WQ0044210_Application (FTSE)_20230504

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State of North Carolina
Department of Environmental Quality DWRDivision of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number:'o M4 C - t (to be completed by DWR)
All items must be completed or the application will be returned
1. APPLICANT INFORMATION:
1. Applicant's name: Town of Fuquay-Varina (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State/County ® Municipal
3. Signature authority's name: Michael Wagner per 15A NCAC 02T .0106(b)
Title: Public Utilities Director
4. Applicant's mailing address: 134 N. Main Street
City: Fuauav—Varina State: NC Zip: 27526-
5. Applicant's contact information:
Phone number: [phone] Email Address: [e-mail]
11. PROJECT INFORMATION:
1. Project name: Berk-Tek Expansion
❑ Privately -Owned Public Utility
❑ Other
2. Application/Project status: ® Proposed (New Permit) ❑ Existing PermitfProject
If a modification, provide the existing permit number: WQ00 and issued date: ,
For modifications, also attach a detailed narrative description as described in Item G of the checklist.
If new construction, but part of a master plan, provide the existing permit number: WQ00
3. County where project is located: Wake
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.617382' Longitude:-78.807356'
5. Parcel ID (if applicable): 0657-79-5708 (or Parcel ID to closest downstream sewer)
111. CONSULTANT INFORMATION:
I. Professional Engineer: Donald L. Curry. PE License Number: 026970
Firm: The Curry Engineering Groun. PLLC
Mailing address: 205 S. Fuquay Avenue
City: Fuquay-Varina State: NC Zip: 27526-2212
Phone number: [phone] Email Address: don ar curryeng.com
1V. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Terrible Creek WWTP Permit Number: NCO066516
Owner Name: Town of Fuauav-Varina
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQCS00193
2. Downstream (Receiving) Sewer Information: 8 inch ® Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS00193
Owner Name(s): Town of Fuauav-Varina
FORM: FTA 06-21 Pagel of 5

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
[-]Yes ❑ No ®N?A
2. If the Applicant is a Developer of lots to be sold, has a Dcrcloper's Operational Agreement (FORM: DF V} been attached?
[:]Yes ❑ No ®N!A
3. If the Applicant is a Home.:Property Owners' Association, has an I10A POA (h)erational AZecrosnt {FORM: I IOAI and
supplementary documentation as required by 15A NCAC 02T.0115(c) been attached'?
❑ Yes ❑ No ® N+A
4. Origin of wastewater: (check all that apply). -
El Residential (Individually Owned) ❑ Retail (stores, centers, malls) ❑ Car Wash
❑ Residential (Leased) ❑ Retail with food preparation'service ❑ Hotel and ;'or Motels
El School r' preschool ! day care El Medical + dental r' veterinary facilities El Swimming PoolrClubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool.:Filter Backwash
® Businesses 1 offices! factories ❑ Nursing Home ❑ Other (Explain in Attachment)
S. Nature of wastewater: 100 % Domestic % Commercial _ % Industrial (See 15A NCAC 021'.0103(20))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes® No
G. Hasa 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(f))
Daily Design Flow '°
No. of Units
Flow
gale
GPD
gal,
GPD
gal+
GPD
gal'
GPD
gal'
GPD
gal?
GPD
Total
0 GPD
a See 15A NCAC 02T A114(b), (d). (e)(1) and (c)(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. 42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.01 14] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
$. Wastewater generated by project: 0 GPD (per 15A NCAC 021 .0114)
Y 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

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 021,030 & %1K.'4Gravitti, Sewers):
l_ Summarize gravity sewer to be permitted:
Sire (inches)
Length (feet)
Material
8"
573
C900 PVC
8"
101
SDR-35 PVC
7 Section 11 & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
Y Section I II 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
Vill. PUMP STATION DESIGN CRITERIA (if Applicable) —02T .0305 & MDC (Pump Stations/Force Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION_ INCLUDED IN THIS PROJECT
1. Pump station number or name:
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)
Y 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 2.01C.I.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(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
Y 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)(l)(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_
Y 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 pennit 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(f)):
1. Does the project comply with all separatiow,alternatives found in 15A NCAC 02 f .0305(f) & (g)? ® 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
=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-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-I or WS-V), B, SA, ORW, HQW, or SB from normal
high water (or tide elevation) and wetlands associated with these waters (see item IX.2)
50 feet
"Any other stream, iakc, 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 021'.0305(_) or (g), see Section X.l of this application
*15A NCAC 02T.0305(a) contains alternatives where separations in 021'.0305(f) cannot be achieved. Please check -'%es"
above if these alternatives are used and provide narrative information to explain,
**Stream classifications can be identified using the Division's INC Surface Water Classifications webpaae
2. Does this project comply with the minimum separation requirements for water mains? ® Yes [—]No ❑ N.-'A
If no, please refer to 15A NCAC 18C.0906(f) for documentation requirements and submit a separate document,
signed+sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? ® Yes [—]No ❑ N.-'A
7 Please provide supplementary information identifying the areas of non-conformance.
);� See the Division's draft separation requirements for situations where separation cannot be met.
Y 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 15A NCAC 02B .0200? ❑ Yes ❑ No
> This includes Trout Buffered Streams per 15A NCAC 26.0202
S. Does the project require coverage -authorization under a 404 Nationwide/individual permits ❑ Yes ® No
or 401 Water Quality Certifications?
Please provide the permit numberfpermitting status in the cover letter if coverage/authorization is required.
6. Does project comply with ISA NCAC 02T.0105(c)(6) (additional permits..certifications)? ® Yes ❑ No
Per 15A NCAC 02T.0105(c)(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 and- sewer collection lines that are deemed "high -priority?" ❑ Yes ® No
Per 15A 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.
Y 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

