WQ0042699_Application_20230420

DocuSign Envelope ID: A38B6E50-D55B-4DDB-B42C-01 CD781 BB14B
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April 20, 2023
NCDEQ — Division of Water Resources
Water Quality Permitting Section, Non -Discharge Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Re: Holly Springs Reclaimed Water Distribution System Extension Request; Application for Approval
Project: RECLAIMED Water Modification Permit and PARTIAL Certification —
Carolina Springs Ph 1 Sections 1-5
Dear Sir or Madam:
Please find enclosed the following items in application for a RECLAIMED water extension modification
and PARIAL reclaimed certification to the Town of Holly Springs' existing reclaimed water distribution
system:
❑ One copy of the engineer certification
❑ One copy of the locally -required Reclaimed Water Extension Design and Application
Certification (Form 3016)
❑ One copy of the Town Engineering Design and Construction Standards Reclaimed Water
❑ Owner Certification Form
❑ One copy of the original permit WQ0042699
❑ One copy of the plats
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,
DnocuSigned by:
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03C05B69FC34440...
Kendra D. Parrish, P.E., C.F.M
Executive Director of Utilities and Infrastructure Services
KDP/ek
cc: Project Consultant Engineer, Curtis Blazier
Rachel Ingham, Utility Engineer Manager
Drew Johnson, Development Construction Manager
Seann Byrd, Director Public Utilities
3021
12.19.2022
it"
Rachel Ingham
Engineering Manager - Utilities
Utilities and Infrastructure Services
P.O. Box 8 • 128 S. Main Street • Holly Springs, NC 27540 • www.hollyspringsnc.gov

DocuSign Envelope ID: A38B6E50-D55B-4DDB-B42C-01CD781BB14B
10 WithersRavenel
Our People. Your Success.
April 12, 2023
Town of Holly Springs
Development Engineering Services
128 South Main Street
Holly Springs, NC 27540
RE: Carolina Springs Reclaimed Water Line Certification for Carolina Springs Phase 1, Section
1A and Phase 1, Sections 1-5 Permit Modification - WQ0042699 (Modification)
Dear Mr. James Smith:
This letter serves as documentation to accompany a reclaimed water line certification for
Carolina Springs Phase 1, Section 1A and a reclaimed water line permit modification for Carolina
Springs Phase 1, Sections 1-5 in Holly Springs.
Approximately 3,393 LF of 6" reclaimed waterline and 1,823 LF of 12" reclaimed waterline has
been constructed. The total permitted 6" reclaimed waterline from Permit No. WQ0042699 is
12,546 LF. The 1,823 LF of 12" reclaimed waterline is in addition to what was permitted in
WQ0042699. The reclaimed water line was mistakenly called out as 6" diameter on Sheet C3.1
of the approved CD plan sheet, but was shown correctly in the plan and profiles sheets. The 12"
reclaimed waterline is shown on Sheets C3.1 and C6.27 and C6.28 in the As -Built Drawings plan
set. Also, the actual distribution line design quantity is 12,264 LF of 6" reclaimed waterline.
Attached, please find the engineering certification, as -built drawings, fee, and all associated
documents for your review.
If you have any questions or need additional information, please contact me at
[e-mail].
Sincerely,
WithersRavenel
Curtis M. Blazier, PE
Director of Small Scale Residential Development
115 MacKenan Drive I Cary, NC 27511
t: 919.469.3340 1 f: 919.467.6008 1 www.withersraveneI.com I License No. F-1479
Asheville I Cary I Charlotte I Greensboro I Lumberton I Pittsboro I Raleigh I Southern Pines I Wilmington

DocuSign Envelope ID: A38B6E50-D55B-4DDB-B42C-01CD781BB14B
Permit No. WQ0042699
Town of Holly Springs
Carolina Springs — Phase 1, Sub Phases 1-5 RWDL
ENGINEERING CERTIFICATION
❑X Partial ❑ Final
Reclaimed Water Distribution
November 16, 2021
Wake County
1, Curtis M. Blazier , as a duly licensed North Carolina Professional
Engineer, having ❑X periodically / ❑ fully observed the construction of the permitted facilities, do hereby
state to the best of my abilities that the facility was constructed in compliance with G.S. 143-215.1,
Administrative Code Title 15A Subchapter 02U, this permit, and the Division -approved plans and
specifications.
Documentation of any variation to this permit, and the Division -approved plans and specifications, is in the
attached as -built drawings.
Description of variations:
Partial certification covering 3,393 LF of 6" reclaimed water distribution line and
1,823 LF of 12" reclaimed water distribution line in Phase 1 Section 1A and associated
appurtenances
Curtis M. Blazier
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2/3/2023
Professional Engineer's Name
WithersRavenel
F-1479
Firm Name
Firm No.
115 MacKenan Drive
Address
Cary
NC
27511
City
State
Zip Code
919-238-0361
[e-mail]
Telephone AEmail
Seal, Signature, and Date
THE COMPLETED ENGINEERING CERTIFICATION, INCLUDING ALL SUPPORTING
DOCUMENTATION, SHALL BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
NON -DISCHARGE BRANCH
By U.S. Postal Service By Courier/Special Courier/Special Delive�Delivee
1617 MAIL SERVICE CENTER 512 N. SALISBURY ST.
RALEIGH, NORTH CAROLINA 27699-1617 RALEIGH, NORTH CAROLINA 27604
WQ0042699 Version 1.0 Shell Version 200201
Page 6 of 6

DocuSign Envelope ID: A38B6E50-D55B-4DDB-B42C-01 CD781 BB14B
State of North Carolina
TUAID Department of Environmental Quality
Division of Water Resources
15A NCAC 02U — RECLAIMED WATER SYSTEMS — DISTRIBUTION LINES
Division of Water Resources INSTRUCTIONS FOR FORM: RWDL 06-16 & SUPPORTING DOCUMENTATION
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application.
For more information, visit the Water Quality Permitting Section's Non -Discharge Permitting Unit website
General — This application is for projects involving the construction of reclaimed water distribution lines that will supply reclaimed
water for conjunctive use activities. Unless otherwise noted, the Applicant shall submit one original and two copies of
the application and supporting documentation.
Do not submit this application without an associated Reclaimed Water Project Information (FORM: RWPI) form.
A. Reclaimed Water Distribution Lines (FORM: RWDL 06-16) Application (All application packages):
® Submit the completed and appropriately executed Reclaimed Water Distribution Lines (FORM: RWDL 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to
the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
® The system name in Item II.1. shall be consistent with the user name on the plans, specifications, agreements, etc.
® The Professional Engineer's Certification on Page 5 of this form shall be signed, sealed and dated by a North Carolina licensed
Professional En ig neer.
® The Applicant's Certification on Page 5 of this form shall be signed in accordance with 15A NCAC 02T OlM b). The
application must be signed by a principal executive officer of at least the level of vice-president or his authorized representative
for a corporation; by a general partner for a partnership or limited partnership; by the proprietor for a sole proprietorship;
and by either an executive officer, an elected official in the highest level of elected office, or other authorized employee for a
municipal, state, or other public entity. An alternate person may be designated as the signing official if a delegation letter is
provided from a person who meets the criteria in 15A NCAC 02T .0106(b).
B. Property Ownership Documentation (All Application Packages):
® Per 15A NCAC 02U .0201(e) or 15A NCAC 02U .0202(f), the Applicant shall demonstrate that they are the owner of the
property where the reclaimed water lines will be installed. Documentation shall consist of one of the following (or a
combination of):
® Legal documentation of ownership (i.e., GIS, deed or article of incorporation), or
❑ Written notarized intent to purchase agreement signed by both parties with a plat or survey map, or
❑ An easement specifically indicating the intended use of the property and meeting the requirements of 15A NCAC 02L
.0107 , (i.e. municipality right of way) or
❑ A written notarized lease agreement signed by both parties, indicating the intended use of the property, as well as a plat
or survey map.
INSTRUCTIONS FOR FORM: RWDL 06-16 & SUPPORTING DOCUMENTATION Page 1 of 2

