WQ0040399_Application (FTSE)_20180913

State of North Carolina
Department of Environmental Quality
.DWRDivision of Water Resources
15A NCAC 02T.0300-- FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number. N U o -1 o 3 qq ito be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
I . Applicant's name: Orange Water & Sewer Authority (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ❑ Municipal ® Other
3. Signature authority's name: Ed Kerwin per 15A NCAC 02T .0106 b
Title: Executive Director
4. AppIicant's mailing address: 400 Jones Feny Road
City: Carrboro State: NC Zip: 27510-
5. Applicant's contact information:
Phone number: (2L9) 537-420I Email Address: n arker owasa.or
II. PROJECT INFORMATION:
I. Project name: SECU Family House Ex ansion
2. Application/Project status: ® Proposed (New Permit) ❑Existing Permit/Project
y
=
0
If a modification, provide the existing permit number: WQ00_ and issued date:
CY
If new construction but part of a master plan, provide the existing permit number: WQ00_
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_
3. County where project is located: Orange
E
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.901055' Longitude:-79.029646
5. Parcel ID (if applicable): PM 9788-54-3697
(or Parcel ID to closest downstream sewer)
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0
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III. CONSULTANT INFORMATION:
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A
I. Professional Engineer: Charles N. Hill Jr. P.E. 2
g License Number: NC ..346 i
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Firm: Coulter Jewell Thames P.A.
Mailing address: I I I West Main Street
City: Durham State: NC Zip: 27701-�
Phone number: [phone] Email Address: chi�citna.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Mason Farm Wastewater Treatment Plant Permit Number: NC 0025241
Owner Name: OWASA
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ-3-0(,9q Downstream (Receiving) Sewer Size: 13 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS00031
Owner Name(s): Orange Water & Sewr Authori
FORM: FTA 04-16 Page 1 of 5

VI. - GENERAL REQUIREMENTS
I. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes []No ON. -:A
2. If the Applicant is a Developer of lots to be sold, has a Uevekaper's Operational Agreement (FORM: DEV} been attached?
❑ Yes []No ®N!A
3. If the Applicant is a Horne?Pro ertw Owners' Association, has an Operational Agreement { FORM: HOA) been attached?
❑ Yes ❑No ®N/A
4. Origi f wastewater: (check all that apply):
Residential Owned El Retail (stores, centers, malls)
Residential Leased ❑ Retail with food preparatione'service
❑ SchooI J preschool ,` day care ❑ Medical ; dental veterinary facilities
❑ Food and drink facilities ❑ Church
❑ Businesses offices factories ❑ Nursing Home
5. Nature of wastewater: 100 % Domestic. -Commercial % Commercial
Qti
� "'t
El Car Wash ! tom`.
Hotel and/or Motels
Swimming Poo! /Clubhouse
❑ Swimming Pool?Filter Backwash
❑ Other (Explain in Attachment)
% Industrial See 15A NCAC 02T .0103(M)
1Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 02T .01 14 ? ❑ Yes ® No
If yes, provide a cony of flow reduction annroval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114 Daily Design Flow
No. of Units
Flow
�*
Hotel Rooms 120 gal/day
36
4320 GPD
gall
GPD
gal/
GAD
gall
GPD
gall
GPD
gal/
GPD
Total
4320 GPD
a See 15A NCAC 02T .0114(b). (d). (e)(I)and (e)(2) for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use areas;
and residential property Iocated south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in G.S. 42A4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.0114I shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated b project: 4320 GPD g Y J P (per 15A NCAC 02T .0114
D 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 sewer with no new flow expected
❑ Other (Explain):
FORM: FTA 04-16 Page 2 of 5

VI1. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 132 DIP
➢ Section I1 & 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
I . Pump station number or name: NA
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: -
3. Design flow of the pump station: __ millions gallons per day (firm capacity)
4. 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 reliability in accordance with 15A NCAC 02T .0305(h)(1):
❑ 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)(1)(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

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
I- Does the project comply with all separations found in 15A NCAC 02T .0305(f) & (a,)
® Yes [:]No
➢ 15A NCAC 02T.0305 contains alternatives where separations in 02T.0305(f) cannot be achieved.
*"Stream classifications can be identified using the Division's NC 5grface Water lja_ssifications webpaTe
➢ If noncompliance with 02T.0305(f) or (e). see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ® Yes ❑ No
➢ 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 213.0202
4. Does the project comply with an individual 404 Permit or any 401 Certifications? NA []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 Permitting Branch
5. Does project comply with 15A NCAC 02T.0105 c 6 (additional permits/certifications)?
® Yes ❑ No
Per I JA NCAC 02 010 6 , directly related environmental permits or certification applications are being prepared, have
been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion and
sedimentation control plans, stormwater management plans, etc.).
6. Does this project include any sewer collection lines that are deemed "high -priority?"
Per 1�A 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 04-16 Page 4 of 5