X. CERTIFICATIONS:
1. Does the submitted system comply with ISA NCAC 02T, the 1liminum Dcst_.n C'rtterio foi 0% Periim ink of P.naii� tit,,;loil%
.rid f urcc l,tint I,rir,t t �r,i��it , and the liras in lsC11 er %hilinitim I esi_.n C r IC1.1.1 I lalC�l s e. - 4.11i 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. Appr•osal or the request .-till be i5stied
concurrently srilh lhr anprmai of the permit, andyrojrc,ts requiring a ►arianee appr•o%al may he subiecl to lonQcr
revie%i times. For proicels rc uirki ! twt) or more sariances or where the snriunce is determined hs the Visision to bca
significant liortiou of the hroieet, tht full technical re%icw is required.
2. Professional Engineer's Certification:
I, V--q4c&D L- Cr R(2- °t.T7L , attest that this application for �-XK— 7 6iiXiP1^)!R04/
(Professional Eng`mcer's name from Application Item II1 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,
Mininitim Dcslun C iileria Itir Ora il% Se%%ers (Invest sersion). and the %linintunt Design Criteria 1'or the Fa-;t-1 rack Perrnitting,
of Pump Stations and Force ,Mains i latest Nei-Nion). 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 143-215.613, 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. 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 t5A NCAC 02T .0106(b)
t, Michael Wagner , attest that this application for Berk-Tek Expansion
(Signature Authority Name from Application Item 1.3.) t?roject Namc from Application Item 11.1)
attest that this application has been reviewed by me and is accurate and complete to the best of my knowledge.
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 143.215.613, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: &4//4401�
Date: 03/09/2023
FORM: FTA 06-21 Pale 5 of 5