DocuSign Envelope ID: A38B6E50-D55B-4DDB-B42C-01 CD781 BB14B
C. Engineering Plans (All Application Packages):
® Per 15A NCAC 02U .0201(c)(1) or .0202(c), submit standard size and 11 x 17-inch plan sets that have been signed, sealed and
dated by a North Carolina licensed Professional Engineer. At a minimum, the engineering plans shall include the following
items:
® Table of contents.
® A general location map with at least two geographic references and a vicinity map.
® Plan and profile views of all pump stations and reclaimed water line extensions as well as the proximity of the reclaimed
water line extensions to other utilities and natural features.
® Depict minimum separation distances required by 15A NCAC 02U .0403(h), (i), and 15A NCAC 02T .0305).
® Minimum cover in accordance with 15A NCAC 02T .0305(Q)(4).
® Location and details of all pump stations.
❑ All labeling and color coding requirements per 15A NCAC 02U .0403.
® Plans shall represent a completed design and not be labeled with preliminary phrases (e.g., FOR REVIEW ONLY, NOT
FOR CONSTRUCTION, etc.) that indicate they are anything other than final specifications. However, the plans may be
labeled with the phrase: FINAL DESIGN - NOT RELEASED FOR CONSTRUCTION.
D. Specifications (All Application Packages):
® Per 15A NCAC 02U .0201(c) or .0202(c), submit specifications that have been signed, sealed and dated by a North Carolina
licensed Professional Engineer. At a minimum, the specifications shall include the following items:
® Specifications for standard equipment may be omitted for municipalities with approved standard specifications. Use of
standard specifications must be noted on each page of the plans.
® Table of contents with each section/page numbered.
® Detailed specifications for each reclaimed water line and pump station (as applicable).
® Site Work (i.e., earthwork, clearing, grubbing, excavation, trenching, backfilling, compacting, fencing, seeding, etc.)
® Materials (i.e., concrete, masonry, steel, painting, method of construction, etc.)
® Electrical (i.e., control panels)
® All labeling and color coding requirements per 15A NCAC 02U .0403.
® Specifications shall represent a completed design and not be labeled with preliminary phrases (e.g., FOR REVIEW ONLY,
NOT FOR CONSTRUCTION, etc.) that indicate they are anything other than final specifications. However, the
specifications may be labeled with the phrase: FINAL DESIGN - NOT RELEASED FOR CONSTRUCTION.
E. Engineering Calculations (All Application Packages):
® Per 15A NCAC 02U .0201(c) or .0202 c , submit calculations that have been signed, sealed and dated by a North Carolina
licensed Professional En ig neer. At a minimum, the calculations shall include the following items:
® Provide justification for the required pipe capacity, and details for how pipe sizes were determined.
® Minimum velocities to be maintained in the reclaimed water line.
❑ Friction/total dynamic head calculations and system curve analysis for each pump used.
❑ Pump selection information including pump curves, manufacturer's information, and recommended installation guidelines.
® Detailed specifications for each reclaimed water line and pump station (as applicable).
❑ Floatation calculations for any pump stations entirely or partially below grade.
❑ For connection to a pump station, submit an evaluation of the existing pump station's ability to handle peak flows. Provide
calculations to detail how peak flows were determined.
❑ For connection to a force main, submit an evaluation of the existing force main based on peak flows to the proposed project
and peak flows already tributary to the existing force main.
ONE ORIGINAL AND TWO COPIES OF THE COMPLETED APPLICATION AND SUPPORTING DOCUMENTATION
SHALL BE SUBMITTED TO:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NON -DISCHARGE PERMITTING UNIT
By U.S. Postal Service:
1617 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1617
TELEPHONE NUMBER: [phone]
By Courier/Special Delivery:
512 N. SALISBURY STREET
RALEIGH, NORTH CAROLINA 27604
FAX NUMBER: [phone]
INSTRUCTIONS FOR FORM: RWDL 06-16 & SUPPORTING DOCUMENTATION Page 2 of 2

DocuSign Envelope ID: A38B6E50-D55B-4DDB-B42C-01 CD781 BB14B
DWR
Division of Water Resources
I. CONTACT INFORMATION:
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02U — RECLAIMED WATER SYSTEMS — DISTRIBUTION LINES
FORM: RWDL 06-16
1. Applicant's name: Town of Holly Springs
Mailing address: 128 South Main Street
City: Holly Springs State: NC Zip: 27540-
Telephone number: [phone] Email Address: Kendra. [e-mail];
emily.koncz(&hollysspringsnc. gov
2. Signature authority's name: Kendra Parrish (per 15A NCAC 02T .0106)Title: Executive Director of Utilities and Infrastructure
3. Consulting Engineer's name: Curt Blazier License Number: 033840 Firm: WithersRavenel
Mailing address: 115 MacKenan Drive
City: CaU State: NC Zip: 27511-
Telephone number: [phone] Email Address: cblazierna,withersravenel.com
II. DISTRIBUTION SYSTEM INFORMATION
1. Distribution system project name (name of subdivision, shopping center, etc.): Carolina Springs Phase 1, Sections 1-5
2. Project county: Wake
3. USGS map name: New Hill
4. Owner of reclaimed water generating facility: Town of Holly prings
5. Permit number of reclaimed water generating facility: WQ0032289
6. List the owner(s) of any intermediate reclaimed water lines if different from the applicant, or the generating facility. n/a
7. Permit number for reclaimed water line immediately upstream: WQ0039336
8. Pipe diameter for reclaimed water line immediately upstream: 6" and 12"
Specify the proposed destination of the reclaimed water: Reclaimed water will be used for irrigation and similar uses on single family
9.
10. Capacity of proposed distribution system: 0 gallons per day
11. Explanation of how capacity was determined: n/a
III. DISTRIBUTION LINE DESIGN INFORMATION
1. Complete the table below for by providing the required information on the proposed distribution lines:
Diameter (inches)
Length
linear feet
pipe Material
High Elevation
ft
Discharge Elevation
ft
6
12,264
C900 PVC
320
316
12
1,823
C900 PVC
325
270
2. Station location of air release valves: 29+85 Woods Creek Road
Note: Air release valves must be provided at all high points along the line where the elevation difference exceeds 10 ft.
FORM: RWDL 06-16 Page 1 of 5

DocuSign Envelope ID: A38B6E50-D55B-4DDB-B42C-01CD781BB14B
III. DISTRIBUTION LINE DESIGN INFORMATION (Continued)
3. Complete the table below by providing the location of each design criteria in the specification and/or plans in accordance with
15A NCAC 02U .0403. Items that are not applicable shall be marked N/A.
Design Criteria
Page Number in Plans
Page Number in Specifications
Labeling on reclaimed water piping, valves, storage
C3.1-C3.2, C3.9-C3.11
N/A
facilities, and outlets
Color coding on reclaimed water piping, valves, etc.
C8.7
N/A
Method of securing valves and outlet for operation by
C8.7
N/A
authorized personnel only
Locking mechanism for hose bibs
C8.7
N/A
Cross connection control devices
C8.7
N/A
IV. SETBACKS (15A NCAC 02U .0701)
1. Provide the actual minimum distance (in feet) from any reclaimed water storage units and/or pump station within the
distribution system to each item listed (distances greater than 500 feet may be marked N/A):
Setback Parameter
Pump stations within
Reclaimed Water
distributions stem
Storage Units
Required
Actual
Required
Actual
Any private or public water supply source
N/A
100
N/A
Any property line
N/A
W
50
N/A
Any well with exception of monitoring wells
100
N/A
100
N/A
Surface waters (streams — intermittent and perennial,
100
N/A
50
N/A
perennial waterbodies, and wetlands) classified as SA
Surface waters (streams — intermittent and perennial,
25
N/A
50
N/A
perennial waterbodies, and wetlands) classified as SA
2. Do the pump stations and storage units comply with all setbacks found in the river basin rules 05A NCAC 213.0200)?
❑ Yes or ❑ No
✓ If no, list non -compliant setbacks:
3. Are any setback waivers required in order to comply with 15A NCAC 02U .0701? ❑ Yes or ®No
✓ If yes, have these waivers been written, notarized, signed by all parties involved and recorded with the County Register of
Deeds? ❑ Yes or ❑ No
✓ If yes, have the required Non -Discharge Wastewater System Waiver (FORM: NDWSW) forms been included with this
application package? ❑ Yes or ❑ No
FORM: RWDL 06-16 Page 2 of 5

