WQ0040493_Application (FTSE)_20181016

State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
15ANCAC 02T.0300-FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Olvlsloe of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: WQOO 9OH q,�_(to bccomplctcdbyDWR)
All items must be completed r the aflMication will be returns
1. APPLICANT INFORMATION:
1.
Applicant's name: T f H (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: KkAdra D. Parrish. P.E.per 15A NCA C 02T .0106(b)
Title: Director of Fir ineerin
4.
AppIicant's mailing address: 12LSouth Main Street
City: HolIjr S, rings State: IC Zip: 27540-
5.
Applicant's contact information:
Phone number: (21D 555 -393 Email Address: ken dra. rrishnhQIlvsnringsnc.us
I1. PROJECT INFORMATION:
0
ty
1.
Project name: SQLW1;m Crossroads Southwest Sanitary Sewer Outfall
m
2.
Application/Project status: ® Proposed (New Permit) ❑ Existing Pennit/Project
10-
n
t
If a modification, provide the existing permit number: WQ00 and issued date:
If new construction but part of master plan, provide the existing pen -nit number: WQOO
U?�
o
cm
Ozr.a g
3.
County where project is located: Wake
3
4.
Approximate Coordinates (Decimal Degrees): Latitude: 356299 Longitude:-78.8263
5.
Parcel ID (if applicable): 0648846643
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
I. Professional Engineer: Trenton D. Stewart License Number: 024454
Firm: Arcadia Consulting Engineers, PLLC
Mailing address: PO Box 2077
City: Apex State: NC Zip: 27502 _
Phone number: 9{ 19) 363-1422 Email Address:-([e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
I. Facility Name: Utley Creek WastewaterTreatment Plan Permit Number: NCO063096
Owner Name: Town of Holly -Springs
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s). W DD3J331 Downstream (Receiving) Sewer Sipe: -ilk inch
System Wide Collection System Permit Numbers) (if applicable): WQCS �01 9
Owner Name(s): -7-014 S
FORM: FFA 04-16 Page] of5

V1.
GENERAL REQUIREMENTS
I. If the Applicant is a Privatcly-Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑ No [A N/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's0id.r Wivnal Agreerncnt (rORM. [ EVI been attached?
❑ Yes ❑ No © N/A
3. If the Applicant is a HornclProperty Owners' Assacialiyn,has t+n OperatinnaI Aereerrrnt (FORA- HOA) been attached?
❑ Yes [:]No x❑ 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
_% Industrial 15A NCAt' J 10 3J20))
bIs there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 02T .0114(❑ Yes ❑ No
D If yes. provide a cony of flow reduction aWEoval letter
7. Sumn rim wastewater generated by project:
Establishment Type (see 02T.0114(fll
Daily Design Flow '-'
No. of Units
Flow
2.43 ac Daycare
25 gal/ person
192
4,800 GPD
gaV du
GPD
gaV
GPD
gaV
GPD
gal/
GPD
gaV
GPD
Total
4,800 GPD
a See 15A NCAC 02T .0114(b). (d)._&)(l) 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 oreast ofthe Atlantic Intracoastal Waterway to be used as vacation rentals as define d
in GS. 42A-4).
b Per 15A NCAC 02T .01I4(c), design flow rates for establishments not identified [in table A NCAC 2T. 1 141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other rheas ured data.
8. Was tewatergenerated by project: _ GPD (per 15A j'C'AC Q T .0] 14)
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 thatconneetto 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

VIL GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T,0305 & MDC (Gravity Sewers):
I. Summarize gravity sewer to be permitted-
Size(inches) Length (feet) Material
12 1,043.48 PVC
➢ Section 11 & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section III contains information related tominimum slopes forgravity sewer(s)
➢ Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
VI11. PUMP STATION DESIGN CRITERIA (If Applicable) -- 02T.0305&
COMPLETE R EACH PUMP STATION INCLUDED IN THIS PROJWr
I. 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 02T .0305(h)(1):
❑ Standby power source orpump 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 perday
➢ 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 therotation schedule of the portable power source or pump, including travel tirneframes, shall be provided
in the case of multiple station power outage.
FORM: FTA 04-16 Page 3 of 5

