WQ0044897_Application (FTSE)_20231101

DocuSign Envelope ID- B3318COB-FB5A-4C82-BB01-5BF6C6D00297
'19WADAMS
September 13, 2023
NCDEQ. DWR
Raleigh Regional Office
Water Quality Section
3800 Barrett Drive
Raleigh, North Carolina 27609
EAST TRACK SEWER SYSTEM APPLICAT ON COVER LETTER > DKE22004
NCDepfo; ErvirorlrtetttalQuality
Nov z 2023
Raleigfz RegionaI 01"fice
RE: Duke Energy Progress Holly Springs Operation Center and Training Facility — Cinder Station Road
Holly Springs, North Carolina
DKE22004
The enclosed Fast -Track (FTA 06-21) and Flow Tracking/Acceptance for Sewer Extension (FTSE 10-18)
applications reflect 1,008 linear feet of 8" DIP gravity sanitary sewer main extension and 44 linear feet of 8"
PVC gravity sanitary sewer main extension, for a total of 1,052 of 8" gravity sanitary sewer main, for the
proposed Cinder Station Road project located at the intersection of Cinder Station Road and Woods Creek
Road in Holly Springs, NC (see enclosed Vicinity Map). The sewer system will be a part of a public authority
system, owned and operated by the Town of Holly Springs. Cinder Station Road is a proposed new street
that would be maintained by the Town of Holly Springs upon acceptance. The project will also include a new
Duke Energy Operations and Training Center and a Town of Holly Springs fire station. Utilities for the two
building projects are being constructed according to an agreement between Duke Energy and the Town.
Sanitary sewer service for the fire station will be via a grinder pump station and 2-inch PVC force main.
The proposed project will be constructed in two phases. Cinder Station Road and the utility mains will be
constructed in the first phase. The utility mains will provide service to the proposed Town of Holly Springs
fire station (on Lot 2, see site plan). The fire station will house eleven employees on one shift (550 gallons
per day, pre the 2T rules). The second phase will include the construction of an Operations Center and
Training Center for Duke Energy, which will house 210 employees (5,250 gallons per day, per the 2T rules).
This will have a combined wastewater flowrate of 5,800 gallons per day. The anticipated date for I" effluent
discharge from the project is June V, 2024.
The 2" force main serving the fire station will be conveying less than 600 gallons per day and is deemed to
be permitted by regulation according to NCDEQ 15A NCAC 02T .0113. The sanitary sewer becomes a gravity
main on Duke Energy property where the main will pick up sanitary sewer service from the proposed
Operations and Training Center. This permit application is for the 8-inch gravity sanitary sewer main with an
upstream manhole labelled SSMH-8 on the plans.
Treat ng experiences through experience 2905 Meridian Parkway, Durham, NC 27713 / 919. 361. 5000

DocuSign Envelope ID. 83318COB-FB5A-4C82-BB01-5BF6C6D00297
tJ MCADAMS
FAST TRACK SEWER SYSTEM APPLICATION COVER LETTER > DKE22004
401/404/NWP 12 permits are not required for this project. The erosion and sedimentation control plan has
been approved by the Division of Energy, Mineral, and Land Resources and a Certification of Coverage has
been granted. The Department of Transportation has approved a temporary driveway permit.
A check payable to North Carolina Department of Environmental Quality for $480 is enclosed for the
application fee. t
Sincerely,
MCADAMS
Patrick L 0918"ysipnedbyPetri kLCOW1
ONE c,.P,,ick L Cov11..-U..
McAdam.
ate42�104C0YII G1.09.3 221a53 W
Patrick Covif, PE
Enclosures:
FTA 06-21 Application
FTSE 10-18
Sewer Design and Application Certification
Fig. 1 Aerial Map
Fig. 2 USGS Quad Map
a-
0
fl
�t
creating experiences through experience 20t I

