WQ0037114_Application (FTSE)_20230803

July 17.2O23
Trent Allen
NCOVVR Raleigh Regional Office
Water Quality Section
38OOBarrett Drive
Raleigh, North Caro|ino278OQ
RE: Modification bzPermit No. VVQ0037114
Chatham -Randolph yWegositeSewer System Extension Project
Chatham County, North Carolina
Deer Mr. Allen:
Please find enclosed for your review one (1) original and one (1) copy of the Fast -Track Application
form and related attachments for the proposed lift ataUon, force main, and related appurtenances
to be installed on the above referenced project. This is a modification to the Wastewater Collection
System Extension Permit VVQ0037114 issued on April 20' 2014. which is being submitted because
of design changes to the proposed sewer pump station. Please also find a check in the amount of
$48O.00bocover the application fee.
The overall project consists ofthe installation ofone (1) new lift station and apAroxirnabs|y38.8OO
linear feet of 18-inch force main piping and related appurtenances to provide 1.0 MG[> of
wastewater capacity to the proposed Chatham -Randolph KJegasika. The vast majority of i�,_,
proposed infrastructure will be installed in Chatham County; hovvever, e srna|| section of force main
is intended to be installed within Randolph County. We assume that the Raleigh Regional office will
coordinate any additional navievvo needed with the Winston-Salem Regional Office.
If you have any questions during your review or require further information regarding this project,
please donot hesitate togive rneacall atQ10-2Q5-315Q.
Sincerely,
0lcG|LLASSOCIATES, P.A.
DA\y|C)LHONEYCUTT.P.E.
PhncipoK{]fficeK4anager
Enclosures
cc: Hank Raper, Siler City Town Manager

State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
FAST TRACK SENVER SYSTEM EXTENSION APPLICATION
Division of Water Resources INSTRUCTIONS FOR FORM: FTA 06-21 & SUPPORTING DOCUMENTATION
This application is for sewer extensions ulvolvina gravity sewers, pump stations and force mains. or anv combination that has been
certified by a professional engineer and the applicant that the project meets the requirements of 1.5 �IC'At: ; 2, T and the Division's
\-lininium Design Criteria (Gra,,.-itv So%> er & flui o Sty€noes F mCe Vfains) and that plans, specifications and supporting documents
have been prepared in accordance with 15A NCAC'02T, 15A _N C ,C 0=2T .0300. Division policies, and g),00d ewgirteerin(l�.tractices.
While no upfront engineering design documents are required for submittal, in accordance with 15A NCAC' 02T .0305(b). design
documents must be prepared prior to submittal of a fast track perinit application to the Division. This Would include plans, desi�(yn
calculations, and project specifications referenced in 115A N AC. ()1: and the applicable minimum design criteria. These
documents shall be immediately available upon request by the Division.
Projects that are deemed permitted (do not require a permit from the Division) are explained in 1. J -
Projects not eligible for review via the fast track process (must be submitted for fill technical review);
Projects that do not meet any part of the lninimuln design criteria (iti�IDC) documents:
Projects that involve more than one variance from the requirements of 15A NCAC 02T;
Pressure sewer systems utilizing simplex septic tank -effluent pumps (STEPS) or simplex grinder pumps;
Simplex. STEP or simplex grinder pumps connecting to pressurized systems (e.g, force mains};
Vacuum sewer systems.
General — When Submitting an application, please use the following instructions as a checklist in order to ensure all required Items are
submitted. Adherence to these instructions ands ac[[heck((a,ingi the it all
boxes will help
yproduce
y}a quicker
[ review ti ine and preduce
�9 thxe
aii1i; nt : f r-que st'ea.d t,ddiluonal i n 1for-n-.ation. i� ailurL to �9lt B.IfJ a Ckll reltA�F d tt 1£J Til1 A �aLI iJ1tLLL Lid additional processing l d l t S j P
time, and may result in return of the application. Unless otlier,, ise noted, the Applicant shall submit one original and one copy of
the application and supporting documentation.
A. One Original and One Copy (second copy may be digital) of Application and Supporting Documents
N Required unless otherwise: noted. Si<gnatures on original must be ``wet ink" or secure digital sib -natures.
Please do not submit enuineering design plans with the application unless specifically requested.
B. Cover Letter/Narrative Description (Required for All Application Packages):
® List all items included in the application package; as well as a brief description of the requested permitting action.
