WQ0040663_Application (FTSE)_20190117

State of North Carolina
Department of Environmental Quality
DWR
Division of Water Resources
I5A NCAC 02T.0300 FAST TRACK SEWER SYSTEM EXTENSION
DlWslon of Water Resources
APPLICATION
FTA 04-16& SUPPORTING
DOCUMENTATION
Application Number: U (lobe compicledbyDWR)
All items mu tbe c m ete r the application will be returned
1. APPLICANT INFORMATION:
1. AppIicant's name: Town of Holly Springs (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ GeneraI Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County to Municipal ❑ Other
3. Signature authority's name: Kendra D h P F per
Title: Director of Engineering
4. Applicant's mailing address: 12 in Streq
City: Holly Springs State: NC Zip: 27540-
5. Applicant's contact information:
Phone number: (J9) 5,,5 -3,DB Email Address: kgndra,parrishQhoIlvspringsnc,us
If. PROJECT
INFORMATION:
I. Project name: 5gjdvm C ossroads Master Plan Sanitary Sewer Stub
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number. WQ00 and issued date:
If new constriction but part of a master plan, provide the existing permit number. WQOD
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3. County where project is located: Wake
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4. Approximate Coordinates (Decimal Degrees): Latitude: 356320 Longitude: -78,8351
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5. Parcel ID (if applicable): 0648856278
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(or Parcel ID to closest downstream sewer)
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III. CONSULTANT INFORMATION:
1. Professional Engineer: Trenton D. Stewart License Number: 024454
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Firm: Arcadia Consulting Engineers, PLLC
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Mailing address: PO Box 2077
City: Apex State: NC Zip: 27502 _
Prone number. 9( 19) 363-1422 Email Address:—[e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Utley Creek Wastewater Treat ment,Plan Permit Number. NCO063096
Owner Name: Town of Holly Springs
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
I. Permit Number(s): WQjQ12.T9 g94 Downstream (Receiving) Sewer Sipe: inch
System Wide Collection System Permit Number(s) (if applicable): WQCS 4 0 19Z
Owner Name(s): 1�10Jr
FORM: FTA 04-16 Page I of 5

VL GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑ No O N/A
I If the Applicant is a Developer of lots to be sold, has a Developer's Chnrutional Aemi:mcnt (FORM 1 DEV) been attached?
❑ Yes ❑No El N/A
3. If the Applicant is a H me` c y 0"ers' Association. has an Q2crationiol Agmyrngnt (E=ORM; HOT been attached?
❑ Yes ❑ No El 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
❑ Businesses /offices / factories ® Nursing Home
❑ Swimming
❑ Other (Explain
Pool/Filter Backwash
in Attachment)
5. Nature of wastewater. 100 %Domestic/Commercial %Commercial
%Industrial (See t5A_NC.AC OZI .0IQX201)
bIs there a Pretreatment Program in effect?
❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(fh [--]Yes
❑ No
D If +Les, PELA a copy of flow reduction arxrroval letter
7. Surnnmrize wastewater generated by project:
Establishment Type (see 2T 114 Daily Design Flow '-h
No, of Units
Flow
10.0 ac Retirement Center 120 gal/ person
90
10,800 GPD
gaV du
GPD
gal/
GPD
gay
GPD
gaV
GPD
gay
GPD
Total
10,800 GPD
a See 15A NCAC 02T .0114(b)_ (d), 0)(11 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 oreastofthe Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in G.S. 42A-0}.
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 figures, occupancy or operation patterns, and other meas ured data.
8. Wastewater generated by project: 10,800 GPD (per 15A NCAC 02T Al 14}
➢ 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

VIL GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T.0305 & MDC (Gravity Sewers);
I. Summarize gravity sewer to be permitted:
Size(inches) Length (feet) Material
8 90.06 PVC
➢ Section If & 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)
➢ O%ersizing lines to meet minimum slope requirement is not allovwd and a violation of the MDC
VII1. PUMP STATION DESIGN CRITERIA (If Applicable)--02T.Q305&
OOMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROtF(T
I. Pump station number or name:
2. Appro:amate 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 .030 (h)(l):
❑ Standby power source or pump with automatic activation and telemetry - I5A NCAC 02T .0305(h)(1)(B)_
➢ Required for all pump stations with an averagedaily flow greater than or equal to 15,000 gallons per day
➢ Must be permanent to facility
Or if the purnp 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)(I)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry - I5A 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 theportable power sourceorpump is dedicated to multiple purrs 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: PTA 04-16 Page 3 of 5