DocuSign Envelope ID: 133318COB-F65AAC82-131301-5BF6C6000297
NC Dept c State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
NOV 20AST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 10-23 & SUPPORTING DOCUMENTATION
Application Number: "00g001 (1. be complo,d by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Town of Holly Springs
2. Applicant type: ❑ Individual ❑ Corporation
❑ Federal ❑ State?County
3. Signature authority's name: Kendra D. Parrish, PE
Title: Executive Director of Utilities & Infrastructure
(company, municipality, HOA, utility, etc.)
❑ General Partnership ❑ Privately -Owned Public Utility
❑✓ Municipal ❑ Other
4. Applicant's mailing address: 128 South Man Street P.O. Box 8
City; Holly Springs State: North Carolina Zip27540 _
-
Applicant's contact information: [e-mail]
Phone number: 9�) 577_3150 Email Address: emily.koncz@hollyspringsnc_gov
5
II. PROJECT INFORMATION:
15A NCAC 02T .0106(b)
Project name: Duke Energy Progress Holly Springs operations and Training Facility - Cinder Station Road
2. ApplicationfProject status: X❑ Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number. WQ00 and issued date: ,
For modifications, also attach a detailed narrative description as described in Item G of the checklist.
If new construction, but part of a master plan, provide the existing permit number: WQ00._. _ ..
3. County where project is located: Wake
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.6804' Longitude:-78.8798
5. Parcel ID applicableif a ;o73a5>>5s1
( pp ) (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
I. Professional Engineer: Patrick Covil License Number: 034365
Firm: McAdams
Mailing address:.621 Hillsborough St. Ste. 500
City; Raleigh State: North Carolina zip: 27603 _
Phone number; (919) 287 -0795 Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Utley Creek Water Reclamation Facility
Owner Name: Town of Holly Springs
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ 0042364
Permit Number: NCO063096
2. Downstream (Receiving) Sewer Information: 8 ..inch ® Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS 00192
Owner Name(s): Town of Holly Springs
FORM: FTA 10-23 Page I of 5

DocuSign Envefope ID: B3318COB-FB5A4C82-BB01-5BF6C6DO0297
VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑ No 0 N.%A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached?
❑ Yes ❑ No 0 N/A
3. If the Applicant is a Home/Property Owners' Association, has an HOAIPOA Operational A&rUm&nt.(FQRM 1 HOA) and
supplementary documentation as required by 15A NCAC 02T.01 15(c) been attached?
❑ Yes ❑ No 0 N;'A
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 ;'veterinary facilities ❑ Swimming Pool/Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool;Tilter Backwash
® Businesses / offices i factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: _°Io Domestic 100 % Commercial % Industrial (See 15A NCAi'-02T-,O 10�_C20))
IF Industrial, is there a Pretreatment Program in effect? ❑ Yes❑ No
6. Has a flow reduction been approved under 15A NCAC 02T -01 14(1)? El Yes ❑X No
➢ If yes, provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow e.h
No. of Units
Flow
Gen. Business and Office Facilities
25 gall employee
210
5250 GPD
Fire or rescue stations with on -site staff
50 gal/employee
11
550 GPD
gall
GPD
gall
GPD
gall
GPD
gall
GPD
Total
5,800 GPD
a See 1LA NCAC 02T .01 14( )� (d� fe)(1) and (e)f2} for caveats to wastewater design flow rates (i.e. proposed unknown
non-residential development uses; public access facilities located near high public use areas; and residential property
located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined in G.S. 42A-4).
b Per 15A NCAC 02T .0I 14(c), design flow rates for establishments not identified [in table l5A.NCAC 02T.01 14] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project:58OOGPD (per 15A NCAC 02T .0114 and C.S. 143-215.I
Do not include future flows or previously permitted allocations
If permitted flow is zero, please indicate why:
❑ Pump Station/Force Main or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line.
Please provide supplementary information indicating the approximate timeframe for permitting upstream sewers with flow.
❑ Flow has already been allocated in Permit Number: Issuance Date:
❑ Rehabilitation or replacement of existing sewers with no new flow expected
❑ Other (Explain):
FORM: FTA 10-23 Page 2 of 5