Be specific as to the system type, number of homes served, flow allocation required, etc,
Include the permit number status of any other required sewer permits (dovnstreai�irilstreatn )
If necessary for clarity', include attachments to the application form.
C. Application Fee (:_kll New and 4,Iodification Application Packages):
21 Submit a check or money order in the amount of S480.00, dated no more than 90 days prior to application submittal.
Payable to North Carolina Department of Environmental Quality (NCDEQ)
D. Fast Track Application (Required for All Application Packages, Form FTA 05-21):
® Submit the completed and appropriately executed application.
r If necessary for clarity or due to space restrictions, attachments to the application may be made.
❑ If the Applicant Type in [tens I.2 is a corporation or company, provide documentation it is registered for business with the
North Carol i Secretar-,, Of State.
❑ If the Applicant Type in Item 1.2 is a partnership or d`b,'a, enclose a copy of the certificate filed with the Register of Deeds in
the county of business.
® The Project Name in Item 1I.1 shall be consistent with the project name on the flow acceptance letters, agreements, etc.
® The Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a North C lrolii a
li2ensed Professional Fiigrineer.
® The Applicant's Certification on Page 5 of the application shall be signed in accordance with ( N� 4 I f l ti itb). Per
15A NCAC 02T .0106(c), 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 .010{(b).
INSTRUCTIONS FOR FORM: FTA 06-21 & SUPPORTINGi DOCUtMENTATION Page I of 3

E. Flow Tracking/Acceptance Form (Form: FTSE 04-16) (If Applicable):
® Submit the completed and executed FTSE form from the owners of the downstrealn seNvers and treatment facility.
ivlultiple forms maybe required where the downstream sewer owner and wastewater treatment facility are different.
The flow acceptance indicated in form FTSE must not expire prior to permit issuance and must be dated less than one year
prior to the application date.
Submittal of this application and form FTSE indicates that owner has adequate capacity and will not violate G.S. 14 3-2 15.67(a).
•- Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific FTSE.
F. Site Maps (.-ail Application Packages):
E Submit an 8.5-inch x 11-inch color copy of a USGS Topographic NNlap of sufficient scale to identify the entire project area,
includin,2 the closest surface waters.
General location of the project components (gravity sewer. pump stations. S-, force main)
Downstream connection points and permit number (if luiown) for the receiving sewer
® Include an aerial location map showing general project area (sllch as street names or tat itude'longitude) so that Division staff
can easily locate it in the Field.
G. Existing Permit (Application Packages for Modifications to an Existing Permit):
• Submit a copy of the most recently issued existing permit.
• Include a descriptive and clear narrative identifying the previously permitted items to remain in the permit, items to be
added, and/or items to be modified (the application forin itself should include only include items to be added�nnodified). The
narrative should also include whether any previously permitted items have been certified.
® The narrative should clearly identify the requested permitting action and accurately describe the sewers to be listed in
the final permit.
IL Power Reliability Plan (Required if portable reliability option utilized for Pump Station):
❑ Per l �A y t AC.02 I .`' 05 h)i 11. Submit documentation of power reliability for pumping stations.
This alternative is only available for average dailv flows Less than 15,000 gallons per day
r It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant and is compatible with
the station. The Division will accept a letter signed by the applicant (see 15A NCAC 021T .0106(b)) or proposed contractor.
statin = that "the portable power generation unit or portable. independently -powered pumping units. associated appurtenance:
and personnel are available for distribution and operation of this pump station.',
r 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 tinneframes, shall
be provided in the case of a multiple station power outage. (Required at time of certification)
I. Certificate of Public Convenience and Necessity (:ill Application Packages for Privately -Owned Public Utilities):
❑ Per 15A NCAC 02 f .01 151, ��)(€ ) provide the Certificate off Public Convenience and Necessi , from the North t alp ilna .. _ --
Co�tt mil sic�ti demonstrating the Applicant is authorized to hold the utility franchise for the area to be served by_ the sewer
extension, or
❑ Provide a letter from the a` ortl, CarollnJ Utillucs Cornrntl,-sl _ n Wat l a'nd e": ?' Di I`�(tytl Ptlblxc ::staff stating an application
for a franchise has been received and that the service area is COMM-TUOUS to an exlstlno, franchised area or that franchise approval
is expected.
