WQ0040703_Application (FTSE)_20190123

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T,11300— FAST TRACK SEWER SVSTEM EXTENSION APPLICATION
Division of Water Resources INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION
This application is for seiner extensions involving gravity sewers, pump stations and force mains. or any combination that has been
certified by a professional engineer and the applicant that time project meet; the requiremmenis of 15A N"L: 02T and the Division's
Minimum Design Criteria and that plans, specifications and supporting documents haw been prep»red in accordance ssith,
NCAC 02T,-15. .NCAC, 2T,03gtl,Dhision policies and g-ood engineering actice5.
%Vhilc no upfront engineering design documents are required for submittal, in accordance with 15A NCAC 02T .0305(b), design
documents must be prepared prior to submittal of a fast track permit application to the Disision. This would include plans, design
calculations, and project specifications referenced in 15A NCAC 02T .0305 and the app;icable tnininu rn design criteria. These
documents shall be available upon request by the Division.
Projects that are deemed permitted (do not require a permit from the Division) are explained in 15A NCAC 02T.0303.
Projects not eligible for w% iew %is the fast track process (must be submitted for full technical review):
% Projects that require an environmental assessment in accordance with 15A NCAC 1C .0100;
Projects that do not meet any pan of the nnninutm design criteria (MDC) document;
Projects that ins olve a variance from the requirements of 15A NCAC 2T;
Pressure sewer systems utiltaing septic tank -effluent pumps (STEPS) or simplex grinderpumps;
% STEP or simplex grinder pumps connecting to pressurized systems (c.g. force mains);
Vacuum st.wersystems.
General - When submitting an application, please use the following instructions as a checklist in orderto ensureall required items
are submitted. Adherence to these instructions and checking the provided boxes will help produce a quicker review time and
reduce the amount of requested additional information, Failure to submit all required items %sill necessitate additional
processing and review time, and may result in return of the application. Unless otherwise noted, the Applicant shall submit
one original and one copy of the application and supporting documentation.
A. One Original and One Cope of Application and Supporting Documents
Q Required unless otherwise noted
B. Cover Letter (Required for All Application Packages):
X1 List all items included in the application package, as well as a brief description of the requested permitting action.
Be specific as to the system type, number of homes served, flow allocation required, etc.
If necessary for clarity, include attachments to the application form-
C. Application Fee (All New and Major Modification Application Packages):
xn Submit a clieck or money order in the amount of $480.00 dated within 90 days of application submittal.
Payable to North Carolina Department of Environmental Quality (NCDEQ)
D. Fast Track (Form: IF IA 04-16) Application (Required for.All Application Packages):
Submit the completed and appropriately executed application-
Ifnecessary for clarity or due to space restrictions, attachments to the application may be made.
❑ If tic Applicant Type in Item 1.2 is a corporation or company, provide documentation it is registered for business with
the North Carolina Secretary of State.
0 If the Applicant Type in Item 1-2 is a partnership or d-b;'a, enclose a copy of the certificate filed with the Register of
Deeds in the county of business.
XD The Project Name in Item II-1 shall be consistent with the project name on the flow acceptance letters, agreements, etc.
x0 Tile Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a North
Carolina licensed Professional Engineer.
xQ The Applicant's Certification on Page 5 of the application shall be signed in accordance with 15A NCAC 02T .0106(b).
Per 15A NCAC 02T .0106(c), an alternate person may be designated as the signing official if a delegation letter is
provided from a person who meets the criteria in 15A NCAC 02T .0106(b).
INSTR('CTIONS FOR FORM! FTA 04-16 & St PPORTING DOCUM ENTATION Page I of 3