DocuSign Envelope ID 83318COB-FB5A-4C82-BBOt-5BF6C6DO0297
VI[. GRAVITY SEWER DESIGN CRITERIA (If Applicable)- 02T .0305 & MDC(Gravity Sewers
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8
1008
DIP
8
44
PVC
➢ Section Il & 11[ of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section HI contains information related to minimum slopes for gravity sewer(s)
➢ Oversizing lines to meet minimum slope requirements is not allowed and a violation of the MDC
VIIi. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T.0305 & MDC (Puma Stations/Force Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
l . Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: -
3. Total number of pumps at the pump station:
3. Design flow of the pump station: millions gallons per day (firm capacity)
➢ This should reflect the total GPM for the pump station with the largest pump out of service.
4. Operational point(s) per pump(s): gallons per minute (GPM) at feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
If any portion of the force main is less than 4-inches in diameter, please identify the method of solids reduction per
MDCPSFM Section 2.01 C.l.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with I SA_NCAC 02T .0305(h)(1);
❑ Standby power source or ❑ Standby pump
➢ Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(1)(B)_
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
➢ Must be permanent to facility and may not be portable
Or if the pump station has an average daily flow less than 15,000 gallons per day 15A NCACO2T.0305(h)(1)(C):
❑ Portable power source with manual activation, quick -connection receptacle and telemetry -
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry:
➢ Include documentation that the portable source is owned or contracted by the applicant and is compatible with the station.
➢ If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel timeframes, shall be provided
as part of this permit application in the case of a multiple station power outage.
FORM: FTA 10-23 Page 3 of 5

DocuSign Envelope ID- B3318COB FB5A-4C82-BB01-5BF6C6D00297
IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T.0305(f)):
1. Does the project comply with all separations/altematives found in 15A NCAC 02T .0305() & (_ ? ® Yes ❑ No
15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
ZWater mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
ZWater mains (horizontal)
10 feet
Reclaimed water lines (vertical - reclaimed over sewer)
18 inches
Reclaimed water lines (horizontal - reclaimed over sewer)
2 feet
**Any private or public water supply source, including any wells, WS-1 waters of Class I or
Class lI impounded reservoirs used as a source of drinking water, and associated wetlands.
100 feet
"Waters classified WS (except WS-1 or WS-V), B, SA, ORW, HQW, or SB from normal
high water (or tide elevation) and wetlands associated with these waters (see item IX.2)
50 feet
"Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches, as well as wetlands associated with these waters or classified as WL.
10 feet
Any building foundation (horizontal)
5 feet
Any basement (horizontal)
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
➢ if noncompliance with 02T.0305(f) or (g), see Section X.1 of this application
* 15A NCAC 02T.0305Wg . contains alternatives where separations in 02T.0305(o 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 Waterfilassifications webnae
2. Does this project comply with the minimum separation requirements for water mains? [K]Yes [—]No [:]N/A
➢ If no, please refer to 15A NCAC I8C.0906(f) for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? ® Yes ❑ No ❑ N:'A
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ Seethe Division's draft separation requirements for situations where separation cannot be met.
➢ No variance is required if the alternative design criteria specified is utilized in design and construction.
4. is the project located in a river basin subject to any State buffer rules? ❑ Yes Basin name: ® No
If yes, does the project comply with setbacks found in the river basin rules per .I SA NCAC 02B .0200? ❑ Yes ❑ No
➢ This includes Trout Buffered Streams per 15A NCAC 2B.0202
5. Does the project require coverage/authorization under a 404 Nationwide. -individual permits ❑ Yes ® No
or401 Water Quality Certifications?
➢ Please provide the permit number/permitting status in the cover letter if coverage/authorization is required.
6. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permitslcertifications)? F(I Yes ❑ No
Per 15A NCAC 02T.0105(cj6, 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 15A NCAC 02T.0402, "high -priority sewer" means any aerial sewer, sewer contacting surface waters,
siphon, or sewers positioned parallel to streambanks that are subject to erosion that undermines or deteriorates the sewer.
Siphons and sewers suspended through interference/conflict boxes require a variance approval.
➢ If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at least once every six -months and
inspections documented per 15A NCAC 02T.0403(a)(5) or the permittee's individual System -Wide Collection permit.
FORM: FTA 10-23 Page 4 of 5

