WQ0044460_Modification Application (FTSE)_20231130

State of North Carolina
I Department of Environmental Quality
DWR Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number: WQ0044460 MOI�o be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
I . Applicant's name: City of Mebane (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State/County ® Municipal
3. Signature authority's name: Chris Rollins per 15A NCAC 02T .0106(b)
Title: City Manager
4. Applicant's mailing address. 106 E. Washington St
City:Mebane State: NC Zip: 27302-
5. Applicant's contact information:
Phone number: [phone] Email Address: [e-mail]
❑ Privately -Owned Public Utility
❑ Other
11. PROJECT INFORMATION:
1. Project name: Cambridge Park -Phase 3A
2. Application/Project status: ❑ Proposed (New Permit) ® Existing Permit/Project
If a modification, provide the existing permit number: WQ0044460 and issued date: 6-8-2023
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: Alamance
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.050746" Longitude:-79,29087'
5. Parcel ID (if applicable): 163252 (or Parcel ID to closest downstream sewer)
111. CONSULTANT INFORMATION:
1. Professional Engineer: Robert S. Dischi= License Number:
Firm: Evans Engineering, Inc.
Mailing address: 4609 Dundas Drive
City: Greensboro State: NC Zip: 27407-
Phone number: 3( 36) 279- 7442 Email Address: rsdkevans-eng.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name. City of Graham WWTP Permit Number: NCO02121 I
Owner Name: City of Graham
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ0040482
2. Downstream (Receiving) Sewer Information: 10 inch ❑ Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS00081
Owner Name(s): City of Mebane
FORM: FTA 06-21
Page l of 5

t
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 ® 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 ®N/A
3. If the Applicant is a Home/Property Owners' Association, has an HOA/POA Operational Agreement (FORM: HOA) and
supplementary documentation as required by 15A NCAC 02T.0115(c) been attached?
❑ Yes ❑ No ® N/A
4. Origin of wastewater: (check all that apply):
® Residential (Individually Owned) ❑ Retail (stores, centers, malls) ❑ Car Wash
❑ Residential (Leased) ❑ Retail with food preparation/service ❑ Hotel and/or Motels
❑ School / preschool / day care ❑ Medical / dental / veterinary facilities ❑ Swimming Pool/Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater : 100 % Domestic % Commercial % Industrial (See 15A NCAC 02T .0103(20))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(f)? ®Yes [-]No
➢ If yes, provide a cony of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow a,b
No. of Units
Flow
Single Family (4 Bedroom)
300 gal/day
71
2I,300 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
21,300 GPD
a See 15A NCAC 02T .0114(b), (d), (e)(1) 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 G.S. 42A4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.0I 141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 21300 GPD (per 15A NCAC 02T .0114)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero, please indicate why:
❑ Pump Station/Force Main or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line.
Please provide supplementary information indicating the approximate timeframe for permitting upstream sewers with flow.
❑ Flow has already been allocated in Permit Number: Issuance Date:
❑ Rehabilitation or replacement of existing sewers with no new flow expected
❑ Other (Explain):
FORM: FTA 06-21 Page 2 of 5

