WQ0043437_Application_20230830

1STmt Envelope ID: A9FE2695-F3D5-48BD-8013-46�Q gz7e37�40 irpllrrlelltal Quality NN �6 pll State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
AUG
F�ST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number: ` 5457 Mob (to becompleled by DWR)
All items must he completed or the application will he returned
I. APPLICANT INFORMATION:
Applicant's name: Town of Holly Spnnes
Applicam type: ❑ Individual Cot iorttion n,..,....,,..k,;,, �. ,
❑ 1 ❑ Gener� n I ��� HcIV-O�5'nCll 11kb11e 1,tII11Y
❑ Federal ❑ SlatelC:ounty ® Muni, {
�. Signature authority's name: Kendra D. Parri h. PE }
Title- Executive Director of Utilities & Infra,lructnre Sealer fU(
4. Applic.lnt's mailing address: 128 South Main Street. PO I3ox 8
City: Holly springs - State:
5. Applicant's contact i»ritrnlation: . .. /,--I--u , c
Phone qumhtr: (419) 577 i t-50 1=mail AdllkcsK: Nend
11. PROJECT INFORtAIATION:
1. Project name: Regency Subdivision - Phase 2— P'TSU vw�l -CA h..e tia�aCp�
2. Application/Project status: l ❑ Proposed (Nt�w Petmit)
Ifa 1110dificittion. }provide the cxisttng permit number: WQfI
For modifications, also attach a detailed narrative descripti.
If new construction. but part of,, ntasler plan, provide the existing permit number- WQ0()
3. County %ti here proicet kS loc,tled: . Nuke
4. Approxinune Coordinates (Decimal Degrees): Latitude- 35.6524 Longitude:-78.8887
5. Parcel ID of applicablel : 0639311837 (or Parcel ID to closest do%%list re:lttt ~ewer)
I11. CONSULTANT INFORMATION:
I. I'rotcssiunal I:nguxer: Jeremy V'- Finch License Number. 1452
Firm McAdam,
1lailutg address: `905 Meridian Purkwlty
City. Durham Stule_ Nc Zip: 27713
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'J McAL AMS 127376
THE
JJOHNA. McAimmsCiommy INc T R U l ST
621 HILLSBOROUGH ST STE 500 66 46!531 R rm-jwo 603 CHECK DATE
July 11, 2023
0
a
PAY Four Hundred Eighty and 00/100 Dollars
z
AMOUNT 480.00
TO NCDEQ
VOID AFTER 180 DAYS 8
f A jJA n i n

t DocuSign Envelope ID: A9FE2695-F3D5 48BD-8013-46RDel,1131 of Environln eta! Quality N jJ p State of North Carolina
Department of Environmental Quality
DWR G (� �f77 Division of Water Resources
A U FAST TIACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number: 4543`7 0i0 (10 bL' <0n1plC1ed by DwR)
All items must be cornMeted or the auttlication will be returned
1. APPLICANT INFORMATION -
I. Applicant's name: 1F42Nyn of Holly Springs _
2 Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State?County ® Municipal ❑ Other
3. Signature authority's name: Kendra D.- Parrish. PC per 15A NCAC 02T .01061 b)
Title: Executive Director of Utilities & Infirastrueture Service
4. Applicant's mailing address: 128 South Main Street,_PO Box 8 ,
City: [lolly Springs State: NC Zip: 27540
5. Applicant's contact infbnnalion.
Phone number: [phone] Email Address: Kendra.parrislt(rr;holly�rin snc.;ov
11. PROJECT INFORMATION:
L Project name: Regency Subdivision -Phase 2
2. Application/Projecl status- ❑ Proposed (New Permil) ® I-xistang Permitiproject
If a modificalion. provide the exisling permit number: WQO043437 and issued dale: June 3, 2022
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 11w existing permit number: WQ00
3. County where pr(Jccl is located: Wake
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.6524 Longitude:-78.8887
5. Parcel 11) (itapplicable) : 0639311837 (or Parcel ID to closest downstream sewer)
Ill. CONSULTANT INFORMATION:
1. Professional Engineer: Jeremy V_ Finch License Number: 31452.
Firn1: McAdams
Mailing address:. 2905 Meridian Parkway
City: Durham State: NC Zip: 27713
Phone number- [phone] Email Address, : ifinchfiilmcadamcco.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Utley Creek Water Reclamation Facility
Owner Name: Town of Holly Springs
V. RECEIVING DOWNSTREAM SE\VER INFORMATION:
1. Permit Number(s): WQ00 43007
Permit Number. NCO063096
2. Downstream (Receiving) Sewer Information; -8 inch ® Gravity C Force Main
3. System Wide Collection System Pennit. Ntunber(s) (if applicable): WQCSOO192
Owner Nanie(s): gown of Holl y Springs
FORM: FTA 06-21 Page I of 5

t DocuSign Envelope ID: A9FE2695-F3D5-48BD-8013-46BD5907737A
V1. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes [:]No ®NIA
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational A cement (FORM: DEV) been attached?
❑ Yes ❑ No ® NIA
3. If the Applicant is a HomeiProperty Owners' Association, has an HOAIPOA O erat onal A reementLFORM: HOA) and
supplementary documentation as required by 15A NCAC 02T.0I 15(c) been attached?
[—]Yes [:]No ® NiA
4. Origin of wastewater: (check all that apply):
® Residential (Individually Owned) ❑ Retail (stores, centers, malls) ❑ Car Wash
❑ Residential (Leased) ❑ Retail with food preparation/service ❑ Hotel andlor Motels
❑ School i preschool --'day care ❑ Medical i dental i veterinary facilities ❑ Swimming PooliClubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming PooVFilter Backwash
❑ Businesses i offices ' factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater : _. 100 % Domestic _% Commercial % Industrial (See 15A NCAC 02T .0103120})
If Industrial, is there a Pretreatment Program in effect? ❑ Yes❑ No
6. Has a flow reduction been approved under 15A NCAC02T .0I 14(f)? ® Yes ❑ No
➢ If yes, provide a copy of flow reduction approval letter with this almlication
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow A °
No. of Units
Flow
Single Family Home
255 gal/
92
23,460 GPD
gal/
GPD
gall
GPD
gall
GPD
gall
GPD
gall
GPD
Total
23,460 GPD
a See 15A NCAC 02T .011bt. (d), (elt l) and (e)(2) for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use areas;
and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in 6 S_ 42A-4).
b Per 15A NCAC 02T .01 14(c), design flow rates for establishments not identified [in table 15A NCAC 42T_0114] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: __ __. 23,460 GPD (per 15A NCAC 02T .01 14)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero, please indicate why:
❑ Pump Station?Force Main or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line.
Please provide supplementary information indicating the approximate timeframe for permitting upstream sewers with flow.
® Flow has already been allocated in Permit Number: W0043437 Issuance Date: June 3, 2022
❑ Rehabilitation or replacement of existing sewers with no new flow expected
❑ Other (Explain):
FORM: FTA 06-21 Page 2 of 5

DocuSign Envelope ID: A9FE2695. F3D5-48BD-8013-46BD5907737A
V71. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC fGravio- Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8-inch
1,546
I'vC
9-inch
373
Dill
8-inch
835
PVC,
8-inch
809
DIP
TO BE
ADDED
TO BE
REMOVED
i Section II & 111 of the MDC for Permitting of Gravity Sewers contains information related to design criteria
Section III contains intorntation related to minimum slop".. for gravity sewer(s)
:- Over%izing lines to meet minimum slope requirements is not allowed and a violation of the MDC
\1111. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & HDC (Puinti Statioe*fForcc M ain!I):
PROvfDfeSf„jL' COPY OF TIIIS PAGE FOR CACEI pLTMP STON IhJCiI)I;1)_lN Tll,1S 1'R()J[ C=T
l- Pump station number or name: - -.-
2. Approximate Coordinates (DecimalDegree* Latitude: Longitude,
3- Total number ol'pumps at the pump station:
3- Design flow of the pump station: millions gallons per day (firm capacity)
This should reflect the total GPM fix the pump station with the largest pump out of service,
4. Operational point(s) per pump(s):. gallons per minute (GI'M) at.. (ccl total dynamic head (I1)11)
5. Sunlnririic the Irxce main to be permitted (fix this Pump Station):
Size (inches) Length (feet) Material
If any portion of the force main is less than 4-inchcs in diameter, please identify tllc Method of solids reduction per
MDCPSFM Section 2.01 C. Lb. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with I,5A NCAC 02T ,0305(h)ilj:
❑ Standby power source or ❑ Standby pump
Must have automatic activation and telemetry - 15A NCAC 02T.0305(11)(l)(I3),
Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
Must he 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 Nt'ACO2T.0305(h)(I)(C):
❑ Portable power source with manual activation. quick -connection receptacle and telemetry -
or
❑ Portable pumping. unit with plugged einergency pump connection and telemetry:
IV Include documentation that the portable source is owned or contracted by the applicant and is compatible with the station.
I. If the portable powersource or pump is dedicated to multiple pump stations, an evaluation of al I the pump stations' ,forage
capacities and the rotation schedule of the portable prover source or pump. including travel tinletranics. shall he provided
as part of this permit application in the case of a multiple station power outage.
FORM: FTA 06-21 Page 3 of 5