DocuSign Envelope ID: A38B6E50-D55B-4DDB-B42C-01CD781BB14B
V. SEPARATION DISTANCES
1. Provide the actual minimum separation distance (in feet) from the reclaimed water distribution system to each item listed in
accordance with 15A NCAC 02U .0403(h), (i), and (j):
Separation Parameter
Horizontal
Vertical
Required
Actual
Required
Actual
Any water line (feet)
10
14
1.5
1.5
Any well
50
N/A
N/A
kkbomL—
Sewer lines (reclaimed over sewer)
2
5
1.5
1.5
Final earth grade
N/A
3
4
2. Are the separation requirements listed above met? ® Yes or ❑ No
✓ If No, has documentation been provided to show that piping and integrity testing procedures meet water main standards in
accordance with 15A NCAC 18C? ❑ Yes or ❑ No
Note: In no case shall reclaimed water lines be closer than 25 feet to a private well.
VI. PUMP STATION INFORMATION
IF MORE THAN ONE PUMP STATION, PROVIDE ADDITIONAL COPIES OF THIS PAGE AS NECESSARY.
1. Are there any reclaimed water pump stations proposed as part of the distribution system? ❑ Yes or ❑ No
✓ If no, then skip the remaining items in Section VI.
2. Complete the table below by providing the required information regarding the reclaimed water pump station(s)
Pump Station Design
Plan Sheet
Number
Specification
Page Number
Internal dimensions (L x W x H or (p x H)
ft
ft
ft
Volume
gallons
Inlet Elevation
ft
Outlet Elevation
ft
Number of pumps
Pump capacity
GPM
Lead pump on elevation
ft
Lag pump on elevation
ft
Lead pump off elevation
ft
Lag pump off elevation
ft
High water elevation
ft
Audible/Visual high water alarm
EK:
3. What is the 100-year flood elevation? (ft)
4. Precautions to be taken to protect the pump station from flooding: (ft)
FORM: RWDL 06-16 Page 3 of 5

DocuSign Envelope ID: A38B6E50-D55B-4DDB-B42C-01 CD781 BB14B
VII. STORAGE TANK INFORMATION
IF MORE THAN ONE STORAGE TANK, PROVIDE ADDITIONAL COPIES OF THIS PAGE AS NECESSARY.
1. Are there any reclaimed water storage tanks proposed as part of the distribution system? ❑ Yes or ❑ No
✓ If no, then skip the remaining items in Section VII.
2. Complete the table below by providing the required information regarding the reclaimed water storage tank(s)
Storage Tank Design
Plan Sheet
Number
Specification
Pa a Number
Type of storage tank
Select
Internal dimensions (L x W x H or (p x H)
ft
ft
ft
Storage Volume
gallons
Inlet Elevation
ft
Outlet Elevation
ft
High water elevation
ft
Audible/Visual high water alarm
3. What measures will be taken to reduce the risk of overflow?
FORM: RWDL 06-16 Page 4 of 5

DocuSign Envelope ID: A38B6E50-D55B-4DDB-B42C-01 CD781 BB14B
Professional Engineer's Certification:
I, Curt Blazier, PE , attest that this application for Carolina Springs Phase 1, Sections 1-5 has
been reviewed by me and is accurate, complete and consistent with the information supplied in the engineering plans, 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 this application package and its instructions as well as all applicable regulations and statutes.
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 NC 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.
North Carolina Professional Engineer's seal, signature, and date:
txNiilrlr011,
11
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033040 `
DocuSigned:i.}+
S} M 6`10/2023
123EF6CA825E41F...�{JilrllfI55\
Applicant's Certification (signing authority must be in compliance with 15A NCAC 02T .0106):
I, Kendra D. Parrish, RE, Executive Director of Utilities & Infrastructure Services
(signing authority name — PLEASE PRINT) (title)
attest that this application for Town of Holly Springs
(facility name)
has been reviewed by me and is accurate and complete to the best of my knowledge. 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. I further certify
that the applicant or any affiliate has not been convicted of an environmental crime, has not abandoned a wastewater facility without proper
closure, does not have an outstanding civil penalty where all appeals have been exhausted or abandoned, are compliant with any active
compliance schedule, and do not have any overdue annual fees under Rule 15A NCAC 02U .0105. Note: In accordance with NC 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. yD�ocuSigned by: Date: Signature:
'� "- 4/20/2023
FORM: RWDL 06-16 Page 5 of 5

DocuSign Envelope ID: A38B6E50-D55B-4DDB-B42C-01 CD781 BB14B
State of North Carolina
rDWR Department of Environmental Quality
Division of Water Resources
15A NCAC 02U — RECLAIMED WATER SYSTEMS — PROJECT INFORMATION
Division of Water Resources INSTRUCTIONS FOR FORM: RWPI 06-16 & SUPPORTING DOCUMENTATION
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application.
For more information, visit the Water Quality Permitting Section Non -Discharge Permitting Unit website
General —This form is required for all projects involving the generation, utilization, and or distribution of reclaimed water. At least
one of the following forms must also be included in the application package. However, multiple forms may be applicable.
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting
documentation. Please check the boxes below as appropriate to indicate which additional forms are included in the
application package:
❑ Reclaimed Water Generation (FORM: RWG) — for wastewater treatment facilities producing reclaimed water.
❑ Non -Conjunctive Utilization (FORM: RWNC) — for reclaimed water utilization activities, when the reclaimed water
utilization activity is required in order to meet the wastewater disposal needs of the facility.
❑ Conjunctive Utilization (FORM: RWCU) — for reclaimed water utilization activities, when the reclaimed water option is
not necessary to meet the wastewater disposal needs of the facility and other wastewater utilization/disposal methods are
available.
❑ Bulk Distribution (FORM: RWBD) — for distribution of reclaimed water in a bulk manner.
® Distribution Lines (FORM: RWDL) — for construction of reclaimed water distribution lines.
❑ Wetland Augmentation (FORM: RWWA) — for projects seeking to utilize reclaimed water for the purpose of wetland
augmentation.
❑ Local Program Approval (FORM: RWLPA) —for projects seeking permitting delegation for reclaimed water users.
A. Cover Letter (All Application Packages):
N List all items included in the application package, as well as a brief description of the requested permitting action.
B. Application Fee (All New and Major Modification Application Packages):
® Submit a check, money order or electronic funds transfer made payable to: North Carolina Department of Environmental
Quality (NCDEQ) according to the following fee schedules:
N STANDARD REVIEW — Submit the appropriate fee for all new and major modification applications as listed in the
table below.
Facility Classification
New Permit
Major Modification'
Major Generator/User (ADF > 10,000 gallons per day)
$1,310
$395
Minor Generator/User (ADF < 10,000 gallons per day)
$810 $245
Reclaimed Water Distribution Lines
7$480 N/A
' A major modification shall be defined as any permit modification that: increases the generating
facility's average daily flow (ADF); increases the utilization area acreage; adds additional utilization
areas not previously approved; or includes the addition of new treatment units/processes not previously
permitted. There is no fee for minor permit modifications.
INSTRUCTIONS FOR FORM: RWPI 06-16 & SUPPORTING DOCUMENTATION Page 1 of 2

DocuSign Envelope ID: A38B6E50-D55B-4DDB-B42C-01 CD781 BB14B
C. Reclaimed Water Project Information Form (FORM: RWPI 06-16) (All application packages):
® Submit the completed and appropriately executed Reclaimed Water Project Information (FORM: RWPI 06-16) form. Please
do not make any unauthorized content changes to this form.
® The applicant name in Item I.1. shall be consistent with the applicant name on the plans, specifications, agreements, etc.
® The Applicant's Certification on Page 3 of this form shall be signed in accordance with 15A NCAC 02T .0106(b). The
application must be signed by a principal executive officer of at least the level of vice-president or his authorized
representative for a corporation; by a general partner for a partnership or limited partnership; by the proprietor for a
sole proprietorship; and by either an executive officer, an elected official in the highest level of elected office, or other
authorized employee for a municipal, state, or other public entity. An alternate person may be designated as the signing
official if a delegation letter is provided from a person who meets the criteria in 15A NCAC 02T .0106(b).
❑ If this project is for a renewal without modification, use the Non -Discharge System Renewal (FORM: NDSR) application.
There is no fee for permit renewal without modification.
D. Existing Permit: (All Modification Packages):
® Submit the most recently issued existing permit.
❑ Provide a list of any items within the permit the Applicant would like the Division to address during the permit modification
(i.e., compliance schedules, permit description, monitoring, permit conditions, etc.).
ONE ORIGIANL AND TWO COPIES OF THE COMPLETED APPLICATION AND SUPPORTING DOCUMENTATION
SHALL BE SUBMITTED TO:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NON -DISCHARGE PERMITTING UNIT
By U.S. Postal Service:
1617 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1617
TELEPHONE NUMBER: [phone]
By Courier/Special Delivery:
512 N. SALISBURY STREET
RALEIGH, NORTH CAROLINA 27604
FAX NUMBER: [phone]
INSTRUCTIONS FOR FORM: RWPI 06-16 & SUPPORTING DOCUMENTATION Page 2 of 2