Curr
ENGINEERINGL
TRANSMITTAL FORM
TO: NC Dept. of Environmental Quality
Div. of Water Resources
Raleigh Regional Office
Water Quality Section
3800 Barrett Drive
Raleigh, NC 27609
919-719-4200
SUBJECT: Berk-Tek Expansion
CURRY PROJECT NO: 2022-016
we are sending you the following items:
DATE: March 9, 2023
SENT BY: Ed Loeffler
COPIES I ITEM DESCRIPTION
2 Application Fast Track Sewer Application - Berk-Tek Expansion
2 Forms FTSE 10 18 ITown of Fuquay-Varinal
Check I $480.00 Fee. Sewer Application
These are transmitted as checked below:
For Information Approved as Noted - Revise and Resubmit
As Requested Not Approved - Revise and Resubmit
For Review and Comments For Record and File
For Revision Submittal
x For Approval _ For Recording
Approved _ For Signature, then return to:
REMARKS.
Attached please find the signed Fast Track Sanitary Sewer Applications for the Berk TO Expansion
industrial property al 100 Technology Park Lane, Fuquay-Varina, NC. Please contact ma with any
questions. Thank you.
T (9191 552-0849 205 S. Fuquay Avenue
F (9191 552-2043 Fuquay-Varina, NC 27526
NC Dept of Environmental Qualip
MAR 13 .'(i-,"�
Raleigh Regional Office
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ENGINEERING
March 10. 2023
NC department of Environment Quality
Division of Water Resources
Raleigh Regional Office
Water Quality Section
.1800 Barrett Drive
Raleigh, NC 27609
[919) 791-4200
RE: Berk-Tek Expansion
Sewer Fast Track Sanitary Sewer Applicalion Cover Letter
Dear Sir.
NC Dept of Environmental Quau t;
MAP, 13 2023
Raleigh Regional Office
Enclosed please find documentation, design data, application fee and other resources necessary to
review the Fast Track Application for the public sanitary sewer system of the Berk-Tek Expansion in
Fuquay-Varina, Wake County NC. The project consists of construction of replacement gravity sewer
lines connecting to an existing sewer line at the southeast side of the property. These sewer lines
feed to the Terrible Creek Wastewater Treatment Plant, The Berk-Tek factory expansion project is
located at the 100 Technology Park Lane, Fuquay Varina, NC address. The property involved is located
within the Town of Fuquay-Varina, NC planning jurisdiction.
Due to the Berk-Tek factory expansion and associated site work, a se;.t-on of the existing gravity
sanitary sewer tines will be removed and replaced with new Imes. The new sanitary sewer system
lines consist of a total of 674 feet of B" PVC gravity service. The amount of additional wastewater
generated by the project is zero 101 GPD, as this Is a replacement of existing sewers with no new flow
expected.
At the completion of construction, the system wdl be certified by a licensed profess:onal engineer in
accordance with NCDEQ and State and local regulations.
Sincerely,
" l/1/
Ed Loeffler, Project Manager
T (9191552-0849 2055.Fuquay Avenue
F 19191 552-2043 Fuquay-Varina, NC 27526
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NC Dep ,fEnviTlfll ientai Quality State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
Division of Water Resources f+i,�.F* 2 0" FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number:t-{ 4-ZA D ilu be somplc[ed b} DWR)
All items must be comMeted or the anQlication will be returned
I. APPLICANT INFORMATION:
I. Applicant's name: Town of Fuquay-Varina (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State.:County ® Municipal
3. Signature authority's name: Michael Wagner per 15A N(`AC DST .Ql0§Jb)
Title: Public Utilities Director
4. Applicant's mailing address: 134 N. Main Street
City: Fuquav-Varina State: NC Zip: 27526-
5. Applicant's contact information:
Phone number: [phone] Email Address: m_wagnera,fuquay-varina.org
❑ Privately -Owned Public Utility
❑ Other
11. PROJECT INFORMATION:
1. Project name: Berk-Tek Expansion
2. Application, Project status: ® Proposed (New Permit) ❑ Existing Permit. Project
If a modification, provide the existing permit number: WQ00 and issued date: ,
For modifications, also attach a detailed narrative description as described in Item G of the checklist.
If new construction, but part of a master plan, provide the existing permit number: WQ00
3. County where project is located: Wake
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.617382 Longitude:-78,807356
5. Parcel ID (if applicable): 0657-79-5708 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
. Professional Engineer: Donald L, Curry. PE License Number: 026970
Firm: The Curry Engineering Group, PLLC
Mailing address: 205 S. Fuquav Avenue
City: Fuquay,-Varina State: NC Zip: 2 7526-22 12
Phone number: [phone] Email Address: don@cu!lyenp,.com
1V. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
I. Facility Name: Terrible Creek W WTP Permit Number: NCO066516
Owner Name: Town of Fuquay-Varina
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQCS00193
2. Downstream (Receiving) Sewer Information: 8 inch X Gravity Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCSOO193
Owner Name(s): Town of Fuquav-Varina
FORM: FTA 06-21
Page I of 5

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑ No ® N. A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational A[,yrcement (FORM: DEV) been attached?
❑ Yes ❑ No ® N'A
3. If the Applicant is a Horne -Property Owners' Association, has an HOAIPOA Operational Agreement ,FORM: HOA.) and
supplementary documentation as required by 15A NCAC 02T.01 15(c) been attached?
❑Yes ❑No ®NA
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 dental ' veterinary facilities ❑ Swimming Pool,'Clubhouse
❑ Food and drink facilities ❑ Church El SwimmingPool.-Filter Backwash
® Businesses offices i factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater : % Domestic % Commercial 100 % Industrial (See I A NC -AC 02T .0103t201)
If Industrial, is there a Pretreatment Program in effect? ❑ Yes® No
6. Has a flow reduction been approved under 15A NCAC 02T. _0.t l4(El? ❑ Yes ❑ No
r if yes, provide a copy of flow reduction apiproval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T,0114(f))
Daily Design Flow',b
No. of Units
Flow
gall
GPD
gall
GPD
gall
GPD
gall
GPD
gall
GPD
gall
GPD
Total
0 GPD
a See 1,SA NC.AC 02T .0114tb), (d), (gK I and_( 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 ofthe Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in C, S� 42A-4).
b Per 15A NCAC 02T .01 14(c), design flow rates for establishments not identified [in table 15A N,CAC Q21,9 L l41 shall be
detennined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 0 GPD (per I SA ! CAC 02T.O 114)
Do not include future flows or previously permitted allocations
If permitted flow is zero, please indicate why:
❑ Pump Station Yorce 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