i Docu$ign Envelope ID: A9FE2695-F3D5-48BD-8013-46BO5907737A
IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .03115(f)):
1. Does the project comply with all separations/alternatives found in 15A NCAC 02T ,0305(f) & ( ? MY" []No
15A NCAC 02T.0305(t) contains minimum separations that shall be provided for sewer systems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
'Water mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
'Water mains (horizontal)
10 Iect
Reclaimed water lines (vertical • reclaimed over sewer)
18 inches
Ieclaimed water lines (horizontal - reclaimed over sewer)
2 feet
**Any private or public water supply source, including any wells. WS-1 waters of Class I or
Class 11 impounded reservoirs used as a source of drinking water, and associated wetlands.
100 feet
"Waters classified WS (except WS-1 or WS-V), 13. SA. ORW, HQW, or S13 from normal
high water (or tide elevation) and wetlands associated with these waters (see item IX.2)
50 1i et
**Any other stream. lake, impoundment, or ground water lowering and surtace drainage
ditches, as well as wetlands associated with these waters or classified as WL.
10 lcct
Any building foundation (horizontal)
5 feet
Any basement (horizontal)
10 Icct
Top slope of embankment or cuts of 2 feet or more vertical height
10 Icet
Drainage systems .and interceptor drains
5 feel
Any swimming pools
10 lcet
Final earth grade (vertical)
36 inches -:�::d
If noncompliance with 02T-0305(6 or "see Section X.I of this application
* 15A NCAC 02T.0305i r•) contains alternatives where separations in 02T.0305(t) 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 C'lassifacations webeame
?. Does this project comply with the minimum separation requirements for water mains:' ® Yes ❑ No ❑ N?A
It'no, please refer to 15A NCAC 18C'.0906(t) Ior documentation requirements and submit a separate document.
signed/scaled 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 rion-conformance,
Sec the Division's draft Msanatioli ire7tt Ms ttir rrtuattions where separation cannot be met.
0� No variance is required if the alternative design criteria specified rs utilized in design .and construction.
4. Is the project located in a river basin tiub)ect to any State buffer rules? ❑ Yes Basin name: ®No
If yes. does the project comply will) setbacks found in the river basin rules per 15A NCAC 02B.,0200_> ❑ Yes ❑ No
This includes Trout 13uftered Streams per 15A NCAC 2B-0202
5. Does the project require coverage/authorisation undera 404 Nationwidefindividual permits ® Yes ❑ No
or 401 Walcr Quality Certilications?
Picric provide the permit number/permitting status in the cover letter if coverage/:authorization is required.
6. Does project comply with 15A NCAC 02T.0105(cl(6) (additional perntitsJcertitications)'? ® Yes ❑ No
Per 15A NCAC02T,0105c_K6), directly related environmental permits or certification application, -.must he being prepared.
have been applied for, or have been obtained. issuance of this permit is contingent on issuance of dependent pennils (cromon
acid sedimentation control plans, stonmvater management plans, etc.)-
7. Does this project include any sewer collection lines that are deemed "high -priority?" . ❑ Yes ® No
Per 15A NCAC 02T.0402, "high -priority sewer' nicans any aerial sewer, sewer contacting Surface waters.
siphon. or sewers positioned parallel to strearnbanks that arc subject to erosion that undermines or deteriorates the sewer.
Siphons and sewers suspended through interferencelconflict boxes require a variance approval.
If yes, include an attachment with details for each line, including type (atrial line. size. material. and location).
High priority lines shall be inspected by the permittne 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.
NORM: F'I'A 00-21 Page 4 of 5

t DocuSign Envelope ID- A9FE2695-F3D5-48BD-8413-46BD5907737A
X. CERTIFICATIONS:
I. Does the submitted system comply with 15A NCAC 02T, the Minimum. Design Criteria for the Permittin of Pump Stations
and Force Mains tlatest version, and the Gravity Sewer Minimum Design C:ritcri, atest version! as applicable!
® Yes ❑ No
If no, for projects requiring a single variance, complete and submit the Variance;Alternative Design Request application
(VADC 10-14) and supporting documents for review to the Central Office. Approval of the request will be issued
concurrently with the aimroyal of the permit, and projects reuuirint-, a variance approval may be subjecl to longer
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.
2. Professional Friginecr's Certification:
1. .lcren,y V. Finch attest that this application for Regency Subdivision - Phase 2
(I'rotecsionaI I:ngln%vr-c name from Appileauon Item tII.I.) I I'rtgeel Hume Irom Application Item 11. 11
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans,
specifications, engineering calculations, and all tether supporting doeumentation to the best of my knowledge. i further
attest that to the befit of my knowledge the proposed design has been prepared in accordance with the applicable regulations.
Minimum Design Criteria for Gravity Sewers { latest version}, and the Minimum Dc%�n Criteria for the Fast -Track Pennitling,
of Pump Stations .Ind Force Mains ( latest version). Although other professionals may have developed certain portions of this
subminal package. inclusion of these material~ under my signature and seal signifies that 1 have reviewed (his material and
havc.iudged it to be consistent with the proposed design.
NOTI' In accordance with General Statutes. 143-215.6A and 143-215.613, any person who knowingly makes any faisc
s(atenwrit, representation, or certification in any application package shall be pilty of a Class 2 misdemeanor, which may
include a line not to exceed S 10,000, as well as civil penalties up to $25,000 per violation. Misrepresentation of the application
intbrination, including f blare to disclose tiny design non-compliance with the applicable Rules and design criteria. may sublect
the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NC'AC56.0701)
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
a-remy V
FinchQM. zni7 O6 73 13 M IS -09tl0'
1. Kendra D. Parrish, PE . attest that this application for Regency Subdivision - Phase 2
(Signature Authonty Name lion Application Item 1-3.) (I're.14m Nanx from Appheauon Item 11.1)
attest that this application has been reviewed by me and is accurate and complete to the best of my knoirledge.
understand that if all required parts of this application are not completed and that Wall required supporting documentation
and attachments are not included, this application package is subject to being returned as incomplete. 1 understand that .ply
discharge ofwastewater from this non -discharge system to surlacc waters or the land will result in an immlicdiate crilorceinutt
action that may include civil penalties, injunctive relief. andlor criminal prosecution. 1 will make no claim against (he Division
of Water RCSOuree5 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 tell required supporting information and attachments are not included, this application
package will be returned to me as incomplete.
NOTE In accordance with General Statute~ 143-215,ibA and 143-215,6B. any person who knowingly nakcti any false
statement, representation, or certification in any application package shall be guilty of it Class 2 misdemeanor, which ntaty
include a fine not to exceed S10,000 as well as civil penalties up to $25,000 per violation.
pecuSigned by
Signature:u� Dale:
llscax
7/31/2023
FORM: FTA 06-21 Page 5 of 5

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Dow&gn Envelope ID: A9FE2695-F3D5-46BD-8013-46BD5907737A
ROY COOPER
Governew
ELIZABETH S. BISER
Seer rrary
RICHARD E. ROGERS. JR
Dare rnr
NORTH CAROLINA
Environmental Quality
June 3, 2022
Kendra D. Parrish, Executive Director of Utilities & Infrastructure Service
Town of Holly Springs
128 South Main Street, PO Box 8
Holly Springs, NC 27540
Subject: Permit No. WQ0043437
Town of Holly Springs
Regency Subdivision — Phase 2
Wastewater Collection System Extension Permit
Wake County
Dear Permittee:
In accordance with your application received May 3, 2022, we are forwarding herewith Permit No.
WQ0043437 dated June 3, 2022, to the Town of Holly Springs (Permittee) for the construction and
operation upon certification of the subject wastewater collection system extension. This permit shall be
effective from the date of issuance until rescinded and shall be subject to the conditions and limitations
as specified therein. This cover letter shall be considered a part of this permit and is therefore
incorporated therein by reference.
Please pay particular attention to the following conditions contained within this permit:
Condition 11.1: This permit shall not be automatically transferable; a request must be made and
approved.
Condition 11.4. Requires that the wastewater collection facilities be properly operated and maintained
in accordance with 15A NCAC 02T .0403 or any individual system -wide collection system
permit issued to the Permittee.
Condition 11.7: Upon completion of construction and prior to operation of these permitted facilities, the
completed Engineering Certification form with checklist attached to this permit shall be
submitted with the required supporting documents to the address provided on the form.
Permit modifications are required for any changes resulting in non-compliance with
this permit, regulations, or the Minimum Design Criteria. 115A NCAC 02T.01161
It shall be responsibility of the Permittee to ensure that the as -constructed project meets the appropriate
design criteria and rules. Failure to comply may result in penalties in accordance with North Carolina
General Statute §143-215.6A through §143-215.6C, construction of additional or replacement
wastewater collection facilities, and/or referral of the North Carolina -licensed Professional Engineer to
the licensing board.
VorthCzolia&DeptrmenzotEnt;rozmenldC;rzRiv J=r on ofU'aesRwi r;ef
D � Mengh R.epont] Office i 3 S: : B=Kt Dnre Ran¢, Y-D th Cttouni
�� 919 -91 4200

