WQ0040499_Application (FTSE)_20181205

Transmittal
From:41) Emommew- Rms
603 South Lake Drive
Lexington, SC 29072
Phone: [phone]
[e-mail]
To: INC DEQ
Ashville Regional Office
2090 US Hwy 70
Swannanoa, INC 28778
Method: USPS
ATTACHED are the following documents:
❑ Preliminary Plans ® Permit Plans
❑ Calculations
❑ Shop Drawings
❑ Specifications
❑ Other
Nov 2 6 2018 R
\fll ram- n„
Date: November 20, 2018
Project: Murphy Nursing Home
4D Proj. No: 18012
Regarding: Sewer System Permit Application
❑ Construction Plans
❑ Construction Documentation
COPIES
DESCRIPTION OF ATTACHED
CODE
1
Application Fee for $480
8
1
SSEA 08-13 Sewer System Extension Application
1
1
Flow Tracking/Acceptance Form
1
1
Site Maps (USGS and Vicinity Map)
1
1
Applicable Project Specifications (water, storm, site grading, ect excluded)
1
1
Sewer Flow Calculations
1
The above are coded as noted below:
1. For your review and approval 3. Approved 5. Revise and resubmit 7. For your use and distribution
2. For your information and file 4. Rejected 6. Furnish as corrected 8. As requested
Comments Attached is our sewer construction permit package for your review and approval. If you need anything
CC:
else regarding this package, do not hesitate to contact us. Thanks much!
By: /Philip Lowry
Engi eering Associate
,!615)
WWW.4DENGR.COM

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November 14, 2018
State of North Carolina
Department of Environmental Quality
Division of Water Resources
2090 US Highway 70
Swannanoa, North Carolina 28778
Attn: Asheville Regional Office Water Quality Section
Re: FTA 08-13 Cover Letter
Century Care Management
130 Edinburgh South
Cary, NC 27511
Dear Sir or Madam;
i
NOV 2 6 2018 " {[
The purpose of this submittal is to submit a Fast -Track Application (FTA 08-13) for approval by
the Asheville Regional Office Water Quality Section. The sanitary sewer system will consist of
1001 LF of 8" DIP Sewer Main and 7 new manholes. The system will serve a 70,000 sf nursing
home and is located at 190 Slow Creek Road, Murphy NC 28906.
We thank you for your review of our submittal. If there are any questions, or if additional
information is required, please contact us at [phone].
Respectfully,
4D Engineering
Charles W. Deep, PE
President
603 South Lake Drive — Lexington, SC 29072—wwwADEngr.eom

State of North Carolina
DWR
Division of Water Resources
NOV 2 6 201q
for tiRA
of Environment and Natural Resources
Division of Water Resources
FAST -TRACK APPLICATION (FTA 08-13)
SEWERS, PUMP STATIONS, AND FORCE MAINS
General — When submitting this application, please use the'foll,6wing instructions as a checklist in order to ensure
all required items are submitted. Adherence to these instructions and checking the provided boxes will help
produce a quicker review time and reduce the amount of requested additional information.
For more information, visit the Surface Water Section's Collection Systems website or;
contact the Regional Office serving your county
Unless otherwise noted the Applicant shall submit one original and one copy of the application and supporting
documentation to the appropriate Regional Office (see page 3).
0
Include a brief project narrative describing the final design (i.e system and/or pump station to ul
e_ a 500 homes, but flow for only 100 homes being requested now).1 For modifications, clearly
the reason for the modification (i.e. adding another phase, changing line size, length, etc).
B. Application Form (FTA 08-13):
P1 Submit the completed and appropriately executed Fast -Track (FTA 08-13) Application. Any unauthorized
content changes to this form shall result in the application being returned. If necessary for clarity or due
to space restrictions, attachment to the application may be made, as long as the attachments are
numbered to correspond to the section and item to which they refer. You do not need to submit detailed
plans and specifications unless you respond NO to item B(13).
p� The Professional Engineer's Certification of the application shall be signed, sealed and dated by a North
Carolina licensed Professional Engineer.
❑ The Applicant's Certification of the application shall be signed in accordance with 15A NCAC 02T
.0106(b). Per 15A NCAC 02T .0106(c), an alternate person maybe designated as the signing official if
a delegation letter is provided from a person who meets the criteria in 15A NCAC 02T .0106(b).
C. Application Fee:
L� Submit a check in the amount of $480 to: North Carolina Department of Environment and Natural
Resources (NCDENR).
➢ Checks shall be dated within 90 days of application submittal.
D. Certificate of Public Convenience and Necessity (For Privately -Owned Public Utilities Only):
(VEl Per 15A NCAC 02T .0115(a)(1), provide two copies of the Certificate of Public Convenience and
IANecessity from the North Carolina Utilities Commission demonstrating the Applicant is authorized to hold
the utility franchise for the area to be served by the sewer extension, or
❑ Provide two copies of a letter from the North Carolina Utilities Commission's Water and Sewer Division
Public Staff stating an application for a franchise has been received and that the service area is
contiguous to an existing franchised area or that franchise approval is expected.
❑ The project name in the CPCN or letter must match that provided in Item A(2)a of this application.
E. Operational Agreements (For Home/Property Owners' Associations and Developers of lots to be sold):
�//A ➢ Home/Property Owners' Associations
!T ❑ Per 15A NCAC 02T .0115(c), submit the properly executed Operational Agreement (HOA 08-13).
❑ Per 15A NCAC 02T .0115(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
➢ Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(b), submit the properly executed Operational Agreement (DEV 08-13).
Even if the project may be turned over to a municipality upon completion, Form DEV 08-13 is required.
INSTRUCTIONS FOR APPLICATION FTA 08-13 & SUPPORTING DOCUMENTATION Page 1 of 6

