WQ0043394_Application (FTSE)_20240923

oocilhign Envelope ID: 7E15A933-208B-4404-B034-5FCAF1242DC6
�frni 74
no THE TOW N OF
August 8, 2024
Director, Division of Water Resources
Raleigh Regional Office
Water Quality Operation Section
3800 Barrett Drive
Raleigh, NC 27609
���Ily CS'prings
NC Dept of Environmentl Qit,
C. " 2JZ4
Re: Application for Sewer Extension Permit MODIFICATION IWO& Regima of be
Project: South Main Office
Permit: WQ0043394
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 $600.00
0 One original and one copy of the State of North Carolina Fast Track Sewer System
Extension Application (FTA 10-23)
0 Two copies of FTSE 10-23 Flow Track in'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.
Sincerely, initial
OocwSlgntd by IDS
u:�v,1
V'M49ish, P.E., CFM Rachel Jones Catherine Jacobs
Executive Director of Utilities and Infrastructure
KP'ek
cc: Project Consultant Engineer, William Ferrell , PE
Rachel Jones, Utility Engineer
Drew Johnson, Development Construction Manager
Emily Koncz, Utility Permitting Specialist
3uu2
04.17 2018
Utilities and Infrastructure Services
P.O. Box 8 • 128 S. Main Street • Holly Springs, NC 27540 • www,liollyspringsnc.gov

A Do%AIgn Envelope ID: 7B15A933-2088-4404-8034-5FCAF1242DC6
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Project file/Correspondence #42228
rings
NC Dept ofEnvironmenW Quoity
.Raleigh Regional oir
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3uu2
04.17 2019
Utilities and Infrastructure Services
P.O. Box 8 • 128 S. Main Street • Holly Springs, NC 27540 • www.hollyspringsnc-gov

+ r`ccutlgn Envelope ID. 7E15A933-2088-4404-B034-6FCAF1242DC6
E
DELTA LAND DESIGN, PA
June 17, 2024
Mike Hall
NC Dept of Environmental Quality
Raleigh Regional Office — Water Quality Section
3800 Barrett Drive k�? 0 �t+I
Raleigh, NC 27609
RE: South Main Office, WQ0043394
Raleigh Regional Offlee
`Town of Holly Springs, NC
Fast -Track Application
Dear Mike,
Please see enclosed two (2) sets of revised Fast -Track Applications (FTA 1 t1-23) and an accompanying
review fee check of S600.00 for the subject project for your review and approval. Also included are
check list items: FTSE (no additional flow), USGS map. street level map, existing permit. No change to
current permitted flow of 1,250 gallons per day.
The proposed South Main Office project is located at 851 South Main Street in the Town of Holly
Springs, North Carolina. We are seeking to revise the permitted 8" pipe length from 317 LF to 194
LF. 123 LF of existing 8" pipe was inadvertently included in the original permit. A permit revision is
being requested since this is a more than 10% reduction in pipe length.
If you have anv questions or need any additional information. please contact me at [phone].
Sincerely,
William P Ferrell, PF
Delta Land Design, PA
I'Ikl„v' Isy84) 1414-7004) 382 K.dvigh �nvet. 1 h)lly Sl)i g,,, Nt 2'i! , ('

' Docusrgn Envelope ID: 7E15A933-208B4404-B034-5FCAF1242DC6
State of North Carolina
NC Dept ol`CnvimmunW Qt:tstlty Department of Environmental Quality
DWR Division of Water Resources
11 , jF TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 10-23 & SUPPORTING DOCUMENTATION
t5f!
Application Number: 44IZ4 (Io he rrnnpkrcd by MR) of Ed `7i i
All items must be completed or the application will be returned 0, + �lQ ,
31
1. APPLICANT INFORMATION: 4P41 ` f
e�
I. Applicant's name: Town of Holly Springs (company, municipality, HOA, utility, etc.) Re��sl
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately-OwnedQAtt�lc Utility
❑ Federal ❑ State/County R Municipal ❑ Other
3. Signature authority's name: Kendra D- Parrish, PE per 15A NCAC 02T..0.106(b)
Title: Executive Director of Utilities & Infrastructure
4. Applicant's mailing address: 128 South Main Street, PO Box 8
City: Holly Springs State: NC Zip: 27540--
5. Applicant's contact information:
Phone number: [phone] Email Address: emily.koncz(a)hollypringsnc.gom, kendra.parrish g,hollyspringsnc.gov
11. PROJECT INFORMATION:
1. Project name: South Main Office
2. Application/Project status: ❑ Proposed (New Permit) ® Existing Permit/Project ❑ ARPA funded
If a modification, provide the existing permit number: WQ0043394 and issued date: May % 2022.
For modifications, also attach a detailed narrative description as described in Item G of the checklist.
If new construction, but part of a master plan, provide the existing permit number: WQ00
3. County where project is located: Wake
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.641866: Longitude:-78.832454`:
5. Parcel iD (if applicable): 0648-98-7588 (or Parcel ID to closest downstream sewer)
111. CONSULTANT INFORMATION:
1. Professional Engineer: William P Ferrell License Number: 035789
Firm: Delta Land Design, PA
Mailing address: 382 Raleigh St
City: Holly Springs State: NC Zip: 27540
Phone number: [phone] Email Address: will(a?dchalanddesi ng com
IV, WASTEWATER TREATMENT FACILITV (WWTF) INFORMATION:
1. Facility Name: Utley Creek Water Reclamation Facility Permit Number: NC0063096
Owner Name: Town of Holly Springs
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ0032903 Gwtt-fi F1W slm/o$
2. Downstream (Receiving) Sewer Information: 8 inch N Gravity Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS00192
Owner Name(s): Town of Holly Springs
FORM: FTA 10-23 Page 1 of 5

Docusign Envelope ID. 7E15A933-208B-4404-B034-5FCAF1242DC6
V1. GENERAL REQUIREMENTS
I. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑ No MN. -'A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM-- DRVI been attached?
❑ Yes ❑ No ® NIA
3. If the Applicant is a HomelProperty Owners' Association, has an HOAMOA.Opera tional Agreement ( FORM; HOA] and
supplementary documentation as required by 15A NCAC 02T.01 F(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 preparation1service ❑ Hotel andlor Motels
❑ School i preschool I day care ® Medical 1 dental + veterinary facilities ❑ Swimming Pool/Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming PoollFilter Backwash
❑ Businesses! offices! factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 % Domestic 100 % Commercial % Industrial (See 15A NCAC 02T .0103120))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes❑ No
6. Has a flow reduction been approved under 15A NCAC 02T .01 14(f}? ❑ 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.01 14(f))
Daily Design Flow `h
No. of Units
Flow
Medical Office
250 gal/doctor
5
1250 GPD
gall
GPD
gall.
GPD
gall
GPD
gall
GPD
gall
GPD
7alal
1250 GPD
a See 15A NCAC 02T .0I 14(b), WL deli I I and 4e)(21 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 15A N 'AC 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: 0 GPD (per 15A NCAC 02'f .01 14 and G.S. 143-215.1)
➢ Do not include fixture flows or previously permitted allocations
If permitted flow is zero, please indicate why:
❑ Pump StationlForce Main or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line.
Please provide supplementary infonnation indicating the approximate tinleframe for permitting upstream sewers with flow.
® Flow has already been allocated in Permit Number: W00043394 Issuance Date: May 9. 2022
❑ Rehabilitation or replacement of existing sewers with no new flow expected
❑ Other (Explain):
FORM: FTA 10-23 Page 2 of 5

