WQ0040152_Application (FTSE)_20220606

DocuSign Envelope ID. BEE3A7E4.9615-4B9C-96ECAOF9E34820A8
[CLIALTI-LI
Division of Water Resources
Application Number:
State of North Carolina
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 06-21 & SUPPORTING DOCUMENTATION
(to be completed by DWR)
All items must be comoleted or the application will be returned
1. APPLICANT INFORMATION:
1. Applicant's name: Town of Holly Spring
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 perl5ANCA 2T 010G
Title: Executive Director of Utilities & Infrastructure Service
4. Applicant's mailing address: 128 South Main Street P0 Box
City: Holly Shrines State: NC Zip: 222A¢
5. Applicant's contact information:
Phone number: 9( 10 577-3150 Email Address: Kendra.narrishO—hollyspringsnc.gov
II. PROJECT INFORMATION:
I . Project name: Collins Park - i
2. Application/Project status: ❑ Proposed (New Permit) ® Existing Pemiit/Project
If a modification, provide the existing permit number: WQ00 40152 and issued date: _July 19, 2Q18 _
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: 35.6330 Longitude:-78.8291 °
5. Parcel ID (if applicable) : 0014202 (or Parcel ID to closest downstream sewer)
111. CONSULTANT INFORMATION:
I . Professional Engineer: dick Baker License Number: 22530
Firm: -TimmonsGrou
Mailing address: 5410 Trinity Road; Suite 102
City: - Raleigh State: NC Zip: 27609
Phone number: [phone] Email Address:: [e-mail]
TV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Utley Creek Water Reclamation Facility Permit Number: NCO063096
Owner Name: Town of Holly S rip s
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ0037528
2. Downstream (Receiving) Sewer Information: -8 inch ® Gravity 0 Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCSOO192
Owner Name(s): Town of liolly-Sp—rings
FORM: FTA 06-21 Page 1 of 5

DocuSign Envelope ID: BEE3A7E4-9615-4B9C-96EC-40F9E34820A8
V1. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
[-]Yes ❑ No ®NSA
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agrecment (FORM;- I V) been attached?
❑ Yes ❑ No ® NIA
3. If the Applicant is a Home/Property Owners' Association, has an HOA/POA Operational Agreement (FORM. ROM and
supplementary documentation as required by I SA NCAC 02T.0I 15(c) been attached?
❑ Yes ❑ No ® NIA
4. Origin of wastewater: (check all that apply):
❑ Residential (Individually Owned) ® Retail (stores, centers, malls) ❑ Car Wash
❑ Residential (Leased) ® Retail with food preparation/servicc ® Hotel and/or Motels
❑ School / preschool i day care ❑ Medical / dental / 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 .01(13(20))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .01 14(1)? ❑ Yes ®No
➢ If ves,_twovide 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 ' 1
No. of Units
Flow
Grocery Store (130 gpd per 1,000 sf)
130 gall day
20400
2,652 GPD
Hotel (120 gpd per room)
120 gal/ day
108
12,960 GPD
Restaurant (40 gpd per seat)
40 gall day
96
3.840 GPD
Shoppes (Rest. 300 seats and Retail 20 em
gall see attached letter
12,500 GPD
Lot 213 (Rest. 120 seats and retail 10 empl)
gall see attached letter
5,050 GPD
A.
gall
GPD
Total
37,002 GPD
a See 15A NCAC 02T .0114(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. 421-4).
b Per 1 SA NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.01141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project_ 37.002 GPD (per) 5 N . 0214)
D 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

DocuSign Envelope ID: BEE3A7E4-9615-4B9C-96EC40F9E34820AB
VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & iNIDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Lit -if
0
Size (inches) Length (feet) Material
8-inch 1,103 PVC
➢ 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
PUMP STATION DESIGN CRITERIA (If Applicable)— 02T.0305 & NIDC (Pump Stations/Force Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
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 (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) I Length (feet) I 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 2.01 C.l .b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with I SA NCAC 02T .0305(h)i I'i:
❑ Standby power source or ❑ Standby pump
➢ Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(1)(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 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