DocuSign Envelope ID. B3318COB-FB5A-4C82-BB01-5BF6C6DO0297
X. CERTIFICATIONS:
I. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Pump Stations
and Force Mains ,latest version and the Ciiravity Sewer Minimum Design Criteria ( latest version l 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 approval of the permit, and nro'ecl is requiring a variance approval may be subject to longer
review times. For proiects 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 Engineer's Certification:
I, Patrick Covil , attest that this application for Duke Eneray Progress Holly Springs Operation Center
(Professional Engineer's name from Application Item Ill. L) (Project Name from Application Item II 1)
and Training Facili - Cinder Station Road
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans,
specifications, engineering calculations, and all other supporting documentation to the best of my knowledge. 1 further
attest that to the best 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 Design Criteria for the Fast -Track Permitting
of Pumu Stations and Force Mains (latest versionl. Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that I have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE - In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation. Misrepresentation of the application
information, including failure to disclose any design non-compliance with the applicable Rules and design criteria, may subject
the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NCAC 56.0701)
North Carolina Professional Engineer's seal, signature, and date: l W CA
"
Pair1
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034365
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Applicant's Certification per 15A NCAC 02T .0106(b):
I, Kendra D. Parrish, PE , attest that this application for Duke Operations Center
(Signature Authority Name from Application Item 13 (Project Name from Application Item 11-1)
attest that this application has been reviewed by me and is accurate and complete to the best of my knowledge.
I understand that if all required parts of this application are not completed and that if all required supporting documentation
and attachments are not included, this application package is subject to being returned as incomplete. 1 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, andlor criminal prosecution. I will make no claim against the Division
of Water Resources should a condition of this permit be violated. I also understand that if all required parts of this application
package are not completed and that if all required supporting information and attachments are not included, this application
package will be returned to me as incomplete.
NOTE - In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
DocuSlgned by
Signature:
03C05889FC34445
Date: 10/ 30/202 3
FORM: FTA 10-23 Page 5 of 5

DocuSign Envelope ID: B3318COB-FB5AAC82-BB01-5BF6C6D00297
I`?C Dept & EnviIonrgenial Q[I:.I]itv
State of North Carolina
Department of Environmental Quality
NOV I 208 Division of Water Resources
Flow Tracking for Sewer Extension Applications
.Raleigst Regional } %Cw (FTSE 10-23)
Entity Requesting Allocation: Town of Holly Springs
Project Name for which flow is being requested: Duke Operations Center
More titan one FTSE maybe required for a single project if llte owner of the WWTP is not responsible fora!! 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
A11 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 3.036
f. Total flow for this specific request 0.0058
g. Total actual and obligated flows to the facility 4.906
h. Percent of permitted flow used 82%
II. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
List pump stations located between the project connection point and the WWTP:
Pump Pump
Station Station
(Name or Permit
Number) No.
(A)
Design
Average
Daily
Firm Flow**
Capacity, * (Firm 1 pfl,
MGD MGD
Carolina Springs 1 WQ004236, 1.967 0.787
(B)
Approx.
Current
Avg. Daily
Flow,
MGD
0
(C)
(D)=(B+C)
(E)=(A-D)
Obligated,
Total
Not Yet
Current
Tributary
Flow Plus
Daily Flow,
Obligated
Available
MGD
Flow
Capacity***
0.531
0.531
0.256
* 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): Carolina Springs 1
Page 1 of 9
FTSE 10-23