DocuSign Envelope ID: A38B6E50-D55B-4DDB-B42C-01 CD781 BB14B
State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02U — RECLAIMED WATER SYSTEMS — PROJECT INFORMATION
FORM: RWPI 06-16
I. GENERAL INFORMATION:
1. Applicant's name: Town of Holly Springs
Mailing address: 128 South Main Street
City: Holly Springs State: NC Zip: 27540-
Telephone number: [phone] Email Address: Kendra.Parrishnhollyspringsnc.gov
2. Signature authority's name: Kendra Parrish (per 15A NCAC 2U .0106) Title: Executive Director of Utilities and
Infrastructure
3. Applicant type (check all that apply):
® Government > ❑ Federal ❑ State ® Municipal ❑ County
❑ Individual
❑ Corporation
✓ For new permits, submit documentation that the company is registered for business with the NC Secretary of State.
❑ General Partnership
✓ For new permits, submit a copy of the certificate filed with the Register of Deeds in the county of business.
❑ Privately Owned Public Utility
✓ For new permits, submit a Certificate of Public Convenience and Necessity from the NC Utilities Commission, or a
letter from the NC Utilities Commission's Water and Sewer Division Public Staff stating an application for a
franchise has been received and that the service area is contiguous to an existing franchised area or that franchise
approval is expected.
❑ Home Owners Association
✓ For new permits, submit a properly executed Operational Agreement (FORM: HOA); and proposed or approved
Articles of Incorporation, Declarations and By-laws.
❑ Developer (where residential lots are to be sold)
✓ For new permits, submit a properly executed Operational Agreement (FORM: DEV)
4. Demonstration of historical consideration for permit approval:
Has the Applicant or any parent, subsidiary or other affiliate exhibited the following?
a. Has been convicted of environmental crimes under Federal law or G.S. 143-215.6B? ❑ Yes or ® No
b. Has previously abandoned a wastewater treatment facility without properly closing that facility? ❑ Yes or ® No
c. Has unpaid civil penalty where all appeals have been abandoned or exhausted? ❑ Yes or ® No
d. Is non -compliant with an existing non -discharge permit, settlement agreement or order? ❑ Yes or ® No
e. Has unpaid annual fees in accordance with 15A NCAC 02T .0105(e)(2)? ❑ Yes or ® No
FORM: RWPI 06-16 Page 1 of 3

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II. PROJECT INFORMATION Reclaimed Water Distribution Lines
1. Application type: Select (See Instruction B) Fee Submitted$0 (See Instruction B)
2. For modifications, provide the existing permit number: WQ0042699 and most recent issuance date: 11 /16/21
3. Provide a brief description of the activities proposed for permitting: Installation of reclaimed water mains and services for single
family homes for irrigation and similar uses
4. What is the status of the following associated permits and/or certifications ? (if not applicable, please mark as N/A)
Permit/Certification
Date Submitted
Date Approved
Permit/Certification No.
Agency Reviewer
Collection System 0 >
200,000 GPD
N/A
Dam Safety
N/A
Erosion & Sedimentation
Control Plan
6/25/21
8/4/21
17-2021
Town of Holly
Springs Engineering
Nationwide 12 / Section 404
N/A
Pretreatment
N/A
Sewer System
7/12/21
9/10/21
W00042679
NCDEQ - Scott Vinson
Stormwater Management Plan
N/A
Other:
✓ For any of the permits and certifications listed above that will directly impact the construction of the proposed reclaimed
water project, please provide documentation of permit approval or final certification. Note: This application may be
considered incomplete, or the resulting permit may be issued conditionally if a pending issuance of any of the related
permits/certifications directly impacts the proposed facility.
5. Documentation of the presence or absence of threatened or endangered aquatic species at the project site utilizing information
provided by the Department's Natural Heritage Program is required for construction of all new WWTP projects and/or non -
conjunctive utilization sites, and for any project involving expansion of a WWTP and/or non -conjunctive utilization site in
accordance with 15A NCAC 02T .0105(c)(10). Provide the location in application package where this documentation is
located: ; or explain why this item is N/A.
6. Does this project utilize public monies or lands? ❑ Yes or ® No
✓ If yes, was an Environmental Assessment required under 15A NCAC O1 C?
Yes ❑ No
Include one of the following final environmental documents with this submittal:
❑ Finding of No Significant Impact, or ❑ Record of Decision
Describe any mitigating factors from the Environmental Assessment that impact the design and/or construction of the
reclaimed water project:
7. Is any portion of the proposed project (reclaimed water treatment units, storage units, distribution lines, or utilization areas)
located within the 100 year flood plain? ❑ Yes or ® No
✓ If yes, specify which portion(s) of the project are affected?
✓ If yes, has the Applicant submitted written documentation of compliance with § 143 Article 21 Part 6? ❑ Yes or ❑ No
Documentation should consist of a letter from the local authority (i.e., county/municipality) stating that the project
complies with any local floodplain ordinance that may apply.
FORM: RWPI 06-16 Page 2 of 3

DocuSign Envelope ID: A38B6E50-D55B-4DDB-B42C-01 CD781 BB14B
Applicant's Certification (signing authority must be in compliance with 15A NCAC 02U .0106):
I, Kendra D. Parrish, P.E. Executive Director of Utilities and Infrastructure Services
(signing authority name — PLEASE PRINT) (title)
attest that this application for Carolina Springs - Phase 1, Sections 1-5
(facility name)
has been reviewed by me and is accurate and complete to the best of my knowledge. 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.
I further certify that the applicant or any affiliate has not been convicted of an environmental crime, has not abandoned a wastewater
facility without proper closure, does not have an outstanding civil penalty where all appeals have been exhausted or abandoned, are
compliant with any active compliance schedule, and do not have any overdue annual fees under Rule 15A NCAC 02U .0105. Note:
In accordance with NC 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.
DocuSigned by:
Signature: Date: 4/ 2 0/ 2 0 2 3
�L3C0586gF ...
FORM: RWPI 06-16 Page 3 of 3

DocuSign Envelope ID: A38B6E50-D55B-4DDB-B42C-01 CD781 BB14B
DO NOT SUBMIT RECLAIMED WATER EXTENSION APPLICATION UNTIL
CONSTRUCTION DRAWINGS HAVE BEEN APPROVED BY STAFF!
RECLAIMED Water Distribution Extension Design & Application
Certification
Note: This form must be submitted with Permits for Extensions to the Town of Holly Springs
RECLAIMED Water System
Project: Carolina Springs Phase 1 - Sections 1-5
Design Engineer: WithersRavenel, Inc. / Curtis M. Blazier, PE
Address: 115 Mackenan Drive, Cary, NC 27511
Phone Number: [phone] Email: cblazierCwithersravenel.com
4/20/2023
Date Complete Application Package Received by Town:
os y�us os
Date Approved: (by RI) I ' (by KDP) �� (by DJ)
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 Town of Holly Springs
Engineering Design and Construction Standards and the State of North Carolina NC DEQ.
® That each of the following items are completed and enclosed for submittal to the State for a
RECLAIMED Water Distribution System Permit:
❑ One copy of Reclaimed Instructions
❑ One copy of a Reclaimed Water extension permit application for the project
❑ One set of sealed construction drawings, as approved by the Town of Holly Springs. All
comments by the Town of Holly Springs are addressed and reflected on the plans. In
addition, the plans must include all of the information required per Section 15A NCAC
2T.0100 and .0900.
❑ Owner Certification Letter
❑ A check for Town processing fee is enclosed
❑ A check to NC DEQ is enclosed
DocuSigned by:
Design Engineer's Signature tS vit,v' Date 4/13/23
DSOBEDMCND49A...
For your information, a copy of the Town's Engineering Design and Construction Standards
(RECLAIMED Water Distribution System Section 11.00) will be forwarded to the State along
with these plans.
Please contact Theresa Randall at theresa.randall c&hollysnringsnc.gov if you have any questions.
3016. Utilities and Infrastructure Services
01.25.21
P.O. Box 8 • 128 S. Main Street 0 Holly Springs, NC 27540 • www.hollyspringsnc.gov