J. Operational Agreements (Applications from HOA/POA and Developers for tots to be sold):
❑ Home/Property Owners' associations
❑ Per 15 _t C' \(-" ��' I .':� � t ?�_ _l, submit the properly executed Operational A� 2reenieltt �; Ft Il _M: I110 ).
❑ Per 15A NCAC 02T .0115(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
❑ Developers of lots to be sold
❑ Per 15,A NC"_AC 01 01 �fb), submit the properly executed C)lier�itiom-Ll rcen�rent IFQR_%-"I: DZ���.
,For nioi-e in far'ination, visit the Division's collection syslenz.s 'f 1/)SM'>
INSTRUCTIONS FOR FORA: FTA 05-2 1 & SUPPORTING DOCU%IENTATION Page 2 of 3

THE COINIPLETED APPLICATION PACK_XGE INCLDING ALL SUPPORTING INFORMATION AND
(MATERIALS, SHOULD BE SENT TO THE A11"PRO13RIATE REGIONAL OFFICE:
REGIONAL OFFICE ADDRESS
COUNTIES SERVED
Asheville Regional Office 2090 US Highway 70
Avery, Buncombe, Burke, Caldwell, Cherokee,
Water Quality Section Swannanoa, North Carolina 28778-8211
Clay, Graham, Haywood, Henderson, Jackson,
[phone]
Macon, Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Harnett, Hoke,
Water Qu2jLty
Fayetteville, North Carolina 28301-5095
Montgomery, Moore, Robeson, Richmond,
[phone]
Sampson, Scotland
[phone] Fax
Mooresville Regional Office
610 E. Center Avenue
Alexander, Cabarrus, Catawba, Cleveland,
Waj2L Qwaliti, SectiqLi
Mooresville, North Carolina 28115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
Raleigh Reqjonai Office
3800 Barrett Drive
Chatham, Durham, Edgecombe, Franklin,
Walter Quality Section i2
Raleigh, North Carolina 27609
Granville, Halifax, Johnston, Lee, Nash,
[phone]
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
Warren, Wilson
Washington Reqional Office
943 Washington Square Mall
1 Beaufort, Bertie, Camden, Chowan, Craven,
Water Qualitv Section
Washington, North Carolina 27889
Currituck, Dare, Gates, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquotank,
73
[phone] Fax
r Perquirnans, Pitt, Tyrrell, Washington, Wayne
Wilminqton Reqional Office
127 Cardinal Drive Extension Brunswick, Carteret, Columbus, Duplin, New
1 Water Quality Section
Wilmington, North Carolina 28405 Hanover, Onslow, Pender
[phone]
[phone] Fax
Winston-Salem Re, -qional Of
450 W. Hanes Mill Road Alamance, Alleghany, Ashe, Caswell, Davidson,
Water Quality Section
Suite 300 E Davie, Forsyth, Guilford, Rockingham, Randolph,
Winston-Salem, North Carolina 27105 Stokes, SUrry, Watauga, Wilkes, Yadkin
[phone]
[phone] Fax
INSTRUCTIONS FOR FORM: FTA 05-211 & SUPPORTING DOCU%4ENTATION Pave 3 of 3

State of North Carolina
Department of Environmental Quality
Division of Water Resources
wR
Divislon of Water Resources FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number: Me completed by DWR)
All items must be completed or the application will be returned
1. APPLICANT INFORMATION:
I Applicant's name: Town of Siler City (company, , municipality, HOA, utility, etc.)