1X. SETBACKS & SEPARATIONS — (02B.0200 & 15A NCAC 02T.0305(Q):
I. Does the project comply with all separations found in L5A_NQAC
➢ 15A NCAC 02T.0305(f) contains minimum separations that shall be orovided for sewer systems:
❑ Yes 0 No
See t!Ir-,,
Setback Parameter*
Separation Required
Storm sewer; 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-1 waters of Class I or
Class 11 impounded reservoirs used as a source of drinking water
100 feet
*"Waters classified WS (except WS-I or WS-V), B, SA,ORW, HQW, orSB from normal
high water (or tide elevation) and wetlands (see item IX.2)
50 feet
* *Any otherstream, lake, impoundment, or ground water lowering and surfacc drainage
ditches
I0 feet
Any buildinu 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
Anyswinuning pools
10 feet
Final earth grade vertical
36 inches
➢ 15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(fl cannot be achieved.
➢ **Stream classifications can be identified usingthe Division's NC Surface Water Classifications webnaee
➢ 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 El No
➢ See the Division's draft separation requirements for situations where separation cannot be meet S/p Aarr•6i;v*—
➢ 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 ISA NCAC 02B .02000 ❑ Yes ❑ No
➢ This would include Trout Bufirered Streams per 15A NCAC 213.0202
4. Does the project comply with an individual 404 Permit orany 401 Certifications? 0 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 l�`A.N AC' Q2T.Q105(c1(6) (additional pemtits/certifications)?
❑x Yes ❑ No
Per 15A NCAC 02T.0105(r,X directly related environmental permits or certification applications are being prepared, have
been applied for, or have been obtained. Issuanceof this permit is contingenton issuanceofdependent permits (erosion and
sedimentation control plans, stormwater management plans, etc.).
6. Does this project include any sewercollection Iines thatare 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 streambanks that is subject to erosion that undermines or deteriorates the sewer.
El Yes ElNo
➢ 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 leastouce 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. C©tTiFICATIONS:
I. Does the submitted system comply with _I 5A NC"AC_ OZr, the Mjni morn Design Critcria for the PcnrNtting of Purr V Stations
iand F rce Mains I u and the v r i n C'ri err v r1 as applicable?
1 Yes ❑ No
If No, complete and submit the Variance/Altemative Design Request application (VADC 10-14) and supporting documents for
review. Approval of the request is required prior to submittal Qf the Fast Track Aplication and sunrwrtine documents.
2. Professional Engineer's Certification:
1� Trenton D. Stewart, P.E.
(Professional Engineer's name from Application Item III.1.)
attestthat 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 bestof my knowledge. 1 further attestthatto 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 forthe 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 consistentwith 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.
NN"
North Carolina Professional Engineer's seal, signature, and date: i ,.��,�nR�:tl
e
'''','!`JJJJJ�i1J17111ii1411111,�,�`J
3. Applicant's Certification per 15A NCAC 02T .0106(b):
Kendra D. Parrish, PE _ attest that this application for
(Signature Authority's name & title fiom Application Item 1.3.)T
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. l understand that any discharge of wastewater from this non -
discharge systemto surface water; or the land will result in an immediate enforcement action that may include civil penalties,
injunctive relief, and/orcriminal 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 143-215,6A 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: qiz 12-7
FORM: FrA 04-16 Page 5 of 5

State of North Carolina
WDepartment of Environmental Quality
Division of Water Resources
Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: Town of Holly Springs
Project Name for which flow is being requested: southern Crossroads southwest Sanitary Sewer Outtall
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 route of the proposed wastewaterflow.
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 #: NC 0063096
All flows are in MGD
c. WWTP facility's permitted flow 6.0
d. Estimated obligated flow not yet tributary to the WWTP 0.$$(.P
e. WWTP facility's actual avg. flow
f. Total flow for this specific request 0.004800
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
II. 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)
Design
Pump
Average Daily
Station
Firm Flow**
(Name or
Capacity, * (Firm l p0,
Number)
MGD MGD
Basal Creek O 2!�b
(B)
(C)
(D)=(B+C)
(E)=(A-D)
Obligated,
Approx.
Not Yet
Total Current
Current Avg.
Tributary
Flow Plus
Daily Flow,
Daily Flow,
Obligated
Available
MGD
MGD
Flow
Capacity***
0, 12
4 D 2
4. 0
ZS�
* The Firm Capacity of any pump station is defined as the maximum pumped flow that
can be achieved with the Iargest 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.
Downstream Facility Name (Sewer): 45 l cceek Pump sta pyl
Downstream Permit Number: C 40 3 -7 Q
Page 1 of 6
FTSE 04-16

1I1. Certification Statement:
I Kendra D. Parrish, P. E. 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.
Signing
Page 2 of 6
FTSE d4-16

PLANNING ASSESSMENT ADDENDUM (PAA)
Submit a planning assessment addendum for each pump station listed in Section 11 where Available
Capacity is < 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 (F) 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
system infrastructure.
I understand that this does not relieve the collection system 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 system.
Signing Official Signature
Date
Page 3 of 6
FTSE 04-16

Instructions for Flow Trucking/Acceptance form (FTSE) and Planning Assessment Addendum (PAA)
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 facili 's nermitted flow, MGD: From WWTP owner's NPDES or Non -Discharge permit.
d. Estimated obligated flow not vet 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 contributing 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 using all of their flow allocation. Please contact your Pretreatment Coordinator
for information 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 how 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 avg. 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 + e + f]
h. Percent of permitted flow used: Equals [(g 1 c)* 100]
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. There 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 MGD
g. = 3.349 MGD
h. = 55.8 %
Each subsequent FTSE form will be updated in the same manner.
Page 4 of 6
FTSE 04-16

