WQ0040500_Application (FTSE)_20181205

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11,28.2018
Mr. Tim Heim, PE NOV 2 8 2018
NCDWQ-Water Quality Section %.
2090 US Highway 70 it
Swannanoo, NC 28778
RE: Highland Lake Village- Gravity Sewer Extension Permit Application
bear Mr. Helm,
Please find the enclosed the permit submittal forthe Highland Lake Village Project within Henderson County.
This project will require 1,826 LP. of 8" PVC.(SDR 35) sewer and15 new manholes. A total flow allocation of
9,270 GPD Is required to serve the construction of 27new residential houses. I have included the original
and a copy of all the permit documents.
Please give me a call if you have any questions.
Best Regards,
22
ew
Michael , P
Enclosures
HIGH COUNTRY ENGINEERING, PC
TELEPHONE: [phone] FAX: [phone] Clayton St. Ste 300, Asheville, NC. 28801

State of North Carolina
DW Department of Environmental Quality
Division of Water Resources
15A NCAC 02T.0300— FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources ETA 04-16 & SUPPORTING DOCUMENTATION
Application Number: (to be completed by DWB)
All items must be completed or the application will be returned
1. APPLICANT INFORMATION:
I.
2.
3.
4.
5.
Applicant's name: City of Hendersonville (company, municipality, HOA, utility, etc.)
Applicant type: ❑ Individual
❑ Corporation ❑ General Partnership
❑ Federal
❑ State/County ® Municipal
Signature authority's name: Lee
Smith per 15A NCAC 02T .0106(bl
Title: Utilities Director
Applicant's mailing address: 305
Williams Sheet
City: Hendersonville
State: NC Zip: 28731-0000
Applicant's contact information:
Phone number: 828 697-3073
Email Address: lsmith&olnc.gov
❑ Privately -Owned Public Utility
❑ Other
NOV 2 8 2018
H. PROJECT INFORMATION:
1. Project time: Hatband Lake Village Utility Extension
2. Application/Project stamps: ® Proposed (New Permit) ❑ Existing Permit/Project
Ifs modification, provide the existing permit number: W000 and issued date:
If new construction but part ore master plan, provide the existing permit number. W000
3. County where project is located: Henderson
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.67573' Longitude:-8265816°
5. Parcel ID (ifapplicable): 957773524, 9577742053
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION
1. Professional Engineer: Michael R Goforth, PE License Number: 033862
Earn: High Country Engineering, PC (NC Firm No. C-3347)
Mailing address: 41 Clayton Sheet Suite 300
City: Asheville State: NC Zip: 28801-0000
Phone number: (MS) 231-9380 Email Address: meoforth(dhcepc.nel
TV. WASTEWATER TREATMENT FACILITY(WWTF) INFORMATION:
1. Facility Name: Hendersonville WWTP Permit Number: NCO025534
Owner Name: City of Hendersonville
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ Downstream (Receiving) Sewer Size: _inch
System Wide Collection Svstem Permit Number(s) (if applicable): WQCS
Owner Name(s):
FORM: ETA 04-16 Page 1 of 5

VI. GENERAL REQUIREMENTS
1. 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: HEY been attached?
❑ Yes ❑No ®N/A
3. If the Applicant is a Home/Proverty
Owners'Association, has an Olterational Aare
e t (FORM HOA) been attached?
❑ Yes ❑No MN/A
4. Origin of wastewater: (check all that apply):
M 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
Industrial (See 15A NCAC 02T.0103(20)1
"Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 02T .0114(f)? ❑ Yes M No
➢ If Yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see OZT.0114(0)
Daily Design Flow `•°
No. of Units
Flow
Residential (3-Bedrooms/House)
360 gal/House
27
9,720 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
I 9,720,.6PD
a See 15A NCAC 02T.0114(b)fill (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 high public use areas;
and residential property located south or east ofthe Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in G.S. 42A.4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.01141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 9 720 (dPD (per 15A NCAC 02T .01 Ul
), 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

VD. GRAVITY SEWER DESIGN CRITERIA (If Applicable) -02T 60305& MDC IQ avity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8
17826 '
PVC (SDR 35)
➢ Section II & III of the MDC for Permitting of Oravity Sewers contains information related to design criteria
➢ Section IU 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
VIH. 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:
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 02T0305(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 bapermanen ntfacility
Or if the pump station has an average daily flow less than 15,000 gallons per day:
❑ Portable power source with manual activation, quick-comrection 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 timeftames, shall be provided
in the case of a multiple station power outage.
FORM: ETA 04-16 Page 3 of 5