2 F-1 Individual F-1 Corporation F F� Privately -Owned Public Utility
Applicant type: —1 General Partnership
❑ Federal El State/County Z Municipal F Other
3. Signature authority's name: Hank Raper per 15 A NC.AC 0 'IT .0106(b)
Title: Town Manage
4. Applicant's mailing address: Post Office Box 769
City: Siler City State: North Carolina Zip: 27344-
5. Applicant's contact information:
Phone number- [phone] Email Address: hraper(i silercity.or
11. PROJECT INFOWNIATION:
1. Project name: Chatham -Randolph Megasite Sewer Extension
2. Applicationi"Project status: [] Proposed (New Permit) Existing Permit,"Project
If a modification, provide the existing permit number: WQ0037114 and issued date: April,29, ZqI4,
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: WQOO
3. County where project is located: Chatham County,
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.75 1. l' Longitude:-79.545 t
5. Parcel ID (if applicable): 12580 (or Parcel ID to closest downstream sewer)
111. CONSULTANT ENFORNL�TION:
1. Professional Engineer: David L. Honeycutt. PE
:Engineer:
Number: 034999
Firm: McGill Associates
Mailing address: 5 Regional Circle, Suite A
C>
City: Pinehurst State: NC Zip: 28374-
Phone number: [phone] Email Address: david.lioneycuttLt�mcp-illassociates.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORINIATION:
1. Facility Name: Siler City WWTP Permit Number: NCO026441
Owner Name: Town of Siler City
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQR�- own
2. Downstream (Receiving) Sewer Information.: 24 inch Z Gravity 0 Force Main
In —
3. System Wide Collection System Permit Number(s) (if applicable): WQCS00056
Owner Name(s): Town of Siler City
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 Necessitv been attached`?
❑Yes ❑ No ® N` A
?. �elc?per of to be Sold, has a t:e.�:1[cI t�p� 1citl��il��� L1�4��ei.t (i1�,:�1: I:�_��"'t been attached''
If the Applicant is a Det
❑ Yes ❑ :No ® N, A
?. is a Ilome,Propert�- OWTIers' .��ssoctation, has an 11t A I't , t) t;,>rt: ? T c°I Zt_°eat E l ::?Ipt 1 t{� }: % and
If the Applicant
supplementary documentation as required by 15A. NCAC 02T.OI 15(c) been attached.'
❑ Yes ❑ No ® N!;k
4. Orrin of wastewater: (check all that apply):
❑ Residential (Individually Owned) ❑ Retail (stores, centers. nialls) ❑ Car Wash
❑ Residential (Leased) ❑ Retail with food preparation/service ❑ Hotel and. or N'lotels
❑ School preschool day care ❑ ikledical dental i veterinary facilities ❑ Swimming PooLClubhouse
❑ Food and drink facilities ❑ Church ❑ Sty immillg Pool: Filter Backwash
❑ Businesses offices factories ❑ Nursing Home ® Other (Explain in Attachment)
5. Nature of wastewater: °o Domestic Conirnercial IOV,i? ' Industrial 4 'AWL ' ('A 02 1 �o
If Industrial, is there a Pretreatment Program in effect'? ® Ye, ❑ No
6. Has a floe- reduction been approved under l 5: , NC',\" 0 t QI 141 I" ❑ Yes Z No
If Nees, provide a cope of flow reduction approval letter with this application
Summarize waste% ater generated by project:
Establishment Type (see 02T.0I 14(f)) �
D: itv Desi-ii Flow",
3 No. of Units Flow
Industrial Megasite =--
1000000 gal, day
1 1000000 GPD
fgal%"
j GPD
gal.'
GPD
C_-__ _ _ - — ------
`
` a
--- -- GPI)
t f
E
--- ---
2 a L-
GPD
------- _�------
goal
GPD
I Total lt)C}0()OO GPD
a e `` ?: dL � `� 3i 1 1 � }� • !• _ .C)( 1 )_ rl 1 u)(2 ) for caveats to wastewater design flow- rates, (i.e., I111nlinum flow per
j
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 \Vatet-,vay to be used as vacation rentals as defined
in Cr. . 4 2. 4).
b Per 1.5A NCAC O2T .01 14(c), desiun flow rates for establishments not identified [in table l � `it� �C` 02 1,�,) l 1-41 shall be
deternilned usinu available flow data. water using Fixtures, occupancy or operation patterns. and other measured data.
S. Wastewater generated by project: 1000000 GPD (per 1 i-A �d:,�E:' Q_'T ,)I 14)
OW Do not include future flows or previously permitted allocations
If permitted flow is zero, please indicate why:
❑ Pump Station- orce Main or Gravity Serer where flow will be permitted in subsequent permits that connect to this line.
Please provide supplementary information indicating the approximate timefranle For permitting upstream sewers with flow.