DocuSign Envelope In A38B6EFn nc55B-4DDB-PAW' r1CD781BB1AQ
ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
S. DANIEL SMITH
Director
NORTH CAROLINA
Environmental Quality
November 16, 2021
KENDRA D. PARRISH, PE — EXECUTNE DIRECTOR OF UTILITIES AND INFRASTRUCTURE
TOWN OF HOLLY SPRINGS
128 SOUTH MAIN STREET
HOLLY SPRINGS, NORTH CAROLINA 27540
Subject: Permit No. WQ0042699
Carolina Springs — Phase 1, Sub
Phases 1-5 RWDL
Reclaimed Water Distribution
Wake County
Dear Ms. Parrish:
In accordance with your permit application request received July 26, 2021, and subsequent
additional information received October 22, 2021, we are forwarding herewith Permit No. WQ0042699
dated November 16, 2021, to the Town of Holly Springs for the construction only of the subject reclaimed
water distribution facilities.
This permit shall be effective from the date of issuance until rescinded, and shall be subject to the
conditions and limitations therein.
If any parts, requirements, or limitations contained in this permit are unacceptable, the Permittee
has the right to request an adjudicatory hearing upon written request within 30 days following receipt of
this permit. This request shall be in the form of a written petition, conforming to Chapter 150B of the North
Carolina General Statutes, and filed with the Office of Administrative Hearings at 6714 Mail Service
Center, Raleigh, NC 27699-6714. Otherwise, this permit shall be final and binding.
One set of approved plans and specifications is being forwarded to you. If you need additional
information concerning this permit, please contact Poorva Mokashi at [phone] or
poorva.mokashikncdenr. gov.
Sincerely,
S. Daniel Smith, Director
Division of Water Resources
cc: Wake County Health Department (Electronic Copy)
Raleigh Regional Office, Water Quality Regional Operations Section (Electronic Copy)
Debra M. Ferm, PE — WithersRavenel, Inc. (Electronic Copy)
Laserfiche File (Electronic Copy)
Digital Permit Archive (Electronic Copy)
North Carolina Department of Environmental Quality I Division of Water Resources
QEQ>
512 North Salisbury Street 1 1617 Mail Service Center I Raleigh, North Carolina 27699-1617
NORTH CAROLINA
n^w�e^e �i.^m^^�� n^^��
919.707.9000

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DocuSign Envelope ID: A38B6E50-D55B-4DDB-B42C-01 CD781 BB14B
NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENTAL QUALITY
RALEIGH
RECLAIMED WATER DISTRIBUTION PERMIT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Town of Holly Springs
Wake County
FOR THE
construction only of a reclaimed water distribution system extension consisting of:
12,546 linear feet (LF) of 6-inch C-900 PVC reclaimed water distribution line; and all associated piping,
valves, controls, and appurtenances
to serve the Carolina Springs — Phase 1, Sub Phases 1-5 RWDL, with no discharge of wastes to surface
waters, pursuant to the application received July 26, 2021, subsequent additional information received
October 22, 2021, and in conformity with the Division -approved plans and specifications considered a part
of this permit.
This permit shall be effective from the date of issuance until rescinded, and shall be subject to the following
conditions and limitations:
I �Rfol I 101 DIN P Oki
Upon completion of construction and prior to operation of the permitted distribution facilities, the
Permittee shall submit an engineering certification from a North Carolina licensed Professional
Engineer certifying that the permitted facilities have been constructed in accordance with G.S. 143-
215.1, Administrative Code Title 15A Subchapter 02U, this permit, and the Division -approved plans
and specifications. For phased and partially certified facilities, the Permittee shall retain the
responsibility to track further construction approved under this permit, and shall provide a final
engineering certification upon project completion. Mail the Engineering Certification to the Division
of Water Resources, Non -Discharge Branch, 1617 Mail Service Center, Raleigh, NC 27699-1617, or
[e-mail]. [15A NCAC 02T .0116(a)]
2. The facilities permitted herein are for construction only. The Permittee shall submit the following
documentation as a minor modification request:
a. Easements for all the properties on which the distribution line is to be located.
b. A map showing the distribution line and all properties with a table referencing all easements (Deed
Book and Page).
Mail the documentation to the Division of Water Resources, Non -Discharge Branch, 1617 Mail Service
Center, Raleigh, NC 27699-1617, or Non-Discharge.Reportskncdenr.gov. [15ANCAC 02T .0116(a)]
WQ0042699 Version 1.0 Shell Version 200201 Page 1 of 6