IX. Slrt'BACKS & SI!PARATIONS — (02B .0200 & 15A NCAC 02T.0305(4}:
1. Does the project comply with all separations found in 15A NCAC 02T .030$ & (Q)
➢ 15A NCAC 02T.0305(f) contains minimum separations that shall be nrnvided fnr sewer cvcrernc•
❑x Yes ❑ No
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
18 inches
Water mains (horizontal)
10 feet
Reclaimed water lines vertical -reclaimed oversewer
18 inches
Reclaimed water lines horizontal -reclaimed over sewer
2 feet
**Any private or public water supply source, including any wells, WS-I waters of Class I or
Class II 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 surface drainage
ditches
10 feet
Any building foundation
5 feet
Any basement
10 feet
Top slopeof embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swinining pools
10 feet
Final earth grade vertical
36 inches
➢ contains alternatives where separations in 0=30a cannot be achieved.
➢ "Stream classifications can be identified using the Division's NC Surface Water-Classffications webpage
➢ 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) ❑x Yes ❑ No
➢ See the Division's draft separation requirements for situations where separation cannot be meet
➢ No variance is required if the alternative design criteria specified is utilized in design and construction
➢ As built documents should reference the location of areas effected
3. Does the project comply with all setbacks found in the river basin rules per 15AA CAC 02B .0200? ❑ Yes ❑ No
➢ This would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Does the project comply with an individual 404 Permit or any 401 Certifications? 10 Yes ❑ No
➢ Wetland -related permits shall be requested,obtained,and adhered to for projects that impact wetlands or surface water;
➢ Information can be obtained from the 401 & B ff' r Permitting h
5. Does project comply with 15A NCAC 02T.0105(c)(6)(additional permits/certifications)?
❑x Yes ❑ No
Per 15A NCAC 02T.0105(cX6) directly related environmental perntits 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 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 streambanks that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes ❑x No
➢ If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at leastonce ewery six -months and inspections
documented per 15A NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit.
FORM: FTA 04- I 6 Page 4 of 5

4
X. CERTIFICATIONS:
Does the submitted system comply with 65A NCAC.02T. the.Minirrum DesiPit�Yitcria for the Permittinw 01-Nn-y SEmiuns
and Force Mains {latcst version), and the Omyity Sewer Minurum Design C5-it0a Qatest_y_ersiun) as applicable?
(D 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 lKior to submittal of the Fast Track AVOication and supWrting documents.
2. Professional Engineer's Certification:
1, Trenton D. Stewart, P.E. _ attestthatthis application for
(Professional Engineer's name from Application Item 111.1.)
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, Cavity 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 1 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: ,,0'ItA CARo'•.,
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� oFissro'• l�,y�
4454
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3. Applicant's Certification per 15A NCAC 02T .0106(b):
Kendra D. Parrish, PE attest that this application for
(Signature Authority's name & title from Application Item I.3.)
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 systemto surface waters or the land will result in an immediate enforcement action that may include civil penalties,
injunctive relief, andlorcriminal prosecution. 1 will make no claim against the Division of Water Resources should acondition
of this pemut be violated. I also understand that if all required parts of this application package are not completed and t hat if
all required supporting information and attachments are not included, this application package will be returned to me as
inconVIete.
NOTE In accordance with General Statutes 14-215.6A and 1437,215.613, 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:,- � L Date:
FORM. FTA 04-16 Page 5 o f 5