DocuSign Envelope ID B3318C0B-F85A-4C82-B801-5BF6C6D00297
Downstream Permit Number: WQ0042364
II1. Certification Statement:
I Kendra_ D. Parrish ccrtify to the best of my knowledge that the addition of
the volume of wastewater to be permitted in this project has been evaluated along the route to the receiving
wastewater treatment facility and that the flow from this project is not anticipated to cause any capacity
related sanitary sewer overflows or overburden any downstream pump station en route to the receiving
treatment plant under normal circumstances, given the implementation of the planned improvements
identified in the planning assessment where applicable. This analysis has been performed in accordance
with local established policies and procedures using the best available data. This certification applies to
those items listed above in Sections I and II plus all attached planning assessment addendums for which I
am the responsible party. Signature of this form certifies that the receiving collection system or treatment
works has adequate capacity to transport and treat the proposed new wastewater.
by:
Executive Director of utilities & Infrastructure
Title of Signing Official
CW-2, IBIS i2a c; f0IJ
10/30/2023
Date
i2A-c --- S -3 — c(
5. W «',--"J
Page 2 of 9
FTSE 10-23

DocuSign Envelope ID: B3318COB-FB5A-4C82-BBO1-5BF6C6DO0297
DO NOT SUBMIT SEWER EXTENSION APPLICATIONS UNTIL
CONSTRUCTION DRAWINGS HAVE BEEN APPROVED BY STAFF!
Sewer Design and Application Certification IVC�
Note: This form must be submitted with the Fast Tract Application for extension to the Town -of
Holly Springs Sewer System oitr�c''t�I
Project: Holly Springs Operations Center - Cinder Station Road Np Gt'�/lty
Design Engineer:
Address:
Phone Number:
McAdams (Patrick Covil P.E.)
1p?3
621 Hillsborough St. Ste_ 500 Raleigh NC 27603
919.287.0795
Email: [e-mail]
Date Complete Application Package Received by Town:
as M
Date Approved: _ _Cf—T _ (by RI) L
10/27/2023
(by KDP) �,� (by DJ)
As design engineer for this project, I certify the following (please check (x) each applicable box):
That the design of the project is in complete conformance with the Town of Holly
Springs Engineering Design and Construction Standards and NC DEQ Sanitary Sewer
Design Regulations;
N That each of the following items are completed and enclosed for submittal to the State for
a sewer extension permit:
ix One original and one copy of a cover letter that includes a project narrative
o A check in the amount of $480.00 to NC DEQ
o 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 Sewer System Extension Application
0 Two copies of form FTSE 10-18 Flow Trackingfor Sewer Extension
Applications
0 Two color copies of an 8.5-inch by 11-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 (This
form)
Patrick L uDN: rn+u�rea9PeMckeen L`C°Pe°iMI,c+c►LUS,C°r9
t� en%" 09/13/2023
Co Y II emei+e mceEamecoc°m
Design Engineer's Signature Oete:; 3A9.132115AS-04V Date
Please contact Emily Koncz at [phone] or ern ily.koncz� hot lvsaringsnc.govov if you have
any questions.
2003 Sewer Design Application Cartificatiun
01.14.21
lee
Utilities and Infrastructure Services
P.O. Box 8 • 128 S. Main Street • Molly Springs, NC 27540 • www.hollyspringsnc.gov

DocuSign Envelope ID: B3318COB-FB5A-4CB2-BB01-5BF6C6000297
Z 11�all 11 .
THE TOWN OF
October 25, 2023
Director, Division of Water Resources
Raleigh Regional Office
Water Quality Operation Section
3800 Barrett Drive
Raleigh, NC 27609
o)cVprings
y
NC Dept
NOV 1 2023
Re: Application for Sewer Extension Permit Raleigh R �I ()xface
Project: Duke Operation Center
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 11-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.
LrT
Sincerely,
z
uSigr�ed by.
4 Tftrish, P.E., CFM
Executive Director of Utilities and Infrastructure
KPlek
cc: Project Consultant Engineer, Patrick Covil, PE
Rachel Jones, Utility Engineering
Drew Johnson, Development Engineering Manager
Emily Koncz, Utility Permitting Specialist
Project file/Correspondence #€42134
3002
04.17 2018
Utilities and Infrastructure Services
P.O. Box 8 - 128 S. Main Street - Holly Springs, NC 27540 - www.hollyspringsnc.gov