y
Docusign Envelope 10: 7E15A933 20813 4404 l3034.5F:CAF1242DC6
Vil. GRAVITY SEWER DESIGN CRITERIA (if Applicable) - 02T .0305 & MDC (Gravity Sewers);
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 194 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
Villl. 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: 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 (TIN 1)
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.1.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other(please specify)
G. 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 rotations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including tmavel 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. DocAgn Envelope ID 7£15A933-20813A404 B034.%CAF1242DC6
iX. SETBACKS & SEPARATIONS (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separationstalternatives found in 15A NCAC 02T .0305(t) & tel? ® 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)
'Water mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
18 inches
'Water mains (horizontal)
10 feel
Reclaimed water lines (vertical - reclaimed over sewer)
18 inches
Reclaimed water I ines (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-f or WS-V), B, SA, ORW, HQW, or SB from normal
high water (or tide elevation) and wetlands associated with these waters (see item 1X.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
Final earth grade (vertical)
10 feet
36 inches
➢ If noncompliance with 02T.0305 t or see Section X. I of this application
* 15A NCAC 02T.03Q-5 contains alternatives where separations in 02T.0305(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 Waterflassifications webuaste
2. Does this project corn ply with them inim urn 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 PL, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? ® Yes ❑ No ❑ NIA
➢ Please provide supplementary information identifying the areas of non-conformance.
➢ See the Division's daft 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: Ne11sc ❑ 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 Nation widelindividual 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 1.5A NCAC 02T.0105(cg6) (additional permitsicertifications)? ® Yes El No
Per 15A NCAC 02T.0105 c6J, 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 pennits (erosion
and sedimentation control plans, stormwater management plans, etc.).
7. Does this project include any sewer collection lines that are deemed "high -priority?" ® Yes ❑ No
Per I SA 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: 7E'I5A933-208B-4404-B034-5FCAf1242DC6
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 SSewer Minimum Design Criteria (latest version) as appliC- ?
® Yes ❑ No
If no, for projects requiring; a single variance, complete and submit the VariancelAlternative 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 subiect 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 yroiect, the full technical review is required.
2. Professional Engineer's Certification:
I, William P Ferrell , attest that this application for South Main Office
(I'rofessmnal lingmccr's name froin Application Ilan Ill I ) (11rolect Name Irom Application Itcr11 II. I I
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans,
specifications, engineering calculations, anti 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 Perlin L[qg
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-Gf3, 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 (late: & •ARC
141
SEAL '
035789
1441
3. Applicant's Certification per 15A NCAC 02T .0106(b):
Kendra Parrish , attest that this application for South Main Office
(Signature Authority Name from Application Item IA (Prolect Name lion Application Itru1 I I l
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. 1 will make no claim against the Division
of Water Resources should a condition of this permit he 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 arc not included, this application
package will be returned to me as incomplete.
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 tip to $25,000 per violation.
Aocu5lgned by:
Signature: It
_ Dace: 8/14/2024 1 12 : 54 PM PDT
A388E125C87C4AE
FORM: FTA 10-23 Page 5 of 5

r 4 r
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
concurrently with the approval of the permit, and protects requiring a variance approval may be subject to longer
review times. For protects 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, William P Ferrell , attest that this application for South Main Office _
(Professional Engineer's name from Application Item III. l-) (Project Namc from Application Item 11.1)
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 143-215.6B, 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)
........ „ .......
FI, e" f -
North Carolina Professional Engineer's seal, signature, and date: N CARO
•'OF i•/ I
'• • • i
• 035789 p 2-y-0�
•.c�'N I.Nr,' -
....................... �...............................
3. Applicant's Certification per 15A NCAC 02T .0106(b).
I, , attest that this application for
(Signature Authority Name from Application Item 1.3.)
(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 the 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:
FORM: FTA 10-23 Pagc 5 of 5

' bocAlgn bnvelope ID. 7E15A933-208B-4404-13034-5FCAP1242bC6
Entity Requesting Allocation:
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(I=TSF 10-23)
Town of Holly Springs
Project Name for which flow is being requested: South Main Office
More than one FTSE m?I} be required for a ,single project if the owner of the WWTP is not responsible for all pump
stations along the route of the proposed wasleivater floe:
I. 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 #: NCO063096
A11 flews ore in MGD
c. WWTP facility's permitted flow 6.0
d. Estimated obligated flow not yet tributary to the WWTP 1.608 _
e. WWTP facility's actual avg. flow 3.121
f. Total flow for this specific request . 0.00125
g. Total actual and obligated flows to the facility 4 729
h. Percent of permitted flow used 72%
11. Complete this section for each pump station you are responsible for along the route of this
proposed
wastewater flow.
List pump stations located between the project connection point
and the WWTP:
(A) (R)
(C) (D)—(13*C:)
(E)=(A-D)
Design
Obligated,
Pump Pump Average Approx.
Not Yet Totai CUrrcnI
Station Station Firm Daily Flow** Current
Tributary Flow Plus
(Name or Permit Capacity, * (Firm 1 pf), Avg. Daily
Daily Flow, Obligated
Available
Number) No. MGD MGD Flow, MGD
MGD Flow
Capacity***
Bass Lake WQ0013069 _ _ 1.728 0.691 _ 0.367 _ 0.011 0.378 _ _ 0.313
* 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): _ Bass take Pump Station _ w
Downstream Permit Numbcr: WQ0013069
Page i of 8
FTSF 10-23

Docusign Envelope ID: 7E15A933-20884404-BO34-5FCAF1242DC6
III. Certification Statement:
I Kendra D. Parrish 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 11 plus all attached planning assessment addendurns 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.
DoCU Vied by:
Signing . . Tel[
Signature
Director of utilities & infrastructure
Title of Signing Official
8/14/2024 1 12:54 PM PDT
Dale
Page 2 of 8
FTS E 10-23

Docusign Envelope ID: 7E95A933-208B-4404-B034-5FCAF1242DC6
PLANNING ASSESSNIFNI' ADDENDUM (PAA)
Submit a planning assessment addendum for each pump station listed in Section I I where Available Capacity is t= 0.
Pump Station (Name or Number):
Given that:
a. The proportion and amount of Obligated, Not Yet Tributary Daily Flow (C) accounts for
% and MGD of the Available Capacity (E) in Pump Station
; and that
b. The rate of activation of this obligated, not yet tributary capacity is currently approximately
MGD per year; and that
c. A funded Capital Project that will provide the required planned capacity, namely
is in design or under construction with
planned completion in ; and/or
d. The following applies:
Therefore:
Given reasonably expected conditions and planning information, there is sufficient justification to allow
this flow to be permitted, without a significant likelihood of over -allocating capacity in the systern
infrastructure.
i understand that this does not relieve the collection systern owner from complying with G.S. 143-
215.67(a) which prohibits the introduction of any waste in excess of the capacity of the waste disposal
systern.
Signing Off cial Signature
Arne
Page 3 of 8
f=TSE 10-23