DocAign Envelope ID: A9FE2695-F3D5-48BD-8013-46BD5907737A
Town of Holy Springs
Permit No. WQ0043437
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the right to
request an adjudicatory hearing upon written request within 30 days following receipt of this permit. This
request must be in the form of a written petition, conforming to Chapter 150E of North Carolina General
Statutes, and filed with the Office of Administrative Hearings, 6714 Mail Service Center, Raleigh, NC
27699-6714. Unless such demands are made, this permit shall be final and binding.
If you need additional information concerning this matter, please contact Cassidy Kurtz via e-mail at
[e-mail].
Sincerely,
EsDocuSigned by:
Off VIVuSbW
BCOA913925NA461)
for Richard E. Rogers, Jr.
Director, Divislon of Water Resources
by Scott Vinson, Regional Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, NCDEQ
cc: Jeremy Finch (ifinchmcadamsco.com)
Rachel Ingham([e-mail])
Theresa Randall([e-mail])
Raleigh Regional Office Files
DWR Laserfiche
Wake County Health Department
Page 2 of 9

I DocuSign Envelope ID A9FE2695 F3D5-48B0-8013-466D5907737A
NC Dept ofEnvlronmental Quality
AUG 3 0 2023
NORTH CA POLINA
Environmental Quarlty Raleigh Reg,
oval Office
WASTEWATER COLLECTION SYSTEM EXTENSION 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 the
Town of Holly Springs
Wake County
for the construction and operation of approximately 1,644 linear feet of 8 inch gravity sewer to serve 92
homes as part of the Regency Subdivision — Phase 2 project, and the discharge of 23,460 gallons per day
of collected domestic wastewater into the Town of Holly Springs' existing sewerage system, pursuant to
the application received May 3, 2022, and in conformity with 15A NCAC 02T; the Division's Gravity Sewer
Minimum Design Criteria adopted February 12, 1996 and updated in March 2008, as applicable; the
Division's Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains
adopted June 1, 2000 as applicable; and other supporting data subsequently filed and approved by the
Department of Environmental Quality and considered a part of this permit.
This permit shall be effective from the date of issuance until rescinded and shall be subject to the specified
conditions and limitations contained therein.
DOCUSigned by.
BCDAM825NA461)
for Richard E. Rogers, Jr.
Director, Division of Water Resources
By Authority of The Environmental Management Commission
Permit Number: WQ0043437
Permit Issued: June 3, 2022
Page 3 of 9

Docu5ign Envelope ID: A9FE2695-F3D5-48BD-8013-46BD5907737A
SUPPLEMENT TO PERMIT COVER SHEET NC Dept of Environmental Qualil
Town of Holly Springs is hereby authorized to: AUG 3 0 2023
Construct, and then operate upon certification the aforementioned wastewater collection��ree�nal Office
sewage and wastewater collected by this system shall be treated in the Town of Holly Springs ey r
Water Reclamation Facility in accordance with Permit Number NC0063096.
Permitting of this project does not constitute an acceptance of any part of the project that does not meet
15A NCAC 02T; the Division's Gravity Sewer Minimum Design Criteria adopted February 12, 1996 as
applicable; and the Division's Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and
Force Mains adopted June 1, 2000 as applicab'e, unless specifically mentioned herein. Division approval
is based on acceptance of the certification provided by a North Carolina -licensed Professional Engineer in
the application. It shall be the Permittee's responsibility to ensure that the as -constructed project meets
the appropriate design criteria and rules.
Construction and operation is contingent upon compliance with the Standard Conditions and any Special
Conditions identified below.
I. SPECIAL CONDITIONS
None.
It. STANDARD CONDITIONS
1. This permit shall not be transferable. In the event there is a desire for the wastewater collection
facilities to change ownership, or there is a name change of the Permittee, a formal permit request
shall be submitted to the Division accompanied by documentation from the parties involved, and
other supporting materials as may be appropriate. The approval of this request shall be considered
on its merits and may or may not be approved. [15A NCAC 02T.0116; G.S 143-215.1(d3)]
2. This permit shall become voidable unless the wastewater collection facilities are constructed in
accordance with the conditions of this permit; 15A NCAC 02T; the Division's Gravity Sewer Minimum
Design Criteria adopted February 12, 1996 as applicable; the Division's Minimum Design Criteria for
the Fast -Track Permitting of Pump Stations and Force Mains adopted June 1, 2000 as applicable; and
other supporting materials unless specifically mentioned herein. [15A NCAC 02T.0110)
3. This permit shall be effective only with respect to the nature and volume of wastes described in the
application and other supporting data. [15A NCAC 02T .0110]
4. The wastewater collection facilities shall be properly maintained and operated at all times. The
Permittee shall maintain compliance with an individual system -wide collection system permit for the
operation and maintenance of these facilities as required by 15A NCAC 02T .0403. If an individual
permit is not required, the following performance criteria shall be met:
a. The sewer system shall be effectively maintained and operated at all times to prevent discharge
to land or surface waters, and to prevent any contravention of groundwater standards or surface
water standards.
b. A map of the sewer system shall be developed and shall be actively maintained.
Page 4 of 9

. DocuSign Envelope ID A9FE2695-F3D5-48BD-8013-46805907737A
An operation and maintenance plan including pump station inspection frequency, preventative
maintenance schedule, spare parts inventory and overflow response has been developed and
implemented.
Pump stations that are not connected to a telemetry system shall be inspected every day (i.e. 365
days per year). Pump stations that are connected to a telemetry system shall be inspected at
least once per week.
e. High priority sewer lines shall be inspected at least once per every six -months and inspections are
documented.
f. A general observation of the entire sewer system shall be conducted at least once per year.
g. Overflows and bypasses shall be reported to the appropriate Division regional office in accordance
with 15A NCAC 2B .0506(a), and public notice shall be provided as required by North Carolina
General Statute §143-215.1C.
h. A Grease Control Program is in place as follows:
1. For public owned collection systems, the Grease Control Program shall include at least
biannual distribution of educational materials for both commercial and residential users and
the legal means to require grease interceptors at existing establishments. The plan shall also
include legal means for inspections of the grease interceptors, enforcement for violators and
the legal means to contro` grease entering the system from other public and private satellite
sewer systems.
For privately owned collection systems, the Grease Control Program shall include at least bi-
annual distribution of grease education materials to users of the collection system by the
permittee or its representative.
3. Grease education materials shall be distributed more often than required in Parts (1) and (2)
of this Subparagraph if necessary to prevent grease -related sanitary sewer overflows.
Right-of-ways and easements shall be maintained in the full easement width for personnel and
equipment accessibility.
j. Documentation shall be kept for Subparagraphs (a) through (i) of this Rule for a minimum of three
years with exception of the map, which shall be maintained for the life of the system.
S. The Permittee shall report by telephone to a water resources staff member at the Raleigh Regional
Office, telephone number [phone], as soon as possible, but in no case more than 24 hours,
following the occurrence or first knowledge of the occurrence of either of the following:
a. Any process unit failure, due to known or unknown reasons, that renders the facility incapable
of adequate wastewater transport, such as mechanical or electrical failures of pumps, line
blockage or breakage, etc.; or
b. Any SSO and/or spill over 1,000 gallons; or
c. Any SSO and/or spill, regardless of volume, that reaches surface water
Voice mail messages or faxed information is permissible, but this shall not be considered as the initial
verbal report. Overflows and spills occurring outside normal business hours may also be reported to
the Division of Emergency Management at telephone number [phone] or [phone].
Persons reporting any of the above occurrences shall file a spill report by completing and submitting
Part I of Form CS-SSO (or the most current Division approved form) within five days following first
knowledge of the occurrence. This report must outline the actions taken or proposed to be taken to
Page 5 of 9