❑ Flow has already been allocated in Permit Number: _ Issuance Date:
❑ Rehabilitation or replacement of existing sewers with no newflow expected
❑ Other (Explain):
FORM: FTA 06-21 Page 2 of 5

4'II. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - & NiDC ((lravity Sewers):
1. Summarize gravity sewer to be permitted:
Section lI R III of the .IDC for Pennitting of Gravity Severs contains information related to desi�_>n criteria
Section III contains inforniation related to minimum slopes for gravity sewer(s)
:= Oversizing lines to meet minimum slope requirements is tot allowed and a violation of the iN,IDC
VIII. PU4IP STATION' DESIGN CRITERIA (If Applicable) — 112.I. ,0305 & MDC �Pun_ip Stations,"'Force Nfains):
PROVIDE A SEPARATE COPS' OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
i . Pump station nuniber or name: PS-1
2. Approximate Coordinates (Decimal Degrees): Latitude: 35.751 1 Longitude:-79.5451
3. Total number of punips at the pump station: 2
3. Design flOvV of the. pump station: 2.5 millions gallons per day (Limn capacity)
,w 1 should reflect the total t P I for the pump Station �� 1.th the largest pump out of service,
4. Operational point(s) per purnp(s): 1740 gallons per minute ("GP)vI) at 160 feet total dynamic head (TDH)
5. Summarize the lbrce main to be permitted (for this Pump Station):
If any portion of the force main is less than 4-Inches in diameter, please identify the method of solids reduction per
i%IDCPSF%-I Section 2.01 C. I .b. ❑ Grinder Pt1111p ❑ Nfechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with I_ � � °,X �t � (1) 1_ .0 3�� 5 E, f f ):
® Standby power source or ❑ Standby pump
Must have automatic activation and telemetry - 15A NCAC; 02T.0305(h)(1)(B);
= Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
Must be permanent to facility, and may not be portable
Or if the pump station has an average daily flow less than 15.000 gallons per day I SA NC:ACO2T.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.
r 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.
FORTH: FT A 06-21 Page 3 of 5

IY. SETBACKS & SEPARATIONS - (02B .0200 & 15A tiCAC 02T .0305(f)):
1. Does the project comply with all separationsi`alternatives found in 1 5A NCAC� C)2T .0305(f�� ��� i � 3.� ® Yes ❑ No
15A NCAC 02T.0 305(f) contains minimum separations that shall be provided for sewer systems:
Setback Parameter"
Separation Required j
Storm sewers and other utilities not listed below (vertical)
18 inches
'\t'ater mains (vertical - water over sewer preferred, including? in benched trenches)
1S inches
`titi`ater plains (horizontal) --- ---
� -- 10 feet
j Reclaimed water lines (vertical - reclained over sewer)
18 inches
Reclaimed water lines (horizontal - reclaimed over sewer) ----
feet
,"Any private or public water supply source. including any wells. WS-I waters of Class I or
Class I1 impounded reservoirs used as a source of drinking water. and associated wetlands.
--
j tOO feet
I "Waters classified WS (except WS-I or WS-V B, SA, ORWH(- W. or SB from norillal
Mill water (or tide elevation) and wetlands associated with these waters (see item IX,2)
�
50 feet
"Ariv other stream. lake, impoundmen€, or g=round water lowering and surface drainage
ditches. as well as wetlands associated with these waters or classified as WL.
~:any
-- —
10 feet
building foundation (horizontal)
5 feet
Any basement (horizontal) - — —
-- 10 feet
Top slope of embankment or cuts of ? feet or more vertical height
10 feet
Drainage systems and interceptor drains
; 5 feet
Any Swllllnling pools �--------
� 10 feet -----�
Final earth grade (vertical) --_
36 inches
Y If noncompliance with s` 2T 'JJ C{55 # i ;r gy,, see Section X.1 of this application
x 3 , A ' "C -'� C ;,)? TI C!305{ ,,, `) contains alternatives G4 here sel?aratiolls In {'_) � 1 ,t`_1� t 1`,Z t ) ca1127C1t be achle,:"ec1. Please G11ec1C "vet"
a.bov",, if thcsc a'.tern.At14, e arL i �}c ? and 1�z ,s i'i� : air �tt�: e :t;forni"It€o t ex
Stream classifications can be identified using the Division's V_ ;�u fdCe i IIM_ Cl IISII C� IkQfll- ',VCb a2C'
- - - - -_-.. - f . -1.
Goes this project comply ;with the minimum separation requirements for water mains" ❑ Ves ❑Rio ❑ .`v.'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, verify.=ina the criteria outlined in that Rule.