E. Flow Tracking/Acceptance Form (Form: FTSE 04-16) (if Applicable):
xQ Submit the completed and executed FTSE form from the owners of the downstream sewers and treatment facility.
Multiple forms maybe required where the downstream sewer owner and wastewater treatment facility are different.
The flow acceptance indicated in firm FTSE must not expire prior to permit issuance and must be dated less than one
year prior to the application date.
Submittal of this application and form FTSE indicates that owner has adequate capacity and will not violate G.S. 143-
215;67fL.
Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific FTSE.
F. Site Maps (All Application Packages):
x❑ Submit an 9,5-inch x I 1-inch color copy ofa USGS Topographic Map of sufficient scale to identify the entire project
area and closest surface waters.
Location of the project (gravity sewer, pump stations & force main)
Downstream connection points and permit number (if known) for the receiving sewer
QInclude a street level map showing general project area.
G. Existing Permit (All Modification Packages):
❑ Submit the most recently issued existing permit.
❑ Provide a list of any items within the permit the Applicant would like the Division to address during the permit
modification (i.e., permit description, flow allocation, treatment facility, etc.).
H. Power Reliability Plan (Required if portable reliability option utilized for Pump Station):
❑ Per 15A NCAC 02T .0305 h 1 , submit documentation of power reliability for pumping stations_
This alternative is only available for average daily flows less than 15.000 gallons per day
It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant and is compatible
with the station. The Division will accept a letter signed by the applicant (see 15A NCAC 02T .0I06(b)) or proposed
contractor, stating that "the portable power generation unit or portable, independently -powered pumping units, associated
appurtenances and personnel are available for distribution and operation of this pump station."
If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump
stations' storage capacities and the rotation schedule of the portable power source or pump, including travel
timeframes, shall he provided in the case of a multiple station power outage. (Required at time or certification)
I. Certificate of Public Convenience and Necessity (All Application Packages for Privately-Oiwned Public Utilities):
❑ Per 15A NCAC 02T .0115(a)(1) provide the Certificate of Public Convenience and Necessity from the North Carolina
Utilities Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served by
the sewer extension, or
❑ Provide a letter From the North Carolina Utilities Commission's Water and Sewer Division Public Staff stating an
application for a franchise has been received and that the service area is contiguous to an existing franchised area or that
franc his eapproval is expected-
J
. Operational Agreements (Applications from HOA!POA and Developers for lots to be sold):
❑ Home-Pra erty O►vners' Associations
❑ Per 15A NCAC 02T .01 15(c ), submit the properly executed Operational Agreement FORM: HOA).
❑ Per 15A NCAC 02T .01 15(c ), submit a copy of the Articles of Incorporation. Declarations and By-laws.
❑ Developers of lots to be sold
❑ Per 15A NCAC.' 02T .0I 15(b), submit the property executed Operational Agreement ( FORM: DEV).
For more injbi-inat oii, VLv11 the Divis on S collection si st 'in.0 websile
INSTRUCTIONS FOR FORM: FTA 04-I6 & SUPPORTING DOCUMENTATION Page 2 ol'3

THE COMPLETED APPLICATION PACKAGE INCLDINGALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
Asheville Re Tonal Office
Waterpuality Section
ADDRESS
2090 US Highway70
Swannanoa, North Carolina 28778
(828)2964500
[phone] Fax
COUNTIES SERVED
Avery, Buncombe, Burke, Caldwell, Cherokee,
Clay, Graham, Haywood, Henderson, Jackson,
Macon, Madison, McDowell, Mitchell, Polk,
Rutherford, Swain, Transylvania, Yancey
Fayetteville Re ional Office
225 Green Street Suite 714
Anson, Bladen,Cumberland, Harnett, Hoke,
Water Quality Section
Fayetteville, North Carolina 28301-5094
Montgomery, Moore, Robeson, Richmond,
[phone]
Sampson, Scotland
[phone] Fax
Mooresville Regional Office
610E. Center Avenue
Alexander, Cabarrus, Catawba, Cleveland,
WaterQuality Section
Mooresville_ North Carolina 28115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan
[phone]
Stanly, Union
[phone] Fax
Rainigh Re iorral office
1628 Mail Service Center
Chatham, Durham, Edgecombe, Franklin,
Water Qualfty Section
Raleigh, North Carolina 27699-1628
Granville, Halifax, Johnston, Lee, Nash,
[phone]
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
Warren, Wilson
W ashin ton RegionaT Office
943 Washington Square Mall
Beaufort, Bertie, Camden, Chowan, Craven,
WaLer uaJlty Sec lion
Washington, North Carolina 27889
Curriluck, Dare, Gales, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
Wilmington Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
WaterQualitvSection
Wilmington, North Carolina28405
Hanover, Onslow, Pender
[phone]
[phone] Fax
Winston-Salem Re tonal Office
1 450 W. Hanes Mill Road
Alamance,Alleghany, Ashe, Caswell, Davidson,
Water Quality Section
Suite 300
Davie, Forsyth, Guilford, Rockingham, Randolph,
Winston-Salem, North Carolina 27105
Stokes, Surry, Watauga, Wilkes, Yadkin
[phone]
INSTRUCTIONS FOR FORM- FTA 04-16 & Sk'PPORTING DOCU,NI ENTATION Page 3 oi'3