IS. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations found in 15A NCAC 02T 0305(f) & (a) ® Yes ❑ No
O n," ­­�­ ­­­;­,h.., �hnn he ne Mr d FM ecumr m...i a
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
I8 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, W S4 waters of Class I or
Class B impounded reservoirs used as a source of drinking water
100 feet
** Waters classified WS (except WS-I or WS-V), B, SA, ORW, HQW, or Sly from normal
high water or tide elevation and wetlands see item 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 sloe of embankment or cuts of 2 feet or more vertical height
10 feet
Dmina e s stems and interceptor drains
5 feet
An awimmin Dols
10 feet
Final earth made vertical
36 inches
➢ 15A NCAC 02T 0305(a) contains alternatives where separations in 2T 0 05 cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications welemma
➢ If noncompliance with 02T 0305(f) or (a)see Section Xofthis application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ® Yes ❑ No ❑ N/A
➢ 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 setbacks found in the river basin rules per 15A NCAC 02B 0200? ® Yes ❑ No ❑ N/A
➢ This would include Trout Buffered Streams per 15A NCAC 2130202
4. Does the project require coverage/authorization under a 404 Nationwide or ❑ Yes M No
individual permits or 401 Water Quality Certifications?
➢ Information can be obtained from the 401 & Buffer Permitting Branch
5. Does project comply with 15A NCAC 02T.0105(e)(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 permit is contingent on issuance of dependent permits (erosion and
sedimentation control plants, stormwater management plans, etc.).
6. Does this project include any sewer collection lines that are deemed "high -priority?"
Per 15A NCAC 02T 0402, "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streambanes that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes ❑ No ® N/A
➢ 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

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T the Minimum Desio Criteria for the Permits n of Stations
and Force Mains (latest-y—ers-iml and the Gravity Sewei Miniamin Desian Criteria (latest vers'onl as applicable?
® Yes ❑ No
IfNo, complete and submitthe Variance/Attemative Design Request application (VADC 10-14) and supporting documents for
review. Approval ofthe reauest is reauired prior to submittal of the Fast Track Application and supporting documents.
2. Professional Engineer's Certification:
I Michael R. Goforth attest that this application for
(Professional Engineer's name from Application Item III.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 shear 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 andar my signature and seal signifies that I have reviewed this material and
havejudged it to he 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 par violation.
North Carolina Professional Engineer's seal, signature, and date:
High Country Engineering, PC
41 Clayton Street, Suite 300
Asheville, NC 28801
NC Firm No.: C-3347
3. Applicant's Certification per 15A NCAC 02T.0106(b):
this application for
name
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required parts of
this application are not completed and that if all required supporting documentation and attachments are not included, this
application package is subject to being returned as incomplete. I understand that any discharge of wastewater from this non -
discharge system to surface waters or the land will result in an immediate enforcement action that may include civil penalties,
injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water Resources should a condition
of this permit be violated. I also understand that if all required parts of this application package are not completed and that if
all required supporting information and attachments are not included, this application package will be returned to me as
incomplete.
NOTE - In accordance with General Statutes 143-2 5 6A and 143-2 i 5.6B, 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.
A
Signature: 1 /I"' I- / Date:
FORM: FTA 04-16 Page 5 of 5

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State of North Carolina
Department of Environmental Quality
Division of Water Resources
Mvislon of w,at, acsoin <<,5 Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: City of Hendersonville
Project Name for which flow is being requested: Highland Lake Village
More than one FTSE may be required for a single project ithe owner ofthe WWTP is not responsible for'all pump -
stations along the route ofthe proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant. NOV 2 8 7018
a. W WTP Facility Name: City of Hendersonville Waste Water Treatment Plant
b. W WTP Facility Permit #: NC0025534
AlI flows are in MGD
c. W WTP facility's permitted flow 4.8
d. Estimated obligated flow not yet tributary to the W WTP 0.06822
e. W WTP facility's actual avg. flow 2.880
f. Total flow for this specific request - 0.00972
g. Total actual and obligated flows to the facility 2.96
It. Percent of permitted flow used 61.6
H. 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 W WTP:
(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)
MOD
MGD
MGD
MGD
Flow
.Capacity***.
012
0.192
O. 074
0.01
D.6)&P)
.2•51%
/,Qj
* 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 W WTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): J g pJ10147 WNi T
Downstream Permit Number:
Page 1 of 6
FTSE 04-16

