WQ0040541_Application (FTSE)_20181120

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: it Ll� d (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
2.
1. Applicant's name: Orange Water & Sewer Authority, (company, municipality, HOA, utility, etc.)
Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ❑ Municipal ® Other
3. Signature authority's name: Ed. -Kerwin Ed.—Kerwinper 15A NCAC 02T .0106(b)
Title: Executive Director
4. Applicant's mailing address: 40�Qnes_FgM Road �+
City: Carrboro State: N_Q Zip: 27510-
5. Applicant's contact information:
Phone number: (M) 53742Email Address: nnarkerQowasa.=
1I. PROJECT INFORMATION:
1. Project name: UN�urgical Tower Expansion
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ00 and issued date:
If new construction but part of a master plan, provide the existing permit number: WQ00
3. County where project is Iocated: Orange
4. Approximate Coordinates (Decimal Degrees): Latitude: 35,904378 Longitude: - 9 51819
5. Parcel ID (if applicable): 9788543697
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Roy P. Lorenzen License Number: 15834
Firm: Stewart, Inc.
Mailing address: 223 S. West Street. Suite 1100
City: Raleigh State: NC Zip: 27603-
Phone number: ( Imo) 966-4481 Email Address: florenzenOtstewartinc.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Mason Farm Wastewater Treatment Plant Permit Number: NC 0025241
Owner Name: OWASA
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V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQN/A ')� Downstream (Receiving) Sewer Size: 18 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS00031
Owner Name(s): Orange Water and Sewer Authority
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FORM: FTA 04-16 Page I of

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 ®NIA
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached?
❑ Yes ❑No ®N/A
3. If the Applicant is a Home/Property Owners' Association, has an Operational Agreement (FORM: HOA) been attached?
❑ Yes ❑No ®NIA
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/FiIter Backwash
❑ Businesses / offices factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: °10 Domestic/Commercial 100 % Commercial
0 % Industrial (See 15A NCAC 02T .0103(20))
1Is there a Pretreatment Program in effect? ❑ Yes ® No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(f)? ❑ Yes ®No
If yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow . n
No. of Units
Flow
Hospital
300 gal/bed
56
I4,800 GPD
Peaking Factor (x 2.5)
750 gal/bed 1
56
42,000 GPD
gal!
GPD
gal/
GPD
gal,
GPD
gal/
GPD
Total
42,000 GPD
a See 15A NCAC 02T .0114(b), (d), (e)( I) and (e)(2) for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use areas;
and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in G.S. 42A4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified (in table 15A NCAC 02T.0114] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 42.000 GPD (per 15A NCAC 02T .0114)
D Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
❑ Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit Number:
❑ Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain):
FORM: FTA 04-16 page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
12
382
DIP
18
608
DIP
➢ Section iI & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section III contains information related to minimum slopes for gravity sewer(s)
➢ Oversixing lines to meet minimum slope requirement is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations[Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: -
3. Design flow of the pump station: millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s); gallons per minute at feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(1):
❑ Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(h)(1)(B)_
➢ Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
➢ Must be permanent to facility
Or if the pump station has an average daily flow less than 15,000 gallons per day:
❑ Portable power source with manual activation, quick -connection receptacle and telemetry - 15A NCAC 02T
.0305(h)(1)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry - 15A NCAC 02T .0305(h)(1)(C):
➢ It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant (draft agreement)
and is compatible with the station.
➢ If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel timeframes, shall be provided
in the case of a multiple station power outage.
FORM: FTA 04-16 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations found in 15A NCAC 02T .0305(f) & (g) ® Yes ❑ No
D 15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ "Stream classifications can be identified using the Division's NC Surface Water Classifications webpagc
➢ If noncompliance with 02T.0305(f) or (g), see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ❑ Yes ❑ No ® 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 .0200s ❑ Yes ❑ No ® N.:A
➢ This would include Trout Buffered Streams per 15A NCAC 213.0202
4. Does the project require coverage/authorization under a 404 Nationwide or ❑ Yes ® 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(c)(6) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T.0105(c)(6), directly related environmental permits or certification applications are being prepared, have
been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion and
sedimentation control plans, stormwater management plans, etc.).
6. Does this project include any sewer collection lines that are deemed "high -priority?"
Per I5A NCAC 02T.0402, "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes ® No ❑ NIA
➢ 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.
FOILM: FTA 04-16 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15'A NUAC 02T, the Minimum Design Criteria tier the Permitting of Pump Stations
and Force Main; (latest version), and file Gravity Surer .\,hntmum De.r_n Criteria (latest version) as applicable?
® Yes ❑ No
If No, complete and submit the Variance?Alternative Design Request application (VADC 10-14) and supporting documents for
review. Aporoval of the rec uesi is required nrior to submittal orthe Fast Track Armlication andswumirting documents.
2. Professional Engineer's Certification:
.,i attest that this application for
(Professional Engineer's name from Appl -ation Item Ill.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 attest that to the best
of my knowledge the proposed design has been prepared in accordance with the applicable regulations, Gravity Sewer
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Tracy Permitting
of Pump Stations and Force Mains (latest version). Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that I have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215,6A and 143-215.613, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation.
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b);
(Signature Authority's name R title from Application Item I.Z.)
i � , t.:� ;a �� � ;.gyp{.•Z
attest that this application for
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required part, of
this application are not completed and that if all required Supporting documentation and attachments are not included, this
application package is subject to bring returned as incomplete. I understand that any discharge of wastewater from this non -
discharge system to surface wafers or the land will result in an immediate entbrcement 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 vtolated. I also understand that if all required parts of this application package are not completed and that if
all required supposing 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 S 10.000 as well as civil penalties up to S25,000 per violation,
94
Signature. Dltgn R
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FOR41; FTA 04-16 Page 5 of5