111­
DocuSign Envelope ID B3318COB-FB5A-4C82-BB01-5t3F6C6D00297 ronmer:"al Quality
State of North Carolina
Department of Environmental Quality
DWR NOV I 2023 Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources INSTRUCTIONS FOR FORM: FTA 10-23 & SUPPORTING DOCUMENTATION
This application is for sewer extensions involving gravity sewers, pump stations and force mains, or any combination that has been
certified by a professional engineer and the applicant that the project meets the requirements of 15A NCAC 02T and the Division's
Minimum Design Criteria (Gravity Sewer & Pump StationslForcc Mains) and that plans, specifications and supporting documents
have been prepared in accordance with 15A NCAC 02T, 15A NCAC 02T .0300, Division policies, and good engineering ractices.
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 permit application to the Division. This would include plans, design
calculations, and project specifications referenced in 15A_ NCAC 02T .0305 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 15A NCAC 02T.0303.
Projects not eligible for review via the fast track process (must be submitted for full technical review):
➢ Projects that do not meet any part of the minimum design criteria (MDC) 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 and checking the provided boxes will help produce a quicker review time and reduce the
amount of requested 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 be digital) of Application and Supporting Documents
® Required unless otherwise noted. Signatures on original must be "wet 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 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 numberistatus of any other required sewer permits (downstream I upstream)
➢ If necessary for clarity, include attachments to the application form.
C. Application Fee (All New and Modification Application Packages):
IN Submit a check or money order in the amount of $600.00, 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 10-23):
® 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 for business with the
North Carolina Secretary 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 IL l 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 Carolina
licensed Professional En ins racer.
® The Applicant's Certification on Page 5 of the application shall be signed in accordance with 15A NCAC 02T .0106(b). Per
15A NCAC 02T .0I06(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 .0106(b).
INSTRUCTIONS FOR FORM: FTA 10-23 & SUPPORTING DOCUMENTATION Page I of 3

DocuSign Envelope ID B3318COB-FB5A-4C82-BB01-5BF6C6D00297
E. Flow Tracking/Acceptance Form (Form: FTSE 10-23) (If Applicable):
® Submit the completed and executed FTSE form from the owners of the downstream sewers and treatment facility.
➢ Multiple 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. 143-215.61La).
➢ Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific FTSE.
F. Site Maps (All Application Packages):
® Submit an 8.5-inch x l 1-inch color copy of a USGS Topographic Map of sufficient scale to identify the entire project area,
including the closest surface waters.
➢ General location of the project components (gravity sewer, pump stations, & force main)
➢ Downstream connection points and permit number (if known) for the receiving sewer
® Include an aerial location map showing general project area (such as street names or latitude. -'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 form itself should include only include items to be added!modified). 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.
H. Power Reliability Plan (Required if portable reliability option utilized for Pump Station):
❑ Per 15A NCAC 02T .0305(hX I , submit documentation of power reliability for pumping stations.
➢ This alternative is only available for 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 compatible with
the station. The Division will accept a letter signed by the applicant (see 15A NCAC 02T .0106(b)) or proposed contractor,
stating that "the 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
be provided in the case of a multiple station power outage. (Required at time of certification)
1. Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per 1 SA NC'AC 02T.:0115(aj(l) provide the Certificate of Public Convenience and Necessity from the forth 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 from the North Carolina Utilities Commission's Water and Sewer Division Public Staff stating an application
for a franchise has been received and that the service area is contiguous to an existing franchised area or that franchise approval
is expected.
J. Operational Agreements (Applications from HOA/POA and Developers for lots to be sold):
❑ Home/Property Owners' Associations
❑ Per 15A NCAC 02T ,01 15(c), submit the properly executed CoRerational Agreement (FORM: HOA).
❑ Per 15A NCAC 02T .0l 15(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
❑ Developers of lots to be sold
❑ Per 15A NCAC 02T A 115tb1, submit the properly executed (operational Agreement (FORM: DEV).
For more information, visit the Division's collection systems webslte
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INSTRUCTIONS FOR FORM: FTA 10-23 & SUPPORTING DOCUMENTATION Page 2 of 3