III. Certification Statement:
I L @? /� i %� 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 indicates acceptance of this wastewater flow.
Page 2 of 6
FTSE 04-16

USGS Quad Map
.Henderson Quadrangle
North Carolina - Henderson Co.
7.5-Minute Series

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DWR State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T.0300—FAST . TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION
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 Criteriaand that plans, specifications and supporting documents have been prepared in accordance with, 15A
NCAC 02Ty 15A NCAC 02T .0300, Division Policies and eaod eneineering practices.
While noupfront engineering design documents are required for submittal, in accordance with I5A NCAC 02T .0305(b); design
'documents must be prepared prior to submittalof a fast track permit applicationto the Division. This world include plans, design
calculations, and project specifications referenced in 15A NCAC 02T:.0305 and the applicableminimum design criteria. These
documents shall be available upon request by the Division.
Projects that are deemed permitted (do not require a permit from the Division) are explained in: 15A NCACO2T.0303
Projects not eligible for review via the fast track process (must besubmitted for full technical review)
➢ Projects that require an environmental assessment in accordance with 15A NCAC 1C .0100;
➢ Projects that do not meet. any part of the mwmum design criteria (MDC) document;
NOV
➢ Projects that involve a variance from the requirements of 15A NCAC 2T; a
➢ Pressure sewer systems utilizing septic tank -effluent pumps (STEPS) or simplex grinder pumps;
➢ 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 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. 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 of Application and Supporting Documents
® Required unless otherwise noted
B. Cover Letter (Required for All Application Packages):.: NOV ? f3 2018
® 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.
➢ If necessary for clarity, include attachments to the application form.
C. Application Fee (AR New and Major Modification Application Packages):
® Submit checkor money order in the amount of $480.00 dated within 90 days of application submittal
➢ Payable to North Carolina Department of Environmental Quality (NCDEQ)
D. Fast Track (Form: FTA 04-16) Application (Required for All Application Packages):
® 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
the Nortir Carolina Secretary of State,
❑ If the Applicant Type in Item 1.2 is a partnership or d/b/a, enclose acopy of the certificate filed with the Register of
Deeds in the county of business.
❑ The Project Name in Item IL 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.
® The Applicant's Certification on Page 5 of the application shall be signed in accordance with 15A NCAC 02T .0106(b).
Per 15A NCAC 02T .0106(c), an alternate person may be designated as the signing officialif a delegation letter is
provided from a person who meets the criteria in 15A NCAC 02T .0106(b).
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 1 of

E. Flow Tracking/Acceptance Form (Form: FTSE 04-16) (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 expireprior 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(al.
➢ Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific FTSE.
F. Site Maps (All Application Packages):
® Submit an:8.5-inch z 11-inch color copy of a USGS Topographic Map of sufficient scale to identify the entire project
area and closest surface: waters.
➢ Location of the project (gravity sewer, pump stations & tome main)'
➢ Downstream connection points and permit number (if known) for the receiving sewer
® Include a street level map (aerial) showing general project area so that Division staff can easily locate it in the. field.
G. Existing Permit (Ali Modification Packages):
❑ Submit the recently issued existing permit.
❑ Provide a list of any items within the permit the. Applicant would like the Division to address during the. permit
modification (i.e., permit description, flow allocation, treatment facility, etc.).. .
H. Power Reliability Plan (Required Hportable reliabilityoption utilized for Pump Station):
-.❑ Per 15A NCAC 02T0305(h)(1), 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 sourceis 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 an 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. (Required at time of certification)
I.: Certificate of Public Convenience and Necessity (Ali Application Packages for Privately -Owned Public Utilities):
❑ Per 15A NCAC 02T- 0115(a)(1) provide the Certificate of Public Convenience and Necessity from the North Carolina
Utilities. Commission demonstrating the Applicant is authorized to bold the utility franchise for the area to be served by
served by
the sewer extension, or
❑ Provide 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 men is contiguous to an existing franchised area or that
franchise approval is expected.
J. Operational Agreements (Applications from HOA/POA and Developers for lots to be sold):
❑ Home/Property Owners' Associations
❑ Per 15A NCAC 02T 01 15(c), submit the properly executed Operational Agreement (FORM' HOA).
❑ 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 15ANCAC 02T.0115(b), submit the properly executed. Operational Agreement (FORM, DEV).
For more information, visit the Division's collection systems website
:INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 2 o£3.:

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