a
VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8'
1912
SDR35
8"
234
DIP
➢ Section II & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section III contains information related to minimum slopes for gravity sewer(s)
➢ Oversizing lines to meet minimum slope requirements is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: 0Longitude:
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 2.01C.Lb. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(l ):
❑ Standby power source or ❑ Standby pump
➢ Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(1)(14)_
➢ 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 06-21 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T.0305(f)):
1. Does the project comply with all separations/alternatives found in 15A NCAC 02T.0305(f) & (e)? ® Yes ❑ No
15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
'Water mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
'Water mains (horizontal)
10 feet
Reclaimed water lines (vertical - reclaimed over sewer)
18 inches
Reclaimed water lines (horizontal - reclaimed over sewer)
2 feet
**Any private or public water supply source, including any wells, WS-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-I or WS-V), B, SA, ORW, HQW, or SB from normal
high water (or tide elevation) and wetlands associated with these waters (see item IX.2)
50 feet
**Any other stream, 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.l of this application
*15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(fl cannot be achieved. Please check "yes"
above if these alternatives are used and provide narrative information to explain.
**Stream classifications can be identified using the Division's NC Surface Water Classifications weboaee
2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ N/A
➢ If no, please refer to 15A NCAC 18C.0906(f) for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? ❑ Yes ❑ No ® N/A
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ See the Division's draft separation requirements for situations where separation cannot be met.
➢ No variance is required if the alternative design criteria specified is utilized in design and construction.
4. Is the project located in a river basin subject to any State buffer rules? ® Yes Basin name: Cape Fear ❑ No
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ® Yes ❑ No
➢ This includes Trout Buffered Streams per 15A NCAC 2B.0202
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ❑ Yes ® No
or 401 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 permits/certifications)? ® Yes [—]No
Per 15A NCAC 02T.0105(c)(6), directly related environmental permits or certification applications must be being prepared,
have been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion
and sedimentation control plans, stormwater management plans, etc.).
7. Does this project include any sewer collection lines that are deemed "high -priority?" ❑ Yes ® No
Per 15A NCAC 02T.04021 "high -priority sewer" means any aerial sewer, sewer contacting surface waters,
siphon, or sewers positioned parallel to streambanks that are subject to erosion that undermines or deteriorates the sewer.
Siphons and sewers suspended through interference/conflict boxes require a variance approval.
➢ If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at least once every six -months and
inspections documented per 15A NCAC 02T.0403(a)(5) or the permittee's individual System -Wide Collection permit.
FORM: FTA 06-21 Page 4 of 5

X. CERTIFICATIONS:
I. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Pump Stations
and Force Mains (latest version), and the Gravity Sewer Minimum Design Criteria (latest 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
2. Professional Engineer's Certification:
1, _Robert S. Dischinger , attest that this application for _Cambridge Park -Phase 3A
(Professional Engineer's name from Application Item 111.1.) (Project Name from Application Item II. p
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 Pump Stations and Force Mains (latest version). Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that 1 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 di
3. Applicant's Certification per I SA NCAC 02T .0106(b):
1, _Chris Rollins, City Manager attest that this application for _Cambridge Park -Phase 3A
(Signature Authority Name from Application Item I.3.) (Project Name from Application Item II.I)
attest that this application has been reviewed by me and is accurate and complete to the best of my knowledge.
I understand that if all required parts of this application are not completed and that if all required supporting documentation
and attachments are not included, this application package is subject to being returned as incomplete. I understand that any
discharge of wastewater from this non -discharge system to surface waters or the land will result in an immediate enforcement
action that may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division
of Water Resources should a condition of this permit be violated. I also understand that if all required parts of this application
package are not completed and that if all required supporting information and attachments are not included, this application
package will be returned to me as incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, 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.
Signature: 1!(/V - Date: 1 �I 2,1
FORM: FTA 06-21 Page 5 of 5

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: City of Mebane
Project Name for which flow is being requested: Cambridge Park - Phase 3A
More than one FTSE maybe required for a single project if the owner of the JVJ#TP is not responsible for all pump
stations along the route of the proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Allocation to Graham WWTP
b. WWTP Facility Permit #: NCO021211
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
AU lows are in MGD
0.7500 - Mebane Allocation
0.0292
0.0354
0.0213
0.0859
11%
II. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
List pump stations located between the project connection point and the WWTP:
(A) (B) (C)
(D)=(B+C)
(Ep(A-D)
Design Approx. Obligated,
Total
Pump Pump Average Current Not Yet
Current Flow
Station Station Firm Daily Flow" Avg. Daily Tributary
Plus
(Name or Permit Capacity, • (Firm / pf), Flow, Daily Flow,
Obligated
Available
Number) No. MGD MGD MGD MGD
Flow
Capacity***
Cambridge Park 0.720 0.288 0.035 0.050
0.086
0.202
* The Firm Capacity (design flaw) 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): Cambridge Park Onsite Sewer Outfall
Downstream Permit Number: W00040466
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I _ Chris Rollins 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 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.
Signing Offtcj�l Signature
Title of Signing
2
Date
Page 2 of 6
FTSE 10-18

