WQ0045585_Lang_Street_Pump_Station_FTSSE_Application_Final_20240828

NC Department of
Environmi e.ntai Quality State of North Carolina
Received Department of Environmental Quality
AUGDWR 2 8 2M Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources Winston-Salem FTA 10-23 & SUPPORTING DOCUMENTATION
Application Number: �vU �155 21-5 (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Town of Haw River (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ® Municipal ❑ Other
3. Signature authority's name: Sean Tencer per 15A NCAC 02T .0106(b)
Title: Town Manager
4. Applicant's mailing address: PO Drawer 103
i
City: Haw Rivet' State: North Carolina Zip: 27258-
5. Applicant's contact information:
i
Phone number: 336) 578-0784 Email Address: [e-mail]
II. PROJECT INFORMATION:
1. Project name: Lang Street Pump Station SRP-W-ARP-0151)
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ00 and issued date: ,
For modifications, also attach a detailed narrative description as described in Item G of the checklist.
If new construction, but part of a master plan, provide the existing permit number: WQ00
3. County where project is located: Alamance'
s
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.089057' Longitude:-79.370302'
5. Parcel ID (if applicable): 153098 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: John "Clay" Phillips License Number: 052139
Firm: Alley, Williams, Carmen, & King Inc.
f
Mailing address: 740 Chapel Hill Road
City: Burlington State: North Carolina Zip: 27215-
Phone number: 336) 226-5534 Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
s
i
1. Facility Name: East Burlington Wastewater Treatment Plant Permit Number: NCO023868
Owner Name: City of Burlington
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ No Permit
2. Downstream (Receiving) Sewer Information: 16 inch ❑ Gravity E Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS000d
Owner Name(s): Burlington
FORM: FTA 10-23 Pagel of 5

NC Oe.nartmlen[ of
Environ rental Quality,-
Received
Vl. GENERAL REQUIREMENTS AUG 2 0 202�
1. If the Applicant is a Privately -Owned Public W5119tfiaR- 6"i cate of Public Convenience and Necessity been attached?
Re b_YLOD`go ® 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.0I 15(c) been attached?
❑ Yes ❑ No ® N/A
4. Origin of wastewater: (check all that apply):
r
® 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 100 % 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(fl? ❑ Yes ®No
➢ If yes, provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow 1,b
No. of Units
Flow
No New Flow
gal/
= 0 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
✓ 0 GPD
a See 15A NCAC 02T .0114(b). (d). (e)(1) and (e)(2) 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 .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.01141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 0 GPD (per 15A NCAC 02T .0114 and G.S. 143-215.1)
➢ 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

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
12
125
DIP
Nr �Pr)- iic`iiI Gl
�:_n•Jironrnent�;i Qualit:,,;
Recew-ed
Winston-Salem
Regional nff;c=_'
➢ 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 (Puma Stations/Force Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: Lane Street Pump Station
2. Approximate Coordinates (Decimal Degrees): Latitude: 36.089057° Longitude:-79.370320
3. Total number of pumps at the pump station: 2
3. Design flow of the pump station: 1.01 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): 700 gallons per minute (GPM) at 125 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
8
55
DIP
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. l.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(1):
® Standby power source or ❑ Standby pump
➢ Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(1)(B):
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
➢ 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

N C Department of
Environmental Quality
Received
AJ3 a 2 8 2924
IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
��j�
1. Does the project comply with all separations/alternatives found in 15A NCAC 02T .03i,; o1ki 'jiPm` ® Yes ❑ No
15A NCAC 02T.0305 contains minimum separations that shall be provi6d for sewers stems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
'Water mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
'Water mains (horizontal)
10 feet
Reclaimed water lines (vertical - reclaimed over sewer)
18 inches
Reclaimed water lines (horizontal - reclaimed over sewer)
2 feet
**Any private or public water supply source, including any wells, WS-I waters of Class I or
Class II impounded reservoirs used as a source of drinking water, and associated wetlands.
100 feet
**Waters classified WS (except WS-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.1 of this application
*I 5A 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 webnage
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.0I05(c)(61(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.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

