WQ0040184_Application (FTSE)_20180919

DWR
15A NCAC 02T
Dlvlsion of Water Resources
1
Application
State of North Carolina
Department of Environmental Quality
Division of Water Resources
SEWER SYSTEM EXTENSION APPLICATION
TA 04-16 & SUPPORTING DOCUMENTATION
(to be completed by DWR)
All items must he completed or the apolleation will he returned
I. APPLICANT INFORMATION:
L Applicant's name: Cite of Hendersonville (company, municipality. HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State/County ® Municipal
3. Signature authority's name: Brent G, Detwiler. PE per 15A NCAC 02T .0106(U)
Title: City Engineer
=4. Applicant's [nailing address: Operations Center, 305 Williams Street
City: Hendrsonville State: NC Zip: 28792-
5. Applicant's contact information:
Phone number: (828)697-30600V Email Address: bdetwileLilePhvinc_,
II. PROJECT INFORMATION:
❑ Privately -Owned Public Utility
❑ Other
F+ 'ouroas
JUL 10 2019
Wat<S iizi,vrr ryi p^ration
L Project name: NCDOT Project: U-5105 NC 225 Intersection Improvements @4 SR 1164 and SR 1779
2. Application/Project status: Proposed (New Permit) ® Existing Permit/Project
If a modification, provide the existing permit number: WQ00 and issued date:
If new constriction but part of a master plan, provide the existing permit number: WQ00
3. County where project is located: Henderson
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.315212° Longitude: -82.453086'
5. Parcel ID (if applicable):
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Ronald B. Wilkins License Number: 010157
Finn: Hinde Engineering. Inc.
Mailing address: 401 Harrison Oaks Blvd.. Suite 145
City: Cary State: NC Zip: 27513
Phone number: [phone] Email Address: nNilknts�et.li.indeenginecrinz .con
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Hendersonville Waste Water Treatment Facility Permit Number: N00025534
Owner Name: Citv of Hendersonville
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ Downstream (Receiving) Sewer Size: inch
System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s):
FORM: FTA 04-16 Page 1 of 5

t;'

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utili".% has a Certificate of Public Convenience and Necessity been attached?
Daily Design Flow ",b
gal/
❑ Yes ❑No ®N/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached'?
❑ Yes ❑No ®N/A
3. If the Applicant is a Hotne/Property
Owners' Association; has an Operational Agreement (FORM: HOA), been attached'?
❑ Yes ❑No ®N/A
4,. Origin of wastewater: (check all that apply):
® Residential 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 % Commercial
I % Industrial (See 15A NCAC 02T :0103(20))
, Is there a Pretreatment Program in effect? ❑ Yes ® No
6. Hasa floe- reduction been approved under 15A NCAC 02T .0114(f)? [:]Yes ®No
If ves, provide a cony of flow. reduction awroval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(fl)
Daily Design Flow ",b
gal/
No. of Units
Flow
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
GPU
a See 15A NCAC 02T .01141b), dl (e)(1). and (e)(2) for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling: proposed unknown non-residential development uses; public access facilities located near (ugh 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 estabiislunents 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)
:,�- Do not include future flows or previously permitted allocations
If permitted flow is zero. indicate why:
❑ Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit Number:
® Rehabilitation or replacement of existing scN- er with no new flow expected
❑ Other (Explain):
FORM: FTA 0446 Page 2 of 5

VH. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T.0305 & MDC (Gravity Sewers):
1, Summarize gravity sewer to be permitted:
Size (inches)
8
Length (feet)
460
Material
PVC
15
112
PVC
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 requirement is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T.0305 & MDC (Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: N/A
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: -
3. Design flow of the pump station: millions gallons per day (firm capacity)
=l. Operational point(s) of the pump(s): gallons per minute at feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
6. Power reliabilitv in accordance with 15A NCAC 02T .03050h)(]):
❑ Standby power source or pump with 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
Or if the pump station has an average daily flow less than 15,000 gallons per day:
❑ Portable power source with manual activation, quick -connection receptacle and telemetry - 15A NCAC 02T
.0305(h)(L)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry - 15A NCAC 02T .0305(h)(1)(C):
> It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant (draft agreement)
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
in the case of a multiple station power outage.
FORM: FTA 04-16 Page 3 of 5