�. � �� �� �1� f� �
. i l ,f.. e

State of North Carolina
40, - IW-11 I
v Department of Environmental Quality
Division of Water Resources
Divislon of water 4ta5uwtes Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: City of Graham - Mebane Allocation
Project Name for which flow is being requested: Cambridge Park Phase 3A Modified
More than one FTSE maybe required for a single project if the owner of the WWTP is not responsible for all pmnp
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: City of Graham WWTP
b. WWTP Facility Permit #: NC 002121 1
All flows are in MGD
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the
e. WWTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
WWTP 1.421
1.721
.0213 - Meb Allocation
2.944
84%
I1. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
List pump stations located between the project connection point and the WWTP:
(A)
(B)
(C)
(D)=(B+C) (E)--(A-D)
Design
Obligated,
Pump
Pump
Average
Approx.
Not Yet
Total Current
Station
Station
Firm Daily Flow"
Current
Tributary
Flow Plus
(Name or
Permit
Capacity, " (Firm / pf),
Avg. Daily
Daily Flow,
Obligated Available
Number)
No.
MOD MGD
Flow, MGD
MGD
Flow Capacity***
Cherry Lane 2.5 1.0 .04281 .373 .4157 .592
* 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 he attached for each pump station located
between the project connection point and the WWTPwhere the Available Capacity is <0.
Downstream Facility Name (Sewer): AICDZ Outfall
Downstream Permit Number: WQ 0037007
Page I of 6
FTSE 10-18

III. Certification Statement:
I Aaron T. Holland 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 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 transwrt and treat the proposed new wastewater.
Cfit Aol7 C�
Title of Signing Official
Page 2 of 6
Z/ v
Date
FTSE 10-18

—Since 1974 —
Surveyors Planners
October 12, 2023
Jenny Graznak
NCDENR — Division of Water Resources
450 W. Hanes Mill Road — Suite 300
Winston-Salem, NC 27105
Re: Modification to Permit #WQ0044460 (Cambridge Park -Phase 3A & 3B)
Dear Jenny:
Enclosed you will find a modification to an existing permit #WQ0044460. This
modification is to only permit Phase 3A and to not include Phase 3B as originally
permitted. We will permit Phase 3B separately in the future. The flow allocation will now
be 21,300 GPD for 71 single family lots for sale. The original permit allocated 46,720
GPD for 146 lots. Items included in this package consists of, check for $480, FTA 04-16,
FTSE 01-16 and USGS Map. This project is called Cambridge Park Phase 3A, located on
Jones Drive in Mebane, NC. This project is served by an onsite gravity sewer system
(WQ0040482) flowing to a pump station (WQ0040510) then ultimately tying onto an
existing City of Mebane sewer system. Feel free to contact me with any questions or
comments.
Sincerely,
�azlv�_
Dave Southard
Project Manager
4609 Dundas Drive
Greensboro, NC 27407
Phone 336,854.8877
Fax [phone]
License #C,0168

DWR
State of North Carolina
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources INSTRUCTIONS FOR FORM: FTA 06-21 & 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 Stations/Force Mains l 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 practices.
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 number/status of any other required sewer permits (downstream/upstream)
➢ If necessary for clarity, include attachments to the application form.
C. Application Fee (All New and Modification Application Packages):
® Submit a check or money order in the amount of $480.00, dated no more than 90 days prior to application submittal.
➢ Payable to North Carolina Department of Environmental Quality (NCDEQ)
D. Fast Track Application (Required for All Application Packages, Form FTA 05-21):
® Submit the completed and appropriately executed application.
➢ 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 II.1 shall be consistent with the project name on the flow acceptance letters, agreements, etc.
❑ The Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a North Carolina
licensed Professional Engineer.
❑ 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 .0106(c), an alternate person may be designated as the signing official if a delegation letter is provided from
a person who meets the criteria in 15A NCAC 02T .0106(b).
INSTRUCTIONS FOR FORM: FTA 06-21 & SUPPORTING DOCUMENTATION Page] of 3