sNC D_,partr~I^nt of
Received
X. CERTIFICATIONS: A. ; p
1. 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.Desil?n C t6ria (li EkSikigim) as applicable?
® Yes F-1:No �
i ?i �1TjiC
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 projects requiring a variance approval may be subject to longer
review times. For projects requiring two or more variances or where the variance is determined by the Division to be a
significant portion of the project, the full technical review is required
2. Professional Engineer's Certification:
1, John "Clay" Phillips , attest that this application for Lang Street Pump Station (SRP-W-ARP-0 15 1)
(Professional Engineer's name from Application Item Ill. 1.) (Project Name from Application Item II.I)
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans,
specifications, engineering calculations, and all other supporting documentation to the best of my knowledge. I further
attest that to the best of my knowledge the proposed design has been prepared in accordance with the applicable regulations,
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 I have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.613, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation. Misrepresentation of the application
information, including failure to disclose any design non-compliance with the applicable Rules and design criteria, may subject
the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NCAC 56.0701)
....................................................................
North Carolina Professional Engineer's seal, signature, and date: \Y\
Vof
-'7 SEAL
12C.70 9-
.......... ............................................................ ............
.....
3. Applicant's Certification per 15A NCAC 02T .0106(b):
1, Sean Tencer attest that this application for Lang Street Pump Station (SRP-W-ARP-0 15 1)
(Signature Authority Name from Application Item I.3.) (Project Name from Application Item 11.1)
attest that this application has been reviewed by me and is accurate and complete to the best of my knowledge.
I understand that if all required parts of this application are not completed and that if all required supporting documentation
and attachments are not included, this application package is subject to being returned as incomplete. I understand that any
discharge of wastewater from this non -discharge system to surface waters or the land will result in an immediate enforcement
action that may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division
of Water Resources should a condition of this permit be violated. I also understand that if all required parts of this application
package are not completed and that if all required supporting information and attachments are not included, this application
package will be returned to me as incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 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: Date: g, 2 SIZ 4
FORM: FTA 10-23 Page 5 of 5

Division of Water Resources
C / /
��� F ;�„�i�7� �.�t Of State of North Carolina
Environrr c_ r�tai C�uality' Department of Environmental Quality
Received Division of Water Resources
111L p 3 202LI FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 10-23 & SUPPORTING DOCUMENTATION
Winston-Salem
Regional 0111—
Application Number: � .5 (to be coinpleted by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Town of Haw River company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State/County ® Municipal
3. Signature authority's name: Sean Tencer per 15A NCAC 02T .0106(b)
Title: Town Manager
4. Applicant's mailing address: PO Drawer 103
City: Haw River�State: North Carofma Zip: 27258-�
5. Applicant's contact information:
i
Phone number: [phone] Email Address: stencer a,townofhawriver!om
II. PROJECT INFORMATION:
❑ Privately -Owned Public Utility
❑ Other
1. Project name: Lang Street Pump Station (SRP-W-ARP-0 15 1)
2. Application/Project status: ® Pfoposed (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: Alamance
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.089057' Longitude:-79.370302'
5. Parcel ID (if applicable): 153098 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: John "Clay" Phillips' License Number: 052139
Firm: Alley, Williams, Carmen, & King, Inch
Mailing address: 740 Chapel Hill Road
City: Burlington. -State: North Caroliatt Zip: 27215-
Phone number: (336) 226-553,f Email Address: cphillips6�awck.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: East Burlington Wastewater Treatment Plant ' Permit Number: NCO023868
Owner Name: City of Burlington
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ
c�
2. Downstream (Receiving) Sewer Information: inch ®Gravity El Force Main t/
3. System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s):
FORM: FTA 10-23 Page 1 of 5

NC Department of
EnvironMental QualityReceived
VI. GENERAL REQUIREMENTS JUL n 3 2024
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
4ins , r f rr�,,
Y'.es '&'e �I N/A
Giona O,f;ce
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached?
i
❑ 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.0I 15(c) been attached?
El Yes ❑No ®N/A�
4. Origin of wastewater: (check all that apply):
® 1�esidential (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 100 % 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(fl? ❑ Yes ®No
➢ If Yes, provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0I14(f))
F Daily Design Flow a,n
No. of Units
Flow
No New Flow
gal/
0 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
0 GPD
a See 15A NCAC 02T .0114(b),(d). (e)(1) and (e)(2) 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 .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.01141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: Q(GPD (per 15A NCAC 02T .0114 and G.S. 143-215.1)
➢ 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