Section H
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 flow
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-B+C) and the available capacity (E--- 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).
Firm capacity is the maximum pumped flow that can be achieved with the largest pump out 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)=(B+Q
(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 5 of 6
FTSE 04-16

Planning Assessment Addendum Instructions
Submit a planning assessment addendum 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 be performed to evaluate whether
there is significant likelihood that needed improvements or reductions in obligated flows will be 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 scope and funding for a capital promect
entitled Kaw Creek Pump Station upgrade with funding Tanned in July 2014. This ro'ect is 121anned to
add 0.100 MGD to the firm capacity of the 12uml2 station by October 2015. Inclusion of this proposed
capital project as a condition of this Flow Trackin /g/Acceptance for Sewer Extension Permit Application
elevates this project's priority for funding and construction to be implemented ahead of the activation of
obligated, not yet tributM flows in amounts that exceed the firm pump station ca acities identified in
Section 11 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 6 of 6
FTSE 04-16

State of North Carolina
DWR
Department of Environment and Natural Resources
Division of Water Resources
Qiris�n `Afat+es Resources Watershed Classification Attachment (WSCAS 01-15)
These instructions are to be used when completing form WSCAS for sewer extension projects.
Identifying stream classifications that are affected by the project is necessary:
• To determine/confirm the minimum separation distance of sewer system components from
classified waters as specified in 15A NCAC 2T .0305(f)
• To determine/confirm any applicable river basin rules that may affect sewer system components
If any portion of the sewer extension comes within 100 feet of any surface water (waterbody) or
wetland a completed form is required. Determine the names of surface waters within 100 feet of the
project or along the project route and utilize either of the below options to determine stream
classification:
Findine Stream Classifications (Mao or List)
A map with designated streams and their associated classifications can be obtained at:
httF://ncdenr.maps.arc¢is.com/apes/webanoviewer/index.html?Id=6e125ad7628f494694e259c80dd64265
• Find/select the waterbody and record the river basin(s), stream index number and classifications
applicable to the project on the form
or
A listing of stream classifications based on river basin can be obtained at:
http://Portal.ncdenr.ore/web/wa/os/csu/classifications (see left hand side of webpage)
• Select the river basin(s) (hydrological or alphabetically sorted) where your project is located
• Locate the name of the identified waterbody on the list for the selected basin
• For multiple listings of the same waterbody name in the report, select and verify the location
description. The term "source" in the description means the beginning of the waterbody segment
(most upstream point)
• Record the river basin(s), stream index number and classification applicable to the project on the
form
Submittal Instructions
Label any unnamed tributaries as "UT to stream name" as the waterbody name on form per 15A NCAC 02B
.0301(1). See page 2 for additional notes on unnamed streams.
Submit a color copy of a USGS Topographic Map to identify the project area and surface waters. Each map or
maps must show the location of the sewer system and include location identifiers where the system traverses
over or near waterbodies. The map should have location ID's for each different waterbody and corresponding
classifications should be recorded.
"Note that these instructions do not need to be submitted"*

Note on Unnamed Streams (15A NCAC 026.03011:i)9E
Any stream which is not named in the schedule of stream classifications carries the same classification
as that assigned to the stream segment to which it is tributary except:
unnamed streams specifically described in the schedule of classifications;
unnamed freshwaters tributary to tidal saltwaters will be classified "C"; or
after November 1, 1986, any newly created areas of tidal saltwater which are connected to Class
SA waters by approved dredging projects will be classified "SC" unless case -by -case
reclassification proceedings are conducted.
The following river basins have different policies for unnamed streams entering other states or for
specific areas of the basin:
HIWASSEE RIVER BASIN
Streams entering Georgia or Tennessee shall be classified
"C Tr."
LITTLE TENN RIVER BASIN AND SAVANNAH RIVER
Streams entering Georgia or Tennessee shall be classified
DRAINAGE AREA
"C Tr." Such streams in the Savannah River drainage area
entering South Carolina shall be classified "B Tr."
FRENCH BROAD RIVER BASIN
Streams entering Tennessee will be classified "B."
WATAUGA RIVER BASIN
Streams entering the State of Tennessee are classified
13C $1
BROAD RIVER BASIN
Streams entering South Carolina are classified "C."
NEW RIVER BASIN
Streams entering the State of Tennessee are classified
91C „
CATAWBA RIVER BASIN
Streams entering South Carolina are classified "C."
YADKIN-PEE DEE RIVER BASIN
Streams entering Virginia are classified "C," and such
streams entering South Carolina are classified "C."
LUMBER RIVER BASIN
Streams entering South Carolina are classified "C Sw."
ROANOKE RIVER BASIN
Streams entering Virginia are classified "C." Except that all
backwaters of John H. Kerr Reservoir and the North
Carolina portion of streams tributary thereto not
otherwise named or described shall carry the
classification "B," and all backwaters of Lake Gaston and
the North Carolina portion of streams tributary thereto
not otherwise named or described shall carry the
classification "C and B."
CHOWAN RIVER BASIN
Streams entering Virginia are classified "C."
TAR-PAMLICO RIVER BASIN
All drainage canals not noted in the schedule are
classified "C Sw," except the main drainage canals to
Pamlico Sound and its bays which shall be classified "SC."
PASQUOTANK RIVER BASIN
All drainage canals not noted in the schedule are
classified "C."
"Note that these instructions do not need to be submitted*