Docusign Envelope ID: 7E15A933 2086-4404 B034 5FCAF1242OC6
WASTEWATER TREATMENT SYSTEM EXPANSIONS BEYOND EXISTING ALLOCATION
Complete this form and submit applicable supporting documentation if the proposed project is subject to
overallocation allowances outlined per G.S. 143-215.1(f5).
Receiving WWTP Name:
Receiving WWTP Permit Number:
Provide a copy of the active NPDES permit for the receiving WWTP.
Overallocation Criteria
I. Does the receiving WWTP's existing NPDES permit have an expansion flow tier? ❑ Yes or [:]No.
a. If yes, provide the expansion flow tier: MGD; proceed to item 2.
b. If no, overallocation is not allowable for this construction until such a time that the receiving
WWTP's NPDES permit is modified for inclusion of an expansion flow tier capable of receiving
and sufficiently treating the wastewater generated by the proposed construction.
2. Is the receiving WWTP and collection system located within either (1) a county with a projected population
growth rate above two percent annually based on a 20-year residential growth proiection conducted using data
provided by the Office of State Budget and Management (OSBM) State Demographer or (2) one of the top
20% of the fastest growing counties in the State by population based on a 10-year residential growth
projection conducted using data provided by the OSBM State Demographer? ❑ Yes or ❑ No.
a. If yes, submit a residential population projection to support your claim; proceed to item 3
b. If no, overallocation is not allowable for this construction.
3. Has the receiving WWTP received a violation for being non -compliant with any non -flow limitations
identified in the active NPDES permit in the past 5 years? ❑ Yes or ❑ No.
a. If yes, overallocation is not allowable for this construction.
b. If no, submit a limit violation report to support your claim; proceed to item 4
4. Has the receiving WWTP exceeded its monthly average flow limitation identified in the active NPDES permit
more than once in any 12-month period in the past W years? ❑ Yes or ❑ No.
a. If yes, overallocation is not allowable for this construction. The receiving WWTP may not
allocate more than one hundred percent (100%) of the existing system's hydraulic capacity until
the pertmittee complies with the pennitted monthly flow for at least 12 consecutive months.
b. If no, submit a WWTP flow report to support your claim; proceed to item 5.
S. Is completion of construction for work identified in an Authorization to Construct (A,rc) permit that results in
expansion of facility to the next flow tier anticipated to occur within 24 months of the submittal date? ❑ Yes
or ❑ No.
a. If yes, allocation of one hundred ten percent (1 i S%) of the receiving W W'fI''s existing hydraulic
capacity is allowable.
i. Provide the ATC Permit Number:
ii. Submit a construction timeline signed by the contactor's Project Manager;
iii. Submit a letter of agreement of timeline feasibility signed by the NC-licenscd
Professional rngincer responsible for the certification ofwork covered under the
applicable ATC permit;
iv. Proceed to item 6.
b. If no, allocation of one hundred ten percent (I 10%) of the receiving W W"I'P's existing hydraulic
capacity is allowable. Proceed to item 6.
Page 4of8
FTSiv 10-23

DocAgn Envelope ID- 7E15A933-208B-4404-Bo34-5FCAF1242DC6
G. Does the overallocation identified as allowable under item 5 result in a WWTP (low rate greater than the
permitted projected capacity after expansion? ❑ Yes or ❑ No.
a. If yes, overallocation is not allowable for this construction.
b. If no, proceed to item 7.
7. Does the overallocation identified as allowable under item 5 result in a WWTP flow rate greater than 80% of
the permitted projected capacity after expansion? ❑ Yes or ❑ No.
a. If yes, overallocation is allowable. Submit an engineering evaluation of the receiving W WTP's
fixture wastewater treatment, utilization, and disposal needs. This evaluation shall outline plans
for meeting future wastewater treatment, utilization, or disposal needs by either expansion of the
existing system, elimination or reduction of extraneous flows, or water conservation and shall
include the Source of funding for the improvements. If expansion is not proposed or is proposed
for a later date, a justification shall be made that wastewater treatment needs will be met based on
past growth records and future growth projections and, as appropriate, shall include conservation
plans or other measures to achieve waste Flow reductions. This shall be provided to the Division
prior to the proposed activity. Proceed to item 8.
b. If no, overallocation is allowable.
8. Does the overallocation identified as allowable under item 5 result in a WWTP flow rate greater than 90% of
the penmitted projected capacity after expansion? ❑ Yes or ❑ No.
a. If yes, overallocation is allowable. However, the permittee for the receiving WWTP shall obtain
all permits needed for the expansion of the wastewater treatment, utilization, or disposal system
and, if construction is needed, submit final plans and specifications for expansion, including a
construction schedule. if expansion is not proposed or is proposed for a later date, a justification
shall be made that wastewater treatment needs will be met based on past growth records and
future growth projections and, as appropriate, shall include conservation plans or other specific
measures to achieve waste flow reductions. This shall be provided to the Division prior to the
proposed activity.
b. If no, overallocation is allowable.
Signing Official Signalm-e
£ rle
Page 5 of 8
FTSE 10-23

Docu`sign Envelope ID: 7E15A933.2086-4404-B034-5FCAF1242DC6
Instructions for Flow Tracking form (FTSE) and Planning Assessment Addendum (I'AA)
Section I
a. WWTP Facility _Name: Enter the name of the WWTP that will receive the wastewater flow.
b. WWTP Facility Permit #: Enter the NPDES or Non -Discharge number for the WWTP receiving the
wastewater flow.
c. WWTP facility'spermitted flow, MGD: From WWTP owner's NPDL-"S or Non -Discharge permit.
d. Estimated obligated flow not yet tributary to the WWTP, MGD: This includes flows allocated to other
construction projects not yet contributing flow to the collection system. Flows allocated through interlocal
agreements or other contracts not yet contrlbutin g flow to the collection system are also included. For POTWs
that implement a pretreatment program, include flows allocated to industrial users who may not be usin% all of
their flow allocation. Please contact your Pretreatment Coordinator for informat ion on industrial flow tributary
to your WWTP.
As of January 15, 2008 the POTW should have reviewed flow allocations made over the last two years and
reconciled their flow records, to the best of their ability, so it is known ]low much flow has been obligated and
is not yet been made tributary to the WWTP, in accordance with local policies and procedures employed by the
reporting entity.
e. WWTP facility's actual av . flow, MGD: Previous 12 month average.
f. Total flow for this specific request, MGD: Enter the requested flow volume.
g. Total actual and obligated flows to the facility, MGD Equals [d -4 e + fl
h. Percent of permitted flow used: Equals [(g / c)* 1001
For example:
On January 15 a POTW with a permitted flow of 6.0 MGD, reported to the Regional Office that there is 0.5
MGD of flow that is obligated but not yet tributary. The annual average flow for 2007 is 2.7 MGD. ']-here is a
proposed flow expansion of 0.015 MGD.
The first Form FTSE submitted after January 15. 2008 may have numbers like this:
c.-6.0 MGD
d. — 0.5 MGD
e. — 2.7 MGD
f.=0.015MGD
g. — 3.215 MGD
h. — 53.6 %
The next Form FTSE may be updated like this with a proposed flow expansion of 0.102 MGD:
c. = 6.0 MGD
d. = 0.515 MGD
e. -- 2.73 MGD
f. = 0.102 MG D
g.-3.349MGD
h. — 55.8 %
Each subsequent FTS1a form will be updated in the sarne manner.
Page 6of8
FTSE 10-23

bocusign Envelope ID: 7E15A933-208E-4404-6034-5FCAF1242DC6
Section 11
List the pump station name or number and approximate pump station firm capacity, approximate design average
daily flow (A) approximate current average daily Flow (B), and the obligated, not yet tributary now through the
pump station (C) for each pump station that will be impacted by the proposed sewer extension project. Calculate
the total current flow plus obligated flow (D-f3+C) and the available capacity (Ia-A-D). Include the proposed flow
for this project with other obligated flows that have been approved for the pump station but are not yet tributary
(C).
Finn capacity is the maximum pumped flow that can be achieved with the largest pump aut of service as per the
Minimum Design Criteria.
Design Average Daily flow is the firm capacity of the pump station divided by a peaking factor (pf) of not less than
2.5.
If the available capacity (E) for any pump station is < 0, then prepare a planning assessment for that pump station
if the system has future specific plans related to capacity that should be considered in the permitting process.
(A)
(B)
(C)
(D)=(R+C)
(E)-(A-D)
Obligated,
Design
Approx.
Not Yet
Total Current
Firm
Average
Current Avg.
Tributary
Flow Plus
Pump Station
Capacity
Daily Flow
Daily Flow.
Daily Flow.
Obligated
Available
(Name or Number)
MGD
(Firm / pf)
MGD
MGD
Flow
Capacity*
Kaw Creek PS
0.800
0.320
0.252
0.080
0.332
-0.012
Valley Road PS
1.895
0.758
0.472
0.135
0.607
0.151
Page 7of9
FTSC 10-23