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
15A NCAC 112T .0300— FAST TRACK SLAVER SYSTEU INTENSION APPLICATION
Division of Water Resources FiA 04-16 & SUPPORTING DOCUMENTATION
Application Number, J' AU)L(6-JttotxcomplciedbvD%VR)
All items must he comRieled or the apoication ti►ill Ix, returned
1. APPLICANT INFORNLATION:
1, Applicant's name: Town or Holly Springs (company. municipality, HOA, utility, etc.)
2. Applicant type- ❑ Indiridual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
0 Federal ❑ State:County ® Municipal ❑ Other
3. Signature authority's name_ Kendra D. Parrish P.E per 15A_NCAC 02T .0106(b)
Title: Director of Fltginecring
4 Applicant-s [trailing address: 129 South Main Street
City: Holly Springs State: NC Zip: 27540-
5. Applicant's contact inforn ation:
Phone number, (919) i57-393 Enuil Address- kends. arrishrii ltollvs rin gsne.us 0*4
saxes .en,;, kaki yslfri r�Snc
If. rRo.rECr rNFOR,IIATION:
. us
3. Project name: Honeycutt Farm • Phases 3 & 5
2- Application+Project status; ❑X Proposed (Now Permit) ❑ Ddsting Permit:Project
If a modification. provide the existing permit number; WQ00 and issued date:
If new construction but part of master plan, provide the existing permit number. WQ()0
3. County where project is located: Wake
4. Appro.,dmttc Coordinates (Decimal Degrees)- Latitude; 35'37'17'N Longitude: _78'50'46"W
v
5. Parcel ID (if applicable): 0421819 0014190. 03811113
O'
(or Parcel ID to closest downstream sewer)
c
0 C)
III. CONSULTANT INFORMATION:
d
N O
I. Proressional Etgineer: Jahn C. Martin License Number: 043217
o
•••
Cnto
C'V
Firm.McAdams Company
fit]
Z
tblailing address: 2905 Meridian Parkway
c.
U
City: Durham State: NC Zip: 27713
m
❑
cC
C,
Phone number' 919-361-5000 martin mcadamsea.cam
(_.. _ Email Address:) @
Z
IV- WASTEWATER TREATMENT FACILITY (WWTF) INFOR,AIATION:
1. Facility Name: Utley Creek: Was tewaterTreatment Plan Permit Number: NC0063096
Owner Name: Town of o ly Springs
V. RECEIVING DOWNSTREAM SEATER L1FORNIATION (if different than 11 WT1):
I. Permit Number(s): 41'Q AOy0-5607 Downstream (Rccek ing) Sc►%er Size; inch
System Wide Collection System Permit Number(s) (if applicable); WQCS-P-0—J 9a
Owner Natte(s): :n2k/ S
Ft3RIvl: FTA 04-16 Page 1 of;