DWR
DlrisWa of Water Resources
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Watershed Classification Attachment (WSCAS 01-15)
Along with this form, submit a color copy of a USCS Topographic Map to identify the project area and
waterbodies. Each map or maps must show the location of the sewer system and include location Identifiers
where the system traverses over or near waterbodies. The map should have location ID's for each different
waterbody and corresponding classifications should be recorded.
Include the completed form and map portions with the permit application for submittal to the appropriate review
agency. A list of the Division's regional offices, their county coverage, and contact information can be obtained
from: htta://Portal.ncdenr.org/web/wq/home/ro
Location ID
Name of Waterbody'
River
Basin
Waterbody
Index No.
Waterbody
Classification
Southwestautfall
Basal Creek
Neuse
27-43-15-3
B:NSW
1 If unnamed, Indicate "unnamed tributary to X", where X is the named waterbody to which the unnamed tributary joins.
1 certify that as a Registered Professional Engineer in the State of
North Carolina that 1 have diligently followed the Division's
instructions for classifying waterbodies and that the above
classifications are inclusive of the stated project, complete and
correct to the best of my knowledge and belief.
PE Seal, Signature and Date

Owl, ZrP 2,
- SRO
J,,
L&Y

Water Resources
LNVIROHMENTAL QUALITY
May 5, 2017
Southern Crossroads, Inc.
ATTN: H. Brantley Powell
5210 Driftwood Lane
Morehead City, NC 28557
ROY COOPLR
MICIIAI-A S. RLGAN
S. JAY 71NIME=RNIAN
DWR # 2017-0203
Wake County
Subject: APPROVAL OF 401 WATER QUALITY CERTIFICATION AND RIPARIAN BUFFER WITH
ADDITIONAL CONDITIONS
Southern Crossroads
Dear Mr. Powell:
You have our approval for the impacts listed below for the purpose described in your
application dated February 13, 2017, received by the Division of Water Resources (Division) on
February 17, 2017, with additional information received April 11, 2017 and April 12, 2017.
These impacts are covered by the attached Water Quality General Certification Number 4092 /
Neuse Riparian Buffer Rules and the conditions listed below. This certification is associated
with the use of Nationwide Permit Number 39 once issued to you by the U.S. Army Corps of
Engineers. Please note that you should get any other federal, state or local permits before
proceeding with your project, including those required by (but not limited to) Sediment and
Erosion Control, Non -Discharge, and Water Supply Watershed regulations.
This approval requires you to follow the conditions listed in the enclosed certifications) or
general permit and the following additional conditions:
1. The following impacts are hereby approved provided that all of the other specific and
general conditions of the Certification and the Neuse Riparian Buffer Rules are met. No
other impacts are approved, including incidental impacts. [15A NCAC 02H .0506(c)]
state of North Carolina Environmental Quality water Raow=
1617 Mail service Cemer Raleigh, North Carofrta 27699-1617
919 807 6300

Southern Crossroads
DWR# 17-0203
Page 2 of 3
2. This approval is for the purpose and design described in your application. The plans and
specifications for this project are incorporated by reference as part of the Certification.
If you change your project, you must notify the Division and you may be required to
submit a new application package with the appropriate fee. If the property is sold, the
new owner must be given a copy of this approval letter and General Certifications and is
responsible for complying with all conditions. 115A NCAC 02H .0507(d)(2)]
3. You are required to obtain a stormwater management plan (SMP) approval letter from
the Town of Holly Springs before any impacts authorized in this certification occur.
After it is approved, the SMP may not be modified without prior written authorization
from the Town of Holly Springs. 115A NCAC 028.0233(5)1
4. All wetlands, streams, surface waters, and riparian buffers located within 50 feet of the
construction area on the project site shall be clearly marked (e.g. orange fabric fencing)
prior to any land disturbing activities and must be maintained on the property until the
project phase Is completed. [15A NCAC 02H .0506 (b)(2) and (c)(2) and 15A NCAC 02H
.0507 (c)]
This approval and its conditions are final and binding unless contested. [G.S. 143-215.51
This Certification can be contested as provided in General Statute 15013 by filing a written petition
for an administrative hearing to the Office of Administrative Hearings (hereby known as OAH)
within sixty (60) calendar days.
A petition form maybe obtained from the OAH at httn://www.ncoah.com/ or by calling the OAH
Clerk's Office at [phone] for information. A petition is considered filed when the original
and one (1) copy along with any applicable OAH filing fee is received in the OAH during normal
office hours (Monday through Friday between 8:00am and 5:00pm, excluding official state
holidays).
The petition may be faxed to the OAH at [phone], provided the original and one copy of
the petition along with any applicable OAH filing fee is received by the OAH within five (5)
business days following the faxed transmission.
Mailing address for the OAH:
If sending via US Postal Service: if sending via delivery service (UPS, FedEx, etc):
Office of Administrative Hearings Office of Administrative Hearings
6714 Mail Service Center 1711 New Hope Church Road
Raleigh, NC 27699-6714 Raleigh, NC 27609-6285
One (1) copy of the petition must also be served to Department of Environmental Quality:

Southern Crossroads
DWR# 17-0203
Page 3 of 3
William F. Lane, General Counsel
Department of Environmental Quality
1601 Mail Service Center
Raleigh, NC 27699-1601
This letter completes the review of the Division under section 401 of the Clean Water Act.
Please contact me at karen.h1Rgins@)ncdenr.gov if you have any questions or concerns.
Karen Higgins, Supervisor
401 & Buffer Permitting Branch
Enclosures: GC 4092
cc (w/out enclosures): Robert Turnbull, Environmental Services, Inc. (email)
USACE Raleigh Regulatory Field Office
DWR 401 & Buffer Permitting Branch fife
Filename: 1702035outhernCrossroads(Wake)_.401 GC NRB

U.S. ARMY CORPS OF ENGINEERS COPY
WELMINGTON DISTRICT
Action bL SAW 2014-01511 County: Wake U S.G.S. Quad: GAP
NOTM 3ATION OF JURISDICTIONAL DETE UMNATION
Property Owner:
H. Brantley Powell
Address: 5210 Driftwood Lane
Morehead City, NC 2t1557
Telepbooe Number: 919 656-7i�0
Size (acres) 57 Nearest Town lH I, o y Suringg
Nearest Waterway Basai Creek River Basin Up riuse. North CaroBna.
USGS HUC 3020201 Coordinates Latitude: 35,6319073325825
longitude:-7&X0775691029
Location description; The Property is approximately N acres d9MInaka by sericulture-flelds, located at 1936 Ralph
Stevens Rd., PIN 064el,5 2. near the town ofHoliy Sprium Wake County, North Carolina. Aquatic features on site
gain to Basal Creek, in Neuse it2l %.r basin.
Indicate Which of the Followin A :
A. Preliminary Determination
Based on preliminary information, there may be wetlands on the above described property. We strongly suggest you have
this property inspected to determine the extent of Department of the Army (DA) jurisdiction. To be considered final, a
jurisdictional determination must be verified by the Corps. This preliminary determination is not an appealable action
under the Regulatory Program Administrative Appeal Process (Reference 33 CFRPart331). Yf you wish, you may request
an approved !D (which may be appealed), by contacting the Corps district for further instruction. Also, you may provide
new information for further consideration by the Corps to reevaluate the ID.
B. Approved Determination
There are Navigable Waters of the United States within the above described property subject to the permit requirements of
Section 10 of the Rivers and Harbors Act and Section 404 of the Clean Water Act. Unless there is a change in the law or
our published regulations, this determination may be relied upon for a period not to exceed five years from the date of this
notification.
X There are waters of the U.S. including wadands on the above described property subject to the permit requirements of
Section 404 of the Clean Water Act (CWA)(33 USC § 1344). Unless there is a change in the law or our published
regulations, this determination may be relied upon for a period not to exceed five years from the date of this notification.
We strongly suggest you have the wetlands on your property delineated. Due to the size of your property and/or our
present workload, the Corps may not be able to accomplish this wetland delineation in a timely manner. For a more timely
delineation, you may wish to obtain a consultant: To be considered final, any delineation must be verified by the Corps.
_ The waters of the U.S..tacluding wetlands on your project area have been delineated and the delineation has been
vaified by the Corp. We strongly suggest you have this delineation surveyed. Upon completion, this survey should be
reviewed and verified by the Corps. Once verified, this survey will provide an accurate depiction of all am subject to
CWA jurisdiction on your property which, provided there is no change in the law or our published regulations, may be
relied upon for a period not to exceed five years.
X The waters of the U.S. including wetlands have been delineated and surveyed and are accurately depicted on the plat
signed by the Corps Regulatory Official identified below on l0lecember 15, 2014. Unless there is a change in the law or
our published regulations, this determination may be relied upon for a period not to exceed five years from the date of this
notification.
There are no waters of the U.S., to include wetlands, present on the above described project area which are subject to the
permit requirements of Section 404 of the Clean Water Act (33 USC 1344). Unless there is a change in the law or our
Page 1 of 2