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3. Operation of the reclaimed water distribution facilities shall be contingent upon construction and
operation of permitted reclaimed water distribution lines immediately upstream and downstream of the
reclaimed water distribution facilities permitted herein. Specifications for future upstream and
downstream reclaimed water distribution lines shall include quality assurance testing procedures, which
shall be adhered to prior to operation of the reclaimed water distribution facilities permitted herein.
[G. S. 143-215.1 ]
II. PERFORMANCE STANDARDS
1. The Permittee shall maintain and operate the subject reclaimed water distribution facilities so there is
no discharge to surface waters, nor any contravention of groundwater or surface water standards. In
the event the facilities fail to perform satisfactorily, including the creation of nuisance conditions due
to improper operation and maintenance, the Permittee shall take immediate corrective actions, including
Division required actions, such as the construction of additional or replacement reclaimed water
distribution facilities, or cessation of reclaimed water distribution. [15A NCAC 02T .0108(b)(1)(A)]
2. This permit shall not relieve the Permittee of their responsibility for damages to groundwater or surface
water resulting from the operation of this facility. [15A NCAC 02T .0108(b)(1)(A)]
3. Construction of the reclaimed water distribution facilities permitted herein shall be scheduled as not to
interrupt service of existing utilities. [15A NCAC 02T .0108(b)(1)(A)]
4. All reclaimed water valves, storage facilities, and outlets shall be tagged or labeled to warn the public
or employees that the water is not intended for drinking. [15A NCAC 02U .0403(b)]
5. All reclaimed water piping, valves, outlets, and other appurtenances shall be color -coded, taped, or
otherwise marked to identify the source of the water as being reclaimed water as follows:
a. All reclaimed water piping and appurtenances shall be either colored purple (Pantone 522 or
equivalent) and embossed or integrally stamped or marked "CAUTION: RECLAIMED WATER -
DO NOT DRINK" or be installed with a purple (Pantone 522 or equivalent) identification tape or
polyethylene vinyl wrap. The warning shall be stamped on opposite sides of the pipe and repeated
every three feet or less;
b. Identification tape shall be at least three inches wide and have white or black lettering on purple
(Pantone 522 or equivalent) field stating "CAUTION: RECLAIMED WATER - DO NOT
DRINK". Identification tape shall be installed on top of reclaimed water pipelines, fastened at least
every 10 feet to each pipe length and run continuously the entire length of the pipe; and
c. Existing underground distribution systems retrofitted for the purpose of conveying reclaimed water
shall be taped or otherwise identified as noted in 11.5.a. and 1I.5.b. This identification need not
extend the entire length of the distribution system but shall be incorporated within 10 feet of
crossing any potable water supply line or sanitary sewer line.
[15A NCAC 02U .0403(c)]
6. All reclaimed water valves and outlets shall be of a type, or secured in a manner, that permits operation
by personnel authorized by the entity that operates the reclaimed water system. [15A NCAC 02U
.0403(d)]
7. Hose bibs shall be located in locked, below grade vaults that shall be labeled as being of non -potable
quality. As an alternative to the use of locked vaults with standard hose bib services, other locking
mechanisms such as hose bibs that can only be operated by a tool may be placed above ground and
labeled as non -potable water. [15A NCAC 02U .0403(e)]
8. There shall be no direct cross -connections between the reclaimed water and potable water systems,
unless such connection has been approved by the Department pursuant to 15A NCAC 18C .0406. [15A
NCAC 02U .0403(f)]
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9. Reclaimed water distribution lines shall be located at least 5 feet horizontally from and 18 inches below
any water line if practicable. If these separation distances cannot be met, the piping and integrity testing
procedures shall meet water main standards in accordance with 15A NCAC 18C. [15A NCAC 02U
.0403(h)]
10. Reclaimed water distribution lines shall not be less than 50 feet from a well unless the piping and
integrity testing procedures meet water main standards in accordance with 15A NCAC 18C, but in no
case shall they be less than 25 feet from a private well. [15A NCAC 02U .0403(i)]
11. Reclaimed water distribution lines shall meet the separation distances to sewer lines in accordance with
15A NCAC 02T .0305. [15A NCAC 02U .04030)]
III. OPERATION AND MAINTENANCE REQUIREMENTS
1. The Permittee shall operate and maintain the subject facilities as anon -discharge system. [15A NCAC
02U .0101]
2. The Permittee shall maintain an Operation and Maintenance Plan, which shall include:
a. A description of the operation of the system in detail to show what operations are necessary for the
system to function and by whom the operations are to be conducted;
b. A sampling and monitoring plan to evaluate quality of reclaimed water within the distribution
system to provide quality assurance at the time of reuse, and specify actions to be taken in response
to unsatisfactory monitoring results;
c. A map of all reclaimed water distribution lines;
d. A description of anticipated maintenance of the system;
e. Provisions for safety measures, including restriction of access to the site and equipment; and
f. Spill control provisions that include response to upsets and bypasses, including control,
containment, and remediation, and contact information for personnel, emergency responders, and
regulatory agencies.
[15A NCAC 02U .0801(a)]
Only reclaimed water generated from Utley Creek WWTP Reclaimed Water System (Permit No.
WQ0032289) shall be conveyed in the reclaimed water distribution facilities permitted herein. [15A
NCAC 02U.0101]
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IV. MONITORING AND REPORTING REQUIREMENTS
1. The Permittee shall conduct and report any Division required monitoring necessary to evaluate this
facility's impact on groundwater and surface water. [15A NCAC 02T .0108(c)]
2. Noncompliance Notification:
The Permittee shall report to the Raleigh Regional Office, telephone number [phone], within
24 hours of first knowledge of the following:
a. Any failure rendering the reclaimed water distribution facilities incapable of adequately conveying
the reclaimed water (e.g., mechanical or electrical failures, line blockages or breaks, etc.).
b. Any failure resulting in a discharge to surface waters.
c. Any discharge to land surface greater than or equal to 5,000 gallons. The Permittee shall document
discharges less than 5,000 gallons to land surface, but do not require Regional Office notification.
Emergencies requiring reporting outside normal business hours shall call the Division's Emergency
Response personnel at telephone number [phone], [phone], or [phone]. All
noncompliance notifications shall file a written report to the Raleigh Regional Office within five days
of first knowledge of the occurrence, and this report shall outline the actions proposed or taken to ensure
the problem does not recur. [15A NCAC 02T .0108(b)(1)(A)]
V. INSPECTIONS
1. The Permittee shall perform inspections and maintenance to ensure proper operation of the reclaimed
water distribution facilities. [15A NCAC 02U .0801(i)]
2. The Permittee shall inspect the reclaimed water distribution facilities to prevent malfunctions, facility
deterioration, and operator errors that may result in discharges of wastes to the environment, threats to
human health, or public nuisances. The Permittee shall maintain an inspection log that includes the
date and time of inspection, observations made, and maintenance, repairs, or corrective actions taken.
The Permittee shall maintain this inspection log for a period of five years from the date of the inspection,
and this log shall be made available to the Division upon request. [ 15A NCAC 02U .0801(h), 02U
.0801(i)]
Division authorized representatives may, upon presentation of credentials, enter and inspect any
property, premises, or place related to the reclaimed water distribution facilities permitted herein at any
reasonable time for determining compliance with this permit. Division authorized representatives may
inspect or copy records maintained under the terms and conditions of this permit, and may collect
groundwater, surface water, or leachate samples. [G.S. 143-215.3(a)(2)]
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VI. GENERAL CONDITIONS
1. Failure to comply with the conditions and limitations contained herein may subject the Permittee to a
Division enforcement action. [G.S. 143-215.6A, 143-215.613, 143-215.6C]
2. This permit is effective only with respect to the nature and volume of wastes described in the permit