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DocuSign
Certificate Of Completion
Envelope Id: B3318COBFB5A4C82BB015BF6C6DO0297 Status: Completed
Subject: Complete with DocuSign: 42134 Duke Operations Center Sewer Permit Application.doc, Cinder Stat...
Source Envelope:
Document Pages: 23 Signatures: 3 Envelope Originator:
Certificate Pages: 5 Initials: 5 Emily Koncz
AutoNav: Enabled PO Box 8
Envelopeld Stamping: Enabled Holly Springs, NC 27540
Time Zone: (UTC-05:00) Eastern Time (US 8 Canada) [e-mail]
IP Address: 204,84,166.2
Record Tracking
Status: Original Holder: Emily Koncz Location: DocuSign
10/25/2023 8:55:29 AM [e-mail]
Signer Events Signature Timestamp
Rachel Jones t 5 Sent: 10/27/2023 1:39:12 PM
[e-mail] Resent: 10/27/2023 3:41:38 PM
Utility Engineer Viewed: 10/27/2023 3:4311 PM
Security Level: Email, Account Authentication Signed: 10/27/2023 3:46:39 PM
(None) Signature Adoption: Pre -selected Style
Using IP Address: 64.98.114.214
Electronic Record and Signature Disclosure:
Accepted: 5/17/2021 2:39:29 PM
ID: 126bfa6d-c99c-4b40-be28-00aa263b860b
Company Name: Town of Holly Springs
Catherine Jacobs Sent: 10/27/2023 3:46:43 PM
[e-mail] E035 Viewed: 10/30/2023 8-14:00 AM
Engineering Manager Signed: 10/30/2023 8-20:53 AM
Security Level: Email, Account Authentication
(None) Signature Adoption: Pre -selected Style
Using IP Address, 204.84.166.2
Electronic Record and Signature Disclosure:
Accepted 10/30/2023 8:14 00 AM
ID:fObcO5de-f65d-49fd-8ac2-19Of5d8dO834
Company Name: Town of Holy Springs
Kendra Parrish
o- Sbg d by Sent: 10/30/2023 8:20:57 AM
kendra [e-mail]
( l Viewed: 10/30/2023 8 58.05 AM
Exec Director of Utilities and Infrastructure
97COSB89F 3///4 Signed: 10/3012023 8,58:22 AM
Holly Springs
Signature Adoption. Drawn on Dev ce
Security Level- Email, Account Authentication
(None)
Using tP Address- 71 76 147 91
Electronic Record and Signature Disclosure:
Accepted- 4/6/2021 7:18:46 PM
ID 6cbf2406-2f8d-46a2-8e81-c6f600daf744
Company Name: Town of Holly Springs
In Person Signer Events Signature Timestamp
Editor Delivery Events Status Timestamp
Agent Delivery Events Status Timestamp
Intermediary Delivery Events Status Timestamp

Certified Delivery Events
Status
Timestamp
Carbon Copy Events
Status
Timestamp
Jeanne Bromszewski
Sent: 10/30/2023 8 58-26 AM
Leanne.broniszewski@hol"pringsnc.gov
COPIED
Security Level: Email. Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Witness Events
Signature
Timestamp
Notary Events
Signature
Timestamp
Envelope Summary Events
Status
Timestamps
Envelope Sent
Hashed/Encrypted
10/27/20231:39:12 PM
Envelope Updated
Security Checked
10/27/2023 3:33:45 PM
Envelope Updated
Security Checked
10/27/2023 3:33:45 PM
Envelope Updated
Security Checked
10/27/2023 3:33:45 PM
Envelope Updated
Security Checked
10/30/2023 7:14:02 AM
Certified Delivered
Security Checked
10/30/2023 8:58:05 AM
Signing Complete
Security Checked
10/30/2023 8:58:22 AM
Completed
Security Checked
10/30/2023 8:58-26 AM
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 Jones, 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 be sent to you electronically

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: [e-mail]
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:

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 jef£[e-mail] 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: https://support.docusi n.coml uides/si ner-guide-
sj e,ning-system-requirements.
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 `I agree to use electronic records and signatures' before
clicking `CONTINUE' within the DocuSign system.
By selecting the check -box next to `I 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.