DacuSign Envelope ID: A9FE2695-5305-486D-8013-46BD5907737A
ensure that the problem does not recur. Part II of Form CS-SSO (or the most current Division approved
form) can also be completed to show that the SSO was beyond control. [G.S. 143-215.1C(al)]
6. Construction of the gravity sewers, pump stations, and force mains shall be scheduled so as not to
interrupt service by the existing utilities nor result in an overflow or bypass discharge of wastewater
to the surface waters of the State. [15A NCAC 02T.0108(b)]
7. Upon completion of construction and prior to operation of these permitted facilities, the completed
Englneering Certification form with checklist attached to this permit shall be submitted with the
required supporting documents to the address provided on the form. A complete certification is one
where the form is fully executed and the supporting documents are provided as applicable. Any
wastewater flow made tributary to the wastewater collection system extension prior to completion
of this Engineer's Certification shall be considered a violation of the permit and shall subject the
Permittee to appropriate enforcement actions.
If the permit is issued to a private entity with an Operational Agreement, then a copy of the Articles
of Incorporation, Declarations/Covenants/Restrictions, and Bylaws that have been appropriately
filed with the applicable County's Register of Deeds office shall be submitted with the certification.
A complete certification is one where the form is fully executed and the supporting documents are
provided as applicable. Supporting documentation shall include the following:
a. One copy of the project construction record drawings (plan & profile views of sewer lines & force
mains) of the wastewater collection system extension. Final record drawings should be clear on
the plans or on digital media (CD or DVD disk) and are defined as the design drawings that are
marked up or annotated with after construction information and show required buffers,
separation distances, material changes, etc.
b. One copy of the supporting applicable design calculations including pipe and pump sizing, velocity,
pump cycle times, and level control settings, pump station buoyancy, wet well storage, surge
protection, detention time in the wet well, and force main, ability to flush low points in force
mains with a pump cycle, and downstream sewer capacity analysis. If a portable power source or
pump is dedicated to multiple stations, an evaluation of all the pump stations' storage capacities
and the rotation schedule of the portable power source or pump, include travel timeframes, shall
be provided.
c. Changes to the project that do not result in non-compliance with this permit, regulations, or the
Minimum Design Criteria should be clearly identified on the record drawings, on the certification
in the space provided, or in written summary form.
Prior to Certification (Final or Partial): Permit modifications are required for any changes resulting
in non-compliance with this permit (including but not limited to pipe length changes of 10% or
greater, increased flow, pump station design capacity design increases of 5% or greater, and
increases in the number/type of connections), regulations, or the Minimum Design Criteria.
Requested modifications or variances to the Minimum Design Criteria will be reviewed on a case -by -
case basis and each on its own merit. Please note that variances to the Minimum Design Criteria
should be requested and approved during the permitting process prior to construction. After -
construction requests are discouraged by the Division and may not be approved, thus requiring
replacement or repair prior to certification & activation. [15A NCAC 02T .0116]
Page 6 of 9

Docudign Envelope ID. A9FE2695-F3D5-48BD-8013-46BD5907737A
Gravity sewers installed greater than ten percent below the minimum required slope per the Division's
Gravity Sewer Minimum Design Criteria shall not be acceptable and shall not be certified until
corrected. If there is an unforeseen obstacle in the field where all viable solutions have been
examined, a slope variance can be requested from the Division with firm supporting documentation.
This shall be done through a permit modification with fee. Such variance requests will be evaluated
on a case -by -case basis. Resolution of such request shall be evident prior to completing and submitting
the construction certification. ( 15A NCAC 02T.0105(n)]
9. A copy of the individual permit and construction record drawings shall be maintained on file by the
Permittee for the life of the wastewater collection facilities. [15A NCAC 02T .01161
10. Failure to abide by the conditions and limitations contained in this permit; 15A NCAC 02T; the
Division's Gravity Sewer Design Criteria adopted February 12, 1996 as applicable; the Division's
Minimum Design Criteria for the Fast -Track Permitting of Pump Station and Force Mains adopted June
1, 2000 as applicable; and other supporting materials may subject the Permittee to an enforcement
action by the Division, in accordance with North Carolina General Statutes §143-215.6A through §143-
215.6C, construction of additional or replacement wastewater collection facilities, and/or referral of
the North Carolina -licensed Professional Engineer to the licensing board. [15A NCAC 02T .0108(b-c)]
11. In the event that the wastewater collection facilities fail to perform satisfactorily, including the
creat on of nuisance conditions, the Permittee shall take immediate corrective action, including those
as may be required by this Division, such as the construction of additional or replacement facilities.
[15A NCAC 02T .0110; 15A NCAC 02T .0108(b)]
12. The issuance of this permit shall not exempt the Permittee from complying with any and all statutes,
rules, regulations, or ordinances that may be imposed by the Division any other Federal, State, or Local
government agencies which have jurisdiction or obtaining other permits which may be required by
the Division or any other Federal, State, of Local government agencies. [G.S. 143-215.1(b)]
Page 7 of 9

DocAgn Envelope ID: A9FE2695 F3D5 48BD-8013-46BD5907737A
CERTIFICATION CHECKLIST
To be completed by the certifying engineer prior to operation of the permitted sewers, per 15A NCAC 02T.0116.
Certifying Engineer:
Certification Review Date:
Project Name:
WQOO
Project County:
1) Has permittee information changed since the permit was issued (or last modified): change of mailing address,
change of ownershipr transfer from developer to HOA/POA, etc. ❑ Yes ❑ No
If yes, please provide either a change of ownership form or new contact information. Note that transfer of
permits from the developer to the HOA/POA must occur with the first certification.
2) Have the as -built drawings have been signed, sealed, and dated by an N.C. PE? ❑ Yes ❑ No
3) Final Engineering certification? ❑ Yes ❑ No
• If Partial Engineering certification, provide detailed narrative including what is being certified in the current
phase, what was previously certified (if applicable), and what is left to be certified.
4) Adequate information related to sewer lines: ❑ Yes ❑ No ❑ N/A
Three feet minimum cover has been provided for all sewers unless ferrous pipe was installed.
Minimum diameters for gravity sewers are 8-inches for public lines and 6-inches for private lines.
Manholes have been installed: At the end of each line, at all changes in grade, size, or alignment, at all
intersections, and at distances not greater than 425 feet; minimum diameter shall be 4 feet (48-inches).
5) Adequate information related to pump stations: ❑ Yes ❑ No ❑ N/A
• Ensure power reliability option was selected per 15A NCAC 02T.0305(h).
6) Was project construction completed in accordance with all of the following: ❑ Yes ❑ No ❑ N/A
• 15A NCAC 02T, Minimum Design Criteria (MDQ for the permitting of Gravity Sewers (latest version), and MDC
for the Permitting of Pump Stations and Force Mains (latest version)?
If not, a variance approval is required in accordance with 15A NCAC 02T.0105(b), prior to certification and operation.
• Contact the Central Office to discuss the variance to determine a course of action.
• Applicant must submit two copies of the variance request form, plans, specifications, calculations, and any other
pertinent information to the Central Office (one hard copy, one digital copy).
• The central office will review the variance request, and if approvable, specific language regarding the variance
will be incorporated into the permit, either via a special condition or a supplementary letter. A copy of the
reissued permit with variance language or the variance letter must be maintained with the original documents.
7) Does the project contains high priority lines (15A NCAC 02T .0402(2))? ❑ Yes ❑ No
• If yes, ensure that the permit already contains the necessary condition related to high priority lines 15A NCAC
02T.0403 (a)(5). If the permit does not include this language, the Fast Track reviewer will reissue the permit with
the appropriate language.
8) Are Permit modifications are required for any changes resulting in non-compliance with this permit (including but not
limited to pipe length changes of 10% or greater, change inflow, pump station design capacity design change of 5%or
greater, and/or change in the number/type of connections)? ❑ Yes ❑ No
• If yes, a permit modification request must be submitted to the appropriate Regional Office, and a modified
permit with revised certification must be issued prior to certification and operation.
Noah Carolina Department of rnvirnnmental Quality t)ivscion o+ W11rr Resources
Raleigh Regional Office 11828 Mail Service Center. Raleigp. NC 27G99 1628
Physical Address: 3800 Barrell Drive. Raleigh. NC 27609 919 791. 4200