Downstream Sewer, WWTF Capacity and Flow Tracking/Acceptance Form (FTSE 08-13)
19/ Submit the completed and appropriately executed Flow Tracking/Acceptance for Sewer Extension Permit
(FTSE 08-13) Form for all applications.
➢ The applicant (and owners of downstream sewers, pump stations and/or treatment facilities submitting
form FTSE 08-13 certifies that the addition of the volume of wastewater to be permitted in this project
has been evaluated along the route to the receiving treatment plant, and that the flow from this project
will not cause capacity related sanitary sewer overflows or overburden any downstream pump station en
route to the receiving wastewater treatment plant.
➢ Where the applicant is not the owner of the downstream sewer, submit two copies of form FTSE 08-13
from the owner of the downstream sewer and owner of the WWTF, if different.
➢ The flow acceptance indicated in form FTSE 08-13 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 08-13 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 08-13.
G. S
C9 Submit an 8.5-inch x 11-inch color copy of a USGS Topographic Map of sufficient sca_le.t
entire project area and closest surface waters. Each map must include at a minimu_m�_
➢ The location of the sewer line and pump stations and be of reproducible quality.
➢ Downstream connection points and the permit number for the receiving sewer (if known)
➢ Pump Station Locations and the longitude and latitude for each pump station (if applicable)
L�1 Include a street level map showing all relevant project areas.
H. Stream Classification (WSCAS 08-13)
(VIA ❑ Submit the completed and appropriately executed Watershed Classification Attachment form
(WSCAS 08-13) if any portion of the sewer system project is within 100 feet of any surface water or
wetlands.
➢ A variance must be requested for encroachment within required setbacks or buffers pursuant to 15A
NCAC 02T .0305(f)
I. Environmental Assessments (Projects subject to an Environmental Assessment (EA)):
➢ Projects involving an Environmental Assessment per 15A NCAC 01C .0408, must be submitted for a full
technical review and must be submitted to the PERCS Unit on application forms provided by the Division.
Alternative Sewer Systems
➢ Projects involving low pressure sewer systems, vacuum sewer systems and other alternative sewer
systems must be submitted for a full technical review and must be submitted to the PERCS Unit on
application forms provided by the Division.
K. Flow Direction
➢ Many wastewater treatment systems are entering into agreements for regionalization efforts and
emergency treatment capacity. Parts of the system are installed so that the wastewater flow can be
directed to more than one treatment facility. If this is the case with the project, please indicate in B(12)
and give the permit number of the second facility.
L. Certifications— Section C
➢ The application must be certified by both the applicant and the design engineer who is a North Carolina
Registered Professional Engineer (PE). The applicant signature must match the signing official listed in
Item A(1 b). The PE should NOT certify the application if he/she is unfamiliar with 15A NCAC Chapter
2T, The Gravity Sewer Minimum Design Criteria (most recent version) and the Minimum Design Criteria
for the Permitting of Pump Stations and Force Mains (most recent version), as applicable to the project.
INSTRUCTIONS FOR APPLICATION FTA 08-13 & SUPPORTING DOCUMENTATION Page 2 of 6