E. Flow Tracking/Acceptance Form (Form: FTSE 04-16) (If Applicable):
® Submit the completed and executed FTSE form from the owners of the 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 ofthis application and form FTSE indicates that owner has adequate capacity and will not violate G.S. 143-215.67(a).
➢ 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 11-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(h)(1), 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)
I. Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per 15A NCAC 02T .0115(a)(1) provide the Certificate of Public Convenience and Necessity from the North 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 I5A NCAC 02T .0115(c), submit the properly executed Operational Agreement (FORM: HOA).
❑ Per 15A NCAC 02T .0115(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
❑ Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(b), submit the properly executed Operational Agreement (FORM: DEV).
For more information, visit the Division's collection systems website
INSTRUCTIONS FOR FORM: FTA 05-21 & SUPPORTING DOCUMENTATION Page 2 of 3

THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional Office
2090 US Highway 70
Avery, Buncombe, Burke, Caldwell, Cherokee,
Water Quality Section
Swannanoa, North Carolina 28778-8211
Clay, Graham, Haywood, Henderson, Jackson,
[phone]
Macon, Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Harnett, Hoke,
Water Quality 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 Qualitv Section
Mooresville, North Carolina 28115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
Raleiqh Regional 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
Warren, Wilson
Washington Regional Office
943 Washington Square Mall
Beaufort, Bertie, Camden, Chowan, Craven,
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
Wilmington Reqional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
Water Quality Section
Wilmington, North Carolina 28405
Hanover, Onslow, Ponder
[phone]
[phone] Fax
Winston-Salem Regional Office
450 W. Hanes Mill Road
Suite 300
Alamance, Allegheny, Ashe, Caswell, Davidson,
Davie, Forsyth, Guilford, Rockingham, Randolph,
Water Quality Section
Winston-Salem, North Carolina 27105
Stokes, Surry, Watauga, Wilkes, Yadkin
[phone]
[phone] Fax
INSTRUCTIONS FOR FORM: FTA 05-21 & SUPPORTING DOCUMENTATION Page 3 of 3

ROY COOPER
Govemor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
olrector
Chris Rollins, City Manager
City of Mebane
106 East Washington Street
Mebane, NC 27302
Subject: Permit No. WQ0044460
NORTH CAROLINA
Environmental Quality
June 8, 2023
City of Mebane
Cambridge Park- Phase 3A & 3B
Wastewater Collection System Extension Permit
Alamance County
Dear Mr. Rollins:
In accordance with your application received June 6, 2023, we are forwarding herewith Permit No.
WQ0044460 dated June 8, 2023 to the City of Mebane (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 priorto 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. [15A 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.
�� North Curolinn Department of Eovironmental Quality I Dlviston of Water Resoutws
WLtslon•Snlem Fe9lennlORlcc I4S0\Vesttioncs Mlll Foaci.Sulte3001 Wloston•Stlem. North Qtrollnm 2710E
and a3b.771x%0D

•� r
City of Mebane
Permit No. WQ0044460
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 150B 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 Jenny Graznak at (336) 776-
9695 or via e-mail at [e-mail].
Sincerely,
OeaYSlynetl py:
0g80.9Ck3F19r45Q..
for Richard E. Rogers, Jr.
Director, Division of Water Resources
by Jennifer F. Graznak, Assistant Regional Supervisor
Water Quality Regional Operations Section
Winston-Salem Regional Office
Division of Water Resources, NCDEQ
cc: Robert S. Dischinger, Evans Engineering, Inc.
Aaron Holland, City of Graham
Page 2 of 7

NORTH CAROLINA
Environmental Quality
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
City of Mebane
Alamance County
for the construction and operation of approximately 6,134' linear feet of 8-inch gravity sewer to serve a
single family subdivision with 146 four -bedroom homes as part of the Cambridge Park - Phase 3A & 3B
project, and the discharge of 46,720 gallons per day of collected domestic wastewater into the City of
Mebane's and the City of Graham's existing sewerage systems, pursuant to the application received June
6, 2023, and in conformity with 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
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 subjectto the specified
conditions and limitations contained therein.
*On March 15, 2023, the Division approved for use by the City of Mebane an adjusted daily design flow
rate for 80 gallons per day per bedroom with a minimum of 160 gallons per day per dwelling.
ancusmnea ax;
r.>4ni�en. �i'..i'J�n•ak.
onzaact3Ftaaasa..
for Richard E. Rogers, Jr.
Director, Division of Water Resources
By Authority of The Environmental Management Commission
Permit Number: WQ0044460
Permit Issued: June 8, 2023
Page 3 of 7