Docu&ign Envelope ID: A9FE2695-F3135-486D 8013 46BO5907737A
FAST TRACK SEWER ENGINEERING CEIRTOkAkOfff Environmental ()city
PERMITTEE: Town of Holly Springs AUG 3 O 2023
PERMIT #: WQ0043437
PROJECT: Regency Subdivision Phase 2
ISSUE DATE: June 3, 2022 Raleigh Regional Office
This project shall not be considered complete nor allowed to operate in accordance with Condition 7 of
this permit until the Division has received this Certification and all required supporting documentation. It
should be submitted in a manner that documents the Division's receipt. Send the required documentation
the Regional Supervisor, Water Quality Regional Operations Section at the address at the bottom.
Any wastewater flow made tributary to the wastewater collection system extension prior to completion
of this Certification shall be considered a violation of the permit and shall subject the Permittee to
appropriate enforcement actions. The Permittee is responsible for tracking all partial certifications up
until a final certification is received. A Final Certification shall be a complete set of record drawings and
design calculations regardless of whether partials have been submitted.
PERMITTEE'S CERTIFICATION
I, the undersigned agent for the Permittee, hereby state that this project has been constructed pursuant
to the applicable standards & requirements, the Professional Engineer below has provided applicable
design/construction information to the Permittee, and the Permittee is prepared to operate & maintain
the wastewater collection system permitted herein or portions thereof.
Printed Name, Title Signature Date
ENGINEER'S CERTIFICATION
I, , as a duly registered Professional Efffull
eer in the State of North Carolina,
having been authorized to observe (❑ periodically, ❑ weekly, time) the construction of the
project name and location as referenced above for the above Permittee hereby state that, to the best of
my abilities, due care and diligence was used in the observation of the following construction:
approximately 1,644 linear feet of 8-inch aravity sewer; such that the construction was observed to be
built within substantial compliance of this permit; 15A NCAC 02T; the Division of Water Resources'
(Division) Gravity Sewer Minimum Design Criteria adopted February 12, 1996 as applicable; the Division's
Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains adopted June 1,
2000 as applicable; and other supporting materials.
North Carolina Professional Engineer's Seal w/signature & date:
❑ Final ❑ Partial (include description)
Certification Comments/Qualifiers (attach if necessary):
Nr�rth Carolina Deriartrnent of Environmental Qunlity Division of Water Pesotlrro-,
Raleigh Regional Office 1628 Mail Service Center. Raleigh. NC 27699 1G28
Physical Addre ". 3800 Barrett Drive. Rale-gh. NC 27609 919-791 4200

DocuSign Envelope ID: A9FE2695•F3D5-4880•8013.46BD5907737A
NC Dept of Environmental Quality State of North Carolina
Department of Environmental Quality
Division of Water Resources
AUG 3020.
Flow Tracking for Sewer Extension Applications
„Ralei e�,ional Office (FTSE 10-18)
Entity Requesting Allocation: Town of Holly Springs
Project Name for which flow is being requested: Regency Subdivision - Phase 2
More than one FTSE may he required for a single project if tire owner of the WWTP is not responsible for all pump
stations along the route of the proposed wastewater flow.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a.
WWTP Facility Name: Utley Creek Wastewater Treatment Plant
b.
WWTP Facility Permit #: NC 0063096
AlI flows are In MGD
c.
WWTP facility's permitted flow
6.0
d.
Estimated obligated flow not yet tributary to the WWTP
1.865
e.
WWTP facility's actual avg. flow
3.013
f.
Total flow for this specific request
0.023
g.
Total actual and obligated flows to the facility
4.901
h.
Percent of permitted flow used
82%
11. 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:
Pump
Pump
Station
Station
Firm
(Name or
Permit
Capacity,
Number)
No.
MGD
Regency
WQ0043014
0.238
HS Bus
WQ0031620
2.506
(A)
(B)
(C)
(D)—(l3+Q
(E)=(A-D)
Design
Average
Approx.
Obligated,
Daily
Current
Not Yet
Total Current
Flow**
Avg. Daily
Tributary
Flow Plus
(Firm / p0,
Flow,
Daily Flow,
Obligated
Available
MGD
MGD
MGD
Flow
Capacity***
0.095
0
0.072
0.072
0.023
1.002
0.095
0.834
0.929
0.073
* The Firm Capacity (design flow) of any pump station is defined as the maximum pumped flow
that can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor
(pf) not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): Regency PS
Downstream Permit Number: WQ0043014
Page 1 of 6
FTSE 10-18

DOCUSign Envelope ID. A9FE2695-F3D5-48BD-8013-46BD5907737A
Ill. Certification Statement:
I 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 lI 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 Official Signature
Title of Signing Official
Date
Page 2 of 6
FTSE 10-18

{ DocuSign Envelope ID- MFE2695-F3D5.4881) 8013-46BD5907737A
PLANNING ASSESSMENT ADDENDUM (PAA)
Submit a planning assessment addendum for each pump station listed in Section II where Available Capacity is <
0.
Pump Station (Name or Number):
Given that:
a. The proportion and amount of Obligated, Not Yet Tributary Daily Flow (C) accounts for
% and MGD of the Available Capacity (E) in Pump Station
; and that
b. The rate of activation of this obligated, not yet tributary capacity is currently approximately
_ MGD per year; and that
C. A funded Capital Project that will provide the required planned capacity, namely
is in design or under construction with
planned completion in ; and/or
d. The following applies:
Therefore:
Given reasonably expected conditions and planning information, there is sufficient justification to allow
this flow to be permitted, without a significant likelihood of over -allocating capacity in the system
infrastructure.
I understand that this does not relieve the collection system owner from complying with G.S. 143-
215.67(a) which prohibits the introduction of any waste in excess of the capacity of the waste disposal
system.
Signing Official Signature
Dare -
Page 3 of 6
FTSF_ 10-18

1 ,
DocuSign Envelope ID: A9FE2695-F3D5-48BD-8013-46BD5907737A
Instructions for Flow Tracking form (FTSE) and Planning Assessment Addendum (PAA)
Section. I
a. WWTP Facility Name: Enter the name of the WWTP that will receive the wastewater flow.
b. WWTP Facility Permit #: Enter the NPDES or Non -Discharge number for the WWTP receiving the
wastewater flow.
c. WWTP facility's Rermitted flow, MGD: From WWTP owner's NPDES or Non -Discharge permit.
d. Estimated obligated flow not yet tributary to the WWTP, MGD: This includes flows allocated to other
construction projects not yet contributing flow to the collection system. Flows allocated through interlocal
agreements or other contracts not yet contributing flow to the collection system are also included. For POTWs
that implement a pretreatment program, include flows allocated to industrial users who may not be using all of
their flow allocation. Please contact your Pretreatment Coordinator for information on industrial flow tributary
to your WWTP.
As of January 15, 2008 the POTW should have reviewed flow allocations made over the last two years and
reconciled their flow records, to the best of their ability, so it is known how much flow has been obligated and
is not yet been made tributary to the WWTP, in accordance with local policies and procedures employed by the
reporting entity.
e. WWTP facility's actual avg, flow, MGD: Previous 12 month average.
f. Total flow for this specific request, MGD: Enter the requested flow volume.
g. Total actual and obligated flows to the facility, MGD Equals [d + e + f]
h. Percent of permitted flow used: Equals [(gl c)* 100]
For example:
On January 15 a POTW with a permitted flow of 6.0 MGD, reported to the Regional Office that there is 0.5
MGD of flow that is obligated but not yet tributary. The annual average flow for 2007 is 2.7 MGD. There is a
proposed flow expansion of 0.015 MGD.
The first Form FTSE submitted after January 15, 2008 may have numbers like this:
c. — 6.0 MGD
d. — 0.5 MGD
e.-2.7 MGD
f. — 0,015 MGD
g. = 3.215MGD
h. = 53.6 %
The next Form FTSE may be updated like this with a proposed flow expansion of 0.102 MGD:
c.-6.0 MGD
d. — 0.515 MGD
e. — 2.73 MGD
f. = 0.102 MGD
g. = 3.349 MGD
h. — 55.8 %
Each subsequent FTSE form will be updated in the same manner.
Page 4 of 6
FTSE 10-18

DocAgn Envelope ID. A9FE2695-F3D5-48BD-8013-46BD5907737A
Section 11
List the pump station name or number and approximate pump station firm capacity, approximate design average
daily flow (A) approximate current average daily flow (B), and the obligated, not yet tributary flow through the
pump station (C) for each pump station that will be impacted by the proposed sewer extension project. Calculate
the total current flow plus obligated flow (D-B*-C) and the available capacity (E.—A-D). Include the proposed flow
for this project with other obligated flows that have been approved for the pump station but are not yet tributary
(C).
Firm capacity is the maximum pumped flow that can be achieved with the largest pump out of service as per the
Minimum Design Criteria.
Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor (pf) of not less than
2.5.
If the available capacity (E) for any pump station is < 0, then prepare a planning assessment for that pump station
if the system has future specific plans related to capacity that should be considered in the permitting process.
(A)
(B)
(C)
(D)=(B+C)
(E)=(A-D)
Obligated,
Design
Approx.
Not Yet
Total Current
Firm
Average
Current Avg.
Tributary
Flow Plus
Pump Station
Capacity
Daily Flow
Daily Flow,
Daily Flow,
Obligated
Available
(Name or Number)
MGD
(Firm f pf)
MGD
MGD
Flow
Capacity*
Kaw Creek PS
0.800
0.320
0.252
0.080
0.332
-0.012
Valley Road PS
1.895
0.758
0.472
0.135
0.607
0.151
Page 5 of 6
I~TSE 10-18