4
X. , CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design CEiteria for the Permittin oUumy Stations
and Force Mains latest version and the ray�}fewer Minimum Design Criteria (latest versions as applicable?
® Yes ❑ No
If No, complete and submit the VariancefAlternative Design Request application (VADC 10-14) and supporting documents for
review. Approval of the reguest is re uired prior to submittal of the Fast Track Application and supporting documents.
2. Professional Engineer's Certification:
(Professional Engineer's name from Appl
"-s IAA
Item Ill.1.)
attest that this application for
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, Gravity Sewer
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track Permitting
of Pump Stations and Force Mains (latest version). Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that I have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE In accordance with General Statutes 143-215.6A and 143-215.613, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation.
. ...............................
North Carolina Professional Engineer's seal, signature, and date: ,,`�� �� IG'4R0�,�� ?
.� C • �.
SEAL
_ 3461
E : 0. ` 3
I �NGIN
Applicant's Certification per 15A NCAC 02T .0106(b):
(Signature Authority's name &
Dr,rcL�vr
tiom Application Item 1.3.)
_attest that this application for
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 wiII be returned to me as
incomplete.
NOTE In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be Tilty of a Class 2 misdemeanor, which may
include a fine not to exceed $ I0,000 as well as civil penalties up to $25,000 p i lation.
Signature: yILte—CDate:
FORM: FTA 04-16 Page 5 of 5

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Planning for the Future C
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July 25, 2018
Nick Parker
Orange Water and Sewer Authority
400 Jones Ferry Road
Carrboro, NC 27510
RE: SECU Family House Expansion
Wastewater Permit Cover Letter
Mr. Parker,
The SECU Family House is located at 123 Old Mason Farm Road. The proposed project will
add a building to the existing site, with the associated grading, drainage, parking, and water and
sewer service.
Public Utilities, including Public Sewer, are proposed to be installed as a part of this project to
serve the new building addition. Approximately 132 linear feet of 8" DIP sewer line is proposed
to serve the addition. The proposed line will extend along the existing service entrance near the
rear of the existing building, and will connect to the existing sewer manhole at that location.
The requested capacity for the project is 4320 GPD, based on the state requirement of 120
GPD/room for the 36 rooms proposed.
Please contact me if there are any questions regarding this application, and thanks for your
assistance.
Sincerely,
cLt"k A"e
Chuck Hill P.E.
Project Engineer

r
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: Orange Water and Sewer Authority
Project Name for which flow is being requested: SECU Family House Expansion
Adore limn one FTSE maY he required for a single project if the owner of the Il'IVTP is not responsible for all pump
stations along the route of ire proposed wastewater flom
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Mason Farm Wastewater Treatment Plant
b. WWTP Facility Permit #: NC0025241
All flows are in MGD
c. WWTP facility's permitted flow 14.5
d. Estimated obligated flow not yet tributary to the WWTP 0.563
e. WWTP facility's actual avg. flow 8.631
F Total flow for this specific request 0.004 (4320 gpd)
g. Total actual and obligated flows to the facility 9.198
h. Percent of permitted flow used 63.4%
It. Complete this section for each pump station you are responsible for along the route of this
proposed wastewater flow.
List pump stations located between the project connection point and the WWTP:
(A) (B) (C) (D)=(B+C) (E)=(A-D)
Design Obligated,
Pump Average Daily Approx. Not Yet Total Current
Station Firm Flow** Current Avg. Tributary Flow Plus
(Name or Capacity, * (Firm i po, Daily Flow, Daily Flow, Obligated Available
Number) MGD MGD MGD MGD Flow Capacity***
NA
* The Firm Capacity 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 (pi) not less than 2.5.
*** 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):
Downstream Permit Number:
Page 1 of 6
FTSE 04-16

III. Certification Statement:
I Ed Kerwin 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 addendums for which I am the responsible party. Signature of this
form indicates acceptance of this wastewater flow.
Signing Officicil Signant'e
4! --D re
/9
Page 2 of 6
CTSE 04-16

QWASA ORANGE WATER AND SEWER AUTHORITY
A public, non-profit agency providing water, sewer and reclaimed water services
to the Carrboro-Chapel Hill community.
September 6, 2018 NC Dept ofEnvironmentul Qvaliry
2018
NCDEQ Water Quality Section Raleigh 1628 Mail Service Center Reg1onal OffSce
Raleigh, NC 27699-1628
SUBJECT: Permit Application for SECU Family House Expansion
DWR Staff,
Enclosed are the following items for your review and approval. The project includes extension of the
sanitary sewer system to serve a building addition -
Fast -track Application form FTA 04-16 (original and copy)
Flow Tracking/Acceptance form FTSE 04-16 (original and copy)
Check in the amount of $480.00
Project Narrative
Please contact me by telephone at 919 537-4201 or email to nparker(),owasa.orp if you have any
questions or comments.
Respectfully,
Nicholas L. Parker
Engineering Associate
cc: Todd Spencer, PE — QWASA
Charles Hill, PE — Coulter Jewell Thames
400 Jones Ferry Road Equal Opponunitr Emplcrer Voice (919) 968-4.421
Carrboro, NC 27510-2001 Printed on Recycled Paper irim.owasaory