail]
Phone Number: Email:
Date Complete Application Package Received by Town:
Date Approvedr2= 5/26/2022 (by RI 5/26/2022
(by KDP ) (by DJ)
5/26/2G2
As design engineer for this project, I certify the following (please check (x) each applicable box):
❑ 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
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
o 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)
LaeDocuSlgned byDesign Engineer's Signatured t-
5t06s7556FA3402
5/26/2022
Date
Please contact Theresa Randall at [phone] or theresa.randall ct holly-springsnc.gov if you
have any questions.
2003 Sewer Design Applicauo,_ Crnification
01.14.21
Utilities and Infrastructure Services
P.D. Box 8 • 128 S. Main Street • Holly Springs, NC 27540 • www.hollyspringsne.gov