DocuSign Envelope ID. A9FE2695-F3D5-48BD-8013-46BD5907737A
Planning Assessment Addendum Instructions
Submit a planning assessment addendum for each pump station listed in Section 11 where available capacity is < 0
A planning assessment for Kaw Creek PS (see example data above) may be performed to evaluate whether there is
significant likelihood that needed improvements or reductions in obligated flows will be in place prior to activating
the flows from the proposed sewer extension project.
If the system decides to accept the flow based on a planning assessment addendum, it is responsible to manage the
flow without capacity related sanitary overflows and must take all steps necessary to complete the project or control
the rate of flow to prevent sanitary sewer overflows.
The planning assessment may identify a funded project currently in design or construction, or a planned project in
the future not yet funded but in a formal plan adopted by the system. The system should carefully weigh the
certainty of successful timely project completion for any expansion, flow management diversion or infiltration and
inflow elimination projects that are the foundation of a planned solution to capacity tracking and acceptance
compliance.
For example:
Given that:
a. The proportion and amount of obligated, not yet tributary flow accounts for 24 % and 0.080 MGD of the
committed flow in Pump Station Kaw Creek; and that
b. The rate of activation of this obligated, not yet tributary capacity is currently approximately 0.01_MGD
per year; and that
c. A funded capital project that will provide the required planned capacity, namely
is in design or under construction with planned
completion in ; andfor
d. The following applies:
The master l2lan and ten Year cQitallRlan contain recommended scojpe and fundin fora capital project entitled
Kaw Creek Purng Station u rade with fundinlr ulanned in July 2014. This prQi!Lct is planned to add 0.100 MGD
to the firm capacity of the pump -station bar October 201 S. lnclusion of this proposed capital project as a condition
of this Flow Track in Acceptance for Sewer Extension Permit Application elevates this pro'ect's priority for
funding and construction to be implemented ahead of the activation of obligated, not yet trib_utary flows in amounts
that exceed the firm numn station canacities identified in Section II above.
Therefore:
Given reasonably expected conditions and planning information, there is sufficient justification to allow this flow
to be permitted, without a significant likelihood of over -allocating capacity in the system infrastructure.
Page 6 of 6
FTSE 10-18

Certificate Of Completion
Envelope Id: A9FE2695F3D548BD801346BD5907737A
Subject: 42100 Regency Ph 2 Sewer Mod Permit,doc, 2023-07-11 Regency Subdivision...
Source Envelope:
Document Pages: 31 Signatures: 2
Certificate Pages: 5 Initials: 5
AutoNav: Enabled
Envelopeld Stamping: Enabled
Time Zone: (UTC-05:00) Eastern Time (US R Canada)
Record Tracking
Status- Original
7/21/2023 9:19:55 AM
Signer Events
Rachel Ingham
[e-mail]
Engineering Manager - Utilities
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 11/16/2020 9:41:26 AM
ID:Oc7f672d-8bab-496f-91fl-115266328d46
Company Name: Town of Holly Springs
Catherine Jacobs
[e-mail]
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 7/31/2023 12:49:53 PM
ID:ae4f958b-2218-41fa-84eb-c74d0a71501e
Company Name: Town of Holly Springs
Kendra Parrish
[e-mail]
Director of Utilities & Infrastructure
Holly Springs
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 7/3112023 1:25:57 PM
ID:09df03d7-eaW4daa-bld9-88f094c6d574
Company Name: Town of Holly Springs
In Person Signer Events
Editor Delivery Events
Agent Delivery Events
Intermediary Delivery Events
Holder: Emily Koncz
[e-mail]
Signature
�_
Signature Adoption: Pre -selected Style
Using IP Address: 204.84.166.2
E035
Signature Adoption: Pre -selected Style
Using IP Address: 204.84.166.2
Eusron•aM:
6E 175COICOE
S-gnature Adoption: Pre -selected Style
Using IP Address: 71.76.147.91
Signature
Status
Status
Status
DocuSign
Status: Completed
Envelope Originator:
Emily Koncz
PO Box 8
Holly Springs, NC 27540
[e-mail]
IP Address: 204 84 166 2
Location: DocuSign
Timestamp
Sent: 7/21/2023 9:24:53 AM
Viewed: 7/24/2023 12-55:59 PM
Signed. 7/24/2023 1:02:25 PM
Sent: 7/24/2023 1:02:28 PM
Resent: 7/28/2023 9.38.41 AM
Viewed: 7/31/2023 12-24:42 PM
Signed: 7/31/2023 12 51:23 PM
Sent: 7/31/2023 12:51:27 PM
Viewed: 7/31/2023 1 25:57 PM
Signed: 7/31/2023 1 26 08 PM
Timestamp
Timestamp
Timestamp
Timestamp

Certified Delivery Events
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Timestamp
Carbon Copy Events
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Timestamp
Witness Events
Signature
Timestamp
Notary Events
Signature
Timestamp
Envelope Summary Events
Status
Timestamps
Envelope Sent
Hashed/Encrypted
7/21/2023 9:24:53 AM
Certified Delivered
Secur,ty Checked
7/31/2023 1:25:57 PM
Signing Complete
Security Checked
7/31/2023 1:26:08 PM
Completed
Secur,ty Checked
7/31/2023 1:26:08 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 Rachel Ingham. Catherine Jacobs. Kendra Parrish
ELECTRONIC RECORD AND SIGNATURE DISCLOSURE
From time to time, Town of Holly Springs (we, us or Company) may be required by law to
provide to you certain written notices or disclosures. Described below are the terms and
conditions for providing to you such notices and disclosures electronically through the DocuSign
system. Please read the information below carefully and thoroughly, and if you can access this
information electronically to your satisfaction and agree to this Electronic Record and Signature
Disclosure (ERSD), please confirm your agreement by selecting the check -box next to `I agree to
use electronic records and signatures' before clicking `CONTINUE' within the DocuSign
system.
Getting paper copies
At any time, you may request from us a paper copy of any record provided or made available
electronically to you by us. You will have the ability to download and print documents we send
to you through the DocuSign system during and immediately after the signing session and, if you
elect to create a DocuSign account, you may access the documents for a limited period of time
(usually 30 days) after such documents are first sent to you. After such time, if you wish for us to
send you paper copies of any such documents from our office to you, you will be charged a
$0.00 per -page fee. You may request delivery of such paper copies from us by following the
procedure described below.
Withdrawing your consent
If you decide to receive notices and disclosures from us electronically, you may at any time
change your mind and tell us that thereafter you want to receive required notices and disclosures
only in paper format. How you must inform us of your decision to receive future notices and
disclosure in paper format and withdraw your consent to receive notices and disclosures
electronically is described below.
Consequences of changing your mind
If you elect to receive required notices and disclosures only in paper format, it will slow the
speed at which we can complete certain steps in transactions with you and delivering services to
you because we will need first to send the required notices or disclosures to you in paper format,
and then wait until we receive back from you your acknowledgment of your receipt of such
paper notices or disclosures. Further, you will no longer be able to use the DocuSign system to
receive required notices and consents electronically from us or to sign electronically documents
from us.
All notices and disclosures will he sent to you electronically

jr I
Unless you tell us otherwise in accordance with the procedures described herein, we will provide
electronically to you through the DocuSign system all required notices, disclosures,
authorizations, acknowledgements, and other documents that are required to be provided or made
available to you during the course of our relationship with you. To reduce the chance of you
inadvertently not receiving any notice or disclosure, we prefer to provide all of the required
notices and disclosures to you by the same method and to the same address that you have given
us. Thus, you can receive all the disclosures and notices electronically or in paper format through
the paper mail delivery system. If you do not agree with this process, please let us know as
described below. Please also see the paragraph immediately above that describes the
consequences of your electing not to receive delivery of the notices and disclosures
electronically from us.
How to contact Town of Holly Springs:
You may contact us to let us know of your changes as to how we may contact you electronically,
to request paper copies of certain information from us, and to withdraw your prior consent to
receive notices and disclosures electronically as follows:
To contact us by email send messages to: jeff.wilson(chollyspringsnc.us
To advise Town of Holly Springs of your new email address
To let us know of a change in your email address where we should send notices and disclosures
electronically to you, you must send an email message to us at [e-mail]
and in the body of such request you must state: your previous email address, your new email
address. We do not require any other information from you to change your email address.
If you created a DocuSign account, you may update it with your new email address through your
account preferences.
To request paper copies from Town of Holly Springs
To request delivery from us of paper copies of the notices and disclosures previously provided
by us to you electronically, you must send us an email to [e-mail] and in
the body of such request you must state your email address, full name, mailing address, and
telephone number. We will bill you for any fees at that time, if any.
To withdraw your consent with Town of Holly Springs
To inform us that you no longer wish to receive future notices and disclosures in electronic
format you may:

11 ;
i. decline to sign a document from within your signing session, and on the subsequent page,
select the check -box indicating you wish to withdraw your consent, or you may;
ii. send us an email to jeff.wilson(q)hollyspringsnc.us and in the body of such request you must
state your email, full name, mailing address, and telephone number. We do not need any other
information from you to withdraw consent.. The consequences of your withdrawing consent for
online documents will be that transactions may take a longer time to process..
Required hardware and software
The minimum system requirements for using the DocuSign system may change over time. The
current system requirements are found here: httlas://support.docusi n.com/J4uides'sii4ner- rub. ide-
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Acknowledging your access and consent to receive and sign documents electronically
To confirm to us that you can access this information electronically, which will be similar to
other electronic notices and disclosures that we will provide to you, please confirm that you have
read this ERSD, and (i) that you are able to print on paper or electronically save this ERSD for
your future reference and access; or (ii) that you are able to email this ERSD to an email address
where you will be able to print on paper or save it for your future reference and access. Further,
if you consent to receiving notices and disclosures exclusively in electronic format as described
herein, then select the check -box next to `1 agree to use electronic records and signatures' before
clicking `CONTINUE' within the DocuSign system.
By selecting the check -box next to `1 agree to use electronic records and signatures', you confirm
that:
You can access and read this Electronic Record and Signature Disclosure; and
You can print on paper this Electronic Record and Signature Disclosure, or save or send
this Electronic Record and Disclosure to a location where you can print it, for future
reference and access; and
Until or unless you notify Town of Holly Springs as described above, you consent to
receive exclusively through electronic means all notices, disclosures, authorizations,
acknowledgements, and other documents that are required to be provided or made
available to you by Town of Holly Springs during the course of your relationship with
Town of Holly Springs.

Docuagn Envelope ID A9FE2695-F3D5-48BD-8013-46BD5907737A
one1
is THE TOWN OF orgy
July 21, 2023
Director, Division of Water Resources
Raleigh Regional Office
Water Quality Operation Section
3800 Barrett Drive
Raleigh, NC 27609
cYprings
NC Dept of Environmental Quality
AUG 30
Re: Application for Sewer Extension Permit
Project: Regency Subdivision Phase 2 Modification Raleigh Regional Office
Permit Number: WQ0043437
Dear Sir or Madam:
Please find enclosed the following items in application for a sewer extension permit to the Town
of Holly Springs existing sewer distribution system:
0 One original and one copy cover letter including a project narrative
o A check in the amount of $480.00
0 One original and one copy of the State of North Carolina Fast Track Sewer System
Extension Application (FTA 04-16)
0 Two copies of FTSE 04-16 Flow Tracking/Acceptance Form
0 Two color copies of a 8.5-inch by 1 I -inch portion of a 7.5 minute USGS Topographic
Map showing project area
0. Two copies of a street level map showing all relevant project areas
0 One copy of the locally -required Design and Application Certification
Feel free to contact me at 919-577-3150 should you have any questions or need additional
information in order to process this application.
Sincerely,
Oocu3igned by
os
��
o//s��
��
A3B E72 T
endra arrish, P.E., CFM
Rachel Ingham
Catherine Jacobs
Executive Director of Utilities and Infrastructure
KPlek
cc: Project Consultant Engineer, Jeremy Finch
Rachel Ingham, Utility Engineering Manager
Catherine Jacobs, Development Construction Manager
Emily Koncz, l:tility Permitting Specialist
3002
04. t7.2018
Utilities and lnifrastriictitre Services
P.O. Box 8 • 128 S. Main Street - Holly Springs, NC 27540 * www.hollyspringsnc.gov

Docusign Envelope ID: A9FE2695-F305-48BD-8013-46BD5907737A
11 NI■ fI
4►:,r►'� T HE TOWN OF
Project File. -Correspondence #42100
,��lly Springs
3002
04.17 2019
Utilities and Infrastructure Services
P.O. Sox 8 • 128 S. Main Street • Holly Springs, NC 27540 • www.hollyspringsnc.gov

Docuaogn Envelope ID. AgFE2695-F3D5-48BD-8013-46BD5907737A
JMcADAMScoept ofEnvironrt7e
ntal Quality
June 12, 2023
NCDFNR - DWR
Raleigh Regional Office
1628 Mail Service Center
Raleigh, North Carolina 27699-1628
Re: Regency Subdivision - Phase 2
Holly Springs, North Carolina
TOL-20030
AUG 30202-
R a lelgh Regis Off i.,
The accompanied Fast -Track Application (FTA 06-21) is a proposed
modification to the existing permit WQ0043437 for the Regency Subdivision
Phase 2 in Holly Springs. This permit modification includes 1,546 lineal feet
of 8" PVC and 373 lineal feet of 8" DIP gravity sanitary sewer for at total of
1,919 linear feet for the proposed Regency Subdivision - Phase 2 development
located off New Hill Holly Springs Road in Holly Springs, NC.
The proposed roadway/lot layout within a portion of the Regency Subdivision
Phase 2 subdivision has been redesigned resulting in additional gravity
sanitary sewer main. The existing permit was previously approved for 835
lineal feet of 8" PVC and 809 lineal feet of 8" DIP for a total of 1,644 lineal
feet of gravity sanitary sewer. The intent of this permit modification is for the
addition of 711 lineal feet of 8" PVC and reduction of 436 lineal feet of DIP
gravity sanitary sewer main for a net total addition of 275 lineal feet of 8"
gravity sanitary sewer main.
Phase 2 of the project still consists of 92 residential units. The total
wastewater flow generated by Phase 2 of the project remains at the previously
permitted flow of 23,460 GPD and no additional wastewater flow is being
requested as part of this permit modification.
i Sincerely,
The John R. McAdams T . E JOHN R. 141CA)AMS COMPANY, INC.
Company, Inc I
Raleigh / Durham, NC U
2905 Meridian Parkway
OoOam North Cara4na27713 am . Finch, P.E.
19191361 5000
Group Manager, Residential
Charlotte, NC Enclosures
11301 Carmel Commons Blvd
Suite 111
Charlotte Nedh Carolina 28226 i
(7041527-0800
MCAdamsCo.com Designing Tomorrow's infrastructure & Communities

bocuSign Envelope ID: A9FE2695-F3D5-4880-80i3-46BD5907737A
NC Dept of Environmental Quality
DO NOT SUBMIT SEWER EXTENSION APPLICATIONS UNTIL
CONSTRUCTION DRAWINGS HAVE BEEN APPROVED BV STA 1,
Sewer Design and Application Certification Raleigh Regional Office
Note: This firm must be submitted with the Fast Tract Application for extension to the Town of
Holly Springs Sewer System
Project:
Regency Subdivision - Phase 2 - this is a revision to permit #W00043437
Design Engineer: ,Jeremy Finch
Address: 2905 Meridian Parkway, Durham, NC 27713
Phone Number: 919-361-500 Email: [e-mail]
Date Complete Application Package Received by Town:
os us
Date Approved: (by R1)
06-12-2023
o (by KDP) t 1" 3 . (b 94) By 0
_
As design engineer for this project. I certify the following (please check (x) each applicable: hox)
❑x That the design of the project is in complete conformance with the Town of Holly
Springs Engineering Design and Construction Standards and NC DEQ Sanitary Sewer
Design Regulations;
❑x That each of the following items are completed and enclosed for submittal to the State for
a sewer extension permit:
El One original and one copy of a cover letter that includes a project narrative
© A check in the amount of $480.00 to NC DEQ
R A check in the amount of $200.00 to the Town of Holly Springs
0 One original and one copy of the State of North Carolina form FTA 04-16
Fast Tract Sevver.System Extension Applicattrut
E] Two copies of form FTSE 10-18 Flow Tracking. fi r Seiver E-me►1.sion
Applications
El Two color copies of an 8.5-inch by 1 1-inch portion of a 7.5-minute USGS
Topographic Map showing project area
0 Two copies of a street level map showing all relevant project areas
El One copy of the locally -required Design and Application Certification (This
form)
Design Engineer's Signature It-041&
Please contact Emily Koncz at (919 e29'. y.koncx:u.hollys
any questions.
2003 Sewer Design Apphcalion Certification
tl1 14 21
Date 6-13-23
p_Lingsnc.gov if you have
Utilities and Lrjrastruclure Serrices
P.U. Rn_r 8 • 128.5. Mart Street • Holty Springs, gVC 27540 • Irlrrr.hog1ti Yprhtgsnc.gnr