Docusign Envelope lb: 7E15A933-208B-4404-B034-5FCAF1242DC6
Planning Assessment Addendum Instructions
Submit a }Manning assessment addendumn for each pump station listed in Section 11 where available capacity is < 0.
A planning assessment for Kaw Creek PS (see example data above) may he performed to evaluate whether there is
significant likelihood that needed improvements or reductions in obligated flows will he in place prior to activating
the flows from the proposed sewer extension project.
If the system decides to accept the flow based on a planning assessment addendum, it is responsible to manage the
flow without capacity related sanitary overflows and must take all steps necessary to complete the project or control
the rate of flow to prevent sanitary sewer overflows.
The planning assessment may identify a funded project currently in design or construction, or a planned project in
the future not yet funded but in a formal plan adopted by the system. The system should carefully weigh the
certainty of successful timely project completion for any expansion, flow management diversion or infiltration and
inflow elimination projects that are the foundation of a planned solution to capacity tracking and acceptance
compliance.
For example:
Given that:
a. The proportion and amount of obligated, not yet tributary flow accounts for 24 % and 0.080 MGD of the
committed flow in Pump Station Kaw Creek; and that
b. The rate of activation of this obligated, not yet tributary capacity is currently approximately 0.01 MGD
per year; and that
c. A funded capital project that will provide the required planned capacity, namely
is in design or under construction with planned
completion in ; and/or
d. The following applies:
The master plan and ten year capital plan contain recommended sco pe and funding for a capital project entitled
Kaw Creek Pump Station upgrade with fundinplanned- in July 2014. This ro'ect is planned to add 0.100 MGD
to the firm capacity of the pump station by October 2015. Inclusion of this proposed capital project as a condition
of this Flow Track in = Acceptance for Sewer Extension Permit Application elevates this ._pro aget's priority for
ftindinp,andconstruction to be im lemented ahead oftlhe activation ofobli gated not ct tributary flows in amounts
that exceed the firm numn station capacities identified in Section II above.
Therefore:
Given reasonably expected conditions and planning information, there is sufficient justification to allow this flow
to be permitted, without a significant likelihood of over -allocating; capacity in the system infrastructure.
Page 8 of 8
FTSE 10-23

Docusign Envelope ID: 7E15A933 20884404-B034-5FCAF1242DC6
DO NOT SUBMIT SEWER EXTENSION APPLICATIONS UNTIL
CONSTRUCTION DRAWINGS HAVE BEEN APPROVED BY STAFF!
Sewer Design and Application Certification
Note: This form must be submitted with the Fast Tract Application for extension to the Town of
Holly Springs Sewer System
Project:
South Main Office
Design Engineer: William P Ferrell
Address: 382 Raleigh Street, Holly Springs, NC 27540
Phone Number: 984-304-7990 Email: [e-mail]
Date Complete Application Package Received by Town: _ 8/13/2024 1 10: 26 AM PDT
os L
Initial
Date Approved: �� (by R.1) (by KDP) (by C.I)
E
C—
As design engineer for this project, I certify the following (please check (y) 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;
0✓ That each of the following items are completed and enclosed for submittal to the State for
a sewer extension permit:
�]✓ One original and one copy of a cover letter that includes a project narrative
o submitted
0 previously
0 One original and one copy of the State of North Carolina form FTA 44-#6r 10-23
Fast Traci Sewer Sj�stem Extension Apl)licatirrn
0
0 Two color copies of an 8.5-inch by I 1-inch portion of a 7.5-rnintlte USGS
Topographic Map showing proiect area
o Two copies of a street level neap showing all relevant project areas
0 One copy of the locally -required Design and Application Certification (This
form)
Design Engineer's Signature
Date 7-30-2024
Please contact Emily Koncz at [phone] or entily.koncz ii?hollyspringsnc.gov if you have
any questions.
2 10 Sewer besign Application CertiticaLnn
1.92523
Utilities and Ir'tfravructure Services
P.O. Box 8 • 128 S. Main Street • Hollr ,Springs, NC 27540 • xwtv.hnllrspri�ri,Tsltc x�m

Dousign Envelope ID 7E15A933-208B-4404-B034-5FCAF1242DC6
MAPLE STREET
PROPOSED `P
SEWER �L
`2
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E ISTING
z SE ER
m
a
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SITE
PREPARED FOR: SEAL:
South Main Office MACKENNAN PROPERTY GROUP
HOLLY SPRINGS, WAKE COUNTY, NORTH CAROLINA 110 MCARYANC NNAN DRIVE \Q�N••CAR99
Revised - SEWER PERMIT DATE: 06-18-2024 _ \O ���' •''y9
STREET LEVEL MAP FIRM CERTIFICATION a: C-5042 �zA
PROJECT ENGINEER: 035789
DELTA LAND DESIGN, PA
382 RALEIGH STREET !y.•F !�L
HOLLY SPRINGS, NC 27540 �` N1 1 ���,'.CD �����
PHONE:[phone]
DELTA LAND DESIGN PA PROJECT SURVEYOR- 2024-06 - - 18
LAM FL49k"AMOM +c JOHN A. EDWARDS 8 CO.

bocusign Envelope ID: 7E15A933-208B-4404.8034-5FCAF1242DC6
i, L
Z 4= aoA4
HOLLY SPRINGS
�411P 0� n *'NGSPORI Ao
6�
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pUTCH y�ff F Ra S F
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PROPOSED -
SEWER
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SEWER
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1 0-5 0 KILOMETERS 1 2
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1 0.5 0 1
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low 0 1000 7000 3000 4000 5000 6000 7000 8000 9000 1ODDO
FEET .�
APEX, NC
2016
South Main Office
HOLLY SPRINGS, WAKE COUNTY, NORTH CAROLINA
Revised - SEWER PERMIT
USGS QUAD 'APEX'
DELTA LAND DLSIGK PA
woPL*W6 1%0CW 8+va%M
PREPARED FOR:
SEAL;
MACKENNAN PROPERTY GROUP
110 MACKENNAN ORIVE
CARO
CARY, NC 27511
\�`,`.•
�9
DATE: 06-18-2024
`ESS/
���1F5 hhU7
FIRM CERTIFICATION #: C-5042
PROJECT ENGINEER:
03 %89
DELTA LAND DESIGN, PA
382 RALEIGH STREET
HOLLY SPRINGS. NC 27540
Ly••.•F ••
�` .Nc1N��:••���
PHONE: [phone]P.
���'! • • •{��
PROJECT SURVEYOR:
S "2024-06-18
JOHN A. EDWARDS & CO.