UcCuSigri Envelope ID: BEE3A7E4-9615-4B9C-96EC-40F9E34820A8
Ix SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations/alternatives found in 15A NCAC 02T .0305(f) & (g)? ® Yes ❑ No
15A NCAC 02T.0305(t) 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
!Water 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 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, 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 we[] as wetlands associated with these waters or classified as WL.
10 feet
Any building foundation (horizontal)
5 feet
A oy basement (horizontal)
10 feet
'Cop slope of embankment or cuts of 2 feet_ or more vertical height
10 feet
_Drainage systems and interceptor drains
5 feet
Any swinumng pools
10 feet
Final earth grade (vertical)
36 inches
➢ If noncompliance with 02T,0305(f) 4r (g). see Section X.1 of this application
*15A NCAC Q2T.0305(e) contains alternatives where separations in 2T.0305 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'Aster Clussificauotls webnaae
2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ NA
➢ 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 requiremcnis 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: N— ❑ 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 213.0202
S. Does the project require coveragefauthorization under a 404 Nationwidelindividual permits ❑ Yes ® No
or 401 Water Quality Certifications?
➢ Please provide the permit numbedpermitting status in the cover letter i f coverage/authorization is required.
6, Does project comply with 15A HC'AC(} ,01t _. t0) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T-0105ic)(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 I5A NCAC 07T.0407.., "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 BEE3A7E4-9615.4B9C-96EC-40F9E34820A8
X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimpin QCsiµn C'r iteril for thr f'ernimmV Pf Punm St o i.iy
;end Forcr Mates (rarest ver5ronl, and the t.iTak ity S4ucr Mtiilmuiu_Dcsi,?n C'ritcria [ la[cst vcrs tt as applicable"'
® Yes ❑ No
If no, for projects requiring a single variance, complete and submit the Variance/Alternative Design Request application
(VADC 10-I4) and supporting documents for review to the Central Office. Approval of the request will be issued
concurrently with the anuroval of the vermit. and nroiects requirine a variance approval maN_be_sublect to loneer
review times. For ro ect reguirine two or more variances or where the variance is determined by the Division to be a
slizoillicant portion of the aroject. the full technical review is required.
2. Professional Engineer's Certification:
1, Rick Baker _ _ _ , attest that this application for Collins Park - Modification
(professional Engineer's name from Application Item 111.1.) (Project Name from Applcation Item 11. [ )
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,
zlutt MAW 1]e612n Qiletju fUi' QT.twty Sewers (latest vonjon), and the h oinnuin Drsi11] QKgcr[a fnr 1k t-Yrac� Perm myLW
of Ptii= Stations and Force Mains [ rates[ wcrsioil 1. 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 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:
...........
3. Applicant's Certification per 15A NCAC 02T .0106(b):
5
I, Kcrtdra D. Parrish. PE , attest that this application for Collins Park - Modification
(Signature Authority Name from Application Item U.) (Project Name from Application Item 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. 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 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 accordance with General Statutes 143-215.6A and 143-7215, 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.
_DocuSigned
Signature: 4
Date: 6/1/2022
FORM: FTA 06-21 Page 5 of 5

DocuSign Envelope ID. BEE3A7E4-9615-4B9C-96EC-4o✓=9E34820AB
State of North Carolina
Department of Environmental Quality
Division of Water Resources
OlvNion of Wrter 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: Collins Park___
More than one FTSE maybe 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.
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
All flows are in MGD
c. WWTP facility's permitted flow 6.0
d. Estimated obligated flow not yet tributary to the WWTP 1.544
e. WWTP facility's actual avg. flow 2,828
f. Total flow for this specific request .037
g. Total actual and obligated flows to the facility 4.409
h. Percent of permitted flow used 73.5
ll. 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
Current
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
0.058 0.497
0.194
* 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): Bass Lake PS
Downstream Permit Number: WQ0013069
Pagel of 6
FTSE 10-18

DocuSign Envelope to BEE3A7E4-9615-4B9C-96ECAOF9E3482DA8
III. Certification Statement:
I 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.
Doc
u 6y.
Signing Offictal. tgna&ut
Exec Director of utilities and infrastructure
Title of Signing Official
6/1/2o22
Date
Page 2 of 6
PTSE 10-18