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
12 _ 125 DIP
NC Department r
Environirientai G.:!
Received
Winston-Salem
Re ionai Ofl ice
➢ 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: Lang Street Pump Station
2. Approximate Coordinates (Decimal Degrees): Latitude: 36.089057' Longitude:-79.37032'
3. Total number of pumps at the pump station: 2'
3. Design flow of the pump station: 1.01 rfiillions 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): 700 gallons per minute (GPM) at 125 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
8
55
DIP
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.1.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(1):
® 'Standby power source or ❑ Standby pump
➢ Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(1)(B);
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
➢ 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

NC Department of
Environmental Quality
Received
IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)): JUL A 12024
1. Does the project comply with all separations/alternatives found in 15A NCAC 02T AM5(fli'&:(k ', -1 ® Yes ❑ No
15A NCAC 02T.0305(f) contains minimum separations that shall be provided %'rrwer systems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
2Water mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
2Water mains (horizontal)
10 feet
Reclaimed water lines (vertical - reclaimed over sewer)
18 inches
Reclaimed water lines (horizontal - reclaimed over sewer)
2 feet
**Any private or public water supply source, including any wells, WS-I waters of Class I or
Class II impounded reservoirs used as a source of drinking water, and associated wetlands.
100 feet
**Waters classified WS (except WS-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(fl or (g), see Section X.1 of this application
*I 5A NCAC 02T.0305(c) 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 webnaee
2. Does this project comply with the minimum separation requirements for water mains? ® YIes [—]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.
➢ 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.0 I 05(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.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

NC Department of
Environinenta, Quality
Received
X. CERTIFICATIONS: ! U L Q 3 2024
1. 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 Desiglt�ftftbtimffitkaMersion) as applicable?
® Yes- ❑ No Rc'uional Office
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 proiects reouiriniz a variance approval may be subject to lonLyer
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 proiect, the full technical review is required.
2. Professional Engineer's Certification:
I, John C. Phillips ` , attest that this application for Lang Street Pump Station Replacement
(Professional Engineer's name from Application Item III.1.) (Project Name from Application Item II.1)
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans,
specifications, engineering calculations, and all other supporting documentation to the best of my knowledge. I further
attest that to the best of my knowledge the proposed design has been prepared in accordance with the applicable
regulations, 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 I have
reviewed this material and have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.613, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which
may include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation. Misrepresentation of the
application information, including failure to disclose any design non-compliance with the applicable Rules and design criteria,
may subject the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NCAC 56.0701)
North Carolina Professional Engineer's seal, signature, and date
3. Applicant's Certification per 15A NCAC 02T .0106(b):
.................................................................................
%X O
SEAL
2 39
oI�?o?�N
E
H�
���py .,,IN,.
................... . P .....��......................
I, Sean Tencer attest that this application for Lang Street Pump Station Replacement
(Signature Authority Name from Application Item I.3.) (Project Name from Application Item II.1)
attest that this application has been reviewed by me and is accurate and complete to the best of my knowledge.
I understand that if all required parts of this application are not completed and that if all required supporting documentation
and attachments are not included, this application package is subject to being returned as incomplete. I understand that any
discharge of wastewater from this non -discharge system to surface waters or the land will result in an immediate enforcement
action that may include civil penalties, injunctive relief, and/or criminal prosecution. I will make no claim against the Division
of Water Resources should a condition of this permit be violated. I also understand that if all required parts of this application
package are not completed and that if all required supporting information and attachments are not included, this application
package will be returned to me as incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, 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: Date: ! y—
FORM: FTA 10-23 Page 5 of 5

