WQ0044140_Application (FTSE)_20230220

NC Dept of Environmental Quality
State of North Carolim
Department of Environmental Qualit;
FEBDWR 2 0 10?3 Division of Water Resource
FAST TRACK SEWER SYSTEM EXTENSION APPLICATIOr
Division of Water Resources Raleigh Regional Office FTA 06-21 & SUPPORTING DOCUMENTATIOr
Application Number: 0044 f 4-D (to be completed by DWR)
All items must be completed or the application will be returned
L APPLICANT INFORMATION:
1. Applicant's name: The Havens at Oxford. LLC (company, municipality, HOA, utility, etc.)
2. Applicant type. ® Individual ❑ Corporation ❑ General Partnership ❑Privately -Owned Public Utility
❑ Federal ❑ State/County ❑ Municipal ❑ Other
3. Signature authority's name: Robert Jolly per 15A N 2AC 0 ,T .0 1 ON b
Title: Managing Member -The Havens at xford LLC
4. Applicant's mailing address: 8401 Key Blvd
City: Greensboro State: NC zip: 27409-__-_
5. Applicant's contact information:
Phone number: 336) 378-7900 Email Address: roll a weavercooke.com
11. PROJECT INFORMATION:
I. Project name: The Havens at Oxford Apartments
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: Granville
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.296' Longitude:-78.595'
5. Parcel ID (if applicable): Map # 191212976246 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: T. Eugene Mustin License Number: C-0868
Firm: Borum Wade & Associates P.A.
Mailing address: 621 Eu ene Court Suite 100
City: Greensboro State: NC Zip: 27401-
Phone number: [phone] Email Address: jwade __borum-wade.coin
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name:
Owner Name:
Permit Number:
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ
2. Downstream (Receiving) Sewer Information: 8 inch ® Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s):
FORM: FTA 06-21 Page I of 5

V1. GENERAL REQUIREMENTS
I. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑ No ® NJA
2. If the Applicant is a Developer of lots to be sold, has a Devcloper's Oyera[i❑nal Agreer❑era fOORM: DEVI been attached?
❑ Yes ❑ No ® NIA
3. If the Applicant is a Home/Property Owners' Association, has an I IOAIPOA Operational Agreerneat (FORM: HUA) and
supplementary documentation as required by 15A NCAC 02T.0115(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/service ❑ Hotel and/or Motels
❑ School / preschool / day care ❑ Medical I dental / veterinary facilities ❑ Swimming Pool/Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: % Domestic % Commercial _ % Industrial (See 15A NCAC 02T .0103(20))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 02T .01 14(f)? ❑ Yes ❑ No
➢ If yes, provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(o)
Daily Design Flow 0-b
No. of Units
Flow
I or 2 Bedroom Units
240 gal/day
60
14,400 GPD
gall
GPD
gall
GPD
gall
GPD
gall
GPD
gall
GPD
Tolal
14,400 GPD
a See 15A NCAC 02T ,01 14ft (d)t (e)(1) and (e)t2for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use areas;
and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in G.S=42A=4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC: 02"T.01.1.4] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 14,400 GPD (per 15A NCAC 02T A1.14)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero, please indicate why:
❑ Pump Station/Force Main or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line.
Please provide supplementary information indicating the approximate timeframe for permitting upstream sewers with flow.
❑ Flow has already been al located in Permit Number: Issuance Date: . __
❑ Rehabilitation or replacement of existing sewers with no new flow expected
❑ Other (Explain):
FORM: FTA 06-21 Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T.0305 & MDC (Gravity, Sewers):
I. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 356 DIP
6 (service) 64 SDR-26 PVC
➢ Section 11 & 111 of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section III contains infonnation related to minimum slopes for gravity sewer(s)
➢ Oversizing lines to meet minimum slope requirements is not allowed and a violation of the MDC
Vlll. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & M11Dt ' P St 1 ns/Fore 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 pump(s): .. _ gallons per minute (GPM) at - feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.01 C. Lb. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with ,I 5A N A 0 T_ ,0305Lh) 1):
❑ 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 I5A 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 pail of this permit application in the case of a multiple station power outage.
FORM: FTA 06-21 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(t)):
1. Does the project comply with all separations/alternatives found in I �A NCAC 02T ,0305(f) 4 (P, ? ® Yes ❑ 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
2Water 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-I waters of Class I or
Class 11 impounded reservoirs used as a source of drinking water, and associated wetlands.
100 feet
**Waters classified WS (except WS-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 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.03050) or (g), see Section X. i of this application
* l5A_N_ C 021.0305(g) contains alternatives where separations in 02T.030i[f) 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 webpgge
2. Does this project comply with the minimum separation requirements for water mains? ®Yes ❑ No ❑ N/A
➢ If no, please refer to 15A NCAC I8C.0406(f) for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? ® Yes ❑ No ❑ N/A
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ See the Division's draft separation requirt;mgq 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 1.5A NCAC 022_ .02QQJ ❑ Yes ❑ No
➢ This includes Trout Buffered Streams per 15A NCAC 2B-f] .0 .
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ❑ Yes ® No
or 401 Water Quality Certifications?
➢ Please provide the permit number/permitting status in the cover letter if coverage/authorization is required.
6. Does project comply with 15A NCAC 02T.0.105 6) (additional permits/certifications)? ®Yes ❑ No
Per 15.A NCAC 02T.0.105 c](6t, 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 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 fine, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at least once every six -months and
inspections documented per 15A NCAC 02T.0403(a)(5) or the permittee's individual System -Wide Collection permit.
FORM: FTA 06-21 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A.Ni AC 02T, the Minimum Doig1 Criteria or t e Permitting Pump t lions
ano Egret MAin5figigg v and the Gravity Sewer Minimum Design Criteriatlat s ve i Q) 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 anproval of the hermit, and nroiects requiring a variance approval may be subiect to longer
review times. For nroiects requiring two or more variances or where the variance is determined by the Division to be a
significant portion of the proiect, the full technical review is required.
2. Professional Engineer's Certification:
1, T. Eugene Mustin _ , attest that this application for The Havens at Oxford Apartments
(Professional Engineer's name from Application Item 111.1.) (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 best of my knowledge the proposed design has been prepared in accordance with the applicable regulations,
Miij4E4g1_Desi n Cri grip for Qua y Sewers ( latest wtt5ioal, and the Minimum Design Criteria for the Fast -'I tttck Permigin
of Pt MR lations and Force Mains fiatest 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 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:
Applicant's Certification per 15A NCAC 02T .0106(b): y� —Af 6/ / �
1 , attest that this application For " U,/ e IIS l
(fiagn ur Aulliority 7�ne from Application Item 1.3.) (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 requited 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, 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 accordance with General Statutes 143-2 15.6A and 1 43-215.6B, 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.
Signature Date: —716-eom
FORM: FTA 06-21 Page 5 of 5