IAC. SETBACKS & SEPARATIONS — (02B.0200 & 15A NCAC 02T.030-5(0):
1. Does the project comply with all separations found in 15A NCAC 02T .0305(1) & (g)
15A NCAC 02T.0305(f) contains minimum scuarations that shall be provided for sewer systems:
/R M
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
24 inches
Water mains vertical -water over sewer 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 -f waters of Class I or
Class II impounded reservoirs used as a source of drinking water
100 feet
**Waters classified WS (except WS -1 or WS -V), B, SA. ORW, HQW, or SB from normal
high water or tide elevation and wetlands see itenh IX.2)
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches
10 feet
Any building foundation
5 feet
Any basement
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
An • swiniming pools
10 feet
Final earth Eade (vertical)
36 inches
15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(f) cannot be achieved.
**Stream classifications can be identified using the Division's NC Surface Wafter Classifications weboage
If noncompliance with 02T.0305(f) or (g,), see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ® Yes ❑ No
y See the Division's draft separation requirements for situations where separation cannot be meet
No variance is required if the alternative design criteria specified is utilized in design and construction
➢ As built documents should reference the location of areas effected
3. Does the project comply with all setbacks found in the river basin rules per 15A NCAC 02B .0200? ® Yes ❑ No
This would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Docs the project comply with an individual 404 Permit or any 401 Certifications? ® Yes ❑ No
Wetland -related permits shall be requested. obtained, and adhered to for projects that impact wetlands or surface waters
Information can be obtained from the 401 & Buffer Pennitting Branch
5. Does project comply with 15A NCAC 02T.0105(c)(6) (additional. permits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T.0105(c)(6), directly related environmental permits or certification applications are being prepared, have
been applied for, or have been obtained. Issuance of this pennit is contingent on issuance of dependent permits (erosion and
sedimentation control plans, stonnwater management plans, etc.).
6. Does this project include any sewer collection lines that are deemed "high-prioriq,-?"
Per 15A NCAC 02T.0402. "high-priority sewer" means `any aerial sewer, sewer contacting surface waters, siphon_ or sewer
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes ® No
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 permitee's individual System -Wide Collection permit.
FORM: FTA 04- l6 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T - the Minimum Design Criteria for die Pennittigg of Punip Statigns
arid Force Mains Oat�st version) and the Gravi!y Sewer N6nimum Design Criteria flates . I version) as applicable?
1041��Nlm
If No, completeartd submit die Variance/Alternitive Design Request application (VADC 10- 14) and supporfing documents for
review. Am) roval of the renuest is reQu i red v rior to submittal of the Fast Tracli Ap olication and supporting documents.
2. Professional Engineer's Certification:
that this application for
(Professional Engineer's name from Application Itern 111. 1,)
has been reviewed bv me and is accurate, complete and consistent with the inforination supplied in the plans, specifications,
engineering calculations, and all other supporting documentation to tile 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, Gravity Sewer
Minimum Design Criteria for Gravity Sewers (latest version). and the Mirtimunt 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 tinder my signature and seal signifies that I have reviewed this material and
have judged it to be consistent with die proposed design.
NOTE — In accordance with General Statutes 143-2t5.6A 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 misdemeuior, which mav
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation. _,
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15ANCAC 02T.0106(b):
1. Brent Detwiler, PE, City Engineer, City of Hendersonville attest that this application for
(Signature Authority's name & title from Application Item 1.3.)
has been reviewed by me and is accurate mid 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 aocumentation and attachments are not included, this
application package is subject to being returned as incomplete. I understand that any discharge of wastewater ftom this non -
discharge system to sLwface 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 clairnagainst the Division of Water Resources should a condition
of this pertnit 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 143-215.613. 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.
Signature: Date: 7/6/18
FORM: FTA 04-16 Page 5 of 5