NC Department of
Environmental Quality
Rec .ived
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PROJECT NO. -17103
SHEET NO.
alley, williams, carmen & king, inc.
ENGINEERS, MCHrrECTS & SURVEYORS LANG STREET LIFT STATION 1
740 chapel hill road p.o. box 1179 ALAMANCE COUNTY
IBurlington, n.c. 27215 336/226-5534 / HAW RIVER, N.C.
Firm's Engineering License No. F-0203 SCALE: /" = 500' DATE: 1/26/19 owc.av TSK °F 1

Burlington
Treatrnrnt
IN
s Nuevo Balla
V
12,&), Pry
C'3m'�t'Wd Temple Baptist Church
9
17//24 Haw River Auto Center
Hope Baptist Church (P 9 6
C.)
NC Department cnt
Environoient,)i 0— �hty
Received
JUL n 3 2024
Winton-Sj..,!er,-i
Rer-ional 0-F"Ice
SR
The Warehouse
RC Complex
Real istic Water Treatment
E "ill ell T
oakw.-61D,
Source - Google Maps
Red Slide Park
EXISTING LANG STREET
LIFT STATION
N River United
thodist Church
Cummins - Riley House
3 Alt 9 1
S-
"1.,
M PROPOSED LANG
STREET LIFT STATION
PROJECT NO. - 17103
SHEET NO.
alley, Williams, carmen & king, inc. :
STREET LEVEL
ENGINEERS, MCHrrECTS & SUWEYORS
740 chapel hill road p.o. box 1179 MAP
jFPF-V7 —5534 GRAHAM, ALAMANCE COUNTY, N.C.
Burlington, n.c. 27215 336/226
LAAFirm's Enqineerinq License No. F-0203 SCALE: 1 = 400' 1 DATE: 1/26/19 IDWG.By TSK OF

am 2Hey, WRHH'ar s9 ecairmen & kIlng9 Ila®
OKL n g I n e e I' I n n • A I- C {I 1 I e C I U ]- C ° L a n it S u i- v P v 1 n g
July 1", 2024
NC Department of
North Carolina Department of Environmental Quality Environmental Quality
Division of Water Resources Received
450 West Hanes Mill Road, Suite 300 JUL 0 3 2024
Winston-Salem, NC 27105
Winston-Salem
Subject: Fast Track Application for Gravity Sewers, Pump Statio iWr&L_( hUB
Town of Haw River — Lang Street Pump Station Replacement
AWCK Project No. 23008
NCDWI Project No. SRP-W-ARP-0151
Review Team:
On behalf of the Town of Haw River please find enclosed for your review and approval the following:
1. Original and one (1) copy of Fast Track Application with required certification.
2. Application Fee in the amount of $600.00.
3. Color USGS map showing project and surrounding areas (2 copies).
4. Street Level Map (2 copies).
The Town of Haw River is planning to construct a new sewer pump station to replace the existing Lang
Street sewer pump station that was originally constructed in 1980. The existing pump station is located
at 209 Lang Street in Haw River, NC. The Town of Haw River proposes to replace the 44 year old, 300
GPM Lang Street Pump Station with a new 700 GPM Pump Station to serve the future needs of the
Town of Haw River for this service area. The existing force main that discharges directly to the East
Burlington WWTP will continue to be utilized for the proposed pump station.
While the capacity of the Lang Street Pump Station and forcemain will be increased, there is no
projected increase in the average daily flow to the station. As a result, we have shown "No New Flow"
as a result of the pump station upgrade. Requests for sewer allocation in the Lang Street Pump Station
sewershed are expected to be made in the near future, but these individual requests and permitting will
be contingent upon available capacity throughout the system. Two requests were previously made for a
total of 92,400 GPD of future design flow. While these requests have been made, analysis and
acceptance of this flow will be permitted separately from the pump station upgrade project.
Should you have any questions or need any additional information, please feel free to contact me.
With Best Regards,
Alley, Williams, Carmen and King, Inc.
� - C/� AA��
J. "Clay" Phillips, P.E.
cc: Sean Tencer, Town Manager
740 Chapel Hill Road (27215) • P.O. Box 1179 • Burlington, North Carolina 27216
Tel. - [phone] • Fax - [phone] • awck.com
ESTABLISHED • 1960