DocuSign
Certificate Of Completion
Envelope Id- 7El5A933208B4404BO345FCAF1242DC6 Status: Completed
Subject Complete with DocuSign: 42228 South Main Office Sewer Permit Application Modification.doc, 954-...
Source Envelope:
Document Pages: 31 Signatures- 3 Envelope Originator:
Cerlificale Pages- 5 Initials. 5 Emily Koncz
AUIoNaV" Enabled PO Box 8
Envelopeld Stamping: Enabled Holly Springs. NC 27540
Time Zone: (UTC-05:00) Eastern Time (US & Canada) emily.koncz@hollyspringsnc gov
IP Address: 204.84.166.2
Record Tracking
Status: Original Holder: Emily Koncz Location: DocuSign
8/8/2024 8:59:41 AM [e-mail]
Signer Events Signature Timestamp
Rachel Jones C5 Sent 8/8/2024 9.06.12 AM
rachel [e-mail] �° Resent. 8/12/2024 9:01:16 AM
Utility Engineer Viewed: &1312024 1 26:05 PM
Security Level Email, Account Authentication Signed- 51131?024 1 26:56 PM
(None) Signature Adoption Pre -selected Style
Using IP Address- 64 98 12161
Electronic Record and Signature Disclosure:
Accepted- 5/17/2021 2:39:29 PM
ID: 126bfa6d-c99c-4 b40-be28-00a a 263b860b
Company Name: Town of Holly Springs
Catherine Jacobs
Sent. 8/14/2024 8.35,36 AM
[e-mail] E3,
Resent 8/14/2024 3.10 47 PM
Engineering Manager
Viewed- 8/14/2024 3:44-12 PM
Security Level: Email, Account Authentication
Signed. 8/14/2024 3 51-58 PM
(None) Signature Adoption: Pre -selected Style
Using IP Address: 204,84.166.2
Electronic Record and Signature Disclosure:
Accepted: 8/14/2024 3:44:12 PM
ID: f366345d-16c0-4a65-9cla-a86428ab065e
Company Name: Town of Holly Springs
Kendra Parrish
by: Sent: 8/14/2424 3:52:01 PM
[e-mail]
[D-.51q.*d
"__`! Viewed: 8/14/2024 3:54-02 PM
Director of Utilities & Infrastructure
A306FMC87C4AE Signed: 8/14/2024 3:54-21 PM
Holly Springs
Signature Adoption Pre -selected Style
Security Level: Email, Account Authentication
(None)
Using IP Address: 204.84 166.2
Electronic Record and Signature Disclosure:
Accepted: 8/14/2024 3:54:02 PM
ID: 64aa2253-bc36-4c68-8964-923f0620977f
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
Carbon Copy Events
Theresa Randall
[e-mail]
Asset ManagementIADA Coordinator
Town of Holly Springs
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Status
Status
COPIED
Witness Events Signature
Notary Events Signature
Envelope Summary Events Status
Envelope Sent
HashedlEncrypted
Envelope Updated
Security Checked
Envelope Updated
Security Checked
Envelope Updated
Security Checked
Envelope Updated
Security Checked
Certified Delivered
Security Checked
Signing Complete
Security Checked
Completed
Security Checked
Payment Events Status
Electronic Record and Signature Disclosure
Timestamp
Timestamp
Sent 8/14/2024 3-54-24 PM
Timestamp
Timestamp
Timestamps
8/8/2024 9:06:12 AM
8/9/2024 8-19 06 AM
8/9/2024 8:19 06 AM
8/12/2024 9-02:12 AM
8/14/2024 8-35 36 AM
8/14/2024 3 54 02 PM
8/14/2024 3-54 21 PM
8/14/2024 3 54 24 PM
Timestamps

Electronic Record and Signature Disclosure created on- 11i1212020 9,42-57 PM
Parties agreed to Rachel Jones, Catherine Jacobs, Kendra Parrish
ELECTRONIC RECORD AND SIGNATURE DISCLOSURE
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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
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How to contact Town of Holly Springs:
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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.

Docustgn Envelope ID- 7E15A933-208E-4404-13034-5FCAF1242DC6
ROY COOPER
Governro
ELIZABETH S. BISER
lwi r ('fur y
RICHARD E. ROGERS, JR.
9,,, , n u
NORT1. CAROLINA
Environmental Qualify
May 9, 2022
Kendra D. Parrish, PE
Executive Director of Utilities & Infrastructure Service
Town of Holly Springs
128 South Main Street PO Box 8
Holly Springs, NC 27540
Subject: Permit No, WQ0043394
Town of Holly Springs
South Main Office
Wastewater Collection System Extension Permit
Wake County
Dear Permittee:
NC Dept ofEnvironntental Quality
t`:
o;�I' 0 � Jjzq
Raleigh Regiona Office
In accordance with your application received April 8, 2022 we are forwarding herewith Permit No.
WQ0043394 dated May 9, 2022 to the Town of Holly Springs (Permittee) for the construction and
operation upon certification of the subject wastewater collection system extension. This permit shall be
effective from the date of issuance until rescinded, and shall be subject to the conditions and limitations
as specified therein. This cover letter shall be considered a part of this permit and is therefore
incorporated therein by reference.
Please pay particular attention to the following conditions contained within this permit:
Condition 11.1: This permit shall not be automatically transferable; a request must be made and
approved.
Condition 11,4: Requires that the wastewater collection facilities be properly operated and maintained
in accordance with 15A NCAC 02T .0403 or any individual system -wide collection system
permit issued to the Permittee.
Condition 11.7: Upon completion of construction and prior to operation of these permitted facilities, the
completed Engineering Certification form with checklist attached to this permit shall be
submitted with the required supporting documents to the address provided on the form.
Permit modifications are required for any changes resulting in non-compliance with
this permit, regulations, or the Minimum Design Criteria. 115A NCAC 02T.01161
It shall be responsibility of the Permittee to ensure that the as -constructed project meets the appropriate
design criteria and rules. Failure to comply may result in penalties in accordance with North Carolina
General Statute §143-215.6A through §143-215.6C, construction of additional or replacement

Do..tsign Envelope ID: 7E15A933-208B-4404-Bo34.5FCAF1242DC6
Town of Holly Springs
Permit No. WQ0043394
wastewater collection facilities, and/or referral of the North Carolina -licensed Professional Engineer to
the licensing board.
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 Generai
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 Jason Robinson via e-mail at
[e-mail]. NC Dept of Environmental Quality
Sincerely,
DocuSigned by
1aZ;-
I W
KCDA¢D82504A46D
for Richard E. Rogers, Jr.
Director, Division of Water Resources
by Scott Vinson, Regional Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, NCDEQ
cc: Tom@Spaulding group.com
Raleigh Regional Office Files
DWR Laserfiche
Wake County Health Department
Raleigh Regional O#6ica
Page 2 of 9

Docusign Envelope ID: 7E15A933-2086-4404-13034-517CAF1242DC6
NC Dept ofEnvirOnmental Q dity
NORTH C_AR,?LINA
Environmental Quality 'Weigh Regiow OMCC
WASTEWATER COLLECTION SYSTEM EXTENSION PERMIT
In accordance w th the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as
amended, and other applicable Laws, Rules, and Regulations, permission Is hereby granted to the
Town of Holly Springs
Wake County
for the construction and operation of approximately 317 linear feet of 8 inch gravity sewer to serve a five
(5) doctor medical office part of the South Main Office project, and the discharge of 1,250 gallons per day
of collected wastewater into the Town of Holly Spring's existing sewerage system, pursuant to the
application received April 8, 2022 and in conformity with 15A NCAC 02T; the Division's Gravity Sewer
Minimum Design Criteria adopted February 12, 1996 and updated in March 2008, as applicab�e; 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 Quaiity and considered a part of this permit.
This permit shall be effective from the date of rssuance until rescinded and shall be subject to the specified
conditions and limitations contained therein.
SC.H1L l/l.
��2p�aa5J4AAtii] for Richard E. Rogers, Jr,
Director, Division of Water Resources
By Authority of The Environmental Management Commission
Permit Number: WQ0043394
Permit Issued: May 9, 2022
Page 3 of 9