R1 gept.of iEnvtronmental (PWity
DocuSign Envelope ID- A9FE2695-F3D5-4$81)-8013-4613U5907737A
AUG 3 D 2023 State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
1 4694 Rek"*W-SEWER SYSTEM EXTENSION APPLiC:ATION
Division of Water Resources INSTRUCTIONS FOR FORM: FTA 06-21 & SUPPORTING DOCUMENTATION
This application is fir sewer extensions involving; gravity sewer~, pump stations and force mains. or any combination that has been
certified by a professional engineer and the applicant that the project meets [lie requirements of' 15A_NCAC 02T and the Division'~
Minimum Design Criteria (Gravity Sewer & Pump Stations; Force Mains) and that plans, specifications and supporting documents
hire been prepared in accordance with 15A NCAC 02T,1 SA NCAC 02T .0300. Division policies, and good eng-incering- nractiet~s.
Wliik no upfront engineering design document~ are required for submittal, in accordance with 15A NCAC 02T .0305(b), design
docunicnts must be prepared prior to submittal of a fast track permit application to the Division. This would include plans. design
calculations. and project specifications referenced in ISA NCAC 02T -0305 and the applicable minimum design criteria. These
documents shall be immediately available upon request by the Division.
Projects that are deemed permiucd (do not require it permit From the Division) are explained ill I SA NCAC 02T.0303.
Projects not eligible for review via the fast track process (must be suhmitted li)r fill technical review):
Projects that do lint nicet any part of the niinimurn design criteria (MDC) documents;
Projects that involve more than one variance front the requirements of 15A NCAC 02T:
i Pressure sewer sysicnis utilizing simplex septic tank -effluent pumps (STL'•P%) or siniplex grinder pumps:
Simplex STEP or siniplcx grinder punips connecting to pressurized systems (e.g. lorce mains):
Vactruni 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 and checking the provided boxes will help produce a quicker revic%v time and reduce the
aniount ofrequested additional information. Failure to submit all required items will necessitate additional processing and review
time, and may result in return of the application. Unless otherwise 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 he digital) of Application and Supporting; Documents
® Required unless otherwise noted. Signatures on original niust be "we[ ink" or secure digital signatures.
Please do not submit engineering design plans with the application unless specifically requested.
B. Cover Letter/Narrative Description (Required for All Application Packages):
® List all items included ill the application package. as well aS a brief description of the requested permitting action
Be specific as to the system type, number of honic% served. flow allocation required. etc.
Include the permit numherlstalus ofany other required sewer permits (downstream/upstream)
1W Ifnecessary for clarity, include allachnicnts to the application form.
C. Application Fee (All New and Modification Application Packages):
® Submit a check or nioncy order in the amount cif $480.00, dated no more than 90 days prior to application suhnuItal
Ir Payable to North Carolina Department of Environniental Quality (NC'DFQ)
D. Fast Track Application (Required for All Application Packages, Form FTA 116-21):
® Submit the completed and appropriately executed application.
If necessary for clarity or due to space restrictions, attachments to the application may be made.
❑ If the Applicant Type in Item 1.2 is a corporation or company, provide documentation it is registered Ibr business with the
North Carol ina.eeretary of State.
❑ If the Applicant Type in Item 1.2 is a partnership or dfbra, enclose a copy of the certificate filed with the Register of Deeds in
the county of business.
E) The Project Name in Item If. I shall be consistent with the prolcct 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 Carolina
licensed Professional Engineer.
® The Applicant's Certification on Page 5 of the application shall be signed in accordance with 15A NCAC 02T .0106�. Per
ISA NCAC 02T .0106(c). an alternate person may be designated as the signing official if a delegation letter is provided front
a person who meets the criteria in 15A NCAC 02T .0106(b).
INSTRUCTIONS FOR FORM: FTA 06-21 & SUPPORTING DOCUMENTATION Page 1 of 3

Docusign Envelope ID A9FE2695-F3D5-4880-8013-458t)5907737A
E. Flow Tracking/Acceptance Form (Form: 110-18) (If Applicable):
® Submit the completed and executed FTSE form from the owners of the downstream sewers and treatment facility.
r Multiple forms maybe required where the downstream sewer owner and wastewater treatment facility are different.
The flow acceptance indicated in firm FTSE must not expire prior to permit issuance and must be dated less than one year
prior to the .application date.
Submittal ofthis application and firm FTSE indicates that owner has adequate capacity and will wt violate G.S. 143-215.67tax_
Intergovernmental agreements or other contracts will not be accepted in lieu of a project-spccitic I-T,SF.
F. Site Maps (All Application Packages):
® Submit an 8.5-inch x i 1-inch color copy of a USGS Topographic Map of'Sutficienl scale to identify the satire projeci atv.i,
including the closest surface waters.
General location of the project components (gravity sewer, pump stations. & force main)
Downstream connection points and permit number (il'known) Ibr the receiving sewer
® Include in aerial location map showing general project area (such as street names or latituddlongitude) so ihat Di'vismo -Aat'f
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 descriptise and clear narrative identifying the previously permitted items to remain in the permit, items to he
added, andlor items to be modified (the application form itselfshould include only include items to be addedlniodilied), 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 he listed in
the final permit.
H. Power Reliability Plan (Required if portable reliability option utilized for- Pump Station):
❑ Per 15A NCACO2T ,O3b5thx ll}. Submit documentation of power reliability for pumping stations.
This alternative is only available tier average daily flows less than 15.000 gallons per day
It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant and is compolihlc w-itlr
the station The Division will accept it letter signed by the applicant (see 15A NCAC 02T .0106(b)) or proposed contractor.
slating that "Ihe portable power generation unit or portable. independently -powered pumping units, associated appurtenances
and personnel are available for distribution and operation of this pump 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
he provided in the case of a multiple station power outage. (Required at time (rf certification)
1. Certificate of Public Convenience and Necessity (All Application Packages for Privately�Owncd Public Utilities).
❑ Per 15A NCAC t}2T .01 Mail I } provide the Certificate of I ublic Convenience and Necetisily from the -.031) Carolina Utilities
Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served by the sewer
extension. or
❑ Provide a letter tiom the Nortk.Cxrc)lipp ltIiIities Commission's Water and Sewer .Qivision Public StaITstmiing an application
for it franchise has been received and Ihm the service .area is contiguous to an existing franchised area or that franchise approval
is expected.
J. Operational Agreements (Applications from HOAJPOA and Developers for lots to be sold):
❑ Home Owners' Associations
❑ Per 15A NCAC 02T _01 154c1. submit the properly cxectitcd Qpgaf
19aal Agreement.lFORM.. HOA).
❑ Per I5A NCAC 02T _01 I5(c). submit it copy of the Articles of Incorporation, Declarations and Fay -laws,
❑ Developers of lots lobe sold
❑ Per 15A NCAC 02T .0115(bl, submit the properly executed Operational Agreement FORM; DEVr,
For more inforn)(rtrnrt_ vrsrl the Division's (olleatmi .ti steams irebsite
INSTRUCTIONS FOR FORM: FTA 05-21 & SUPPORTING DOCUMENTATION Page 1 of 3

DocuSign Envelope ID A9FE2695-F3D5-488D-881346BD5907737A
THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Reaional 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
225 Green Street Suite 714
Rutherford, Swain, Transylvania, Yancey
Fayetteville Reaional Office
Anson, Bladen, Cumberland, Harnett, Hoke,
Water Qualily Section
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,
Water Quality Section
Mooresville, North Carolina 28115
Gaston, Iredell, Lincoln. Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
Raleigh Reaional Office
3800 Barrett Drive
Chatham, Durham, Edgecombe, Franklin,
Water Quality Section
Raleigh, North Carolina 27609
Granville, Halifax, Johnston, Lee. Nash,
[phone]
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
943 Washington Square Mall
Warren, Wilson
Beaufort. Bertie, Camden, Chowan, Craven,
Washington Regional Office
Water Quality Section
Washington, North Carolina 27889
Currituck, Dare, Gates, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
Brunswick, Carteret, Columbus, Duplin, New
Wilmington -Regional Office
127 Cardinal Drive Extension
Water Quality Section
Wilmington, North Carolina 28405
Hanover, Onslow, Pander
[phone]
[phone] Fax
Winston-Salem Regional Office
450 W. Hanes Mill Road
Alamance, Alleghany, Ashe, Caswell, Davidson,
Water Quality Section
Suite 300
Davie, Forsyth, Guilford, Rockingham, Randolph,
Winston-Salem, North Carolina 27105
Stokes, Surry. Watauga, Wilkes. Yadkin
[phone]
[phone] Fax
INSTRUCTIONS FOR FORM: FTA 05-21 & SUPPORTING DOCUMENTATION Pagc 3 of x