USE THE TAB KEY TO MOVE FROM FIELD TO FIELD Application u
ber
(to completed
y DWR) pi,
1.
Owner/Permjttee:
'la.
Town of Murphy
Full Legal Name (company, municipality, HOA, utility, etc.)
NOV 6 ZD�u
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1b.
Chad Simons Town Administrator
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Signing Official Name and Title (Please review 15A NCAC 2T 0106 (b) for auth rize slgn�g,officials)
,-,.,I n;, r ins
:1 c.
The legal entity who will own this system is:-
'-
❑ Individual ❑ Federal ® Municipality ❑ State/County ❑ Private Partnership ❑ Corporation ❑ Other (specify)
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''1d.
5 Woffard Street '.le. Murphy
ZMailing
Address City
—,1f.
North Carolina 1g. 28906
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State Zip Code
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�111h.
[phone] 11. I1j. town of [e-mail]
QTelephone
Facsimile E-mail
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2.
Project (Facility) Information:
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2a.
Murphy Nursing Home 2b. Cherokee
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Brief Project Name (permit will refer to this name) County Where Project is Located
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',3.
Contact Person:
a3a.
Charles Deep, 4D Engineering
Name and Affiliation of Someone Who Can Answer Questions About this Application
3b.
803-356-0909 3c. Charlie@4dengccom
Phone Number E-mail
11.
Project is ® New ❑ Modification (of an existing permit) If Modification, Permit No.:
'2.
Owner is ® Public (skip to Item B(3)) ❑ Private (go to Item 2(a))
2a.
If private, applicant will be: 2b. If sold, facilities owned by a (must choose one)
❑ Retaining Ownership (i.e. store, church, single office, etc.) or ❑ Public Utility (Instruction D)
❑ Leasing units (lots, townhomes, etc. - skip to Item B(3)) ❑ Homeowner Assoc./Developer (Instruction E)
❑ Selling units (lots, townhomes, etc. - go to Item B(2b))
�3.
Town of Murphy1
Owner of Wastewater Treatment Facility (WWTF) Treating Wastewater From This Project
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F
4a.
Murphy WWTP 4b. NCO020940
Q
Name of WWiF WWTF Permit No.
"5a.
Town of Murphy 5b. 8 Z Gravity 5c Unknown
Size Force Main
❑ Permit # of Downstream Sewer (Instruction F)
of twastewaterream ris
Shat
6.
TOhe origin n of th swner
(check a91 apply)ewer
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❑ Residential Subdivision ❑ Retail (Stores, shopping centers) 100% Domestic/Commercial
❑ Apartments/Condominiums ❑ Institution 0% Industrial
—
❑ Mobile Home Park ❑ Hospital
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❑ School ❑ Church (Attach Description) j
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ElRestaurant ® Nursing Home 0% Other
❑ Office ❑ Other (specify): —
(Attach Description)(.
i,7.
Volume of wastewater to be allocated or permitted for this particular project: 16,080 gallons per day
j
'Do not include future flows or previously permitted allocations
�8.
If the permitted flow is zero indicate why:
i
❑ Pump Station, Outfall or Interceptor Line where Flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit No.
❑ Rehabilitation or replacement of existing sewer with no new Flow expected
(see 15A NCAC 02T .0303 to determine if a permit is required)
FTA 08-13 APPLICATION Page 4 of 6

9. Provide the wastewater Flow calculations used in determining the permitted flow in accordance with 15A NCAC 2T .0114 1
the value in Item B(7) ANDIOR the design flow for line or pump station sizing if a reduced or zero flow is being requested
Item B(7). Values other than that in 15A NCAC 2T .0114 (b) and (c) must be supported with actual water or wastewater u:
data in accordance with 15A NCAC 2T .0114 (f).l
134 Beds (with Laundry) @ 120 gpd = 16,080 gallons per day
'110. Summary of Sewer Lines to be Permitted (attach additional sheets if necessary)
Size (inches) Length (feet) New Gravity or Additional
Force Main
8 DIP............ 1001 ®' New Gravity
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'�,11. Summary of Pump Stations w/ associated Force Mains to be Permitted (attach additional sheets as necessary)
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0 .Pump Station Location ID: _ (self chosen - as shown on plans/map for reference)
0
(Longitude: Latitude:
Z'
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Design Flow Operational Point Power Reliability Option
(MGD) GPM @TDH 1 - permanent generator w/ATS; Force Main Size Force Main Lengl
2 - portable generator w/MTS
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Pump Station Location ID: (self chosen - as shown on plans/map for reference)
F
5 ',Longitude: Latitude:
ii
It
LIJ Design Flow Power Reliability Option
I' (MGD) Operational Point 1 -permanent generator w/ATS; Force Main Size Force Main Lengl
GPM @TDH 2 - portable generator wIMTS
12. Will the wastewater flow in the proposed sewer lines or pump stations be able to be directed to another treatment facility?
❑ Yes ® No If Yes, permit number of 2nd treatment facility
(RO — if "yes" to B,12 please contact the Central Office PERCS Unit)
13. Does the sewer system comply with the Minimum Design Criteria for the Permitting of Pump Stations and Force Mains
(latest version), the Gravity Sewer Minimum Design Criteria (latest version) and 15A NCAC Chapter 2T as applicable?
® Yes ❑ No If No, please reference the pertinent minimum design criteria or regulation and indicate why a
variance is requested. SUBMIT TWO COPIES OF PLANS, SPECIFICATIONS OR CALCULATIONS
PERTINENT TO THE VARIANCE WITH YOUR APPLICATION
FTA 08-13 APPLICATION Page 5 of 6