' Docutign Envelope ID 7E15A933-20884404-B034-5FCAF1242DC6
At IDipr U
SUPPLEMENT TO PERMIT COVER SHEET
Town of Holly Springs is hereby authorized to ��'W* ,?52
Constru(-.t, and then operate upon certification the aforementioned wastewater collection exten%q), The
sewage and wastewater collected by this system shall be treated in the Town of Holly Springs' Utley Creek
Wastewater Treatment Facility in accordance with Permit Number NC0063096.
Permitting of this project does not constitute an acceptance of any part of the project that does not meet
15A NCAC 02T; the Division's Gravity Sewer Minimum Design Criteria adopted February 12, 1996 as
applicable; and the Division's Minimum Design Criteria for the Fast Track Permitting of Pump Stations and
Force Mains adopted June 1, 2000 as applicable, unless specifically mentioned herein. Division approval
is based on acceptance of the certification provided by a North Carolina -licensed Professional Engineer in
the application. it shall be the Permittee's responsibility to ensure that the as -constructed project meets
the appropriate design criteria and rules.
Construction and operation is contingent upon compliance with the Standard Conditions and any Special
Conditions identified below.
I. SPECIAL CONDITIONS
No Special Conditions
II. STANDARD CONDITIONS
1. This permit shall not be transferable. In the event there is a desire for the wastewater collection
facilities to change ownership, or there is a name change of the Permittee, a formal permit request
shall be submitted to the Division accompanied by documentation from the parties involved, and
other supporting materials as may be appropriate The approval of this request shall be considered
on its merits and may or may not be approved. 115A NCAC 02T.0116; G.S 143-215.1(d3)]
2. This permit shall become voidable unless the wastewater collection facilities are constructed in
accordance with the conditions of this permit; 1SA NCAC 02T; the Division's Gravity Sewer Minimum
Design Criteria adopted February 12, 1996 as applicable; the Division's Minimum Design Criteria for
the Fast -Track Permitting of Pump Stations and Force Mains adopted June 1, 2000 as applicable; and
other supporting materials unless specifically mentioned herein. [15A NCAC 02T.01101
3. This permit shall be effective only with respect to the nature and volume of wastes &-scribed in the
application and other supporting data. [15A NCAC 02T .0110]
4. The wastewater collection facilities shall be properly maintained and operated at all times. The
Permittee shall maintain compliance with an individual system -wide collection system permit for the
operation and maintenance of these facilities as required by 15A NCAC 02T .0403. If an individual
permit is not required, the following performance criteria shall be met;
The sewer system shall be effectively maintained and operated at all times to prevent discharge
to land or surface waters, and to prevent any contravention of groundwater standards or surface
water standards.
Page 4 of 9

DovAign Envelope ID: 7E15A933-208B-4404-B034-5FCAF1242DC6
b. A map of the sewer system shall be developed and shall be actively maintained.
An operation and maintenance plan including pump station inspection frequency, preventative
maintenance schedule, spare parts inventory and overflow response has been developed and
implemented.
d. Pump stations that are not connected to a telemetry system shall be inspected every day (i.e. 365
days per year). Pump stations that are connected to a telemetry system shall be inspected at
least once per week.
e. High -priority sewer lines shall be inspected at least once per every six -months and inspections are
documented.
f. A general observation of the entire sewer system shall be conducted at least once per year.
g. Overflows and bypasses shall be reported to the appropriate Division regional office in accordance
with 15A NCAC 2B .0506(a), and public notice shall be provided as required by North Carolina
General Statute §143-215.1C.
h. A Grease Control Program is in place as follows:
For public owned collection systems, the Grease Control Program shall include at least
biannual distribution of educational materials for both commercial and residential users and
the legal means to require grease interceptors at existing establishments. The plan shall also
include legal means for inspections of the grease interceptors, enforcement for violators and
the legal means to control grease entering the system from other public and private satellite
sewer systems.
For privately owned collection systems, the Grease Control Program shall include at least bi-
annual distribution of grease education materials to users of the collection system by the
permittee or its representative.
Grease education materials shall be distributed more often than required in Parts (1) and (2)
of this Subparagraph if necessary to prevent grease -related sanitary sewer overflows.
i. Right-of-ways and easements shall be maintained in the full easement width for personnel and
equipment accessibility.
j. Documentation shall be kept for Subparagraphs (a) through (i) of this Rule for a minimum of three
years with exception of the map, which shall be maintained for the life of the system.
S. The Permittee shall report by telephone to a water resources staff member at the R;eio-0i Regional
Office, telephone number [phone], as soon as possible, but in no case more than 24 hours,
following the occurrence or first knowledge of the occurrence of either of the following:
a. Any process unit failure, due to known or unknown reasons, that renders the facility incapable
of adequate wastewater transport, such as mechanical or electrical failures of pumps, line
blockage or breakage, etc.; or
b. Any SSO and/or spill over 1,000 gallons; or
c. Any SSO and/or spill, regardless of volume, that reaches surface water
Voice mail messages or faxed information is permissible, but this shall not be considered as the initial
verbal report. Overflows and spills occurring outside normal business hours may also be reported to
the Division of Emergency Management at telephone number [phone] or [phone].
Persons reporting any of the above occurrences shall file a spill report by completing and submitting
Part I of Form CS-SSO (or the most current Division approved form) within five days following first
Page 5 of 9

' DocAgn Envelope ID- 7E15A933.20BB-4404-8034-5FCAF1242DC6
knowledge of the occurrence. This report must outline the actions taken or proposed to be taken to
ensure that the problem does not recur. Part II of Form CS-SSO (or the most current Division approved
form) can also be completed to show that the 5SO was beyond control. [G.S. 143-215.1C(al)]
6. Construction of the gravity sewers, pump stations, and force ma..ns shall be scheduled so as not to
interrupt service by the existing utilities nor result in an overflow or bypass discharge of wastewater
to the surface waters of the State. [15A NCAC 02T.0108(b)]
1. Upon completion of construction and prior to operation of these permitted facilities, the completed
Engineering Certification form with checklist attached to this permit shall be submitted with the
required supporting documents to the address provided on the form. A complete certification is one
where the form is fully executed and the supporting documents are provided as applicable. Any
wastewater flow made tributary to the wastewater collection system extension prior to completion
of this Engineer's Certification shall be considered a violation of the permit and shall subject the
Permittee to appropriate enforcement actions.
If the permit is issued to a private entity with an Operational Agreement, then a copy of the Articles
of Incorporation, Declarations/Covenants/Restrictions, and Bylaws that have been appropriately
filed with the applicable County's Register of Deeds office shall be submitted with the certification.
A complete certification is one where the form is fully executed and the supporting documents are
provided as applicable. Supporting documentation shall include the following:
a. One copy of the project construction record drawings (plan & profile views of sewer lines & force
mains) of the wastewater collection system extension. Final record drawings should be clear on
the plans or on digital media (CD or DVD disk) and are defined as the design drawings that are
marked up or annotated with after construction information and show required buffers,
separation distances, material changes, etc.
b. One copy of the supporting applicable design calculations including pipe and pump sizing, velocity,
pump cycle times, and level control settings, pump station buoyancy, wet well storage, surge
protection, detention time in the wet well, and force main, ability to flush low points in force
ma-ns with a pump cycle, and downstream sewer capacity analysis. If a portablf, power source or
pump is dedicated to multiple stations, an evaluation of all the pump stations' storage capacities
and the rotation schedule of the portable power source or pump, include travel timeframes, shall
be provided.
c. Changes to the project that do not result in non-compliance with this permit, regulations, or the
Minimum Design Criteria should be clearly identified on the record drawings, on the certification
in the space provided, or in written summary form.
Prior to Certification (Final or Partial): Permit modifications are required for any changes resulting
in non-compliance with this permit (including but not limited to pipe length changes of 10% or
greater, increased flow, pump station design capacity design increases of 5% or greater, and
increases in the number/type of connections), regulations, or the Minimum Design Criteria.
Requested modifications or variances to the Minimum Design Criteria will be reviewed on a case -by -
case basis and each on its own merit. Please note that variances to the Minimum Design Criteria
should be requested and approved during the permitting process prior to construction. After -
Page 6 of 9