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8"
573
C900 PVC
8"
101
SDR-35 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
Vlll. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
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)
i 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_ I.b. ❑ Grinder Pump L] Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(I is
❑ 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
i 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

IX. SETBACKS & SEPARATIONS — (020.0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations/alternatives found in 15A CAC 02T .0305(t) & t ? ® Yes ❑ No
15A NCAC 02T.0305 contains minimum separations that shall be provided for sewers stems:
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-I 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 1X.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
7 If noncompliance with 02t_05(f1 Qr, see Section X.1 of this application
* 15A NCAC 02T.0305f contains alternatives where separations in 02T,0395ffi 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 webpag
2. Does this project comply with the minimum separation requirements for water mains? ®Yes ❑ No ❑ N.!A
:- If no, please refer to 15A NCAC 18C.0906(f) for documentation requirements and submit a separate document,
signedisealed 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 requirements for situations where separation cannot be met.
No variance is required if the alternative design criteria specified is utilized in design and construction.
4. Is the project located in a river basin subject to any State buffer rules? ❑ Yes Basin name: — ® No
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ❑ Yes ❑ No
This includes Trout Buffered Streams per 15A NCAC 2B.0202
5. Does the project require coverageauthorization under a 404 Nationwide. -individual permits ❑ Yes ® No
or 401 Water Quality Certifications?
Please provide the permit numberlpermitting status in the cover letter if coveragelauthorization is required.
6. Does project comply with ISA NCAC 02T.0I05jc1t6) (additional permits?certifications)? ® Yes ❑ No
Per 15A NCAC 02T.0105(cXf)), directly related environmental permits or certification applications must be being prepared,
have been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion
and sedimentation control plans, stormwater management plans, etc.).
7. Does this project include any sewer collection lines that are deemed "high -priority?" ❑ Yes ® No
Per I SA 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 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

X. CERTIFICATIONS:
I. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Perniitt:iriv of Pump Stations
and Foreemains Llatest. version and theQrayily rwer Minimum Design Criteria (latest ver-,ion) 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 reguest will be issued
concurrently with the anproval of the vermit, and oroiects reguiring a variance approval may be subject to longer
review times. For projects requiring two or more variances or where the variance is determined by the Division to be a,
si nificant Portion of the projec4 the full technical review is re uired.
2. Professional Engineer's Certification:
I, 'fix( 4&D L - CURED' 4. , attest that this application for r 544 —7LV— eA--JSI *A/
(Professional Engineer's name from Application Item III I ) (Project Name from Application Item II 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,
Min nrurn Design Criteria forCiravity Sewe ..([atesIA2MionF and the Minimum Design Criteria fix_the Fast -Track Permitting
of Pumo Stations and Force Mains (latest v rsion . 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 143-215.613, 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. 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 .0I06(b):
I, Michael Wagner , attest that this application for Berk-Tek Expansion
(Signature Authority Name from Application Item 1.3 ) (Project Name from Application Item 11 1)
attest that this application has been reviewed by me and is accurate and complete to the best of my knowledge.
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 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.
&�klzSignature: Date:
03/09/2023
FORM • FTA 06-11 I>— c -F c

NC Dept of Environmental Quality
State of North Carolina
Department of Environmental Quality
DW-4t Division of Water Resources
Division € Z�Re�3fflce Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: Town of Fuquay-Varina
Project Name for which flow is being requested: Berk-Tek Expansion
More than one FTSE ► ay he required for a single project if the owner of the WWTP is not responsible for ay pu►np
stations along the route of lire proposer/ wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Terrbile Creek WWTP
b. WWTP Facility Permit #: NCO066516
A!! flows are in MGD
c. WWTP facility's permitted flow 3.0
d. Estimated obligated flow not yet tributary to the WWTP 1.275
e. WWTP facility's actual avg. flow 1.290
f. Total flow for this specific request 0
g. Total actual and obligated flows to the facility 2.565
h. Percent of permitted flow used 85.5%
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+C) (E)= (A-D)
Design
Average Approx. Obligated, Total
Pump Pump Daily Current Not Yet 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***
DickensRd WQCS00193 0.079 0.032 0.024 .007 .031 .001
* 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
(pfl 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): Terrible Creek WWTP
Downstream Permit Number: NCO0665 l 6
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I Michael Wainer 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 Il 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 O)1
Public Utilities Director
Title of Signing Official
03109/2023
Dale
Page 2 of 6
FTSE 10-18

NC Dept of Environmental Quality
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