DocuSign Envelope ID. BEE3A7E4-9615-4B9C-96EC40F9E34820A8
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DocuSign Envelope ID. BEE3A7E4-9615-4B9C-96EC-40F9E3482OA8
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DocuSign Envelope ID BEE3A7E4-9615-489C-96EC4oF9E34820A8
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TIMMONS GROUP
May 27, 2022
Director, Division of Water Resources
Raleigh Regional Office
Water Quality Section
3800 Barrett Drive
Raleigh, NC 27609
RE: Collins Park
Sanitary Sewer Permit Modification
Permit #: WQ0040152
Holly Springs, NC
Dear Rachel:
5410 Trinity Road P 9 49 866 4951
Suite 102 F 919 8%5663
Raleigh. NC 27607 www.Ommonr.com
NC Dept ofEnvitmmental Qality
Raleigh Regional om,,,e
Please find attached the following items for the Collins Park Mater sewer permit modification.
Original and 1 copy of each provided.
• Cover letter
• FTA 06-21 Fast Track Sewer Application
• FTSE 10-18
+ USGS Topographic Map
• Street Level Map showing project area
• Local 2003 Sewer Design and Application Certification (1 Copy)
• Check to NCDEQ for $480
Note, the sewer design as completed by another Engineer and has already been installed.
This permit modification is for permitting additional flow at Collins Park. The original permit was
for 13,000 GPD and this modification is for an additional 24,002 GPD for a total flow of 37,002
GPD.
As noted in FTA 06-21 Section V1.7, here are the sewer flow calculations for the Shoppes at
Collins Park and Lot 2B.
Shoppes of Collins Park
Restaurant 300 seats x 40 GPD = 12,000 GPD
Commercial (8,585 SF) 20 employees x 25 GPD = 500 GPD
Total Flow = 12,500 GPD
ENGINEERING I DESIGN I TECHNOLOGY

DocuSign Envelope ID. BEE3A7E4-9615-4B9C-96EC40F9E34820AB NC Deg of&vironment( Quality
JUN - 6 2022
Raleigh R4anal Off
Lot 2B
Restaurant 120 seats x 40 GPD = 4,800 GPD
Commercial (4,000 SF) 10 employees x 25 GPD = 250 GPD
Total Flow = 5,050 GPD
Sincerely,
Rick Baker, PE
Principal, Raleigh Commercial
Cc: Town of Holly Springs

NCI ofEnVirMMenW Q►ialitY
DocuSign Envelope ID- 8EE3A7E4 9615-4139C-96EC-40F9E34820A8
JON - 6 2022
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: Collins Park
Design Engineer: Rick Baker PE_ Timmgl3s Group
Address: 5410 Trinity Road: Suite 102, Raleiah NC 27608
Phone Number: - Email: dck.baker0timmons.com
Date Complete Application Package Received by Town:
os O6 oa
Date Approved: 2z 6/1/2022 (by Ri 6/1/2022 (by KD ) �D 6I112p22 (by DJ)
As design engineer for this project, [ certify the following (please check fx) each applicable box)_
EI 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
❑ A check in the amount of $480.00 to NC DEQ
a 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
❑ 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)
Design Engineer's Signature ;il�: :«-•--- Date 05/27/22
Please contact Theresa Randall at [phone] or theresa.randallL;hollysprin sg iic.goov if you
have any questions.
2003 Sewer Design Applicaton Certification
01 14.21
Utilities and Infrastructure Services
P.O. Box 8 • 128 S. Main Street • Holly Springs, NC 27540 • www. hollyspringsn ago v

DocuSign Envelope ID BEE3A7E4-9615-489C-96EC-40F9E34820A8
M11 PRO 11 ti
lit .1
'.�....~' THE
June 1, 2022
TOWN OF ofly s
........ x�_ P g
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: Collins Park Sewer Modification (WQ0040152M)
Dear Sir or Madam:
NC Dept of Envirarment" Quality
JUN - 6 2022
galei►& R400d Ofirce
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,
HDuSiyned 6y:
.
Kendra D. ParrisT,7ff.'�CFM
Executive Director of Utilities and Infrastructure
KP/tr
cc: Project Consultant Engineer, Rick Baker, PE
Rachel Ingham, Utility Engineer
Drew Johnson, Development Construction Manager
Theresa Randall, Utility Permitting Specialist
Project file/Correspondence #41997
DS
Rachel Ingham
Utility Engineer
3002
04 172018
Utilities and Infrastructure Services
P.O. Box 8 - 128 S. Main Street - Holly Springs, NC 27540 - www.hofyspringsnc.gov