DocuSign Envelope ID: 02920719-3DF2-4187-9ACC-E4AF712D6C16
ROY COOPER
cavernar
EUZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Wrectar
Mr. Chris Rollins, City Manager
City of Mebane
106 East Washington Street
Mebane, NC 27302
NORTH CAROLINA
Environmental Quality
March 15, 2023
Subject: Residential Flow Reduction Approval
Mebane Collection System (WQCS00081)
City of Mebane
Alamance County
Dear Mr. Rollins:
On February 15, 2023, the Division of Water Resources (Division) received a request for an
adjusted daily sewage flow rate (flow reduction) that would apply to all permitted but not yet
tributary residential connections and all future residential connections within the City of Mebane
service area that flow to the City of Graham W WTP (NC0021211).
In accordance with 15A NCAC 02T .0114(f (2), the Division has evaluated the request, and
based on the data submitted, the Division hereby approves for use by the City of Mebane an
adjusted daily.sewage design flow rate with the following conditions:
• The flow reduction is applicable to residential single-family and multi -family dwellings
only.
• The minimum flow for 1- and 2- bedroom dwellings shall be 160 gallons per day.
• Each additional bedroom above two bedrooms shall increase the volume by 80 gallons
per day per bedroom.
• This flow reduction shall not apply to sewer extension applications and/or permits for any
other public or private organizations whose wastewater flows are or might become
tributary to the City of Mebane collection system (WQCS00081) and also flow to the
City of Graham WWTP (NC0021211).
Future sewer extension applications should be made using the flow reduction amount stated
above. All other aspects of the permitting process remain unchanged, and all applications must
be in compliance with the statutes, rules, regulations and minimum design criteria as certified by
the owner and engineer.
NwtltCacolina Department afElnironmmtal Quality 1 DivisinnotWaterResuurts
312 Naiih SalisUury Slnvet I IBll ktail Set\•ice Cramer 1 Ruleigt,, Nax6t Caeulina 37eU@-1611
'`xita.`"`.,uw�ror^xe7w.wx a 919.707.9000

DocuSign Envelope ID: 02920719-3DF2-4187-9ACC-E4AF712D6C16
Regardless of the adiusted design daily wastewater flow rate, at no time shall the wastewater
flows exceed the effluent limits defined in the permit for the treatment facility or exceed the
capacity of the sewers downstream of any new sewer extension or service connection(s).
In accordance with 15A NCAC 02T .0114(f), the Division periodically requires reassessment of
wastewater flow data associated with the collection system or the receiving wastewater treatment
plant as applicable to confirm the suitability of the approved flow reduction value. The City of
Mebane shall submit documented representative data in accordance with 15A NCAC 02T
0114(D(1)(A-H) prior to January 31 2031. Failure to submit the required data by this date will
result in this flow reduction approval letter becoming null and void. Upon review of the data, the
Division shall either reapprove modify or not grant reapproval for the previously approved flow
reduction value.
The granting of this flow reduction does not prohibit the Division from reopening, revoking,
reissuing and/or modifying the flow reduction as allowed by the laws, rules, and regulations
contained in 15A NCAC 02T, NCGS 143-215.1, or as needed to address changes in State and/or
Federal regulations with respect to wastewater collection systems, protection of surface waters,
and/or wastewater treatment.
If you have any questions, please contact Charlie Miller, P.E. at [phone] or by email at
[e-mail].
Sincerely, acanstanexax,
cxaaeatasteau�._
for Richard E. Rogers, Jr.
Director, Division of Water Resources
by Michael Montebello
NPDES Branch Chief, Division of Water Resources, DEQ
CC: Troy King, Alley, Williams, Carmen, and King. inc. (TKin awck.com)
Winston-Salem Regional Office, Water Quality Regional Operations
Municipal Permitting Unit (electronic copy)
NanACacoliva Bapatonentarhlrvi�munental Quality I Diviat0adWat tRa0vNn
311 NanhSaliabuty Slwet 1 1611 Mail ser dee Center 1 Italei01ti 1\unA Catalina 17G99.1611
919.70719000

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