i
STEWART
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Fast Track Application - Part B Cover Letter & Project Narrative
TO: NCDEQ Water Resources - Sewer Permitting
FROM: Derick Blankenship, PE
RE: UNCH Surgical Tower Expansion
DATE: October 22, 2018
Existing Site Information
The project site is located along Manning Drive and is situated between
East and West Drive respectively. The site is currently developed with
existing buildings parking lots, sidewalks, pedestrian plazas and some
green space which provides access for the main entrance to UNC Children's
Hospital. This project does not impact any existing wetlands and is not
known to be within any Water Supply Watersheds. The latest version of
the United States Department of Agriculture Soil Conservation Service Soil
Survey of Orange County, North Carolina map indicates that the on -site
soils are predominantly the Appling-Urban land complex which is classified
as Hydrologic Soil Group B. Per FEMA Flood Insurance Rate Map
3710978800K, dated November 17, 2017, the project is within Zone X and
no 100-yr Floodplain is present but the 500-year flood elevation does
impact the southern portion of the site.
Proposed Site Improvements
Proposed development on the site will include the demolition of existing
parking lots and surface structures and all other site features within the
new project footprint. Once demolition of the existing site has occurred, a
proposed seven story surgical tower expansion to the existing hospital will
be constructed. Accessible sidewalks, pedestrian plazas, loading docks,
green space and on site retaining walls will be provided to allow for access
in and around the site. All sewer and water infrastructure within the
development will be re-routed out of the proposed footprint. Existing sewer
and water traverse the site from west to east and will be captured and
routed down East and West drives respectively. Utility improvements
include relocation of existing 12" and 18" sewer lines, along with 8" and
12" water lines. Estimated usage for proposed project is 42,000GPD.
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State of North Carolina
Department of Environmental Quality
Division of Water Resources
-W,
-R
Division of Water Resources Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: Orange Water and Sewer Authority
Project Name for which flow is being requested: UNC Health Care Surgical Tower
A,fore than one FTSE maj, be required for a single project if the ou-ner of the IV IVTP is not responsible for all ptnnp
stations along the route of the proposed wastewaler flow.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Mason Farm Wastewater Treatment Plant
b. WWTP Facility Permit #: NCO025241
All flows are in MGD
c. WWTP facility's permitted flow 14.5
d. Estimated obligated flow not yet tributary to the WWTP 0.764
e. WWTP facility's actual avg. flow 8.631
f. Total flow for this specific request 0.042(42,000) gpd)
g. Total actual and obligated flows to the facility 9.437
h. Percent of permitted now used 65%
11. 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 Flo►v**
(Name or
Capacity, * (Firm i po,
Number)
MGD MGD
N/A
(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
MOD
Flow
Capacity***
* The Firm Capacity of any pump station is defined as the maximum pumped flow that
can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking
factor (pi) not less than 2.5.
*** A Planning Assessment Addendum shall be attached for each pump station located
behveen the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): NA, FIow directly to OWASA WWTP
Downstream Permit Number: NA
Page 1 of 6
FTSE. 04-16

111. Certification Statement:
I Ed Kerwin certify to the best of my knowledge that the addition of
the volume of wastewater to be permitted in this project has been evaluated along the route to the
receiving wastewater treatment facility and that the flow from this project is not anticipated to
cause any capacity related sanitary sewer overflows or overburden any downstream pump station
en route to the receiving; treatment plant under normal circumstances. given the implementation of
the planned improvements identified in the planning assessment where applicable. This analysis
has been performed in accordance with local established policies and procedures using the best
available data. This certification applies to those items listed above in Sections l and 11 plus all
attached planning assessment addendums for which I am the responsible party. Signature of this
form indicates acceptance of this wastewater flow.
t! 1ald
Signing 0 fin71, 11allire ( [*
Page 2 of 6
FTSE 04-16

4IN ORANGE WATER ANC] SEWER AUTHORITY
A public, non prafil agency providing water, server and reclaimed water services
to the Carrboro-Chapel Hill community.
NC Dept of rnvironmentaI Quality
NOV 2?f�i$
November 13, 2018
Raleigh Regional Office
NCDEQ Water Quality Section
1628 Mail Service Center
Raleigh, NC 27699-1628
SUBJECT: Permit Application for UNC Health Care Surgical Tower
DWR Staff,
Enclosed are the following items for your review and approval. The project includes abandonment,
relocation and extension of the sanitary sewer and potable water systems to serve an expansion of the
existing hospital complex.
Fast -track Application form FTA 04-16 (original and copy)
Flow Tracking/Acceptance form FTSE 04-16 (original and copy)
Check in the amount of $480.00
Project Narrative
Please contact me by telephone at 919 5374201 or email to nparkerc@-awas_a,org if you have any
questions or comments.
Respectfully,
Ni 'olas L. Parker
Engineering Associate
cc: Mary Darr, PE — OWASA
Roy Lorenzen, PE, Derick Blankenship, PE — Stewart Engineering, Inc
Larry Hamilton — UNC Hospitals
400 Jones Ferry Road Equal Opporrunfn- Emplorer Voice [phone]
Carrboro, NC 27510-2001 Printed on Recycled Paper H9rwonamor8