Docilsign Envelope ID' 7E15A933-208B-4404-B034-5FCAF1242DC6
construction requests are discouraged by the Division and may not be approved, thus requiring
replacement or repair prior to certification & activation. 115A NCAC 02T .01161
8, Gravity sewers installed greater than ten percent below the minimum required slope per the Division's
Gravity Sewer Minimum Design Criteria shall not be acceptable and shall not be certified until
corrected. If there is an unforeseen obstacle in the field where all viable solutions have been
examined, a slope variance can be requested from the Division with firm supporting documentation.
This shall be done through a permit modification with fee. Such variance requests will be evaluated
on a case -by -case basis. Resolution of such request shall be evident prior to completing and submitting
the construction certification. [ 15A NCAC 02T.0105(n)[
9. A copy of the individual permit and construction record drawings shall be maintained on file by the
Permittee for the life of the wastewater collection facilities. [15A NCAC 02T .0116]
10. Failure to abide by the conditions and limitations contained in this permit; 15A NCAC 02T; the
Division's Gravity Sewer Design Criteria adopted February 12, 1996 as applicable; the Division's
Minimum Design Criteria for the Fast -Track Permitting of Pump Station and Force Mains adopted June
1, 2000 as applicable; and other supporting materials may subject the Permittee to an enforcement
action by the Division, in accordance with North Carolina General Statutes §143-215.6A through §143-
215.6C, construction of additional or replacement wastewater collection facilities, and/or referral of
the North Carolina -licensed Professional Engineer to the licensing board. [15A NCAC 02T .0108(b-c)]
11. In the event that the wastewater collection facilities fail to perform satisfactorily, including the
creation of nuisance conditions, the Permittee shall take immediate corrective action, including those
as may be required by this Division, such as the construction of additional or replacement facilities
[15A NCAC 02T .0110; 15A NCAC 02T .0108(b)]
12, The issuance of this permit shall not exempt the Permittee from complying with any and all statutes,
rules, regulations, or ordinances that may be imposed by the Division any other Federal, State, or Local
government agencies which have jurisdiction or obtaining other permits which may be required by
the Division or any other Federal, State, of Local government agencies. [G.S. 143-215,1(b)]
Page 7 of 9

Docusign. Envelope ID: 7E15A933-208E-4404-B034-5FCAF1242DC6
CERTIFICATION CHECKLIST
To be completed by the certifying engineer prior to operation of the permitted sewers, per 15A NCAC 02T 0116
Certifying Engineer: �r
Certification Review Date:
Project Name:
WQ00 Project County:,_J�_
1) Has permittee information changed since the permit was issued (or last modified): char of mailing address,
change of ownership, transfer from developer to HOA/POA, etc. ❑ Yes ❑ No %
' mw
�tn
• If yes, please provide either a change of ownership form or new contact information. Note thai-A-ransfer of
permits from the developer to the HOA/POA must occur with the first certification,
2) Have the as -built drawings have been signed, sealed, and dated by an N.C. PE? ❑ Yes ❑ No
3) Final Engineering certification? ❑ Yes ❑ No
• If Partial Engineering certification, provide detailed narrative including what is being certified in the current
phase, what was previously certified (if applicable), and what is left to be certified.
4) Adequate information related to sewer lines: ❑ Yes ❑ No ❑ N/A
• Three feet minimum cover has been provided for all sewers unless ferrous pipe was installed.
• Minimum diameters for gravity sewers are 8-inches for public lines and 6-inches for private lines.
• Manholes have been installed: At the end of each line, at all changes in grade, size, or alignment, at all
intersections, and at distances not greater than 425 feet; minimum diameter shall be 4 feet (48-inches).
5) Adequate information related to pump stations: ❑ Yes ❑ No ❑ N/A
• Ensure power reliability option was selected per 15A NCAC 02T.0305(h).
6) Was project construction completed in accordance with all of the following: ❑ Yes ❑ No ❑ N/A
• 15A NCAC 02T, Minimum Design Criteria (MDCLfor the permitting of Gravity Sewers 4latest version), and DC
for the Permitti nig of Pump Stations and Force Mains (latest version)?
If not, a variance approval is required in accordance with 15A NCAC 02T,0105(bj, prior to certification and operation.
• Contact the Central Office to discuss the variance to determine a course of action.
• Applicant must submit two copies of the variance request form, plans, specifications, calculations, and any other
pertinent information to the Central Office (one hard copy, one digital copy).
• The central office will review the variance request, and if approvable, specific language regarding the variance
wilt be incorporated into the permit, either via a special condition or a Supplementary letter. A copy of the
reissued permit with variance language or the variance letter must be maintained with the original documents.
7) Does the project contains high priority lines (15A NCAC 02T .040212))? ❑ Yes ❑ No
• If yes, ensure that the permit already contains the necessary condition related to high priority lines 15A NCAC
02T.0403 (a)(5). If the permit does not include this language, the Fast Track reviewer will reissue the permit with
the appropriate language
8) Are Permit modifications are required for any changes resulting in non-compliance with this permit (including but not
limited to pipe length changes of 10% or greater, change in flow, pump station design capacity design change of 5" •o or
greater, and/or change in the number/type of connections)? ❑ Yes L� No
• If yes, a permit modification request must be submitted to the appropriate Regional Office, and a modified
permit with revised certification must be issued prior to certification and operation,
Noah Carolina Depwinient of Environmenial Quarrty Divisson of Water Resoiru•.es
Raloglt Frcginnai Crtree 1628 Mail 5rrvire Centr;r, Rarr gh. NC 27609.162!t
Physicdl Address 1800 Barrat Dive, rtalogh. NC 27609 919-791­1.2Xi