Does the project comply with separation requirements for wetlands?❑ Yes ❑ No ❑ N � A
Y Please provide supplementary infornl_ation identifying the areas of note -conformance.
r See the Division's d att seQli -!€tt Ql rec;UIDIMIents for situations where separation cannot be met.
r No variance is required if the alternative design criteria specified is utilized in desigii and constriction.
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 I ",A NCAC ?TAU !' 0') ❑ 4`cs ❑ No
This includes Trout Buffered Streams per 1 MA :N .. C 0 1'�Q -I
5. Does the project require coverage_�authorization under a 404 1ationwide�indi�idual permits ❑ `t'es ❑ \�o
or 401 Water Quality Certifications"
rl Please provide the permit number permitting status in the cover letter if coveragei"autli.ezrization is required.
6. Does project comply with t 5A NC_- C 0'TA+ 105(�i(,6) (additional pennits "certifications)" ❑ Yes ❑ No
Per I NCAt C , V,O ( u5€�A6i. 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, A N 1( 0 � t _1��=?02. '`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.
O- tf 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 1SA T CAC 02T.0403(a)(5) or the permittee's individual System -Wide Collection permit.
FORM: FTA 06-21 Pate 4 of 5

X. CERTIFICATIONS;
L Does the submitted system comply with A, NC'L�'C T, the lflnitilt_ir?1 DC'-', �111 'riteria fOr the F' �t���tt�ix�F cj Pttnll) `�t��tions
�F�'r
d
a'nd `r c } 'e '�l unr (f {td°At version), and the 6ra� its Sewer �viinimgm D sl- n Criteria (IatesL version) as applicable?
® Yes ❑ No
If no, for projects regmring- a single variance, complete and submit the Variance. -Alternative Design Request application
(VADC 10-14) and supporting documents for review to the Central Office. approval of the request will be issued
conetirrently with the approval of the permit, and projects requiring a variance approval may be subject to loner
review times. For projects requiring two or more variances or where the variance is determined by the Division to be a
significant portion of the project, the full technical review is required.
Professional Engineer's Certification:
r
I _ p`� t ��. - _ _ . attest that this application for Chatham -Randolph Meg-Yasite Sewer Extension
(Profe.ssumal Fngineer s nanK, from Application Item MA.) (Project Name from Application (teem 1I.I )
has been reviewed by Ine 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 knowwledge. I further
attest that to the hest of my knoww ledge the proposed design has been prepared in accordance ww-ith the applicable regulations,
SL"a =r 1aI- s? e c,rl:?Tli. and the wd1LIlttL[�_;t � 1�e l T;i �_ritti:rl�l lt'r 1;IiC: �<t t- 1 i f > 1' i`11i9t�iT 'r
- __...._
f l't m") ��:�t:t=��.1 'Ind, l t>t �� � l�iir� �.`�1�w At ��?r �li_i:ti. Although other- professionals niav 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
ha-ve judged it to be consistent with the, proposed design.
MOTE - In accordance with General Statutes 143-217.6A 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 nisdemeanor, which may
include a tine not to exceed S 10.000. as well as civil penalties up to 25,000 per violation. Misrepresentation of the application
information. including failure to disclose ally 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 56.07,'01;}
.................................................-.... ........ .......................
...
North Carolina Professional Engineers seal, signature, and date:
�2 Z"Ix4,`l Z Y./\
e \ ° 1� � Pa �
®�sA {f '�3j37171V44411954)b [�`' �4,\
Applicant's Certification per 1-5A NCAC 02T .0106(b):
ij� It
_- ! V,' attest that this application for Cllathani-RancloltA_�'le�,,,asite Sewer Extension
orit<< Name from ApplicatioN Item 1.1.) {PryJect Namz fi'o n Apphcation 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.
MOTE - In accordance with General Statutes 1 ;- 1, AA and 14-3 _-' ( 61-3, any person who knowingly snakes 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 S25,000 per violation.
Signature: Date: G�
FORM: FTA 06-211 Page 5 of 5

Summary of proposed modification to permit:
1. The previously proposed and permitted pump station with triplex suction lift
pumps has been revised to be a duplex submersible type pump station. This
change has resulted from the updated influent sewer line being deeper than
originally considered in the design. The increased depth of the influent line
created a suction lift condition that exceeded the capabilities of the previously
designed pumps. The design flow of the station remains unchanged from the
current permitted design.