published regulations, this determination may be relied upon for a period not to exceed five years from the date of this
notification.
The property is located in one of the 20 Coastal Counties subject to regulation under the Coastal Area Management Act
(CAMA). You should contact the Division of Coastal Management in Morehead City, NC, at [phone] to
determine their requirements.
Placement of dredged or fill material within waters of the US and/or wetlands without a Department of the Array permit may
constitute a violation of Section 301 of the Clean Water Ad (33 USC § 1311). If you have any questions regarding this
determination and/or the Corps regulatory program, please contact James Lastiogrer at 219-5544884 x32 or
James.C.LestinacrMusace army mil.
C. Basis For Determination: Stream channels on site exhibit an establisbed OHWM. Wetlands on site exhibit
the three criteria as described in the Corns 1987 wetland delineation manual and annrooriate regional suonlemeni
D. Remarks: Site visit mi conductedn Av_SnLtJJ 2014.
E. Attention USDA Program Participants
This delineation/detmmination has been conducted to identify the limits of Corps' Clean Water Act jurisdiction for the
particular site identified in this request. The delineation/determination may not be valid for the wetland conservation
provisions of the Food Security Act of 1985. Ifyou or your tenant are USDA Program participants, or anticipate participation
in USDA programs, you should request a certified wetland determination from the local office of the Natural Resources
Conservation Service, prior to starting work
F. Appeals Information (This information applies only to approved jurisdictional determinations as indicated In
B. above)
This correspondence constitutes an approved jurisdictional determination for the above described site. Ifyou object to this
-determination, you may request an administrative appeal under Corps regulations at 33 CFR Part 331. Enclosed you will find a
Notification of Appeal Process (NAP) fad sheet and request for appeal (RFA) foam. If you request to appeal this
debmination you must submit a completed RFA form to the following address:
US Army Corps of Engineers
South Atlantic Division
Attn: Jason Steele, Review Officer
60 Forsyth Street SW, Room 1OM15
Atlanta, Georgia 30303-8801
In order for an RFA to he accepted by the Corps, the Corps must determine that it is complete, that it meets the criteria for
appeal under 33 CFR part 331.5, and that it has been received by the Division Office within 60 days of the date of the NAP.
Should you decide to submit an RFA form, it must be received at the above address by Z43/15.
**It is not necessary to submit an RFA form to the Division Office if you do not object to the determination. in this
correspondence.** '101
Corps Regulatory Official:
Date: Dmember 15, 20f4/ Expiration Date: December 15, 2019

The Wilmington District is committed to providing the highest level of support to the public. To help us ensure we
continue to do so, please complete our Customer Satisfaction Survey, located online at
htt -./ mplatory.usacesurvey.com/.
Copy furnished:
IM
Attu: Robert Turnbull
524 New Hone Rd.
RaleWdb, NC 27610

i
A: INITIAL PROFFERED PERMIT: You may accept or object to the permit.
ACCEPT: If you received a Standard Permit; you may sign the permit document and return it to the district engineer for final
authorization. If you received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your
signature on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all
rights to appeal the permit, including its terms and conditions, and appruved jurisdictional determinations associated with the
permit
• OBJECT: If you object to the permit (Standard or LOP) because of certain terms and conditions therein, you may request
that the permit be modified accordingly. You must complete Section lI of this form and return the form to the district
engineer. Your objections must be received by the district engineer within 60 days of the date of this notice, or you will
forfeit your right to appeal the permit in the future. Upon receipt of your letter, the district engineer will evaluate your
objections and may: (a) modify the permit to address all of your concerns, (b) modify the permit to address some of your
objections, or (c) not modify the permit having determined that the permit should be issued as previously written. After
evaluating your objections, the district engineer will send you a proffered permit for your reconsideration, as indicated in
Section B below
B: PROFFERED PERMIT: You may accept or appeal the permit
• ACCEPT: If you received a Standard Permit, you may sign the permit document and return it to the district engineer for final
authorization. If you received a Letter of Permission (LOP), you may accept the LOP and your work is authorized. Your
signature on the Standard Permit or acceptance of the LOP means that you accept the permit in its entirety, and waive all
rights to appeal the permit, including its term and conditions, and approved jurisdicdonaI determinations associated with the
1ermiL
• APPEAL: If you choose to decline the proffered permit (Standard or LOP) because of certain terms and conditions therein,
you may appeal the declined permit under the Corps of Engineers Administrative Appeal Process by completing Section II of
this form and sending the form to the division engineer. This form must be received by the division engineer within 60 days
of the date of this notice.
C: PERMIT DENIAL: You may appeal the denial of a permit under the Corps of Engineers Administrative Appeal Process by
completing Section H of this form and sending the form to the division engineer. This form must be received by the division
engineer within 60 days of the daft of this notice.
D: APPROVED JURISDICTIONAL DETERMINATION: You may accept or appeal the approved JD or provide new
information.
• ACCEPT: You do not need to notify the Corps to accept an approved JD. Failure to notify the Corps within 60 days of the
date of this notice, means that you accept the approved JD in its entirety, and waive all rights to appeal the approved ID.
• APPEAL: If you disagree with the approved JD, you may appeal the approved JD under the Corps of Engineers
Administrative Appeal Process by completing Section II of this form and sending the form to the district engineer. Ibis form
must be received by the division engineer within 60 days of the date of this notice.