application, and Division -approved plans and specifications. [G.S. 143-215.1(d)]
3. Unless specifically requested and approved in this permit, there are no variances to administrative codes
or general statutes governing the construction or operation of the facilities permitted herein. [15A
NCAC 02T .0105(n)]
4. The issuance of this permit does not exempt the Permittee from complying with all statutes, rules,
regulations, or ordinances that other jurisdictional government agencies (e.g., local, state, and federal)
may require. [15A NCAC 02T .0105(c)(6)]
5. If the permitted facilities change ownership, or the Permittee changes their name, the Permittee shall
submit a permit modification request on Division -approved forms. The Permittee shall comply with
all terms and conditions of this permit until the permit is transferred to the successor -owner. [G.S. 143-
215.1(d3)]
6. The Permittee shall retain a set of Division -approved plans and specifications for the life of the facilities
permitted herein. [15A NCAC 02T .0105(o)]
7. This permit is subject to revocation or modification upon 60-day notice from the Division Director, in
whole or part for:
a. violation of any terms or conditions of this permit or Administrative Code Title 15A Subchapter
02U;
b. obtaining a permit by misrepresentation or failure to disclose all relevant facts;
c. the Permittee's refusal to allow authorized Department employees upon presentation of credentials:
i. to enter the Permittee's premises where a system is located or where any records are required
to be kept;
ii. to have access to any permit required documents and records;
iii. to inspect any monitoring equipment or method as required in this permit; or
iv. to sample any pollutants; or
d. a Division determination that the conditions of this permit are in conflict with North Carolina
Administrative Code or General Statutes.
[15A NCAC 02T .0110]
Permit issued this the 16t' day of November 2021
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
S. Daniel Smith, Director
Division of Water Resources
By Authority of the Environmental Management Commission
Permit Number WQ0042699
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DocuSign Envelope ID: A38B6E50-D55B-4DDB-B42C-01CD781BB14B
Permit No. WQ0042699 Reclaimed Water Distribution
Town of Holly Springs November 16, 2021
Carolina Springs — Phase 1, Sub Phases 1-5 RWDL Wake County
ENGINEERING CERTIFICATION
❑ Partial ❑ Final
I, , as a duly licensed North Carolina Professional
Engineer, having ❑ periodically / ❑ fully observed the construction of the permitted facilities, do hereby
state to the best of my abilities that the facility was constructed in compliance with G.S. 143-215.1,
Administrative Code Title 15A Subchapter 02U, this permit, and the Division -approved plans and
specifications.
Documentation of any variation to this permit, and the Division -approved plans and specifications, is in the
attached as -built drawings.
Description of variations:
Professional Engineer's Name
Firm Name
Firm No.
Address
City
State
Zip Code
Telephone
Email
Seal, Signature, and Date
THE COMPLETED ENGINEERING CERTIFICATION, INCLUDING ALL SUPPORTING
DOCUMENTATION, SHALL BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
NON -DISCHARGE BRANCH
By U.S. Postal Service By Courier/Special Delivery
1617 MAIL SERVICE CENTER 512 N. SALISBURY ST.
RALEIGH, NORTH CAROLINA 27699-1617 RALEIGH, NORTH CAROLINA 27604
WQ0042699 Version 1.0 Shell Version 200201
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DocuSign Envelope ID: A38B6E50-D55B-4DDB-B42C-01CD781BB14B
LENNAR CAROLINAS LLC
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PIN:0730533724
LAND USE: VACANT
ZONING: PUD
TOWN OF HOLLY SPRINGS /
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PIN:0730457251
LAND USE: VACANT
ZONING: R30
TOWN OF HOLLY SPRINGS ETJ
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PIN:0730545847
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SCM 12
MENT
CAPE FEAR BUFFER•::..::::..:....:....:
\ C WET DETENTION / I \ / / ♦ /
/ \ POND / / \ \� / ♦ ` / /
SECTION 2
\ 25' ROW ♦ \ � � iSECTION 3 TO REMAIN / �/ • ��• / \ \`
O \ DEDICATION J / ' ( \ 1 _ — — — \\\ \ �/ / �. ♦ ♦ v \ , »>r,i2:i: ' Jl
03 / 100,30' HOLLY SPRINGS I os� j \ \ / //SCM 8 \ /\ i gOV���PRO SEE SEPARATE CAROLINA SPRINGS BLVD. c'
CAPE FEAR BUFFER Q \ \ WET DETENTION / GS
Rom PLAN SET FOR MORE INFORMATION SHOWN \ \ \
L vOQJ� M \ \ ( POND r �\ ( �O�\NPSPzQJe c FOR REFERENCE ONLY \
Q \ / LENNAR CAROLINAS LLC
N / DB 17612, PG. 1928
PIN:0730533724 0°° \ \ 1 / \
m \ \ \ LAND USE: VACANT _ / 1 — �) _ r \ — // \\ CAPITAL PROPERTIES II LLC,
/ r / \ \\ LENNAR CAROLINAS LLC \ A
ZONING: PUD
TOWN OF HOLLY SPRINGS _ ;:::. I I \ PIN: 0730834534
I :�:' � �. \ � DB 17612, PG. 1928 O
I LAND USE: VACANT \ \\
ZONING: PUD
TOWN OF HOLLY SPRINGS
SCM 7 \ I
• I CONSTRUCTED
WETLANDS
EXISTING EOP \�
FUTURE PUMP STATION #2
(FINAL LOCATION TO BE DETERMINED)
SHEET KEY MAP
[
00 _�� ----., _ _ \ J 50' DIXIE PIPELINE COMPANY R/W
)ODWAY w u€ I — / DB 2758, PG. 643
30' HOLLY SPRINGS Q / \�°'
CAPE FEAR BUFFER(\`� SECTION 1A Y ::.. G—
_ j \
DIXIE PIPELIN P 43 \ \ \ \ \ \\
2758, G. 6
_— IXIE I :LINE COMPANY Klvv
DB 27g' .
SECTION 1 B \ I I 30' HOLLY SPRINGS
CAPE FEAR BUFFER \
.' /\ ✓ 30' HOLLY SPRINGS Lu
CAPE FEAR BUFFER Q I I w
SCM 10 ` :; �..r,• I I I -z:.
:. .
WET DETENTION T
. .. ....... ....
\ POND (5 CCESS EASEMENT) " w.fl"" \ II
30' HOLLY SPRINGS
wzz
\ w I CAFE FEAR BUFFER
\o Q LENNAR CAROLINAS LLC \ I / rr EXISTING
oo�� spa-a�saoo°° DB 17612, PG. 1928 \ \ I I I / , 12 OAKS \
PIN:0730533724 "j SUBDIVISION \
LAND USE: VACANT
= ZONING: PUD
wo I �EP�
U, TOWN OF HOLLY SPRINGSX.
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r
DUKE ENE.,-.,. LLC <<FY
FORMERLY A sey6�
FIRST CITIZENS BANK TRACT.�,�/'
(SEE DB 2086, PG. 677 & CP&L DRAWING #L-D-2581)
DUKE LAND UNIT #1183088
PIN:0730634462
LAND USE: STATE ASSESSED \
WAKE COUNTY
PROPOSED 25' R/W DEDICATION
EXISTING LOCAL I I 30' HOLLY SPRINGS
\ 100 YEAR FLOODPLAIN / / / I CAFE FEAR BUFFER /
PUD BOUNDARY
PROPOSED LOCAL I '
`°° 100 YEAR FLOODPLAIN
DUKE ENERGY PROGR?E.
DB 15289 PG 2437
PIN 0730712692 `
SEWER OUTFALL PART ON THE
\ \ CAROLINA SPRINGS BLVD
cP�@CQ \ ,• \ \ I I AND INFRASTRUCTURE '
6FF� `° \ SCM 6 \ CONSTRUCTION DRAWINGS /
09 \ fie° CONSTRUCTED / TOHS #17-29-0 4
O \ Q WETLANDS / / 1 :: ::; i
UTILITY PLAN NOTES: \ ° MH 378 1 %::::\. /
1. UTILITY AND PIPELINE EASEMENTS SHALL BE RECORDED AFTER CONSTRUCTION IS S;: 'ARATE P AN SET ; // \
COMPLETED AS PART OF THE RIGHT-OF-WAY PLAT. F STON #1
°a OQ MIi
2. ALL STORM DRAINAGE AND SANITARY SEWER LINES SHALL HAVE 20' EASEMENTS CENTERED \k �� 3-P'SS_ Fn. /
ON THE LINES UNLESS LOCATED COMPLETELY IN ROAD ROW. \ \ O MN A / / r / N
3. ALL MANHOLES LOCATED OUTSIDE OF PAVED AREAS SHALL HAVE A RIM ELEVATION OF ONE \- !� / Q //' ` doo
FOOT ABOVE FINISHED GRADE. MANHOLES ADJACENT TO 100-YR FLOOD PLAIN SHALL HAVE A
RIM ELEVATION OF 2' ABOVE THE 100-YR FLOOD ELEVATION. \� H 2 _ _/� /� r •
r
4. WATER LINE SHALL BE 2' MINIMUM OFF EDGE OF CURB UNLESS SHOWN OTHERWISE.
5. WATER MAINS SHALL BE LAID AT LEAST 10 FEET LATERALLY MEASURED EDGE TO EDGE FROM
EXISTING OR PROPOSED SANITARY OR STORM SEWER UNLESS THE ELEVATIONS OF THE
BOTTOM OF THE WATER MAIN IS AT LEAST 18 INCHES ABOVE THE TOP OF THE SEWER WITH A _ _ _ — •
HORIZONTAL SEPARATION OF AT LEAST 3 FEET.
PUD BOUNDARY A
0o e
6. WHERE A WATER MAIN AND A SANITARY SEWER CROSS AND THE VERTICAL SEPARATION IS
LESS THAN 18 INCHES OR THE WATER LINE PASSES UNDER THE SANITARY SEWER, THE SEWER
MAIN SHALL BE DUCTILE IRON PIPE. ALL WATER LINES SHALL BE DUCTILE IRON PIPE. -
7. EACH WATER SERVICE SHALL BE EQUIPPED WITH A PRESSURE REDUCING VALVE ON THE
PRIVATE SIDE OF THE METER. DUKE ENERGY PROGRESS LLC
8. ALL NEW UTILITY LINES MUST BE UNDERGROUND. REMAINDER OF
9. WATER AND SEWER SERVICES SHALL BE INSTALLED WITHIN A 3' RADIUS OF EACH LOT LINE. RCITIZENS
SEE DB 2086PG r77 & CP&ADRAW NG 41 n �rQ
10. RECLAIMED WATER LINE SHALL BE C900 PVC.
11. ALL NEW DISTRIBUTION PIPING IN THE RECLAIMED WATER SYSTEM, INCLUDING SERVICE LINES,
VALVES AND OTHER APPURTENANCES SHOULD EITHER BE COLORED PURPLE (PANTONE 522 " Vm
OR SIMILAR) AND EMBOSSED OR BE INTEGRALLY STAMPED/MARKED "CAUTION: RECLAIMED
WATER - DO NOT DRINK" OR BE INSTALLED WITH A PURPLE IDENTIFICATION TAPE, AND A
PURPLE POLYETHYLENE VINYL WRAP.
12. TEMPORARY 2" BLOW -OFF ASSEMBLIES WITH GV (IF ENTIRE PROJECT IS TO BE CONSTRUCTED
AT ONE TIME THIS IS NOT NEEDED; IF NOT, REMOVE DURING NEXT SECTION OF CONSTRUCTION
DUKE LAND UNIT #1183088
PIN:0730634462
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Job No.
Drawn By
02190372.10
WR
Date
Designer
11/05/2020
WR
%0111 a u1,11
UA No 1i
2 SEAL =
_ 028892
DocuSigneilA vjiNoe RAM. • C; `;`�.
VIYIU """'lu�� 6/8/2021
Revisions
1
PER TOHS COMMENTS
2021.03.08
2
PER TOHS COMMENTS
2021.04.14
3
PER TOHS COMMENTS
2021.05.12
4
PER TOHS COMMENTS
2021.06.09
Ow I
GRAPHIC SCALE Sheet No.
200 0 100 200 400
C3.0
1 inch = 200 Ft.