ta77;
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.THE TOWN OF
December 27, 2018
Director, Division of Water Resources
Raleigh Regional Office
Water Quality Operation Section
1628 Mail Service Center
Raleigh, NC 27699-1628
�'prings
NC Dept of Environmental Quality
Re: Application for Sewer Extension Permit
Project: Southern Crossroads Master Plan Sanitary Sewer Stub
Dear Sir or Madam:
,BAN 17 2019
Raleigh Regional Office
Please find enclosed the following items in application for a sewer extension permit to the Town
of I lolly 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}7stem
ExtensionApplication (FTA 04-16)
0 Two copies of FTSE 04-16 Flow Tracking/Acceptance Corm
0 Two color copies of a 8.5-inch by 11-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.
i erely,
Kendra D. arrish, P.E., CFM
Director o Engineering
KPase
cc: Project Consultant Engineer, Trenton D. Stewart, PE, Arcadia Consulting Engineers
Administrative Manager (for addition to sewer permit Iog)
Rodney Campbell, Development Administrator
Project file/Correspondence 441694
3002
04 172019
Engineering Department
P.O. Box 8 - 128 S. Main Street - Holly 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
Southern Crossroads Master Plan Sanitary Sewer Stub R
Project: rY p
4"
Design Engineer:
Trenton D. Stewart, PE o
PO Box 2077 Apex, NC 27502 L t a
Address: � p � � .� � •�
Phone Number: [phone] Email: [e-mail] o
r a
Date Complete Application Package Received by Town: ! a 1 7'cQ Oil? A
Date Approved: 'L 1217.7bg (by RLC) F�Iy (by KDP)z
As design engineer for this project, I certify the following (please check fx) each applicable box):
N 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
o A check in the amount of $480.00 to DENR
o A check in the amount of $200.00 Town processing fee
0 One original and one copy of the State of North Carolina Fast Track
Application for Gravity Sewers, Pump Stations, and Force Mains
0 Two copies of FTSE 08-13 Flow Tracking/Acceptance Form
0 Two color copies of a 8.5-inch by 11-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
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.
Erl,gineering Department - P.O. Box 8, Holly Springs, NC 27540
919-557-3938 - 919-552-9881 (fax)
2003 Sewcr Design Application Certification
04.11 2018

Email: infoCcD-arcadiaengineers.com
I?CADIA
CONSULTING ENGINEERS
December 3, 2018
Town of Holly Springs
128 South Main Street
Holly Springs, NC 27540
NC Dept of Environmental Quality
Ref: Project 16-14-02-CD-02 Southern Crossroads Master Plan Sanitary Sewer Stub
Dear Staff:
JAN 17 2019
Raleigh Rcgioiial Office
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 Infrastructure Sewer Stub under Southern Crossroads Blvd. will be a gravity
sewer extension to serve the 10.0 acre commercial tract of the Southern Crossroads development. The
sanitary sewer stub will connect to the sanitary sewer outfall in the Exchange at Holly Springs Apartment
Project Number 17-25-01.
Development use and the associated flow are proposed to be as follows.
Commercial —10.0 acres:
Total Flow allocation for retirement facility: 120 gal/bed x 90 beds 10,800 GPD
The following documents are transmitted with this cover letter.
• Town of Holly Springs Sewer Design and Application Certification
• $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
Sincer y,
Trenton D. Stewart, PE
Arcadia Consulting Engineers, PLLC
PO Box 2077, Apex, NC 27539 Telephone [phone] Facsimile 919 363-1477

NC Dept of Environmental Quality
DWR
JAN 17 2019 State of North Carolina
Department of Environmental Quality
DMO&M d Whor a...W� Division of Water Resources
Rafei h Ref Oice
Alow racking/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 Master Plan Sanitary Sewer Stub
More than one FTSE may be required far a single project if the owner of the WWTP is not responsible for all pump
stations along the route of the proposed wastewater flow.
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 4: NC 0063096
A11 flows are in MGD
c. WWTP facility's permitted flow 6.0
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
£ Total flow for this specific request
g. Total actual and obligated flows to the facility
It. Percent of permitted flow used
0. 81q
I, M)
0.010800
2,16
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)
(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 / pf),
Daily Flow, Daily Flow, Obligated Available
Number) MGD
MGD
MGD MGD Flow Capacity***
Basal Creek 0
G p, l5 0. l94
'
IL onmdk t,r,dkdta9n
0.,h09IcL0
21 o {.yi3 2. n4 0,(36
* The Firm Capacity of any pump station is defined as the maximum pumped flow that
can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking
factor (pi) not less than 2.5.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sews.,.
Downstream Permit Number:
alias i CFeeK POtl,p 50 n
INQ 0037350
Page 1 of 6
FTSE 04-16

Ill. 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 Official
Date
Page 2 of 6
1~TSE 04-16

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