E: PRE MvM4ARY JURISDICTIONAL DETERM HATION: You do not need to respond to the Corps regarding the
preliminary JD. The Preliminary ID is not appealable. If you wish, you may request an approved JD (which may be appealed),
by contacting the Corps district for further instruction. Also you may provide new information for further consideration by the
Corps to reevaluate the JD.
REASONS FOR APPEAL OR OBJECTIONS: (Desenbe your reasons for appealing the decision or your objections to an initial
proffered permit in clear concise statements. You may attach additional information to this form to clarify where your reasons or
objections are addressed in the administrative record.)
ADDITIONAL INFORMATION: The appeal is limited to a review of the administrative record, the Corps memorandum for the
record of the appeal conference or meeting, and any supplemental information that the review officer has determined is needed to
clarify the administrative record Neither the appellant nor the Corps may add new information or analyses to the record
However, you may provide additional information to clarify the location of information that is already in the administrative
record.
log IS -0 �.
If you have questions regarding this decision and/or the If you only have questions regarding the appeal process you may
appeal process you may contact: also contact:
District Engineer, Wilmington Regulatory Division Mr. Jason Steele, Administrative Appeal Review Officer
Raleigh Regulatory Field Office CESAD-PDO
Attn: James Lastinger, Regulatory Specialist U.S. Army Corps of Engineers, South Atlantic Division
3331 Heritage Trade Dr., suite 105 60 Forsyth Street, Room 10M15
Wake Forest, NC 27587 Atlanta, Georgia 30303-8801
91.9-554-4884 ext 32 Phone: [phone]
RIGHT OF ENTRY: Your signature below grants the right of entry to Corps of Engineers personnel, and any government
consultants, to conduct investigations of the project site during the course of the appeal process. You will be provided a 15 day
notice of any site invatiotion, and will have the opvo to participate in all site investi2aflons.
Date:
Telephone number:
Slowof pant or
For appeals on initial Proffered Permits send this form to:
District Engineer, Wilmington Regulatory Division, Attn: James Lastinger, 69 Darlington Avenue, Wilmington,
North Carolina 28403
For Permit denials, Proffered Permits and approved Jarbdictional Determinations send this form to:
Division Engineer, Commander, U.S. Army Engineer Division, South Atlantic, Attn: Mr. Jason Steele,
Administrative Appeal Officer, CESAD-PDO, 60 Forsyth Street, Room 10M15, Atlanta, Georgia 30303-8801
Phone: [phone]

Email: info arcadiaen ineers.com
June 27, 2018
Town of Holly Springs
128 South Main Street
Holly Springs, NC 27540
Ref: Project 16-14-03 Southern Crossroads Southwest Sewer Outfall
Dear Staff:
NCUcpt of Environmental Quality
OCT 16 2nis
p,deigh Regional Officc
This cover letter is to transmit the North Carolina Department of Environmental Quality — Division of Water
Resources submittal documents for permitting of the referenced project.
Project Narrative:
The Southern Crossroads Southwest Sewer outfall will be a gravity sewer extension for the 2.43 acre
commercial tract of the Southern Crossroads development. The Southwest Sanitary Sewer Outfall is
located along Basal Creek and connects to the Offsite Sanitary Sewer Outfall "A" Project Number 16-14-
01 at the southern property line.
There are wetlands along the sewer's route. Portions of the sewer line and manholes no. 1 through 5 are
located within the 50' wetland setback. The sewer line and manholes will comply with the alternative
design criteria for the portions located within the 50' wetland setback.
Development use and the associated flow are proposed to be as follows.
Commercial — 2.43 acres: 4.800 GPD
Total Flow allocation: 4,800 GPD
The following documents are transmitted with this cover letter.
• Town of Holly Springs Sewer Design and Application Certification
0 $480.00 Fee for NCDEQ
$200.00 Fee for Town of Holly Springs
• One original and one copy NC Fast Track Application for Gravity Sewer, Pump Stations, and Force
Mains
Two copies of FTSE 04-16 Flow Tracking and Acceptance Form
• Two color copies of 8.5 inch x 11 inch portion of USGS Topographic Map showing project area
• Two copies of street level map showing project area
• Two copies of Watershed Classification Form WSCAS 01-15
Two copies of NC DEQ 401 Certification approval and USACOE 404 NWP 39
Sincerel ,
Trenton D. Stewart, PE
Arcadia Consulting Engineers, PLLC
PO Box 2077, Apex, NC 27539 Telephone [phone] Facsimile 919 363-1477