.DocuSign Envelope ID: A38B6E50-D55B-4DDB-B42C-01 CD781 BB14B
LENNAIZ
I. Lennar Carolinas LLC, By: Stephen Dorn (developer/landowner), certify that I am the owner of the
property upon which the proposed Carolina springs Phase 1, sections 1-5 (subdivisioil/developiment) is
planned as shown on Project #20-17-01 (TOHS Site Plan #), inchrding all offsite
easements required for the extension of public reclaimed water lines. Ownership of said
property and easements is evidenced in the following recorded deeds: (A portion of FIN 0292227):
Deed Book 0176I2 Pages 1912 - 1927
I hereby request that the Town of Holly Springs apply for a Reclaimed Water Distribution Line
permit on my behalf for consriliction of the reclaimed water distribution lines.
I certify that upon complete installation of the reclaimed water extensions and subsequent
approval and acceptance by the Town of Holly Springs, the subject reclaimed waterlines and
easements are hereby dedicated to the Town of Holly Springs.
C
Docu8igned by:
Signed: 3oaeeaFzos;:,,, ,
Date:
4/12/2023
1100 Perimeter Park Drive —Suite 112, Morrisville, NC 27560
Phone: [phone] u

DocuSign Envelope ID: A38B6E50-D55B-4DDB-B42C-01CD781BB14B
Carolina Springs — Phase 1— Sections 1-5 — Utility Certification Tracker
Section 1A —Reclaimed Water
INFRASTRUCTURE DATA
AREA
IACI
UNITS
[TOTAL]
STREETS
ILF)
SIDEWALK
[LF]
GREENWAY
ILF)
6" RECLAIM
MAIN ILF)
8" WATER
MAIN ILF]
12" WATER
MAIN ILF]
STORM
DRAINAGE
MAIN ILF)
8" SEWERtGPM
]
t2' RECLAIM
MAIN [ LF ]
SECTION 1 A
23.87
68
3762
7370
677
3367
1152
2251
5379
34420
1 823
SECTION 18
11.38
1
4956
4030
475
2414
2516
3247
04
0
SECTION 2
14.76
83
3991
4174
1451
1485
274
4195
18480
SECTION 3
5.54
5
1471
2336
1445
1480
2220
7270
SECTION 4
24.71
147
4358
5909
3094
3167
5977
32155
0
SECTION 5
4.55
1252
1712
493
493
1972
4100
0
AMENITYAREA
5.60
0
0
0
0
0
0
0
0
0
TOWN PARK
24.84
0
0
0
0
0
0
0
0
0
TOTAL
115.25
436
19,790
25,531
1,152
12,264
10,293
2,525
22,990
11,685
1,823THIS
CAROLINA SPRINGS SECTION 1 RESIDENTIAL SUBDIVISION PLAN WILL PROVIDE 111,180 GPD, 77 GPM AND A PEAK FLOW OF 1THESE QUANTITIES ARE BASED ON WHAT IS PHYSICALLY LOCATED WITHIN THE PHASE. THERE MAY BE SECTIONS OF STORM THAT
BE REQUIRED TO BE INSTALLED IN A FUTURE PHASE TO DRAIN TO AN SCM IN ORDER FOR THE CURRENT PHASE TO BE ACCEPTED.

DocuSign Envelope ID: A38B6E50-D55B-4DDB-B42C-01 CD781 BB14B
I'
II
II
II
II
41
II
II
r .I
+
II
i
Ag
I
a a r CAROLINA SPRINGS
OVERALL UTILITY PLAN PHASE 1 ■O WithersRavenel
O SECTIONS 1-S ,. Engineers I Planners I Surveyors
9 y " HGLLY SPRINGS, NORTH CAROLINA

DocuSign
Certificate Of Completion
Envelope Id: A38B6E5OD55B4DDBB42C01 CD781 BB14B Status: Completed
Subject: 42074 Carolina Springs 1-5 Reclaim Partial Cent and Mod.doc, 3_20230412...
Source Envelope:
Document Pages: 28 Signatures: 4 Envelope Originator:
Certificate Pages: 5 Initials: 4 Emily Koncz
AutoNav: Enabled PO Box 8
Envelopeld Stamping: Enabled Holly Springs, NC 27540
Time Zone: (UTC-05:00) Eastern Time (US & Canada) [e-mail]
IP Address: 204.84.166.2
Record Tracking
Status: Original Holder: Emily Koncz Location: DocuSign
4/20/2023 9:03:09 AM [e-mail]
Signer Events Signature Timestamp
Curtis Blazier S'g dby:Sent: 4/20/2023 9:16:48 AM
[e-mail] ED
UyY S �tt V Viewed: 4/20/2023 9:44:38 AM
Securit Level: Email Account Authentication 123EF6CA825E41F... Signed: 4/20/2023 9:48:26 AM
Y 9
(None)
Signature Adoption: Pre -selected Style
Using IP Address: 96.10.0.210
Electronic Record and Signature Disclosure:
Accepted: 4/20/2023 9:44:38 AM
ID:eb9a16cc-712b-426e-9aca-e7a4bec9eb02
Company Name: Town of Holly Springs
Rachel Ingham LD,
Sent: 4/20/2023 9:48:31 AM
[e-mail] Viewed: 4/20/2023 1:27:24 PM
Engineering Manager - Utilities Signed: 4/20/2023 1:29:32 PM
Security Level: Email, Account Authentication
(None) Signature Adoption: Pre -selected Style
Using IP Address: 75.189.128.27
Electronic Record and Signature Disclosure:
Accepted: 11/16/2020 9:41:26 AM
ID: 0c7f672d-8bab-496f-91 f1-115266328d46
Company Name: Town of Holly Springs
Drew Johnson Sent: 4/20/2023 1:29:38 PM
[e-mail] Viewed: 4/20/2023 1:31:08 PM
Development Construction Manager Signed: 4/20/2023 1:31:22 PM
Security Level: Email, Account Authentication
(None) Signature Adoption: Pre -selected Style
Using IP Address: 204.84.166.2
Electronic Record and Signature Disclosure:
Accepted: 4/20/2023 1:31:08 PM
ID: 16ae8cd0-9ccf-4770-973c-15167f6160d 5
Company Name: Town of Holly Springs
Kendra Parrish
EDSig dbv:Sent: 4/20/2023 1:31:28 PM
[e-mail]
Viewed: 4/20/2023 2:37:57 PMExec
Director of Utilities and Infrastructure
o3Co5669FC34444o Signed: 4/20/2023 2:38:08 PM
Holly Springs
Signature Adoption: Drawn on Device
Security Level: Email, Account Authentication
(None)
Using IP Address: 204.84.166.2
Electronic Record and Signature Disclosure:

Signer Events
Signature
Timestamp
Accepted: 4/6/2021 7:18:46 PM
ID: 6cbf2406-2f8d-46a2-8e81-c6f600daf744
Company Name: Town of Holly Springs
In Person Signer Events
Signature
Timestamp
Editor Delivery Events
Status
Timestamp
Agent Delivery Events
Status
Timestamp
Intermediary Delivery Events
Status
Timestamp
Certified Delivery Events
Status
Timestamp
Carbon Copy Events
Status
Timestamp
Witness Events
Signature
Timestamp
Notary Events
Signature
Timestamp
Envelope Summary Events
Status
Timestamps
Envelope Sent
Hashed/Encrypted
4/20/2023 9:16:48 AM
Certified Delivered
Security Checked
4/20/2023 2:37:57 PM
Signing Complete
Security Checked
4/20/2023 2:38:08 PM
Completed
Security Checked
4/20/2023 2:38:08 PM
Payment Events
Status
Timestamps
Electronic Record and Signature Disclosure

Electronic Record and Signature Disclosure created on: 11/12/2020 9:42:57 PM
Parties agreed to: Curtis Blazier, Rachel Ingham, Drew Johnson, Kendra Parrish
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