NC Dept of Environmental Quality
NC De:; If"-.
Stgtc of North Caroling
FEB 2 0 2023 Department of Environmental Quality
Division of Water Resources
Raleigh Regional MCC Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: The City of Oxford
Project Name for which flow is'l)eing requested: The Havens at Oxford Apartments
More than one FTSE maybe required fora single project iflhe owner of the WWTP is not responsible for all pump
stations along Ilse 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: City of Oxford WWTP
b. WWTP Facility Permit #: NCO025054
All flows are in MGD
c. WWTP facility's permitted flow 3.50
d. Estimated obligated flow not yet tributary to the WWTP 0.12
e. WWTP facility's actual avg. flow 1.17
f. Total flow for this specific request 0.01440
g. Total actual and obligated flows to the facility 1.30
h. Percent of penmitted flow used 37.1%
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+Q (E)=(A-D)
Design
Obligated,
Pump
Pump
Average
Approx.
Not Yet
Total Current
Station
Station
Firm Daily Flow**
Current
Tributary
Flow Plus
(Name or
Permit
Capacity, * (Firm / pt),
Avg. Daily
Daily Flow,
Obligated Available
Number)
No.
MGD MGD
Flow, MGD
MGD
Flow Capacity***
* The Firm Capacity (design flow) of any pump station is defined as the maximum pumped now
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):
Downstream Permit Number:
Page 1 of 6
1'1"SL 10-19

III. Certification Statement:
1 ciit-L2W,0tI 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 cial Signature Date
Title of Signing 4fcia1 - ----
Page 2 of 6
F- TS Ft 10-18

d Engineers
Planners
- Surveyors
Boru n, Wade and Associates, P.A.
February 17, 2023
N.C.D.E.Q.
Division of Water Resources
Raleigh Regional Office
3800 Barrett Drive
Raleigh, NC 27609
Regarding: The Havens at Oxford Apartments
E. Industry Drive
Oxford, INC
FTA 06-21 for Gravity Sewer (Private)
Dear Sir or Madam:
NC DePf of Environment
a1 Quality
Raleigh ,Regional Off,cc
The Havens at Oxford, LLC proposes to develop the above noted 60 unit apartment
complex. In conjunction with this development, a new private gravity sanitary sewer line
owned by the The Havens at Oxford, LLC will be installed. The entrance to this project is
located off the E. Industry Drive in Oxford, North Carolina. The proposed private sanitary
sewer line will tie in to the City of Oxford's existing gravity sanitary sewer outfail adjacent
to the site.
Please find the following attached information for review for processing a Gravity Sewer
Permit for the above mentioned project. Included in this package are the following.
1. One original and one copy of the Fast Track Application.
2. One check for $480 (check# 4060)
3. One original and one copy of the Downstream Sewer Flow Track inglAcceptance.
4. One original and on color copy USGS Topographic Map and one street level map.
Please call if you have any other questions.
Best Regards,
Jo?athan Wade
621 Eugene Court, Suite 100, Greensboro, NC 27401-2711 - PO Box 21882, Greensboro, NC 27420-1882
Phone [phone] - Fax 336-27S-3719
Website: www.borum-%vade.com

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