DocJsign Envelope ID- 7E15A933-208E-4404-8034-5FCAF1242DC6
FAST TRACK SEWER ENGINEERING CERTIFICATION
PERMITTEE: Town of Holly Springs
PERMIT ff: WQ0043394
PROJECT: South Main Office
ISSUE DATE: May 9, 2022
This project shall not be considered complete nor allowed to operate in accordance with Condition 7 of
this permit until the Division has received this Certification and all required supporting documentation. It
should be submitted in a manner that documents the Division's receipt. Send the required documentation
the Regional Supervisor, Water Quality Regional Operations Section at the address at the bottom.
Any wastewater flow made tributary to the wastewater collection system extension prior to completion
of this Certification shall be considered a violation of the permit and shall subject the Permittee to
appropriate enforcement actions. The Permittee is responsible for tracking all partial cert=fications up
until a final certification is received. A Final Certification shall be a complete set of record drawings and
design calculations regardless of whether partials have been submitted.
PERMITTEE'S CERTIFICATION
I, the undersigned agent for the Permittee, hereby state that this project has been constructed pursuant
to the applicable standards & requirements, the Professional Engineer below ha= provided applicable
design/construction information to the Permittee, and the Permittee is prepared to operay. & maintain
the wastewater collection system permitted herein or portions thereof.
Printed Name, Title Signature Date
ENGINEER'S CERTIFICATION
1, , as a duly registered Professional En sneer in the State of North Carolina,
having been authorized to observe (❑ periodically, ❑ weekly, full time) the construction of the
project name and location as referenced above for the above Permittee hereby state that, to the best of
my abilities, due care and diligence was used in the observation of the following construction:
approximately 317 linear feet of 8-inch gravity sewer; such that the construction was observed to be
built within substantial compliance of this permit; 15A NCAC 02T; the Division of Water Resources'
(Division) Gravity Sewer Minimum Design Criteria adopted February 12, 1996 as applicable; the Division's
Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains adopted June 1,
2000 as applicable; and other supporting materials.
North Carolina Professional Engineer's Seal w/signature & date:
❑ Final ❑ Partial (include description)
Certification Comments/Qualifiers (attach if necessary):
North Carolina Department of Environmental Quality Division of Water Resources
Raleigh Regional Office 1628 Marf 5« rvice Center. Raleigh, NC 27699 1628
Physiral Address: 3800 Barrett Drwr. Raleigh, NC 27609 919-791 4200

DocuhnLrivelopelD 7E15A933-20884404-B034-SFCAF1242DC6
NCtk;4ONW,y1fQ ,W State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
$& V ,,,�
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources INSTRUCTIONS FOR FORM: FTA 10-23 & SUPPORTING DOCUMENTATION
offie
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 ((aravit� Sewer & Pump Stationsforce Mains) and that plans, specifications and supporting documents
have been prepared in accordance with I5A 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 r m design criteria. These
documents shall be immediately available upon request by the Division, t0,%
n��=11t1
Projects that are deemed permitted (do not require a permit from the Division) are explained in 15A NCAC 02T-0303. �t81
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 1 SA NCAC 02T; Ral�fghR
➢ Pressure sewer systems utilizing simplex septic tank -effluent pumps (STEPS) or simplex grinder pumps;e��lp�
➢ 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 al I 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 maybe 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 numberfstatus of any other required sewer permits (downstream."upstrearn)
➢ If necessary for clarity, include attachments to the application foram.
➢ If the project is funded by American Rescue Plan Act (ARPA) funds, please include the ARPA project number in the cover
letter and in parentheses under Project Name (Section 11.1. of the application).
C. Application Fee (All New and Modification Application Packages):
® Submit a check or money order in the amount of $600.00, dated no more than 90 days prior to application 4ubmittai.
➢ 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 tltc
North Carolina Secretary of State.
❑ If the Applicant Type in Item 1.2 is a partnership or dlb/a, enclose a copy of the certificate filed with the Register of Deeds in
the county of business.
® The Project Name in Item I1.1 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.
INSTRUCTIONS FOR FORM: FTA 10. 23 & SUPPORTING DOCUMENTATION Page i of 3

DocAign Envelope ID 7E1SA933..208B-4404-8034.5fCAF'1242DC6
® The Applicant's Certification on Page 5 of the application shall be signed in accordance with 15A NCAC 021' .0106L}, 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).
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. 143-215.67(a}.
➢ Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific FTSE.
F. Site Maps (All Application Packages):
0 Submit an 8.5-inch x f 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 latitudellongitude) 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 addedlrnodified). 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 I5A NCAC 02T .03051h1( 11, 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 fire 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 15A NCAC 02T .01 I N;ILIJ provide the Certificate of Public Convenience and Necessity from the North Carolina 1.1ditics
Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to he served by the sewer
extension, or
❑ Provide a letter from the North Carolina Utilities Commission's Water and Sewer Division Public St,Iff 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 iIOA/POA and Developers for lots to be sold):
❑ Home/Property Owners' Associations
❑ Per 15A NCAC 02T .O1 15(c), submit the properly executed Operational Agreement {FORM= VIOA.�.
❑ Per 15A NCAC 02T .01 15(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
❑ Developers of lots to be sold
❑ Per 15A NCAC 02T .01 15(h). submit the properly executed Operational Agreement (rQgM: DEVI_
For more information, visit the Division's eolleclion sjPste►ns %reh-Wei
INSTRUCTIONS FOR FORM: FTA 10-23 & SUPPORTING DOCUMENTATION Page 2 of 3

` DocAign Envelope ID: 7E15A933 208B-4404-8034-5FCAF1242DC6
THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
ADDRESS
2090 US highway 70
COUNTIES SERVED
Asheville Realonal Office
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
610 E. Center Avenue
Mooresville Realonal Office
Alexander, Cabarrus, Catawba, Cleveland,
Water Quality Section
Mooresville, North Carolina 28115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
Raleigh 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
Washin ton 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
Wilminaton Realonal Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
Water Quality Section
Wilmington, North Carolina 28405
Hanover, Onslow, Pender
[phone]
[phone] Fax
Alamance, Alleghany, Ashe, Caswell, Davidson,
Winston-Salem Regional Office
450 W. Hanes Mill Road
Water Quality Section
Suite 300
Davie, Forsyth, Guilford, Rockingham, Randolph,
Winston-Salem, North Carolina 27105
Stokes, Suny, Watauga, Wilkes, Yadkin
[phone]
[phone] Fax
INSTRUCTIONS FOR FORM: FTA 10-23 & SUPPORTING DOCUMENTATION Page 100 3

Wilson, Susan A
From: Brian Duncan <[e-mail]>
Sent: Monday, September 23, 2024 1:29 PM
To: Wilson, Susan A; William Ferrell
Subject: [External] Re: Fast Track Sewer Extension Application/Modification: South Main Office
(WQ0043394 MOD)
Follow Up Flag: Follow up
Flag Status: Flagged
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Good afternoon Susan. That is correct. The previous engineer accidentally counted some service line
Length. Thank you!
Brian G Duncan, Managing Partner
DELTA LAND DESIGN, PA
Phone [phone] Mobile [phone]
brian()deltalanddesign.com delta-land-
design.com
382 Raleigh Street, Holly Springs, NC 27540
NC Firm C-5042 I Confidentiality Notice
From: Wilson, Susan A <[e-mail]>
Sent: Monday, September 23, 2024 1:12:S7 PM
To: William Ferrell <wilI@delta landdesign.com>
Cc: [e-mail] <[e-mail]>; Rachel Ingham
<[e-mail]>
Subject: Fast Track Sewer Extension Application/Modification: South Main Office (WQ0043394 MOD)
Ili [f 11'i,
Just want to confirm that this modification is as simple as it appears!
So all we're doing is correcting/modifying the 8 inch gravity sewer line length to 194 LF? (from the previously issued
Length of 317 LF?)
Thanks much. If that's the case, I hope to get this up for signature this week.
Respectfully,
Susan Wilson
Environmental Engineer (Part Time, Temporary)
1

Water Quality Regional Operations — Raleigh Regional Office
NC Department of Environmental Quality
Office: 919-791-4240
Email correspondence to and from this address may be subject to the North Carolina Public Records Law and may be disclosed to third parties by an authorized
state official.