Robinson, Jason
From: Trenton Stewart <[e-mail]>
Sent: Thursday, November 29, 2018 4:56 PM
To: Robinson, Jason
Cc: [e-mail]; Sara Emig; Cashion, Ted; Deck, Erin M
Subject: [External] Re: Southern Crossroads Southwest Sanitary Sewer Outfall
t nat cikrk f n6 chr—MF6 iei nrlf-J Send all QW065 emAll as a-h Aiacinment to
.......... . • --a
Hi Jason,
I. Yes. Please add 4,800 GPD to VI.8.
2. Section IX.1 was checked "no" because wetlands is listed in the surface waters row. All other setback parameters are
met for this section.
Please let me know if you need additional information.
Thank you,
Trent
On Nov 29, 2018, at 4:01 PM, Robinson, Jason <[e-mail]> wrote:
We are reviewing the referenced sewer extension application and have the following
questions/comments:
1. Section V1.8 should show the total flow for this project. With your permission, I will add 4,800
GPD to this section.
2. Section IX.1 states that separation requirements are not met. Please explain what is not met
and how it will be addressed (this does not include wetland separation, which is addressed in
the next item).
3. Section IX.2 states the wetland separations are not met, but it is explained in the narrative that
the sewerline and manholes will comply with the alternative design criteria, which is acceptable,
and nothing further is needed for this section.
Please respond in writing to question 1 & 2 above.
Thanks,
Jason
------------
Jason T. Robinson, P.E.
Raleigh Regional Office
Water Quality Regional Operations
Division of Water Resources, DEQ
919-791-4200
1

T H E TO W N OF
September 6, 2018
Director, Division of Water Resources
Raleigh Regional Office
Water Quality Operation Section
1628 Mail Service Center
Raleigh, NC 27699-1628
�lly Sprin
Re. Application for Sewer Extension Permit
Project: Southern Crossroads Southwest Sewer OutfalI
Dear Sir or Madam:
r,.
INC Dept of Environmental Quality
Raleigh Regional Office
Please find enclosed the following items in application for a sewer extension permit to the Town
of Molly Springs existing sewer distribution system:
0 One original and one copy cover letter including a project narrative
o A check in the amount of $480.00
0 One original and one copy of the State of North Carolina Fast Track Sewer S,yslenz
Extension Applicalion (FTA 04-16)
0 Two copies of FTSE 04-16 Flow Tracking/Acceptance Form
0 Two color copies of a 8.5-inch by I 1-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 919-557-3938 should you have any questions or need additional
information in order to process this application.
Sin 4h,
Kend., CFM
Director of Engineering
KP/se
cc: Project Consultant Engineer, Trenton D. Stewart, PE, Arcadia Consulting Engineers
Administrative Manager (for addition to sewer permit log)
Rodney Campbell, Development Administrator
Project file/Correspondence #41674
3002
44.17.20E 8
Engineering Department
P.O. Box 8 - 128 S. Main Street - HoIly Springs, NC 27540 - www.hollyspringsnc.us

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 Gravi1y Sewers Pump
Stations. and Force Mains for extension to the Town of Holly Springs Sewer System
Project:
Design Engineer:
Southern Crossroads Southwest Sanitary Sewer Outfali
Trenton D. Stewart, PE
Address: PO BOX 2077, Apex, NC 27502
Phone Number: [phone] Email: [e-mail]
Date Complete Application Package Received by Town:
Date Approved: &C 9l L � (by RLC) (by KDP)
As design engineer for this project, I certify the following (please check (x) each applicable box):
• That the design of the project is in complete conformance with Town of Holly Springs
Engineering Design and Construction Standards and NCDENR Sanitary Sewer Design
Regulations;
• That each of the following items are completed and enclosed for submittal to the State for
a sewer extension permit:
0 One original and one copy cover letter including a project narrative a
o A check in the amount of $480.00 to DENR
o A check in the amount of $200.00 Town processing fee E
0 One original and one copy of the State of North Carolina Fast Track °
Application for Gravity Sewers, Pump Stations, and Force Mains w
0 Two copies of FTSE 08-13 Flow Tracking/Acceptance Form o
0 Two color copies of a 8.5-inch by 11-inch portion of a 7.5 minute USGS
Topographic Map showing project area q
0 Two copies of a street level map showing all relevant project areas v
0 One copy of the locally -required Design and Application Certification 2
Design Engineer's Signature
In addition, once your construction drawings are approved and this application is complete, you
will receive a copy of the Town's letter of transmittal to the State as your confirmation that the
application is complete and has been forwarded to the State for permitting. Please contact Sara
Emig at [phone] if you do not receive this confirmation or if you have any questions.
Engineering Department • P.O. Box 8, Holly Springs, NC 27540
919-557-3938 • 919-5S2-9881(fax)
VJ
2003 Sewer Design Application Certification
04 11.2018