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14. Have the following permits/certifications been submitted for approval for the system or project to be served?
Wetland/Stream Crossings - General Permit or 401Certification? [:]Yes ❑ No ® N/A
Sedimentation and Erosion Control Plan? ® Yes ❑ No ❑ N/A
Trout Buffer Waiver?
Stormwater?
❑ Yes ❑ No IR NIA
❑ Yes ❑ No 0 N/A
15. Does this project include any high priority lines (15A NCAC 02T .0402 (2)) involve aerial lines, siphons, or interference
manholes)? These Imes will be considered high priority and must be checked once every six months
Check if Yes: ❑ and provide details:
1. Owner/Permittee's Certification: (Signature of Signing Official and Project Name)
la.
1, Chad Simons attest that this application for Murphy Nursing Home 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 requiredsupporting documentation and attachments are not included, this
application package is subject to being returned as incomplete. Note: In accordance with North Carolina General Statutes
143-215.6A and 143-215.6E any person who knowingly makes any false statement, representation, or certification in any
application 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.
Official Signature Date
ENGINEERING DESIGN DOCUMENTS MUST BE COMPLETED PRIOR TO SUBMITTAL OF THIS
APPLICATION. THESE DOCUMENTS MUST INCLUDE PLAN AND PROFILE OF SEWERS, THEIR PROXIMITY
TO OTHER UTILITIES, DESIGN CALCULATIONS, ETC. REFER TO 15A NCAC 02T .0305
2. Professional Engineer's Certification: (Signature of Design Engineer and Project Name)
1, Charles W Deep ,attest that this application for Murphy Nursing Home has been
reviewed by me and is accurate, complete and consistent with the information in the engineering plans, 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 adopted February 12, 1996, and the Minimum Design Criteria for the Fast -Track Permitting of Pump
Stations and Force Mains adopted June 1, 2000 and the watershed classification in accordance with Division guidance.
Although other professionals may have developed certain portions of this submittal package, inclusion of these materials
undermy 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 NC General Statutes 143-215.6A and 143-215.6B. any person who knowingly makes
any false statement, representation, or certification in any application 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.
2a. Charles W. Deep
Professional Engineer Name
2b. 4D Engineering Group PLLC
Engineering Firm
2c. 603 South Lake Drive
Mailing Address
2d. Lexington -
City
2g. 803-356-0909 2h. N/A
Telephone Facsimile
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I s 3 10
- 2f 29072
ate zip
arlie@4 dengccom
FTA 08-13 APPLICATION Page 6 of 6

State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Divi6ian of VY der Resources Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 08-13)
Project Applicant Name: Century Care Management
Project Name for which flow is being requested: Murphy Nursing Home
More than one FTSE may be required for a single project if the owner of the WWTP is not responsible for all pump
stations along the rottte of the proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Town of Murphy WWTP
b. WWTP Facility Permit #: NCO020940
All flows are in MGD
c. WWTP facility's permitted flow
1.400
d. Estimated obligated flow not yet tributary to the WWTP 0.29000
e. WWTP facility's actual avg. flow
0.561
f. Total flow for this specific request
0.010
g. Total actual and obligated flows to the facility
0.8511
h. Percent of permitted flow used
0.57 i
Il. 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 / pt), Daily Flow,
Daily Flow, Obligated Available
Number) MGD MGD MGD
MGD Flow Capacity***
Hospital 1.0 0.40 0.1
0 0.1 0.3
Ice Plant 1.0 0.40 .20
0 .2 .2
No. I WWTP 3.6 1.4 .561
.29 .851 .55
* 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 (pf) 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.
Page 1 of 6
FTSE 08-13

III. Certification Statement:
I Chad Simons certify to the best of my knowledge that the addition of
the volume of wastewater to be permitted in this project has been evaluated along the route to the
receiving wastewater treatment facility and that the flow from this project is not anticipated to
cause any capacity related sanitary sewer overflows or overburden any downstream pump station
en route to the receiving treatment plant under normal circumstances, given the implementation
of the planned improvements identified in the planning assessment where applicable. This
analysis has been performed in accordance with local established policies and procedures using
the best available data. This certification applies to those items listed above in Sections I and II
plus all attached planning assessment addendums for which I am the responsible party.
Signature of this form in4icates acceptance of this wastewater flow.
Signing—Qfficial Signature
Date
Page 2 of 6
FTSE 08-13