VI.
x.
GE14'-RAL REQUIREIIENTS
L lf'the Applicant is a Privately -Owned Public Utility, has a Certificate of -Public Convenience and Necessity been attached''
❑ Yes ❑ No X❑ N.:A
2. If the Applicant is a Developer of lots to he sold, has a Developer's e a io t F been attached"
❑ Yes ❑ No EN - A
3. If the Applicant is a 1tuRx. f'. �ncrs' Assuc lion hasan Operniopal A = RM: WAI beenattached''
❑ Yet ❑ No 0 N: A
4. Orrin of wastewater: (check all that apply):
Bx Residential Owned ❑ Retail (stores. centers, malls) ❑ Car Wash
Residential Leased ❑ Retail with food preparation?sen-ice ❑ Hotel and. or Motels
❑ School . preschool? day care ❑ Medical dental Velerinary facilities ElSwinuning Pool Clubhouse
❑ Food and drink facilities Cl C7turch ❑ Swimrning Poo4-Filter Backwash
❑ Businesses; offices factories ❑ Nursing Honx: ❑ Other (Explain in Attachment)
5. Nature ofwastewater: 100 %, Dornestic+Cotnmercia I °a Commercial
'/„ Industrial (See I5A N AC 02T .0103(20))
;Is there a Pretreatment Progrtm in effect'? El Yes ❑ No
b. Hasa flow reduction been approved under 1sA_NC,"kC 02T .01I4li)'' M Yes ❑ No
If yes. pro%ide it copy or Ilow reduction annro►ul letter
7. Sumrtnriz! wasiewatergeneraled byproject:
Establishment Type (sec 2T 114 )
SINGLE FAMILY HOME
Daily Design Flaw 'j'
255 gal' UNIT
No, of Units
89
Flow
22 695 GPD
gall
GPD
gall
GPD
gaff
GPD
gav
GPD
gal'
GPD
Tolccl 1 22,695 GPD i
a See 15A NCAC 02f .ill I-411l,t W9 NIXII and ieV1 forcaveatsto wastewaterdesign flow rates 0,e.. Ittinintum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public useareas;
and residential properly located south oreast of the Atlantic Intracoastal Watenvav io be used as vacation rentals as defined
in G.S. 42A-4).
b Per I5A NCAC 02T .0114(c). design flow rates fbr establishments not identified [in table I5A NCAC 02T.01141 shall be
detemnined using available flow data, water usingfimures. occupancy or operation patterns,andothermeasured data.
Was tewatergenerated by project:22,695 GPD per f A N _AC 02T .0114)
Do not include future flows or previously perntitted allocations
If pemtitted flow is zero, indicate why:
❑ Pump Station or Gravity Sewer where flow will be pemtitted in subsequent perinks that connect to this line
❑ Flow has already been allocated in Pennit Number:
❑ Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain):
FORM - FTA 04-16 Page 2 of 5

VIE. GRANITE' SLIVER DESIGN CRITERIA (if Applicable) - 27'. ;05 R 1NIDC (Grasity Scisers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 3,865 PVC
Section II & ill ofthe NIDC for Permitting ofGrlvity Savers contains inibtmation related to designcriteria
Section III contains information related to minimum slopes for gravity sewer(s)
O%ersizing lines to meet minimum slope requirement is not allowed and a %iolation of the 1MDC
VIll. PUMP STATION DESIGN CRFTERI.-A (If Applicable) — 2T. 305$ TRC (Purntations/F rce Main. :
COMPLETE FOR FACW PUMP STATE ,` INCLUDED IN THIS PROJECI
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 capacit)) `
d. Opemtional point(s) of the pump(s): gallons per minute at feet total dy nanic head (TDW)
5. Sunttn-ariae the force main to be pernitted (for this Pump Station):
Size (inches) Length (feet) Material
6. Power rehabiiiiv in accordance with 55A NCAC 02T .030(W(I 1:
❑ Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(h)(1)(13)_
(Required fbr all pump stations %%ith an a%cragedaily flow greater than or equal to 15,000 gallons perday
Must be permanent to facility
Or if the pump station has an average daily flon. less than 15.000 gallons per day:
❑ Portable power source with tttanual activation. quick -connection receptacle and tclemetry - I5A NCAC 02T
.0305(h 0 1 ) (C)
or
❑ Portable pumping unit with pluggedetmrgency pump connection and telemetry - 15A NCAC 02T .0305(h)(l)(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.
Ifthe portable power sourceor pump is dedicated to multiple pump staiions.an evaluation ofall the pump stations'storage
capacities and the rotation schedule of the portable power soutreor pump, including travel tirriefranxs, shall be provided
in thecase of multiple station power outage.
FO RM : FTA 04-16 Page 3 of 5

IX.
SEi'BACICS & SEPARATIONS — (0213 .0200 & 15A NCAC 02T.03051(f)):
Dots the project comply with all separations t'ound in 15A NCAC 02T .0305 1 Ql'es ❑ Nu
15A NCAC 02T 0104t f)
Setback Parameter
Separation Required
Storm sewers and other utilities not listed below (vertical)
Water mains (vertical -water over sewer including in benched trenches)
Water trains (horizontal)
24 inches
18 inches
10 feet
Reclaimed waterlines (vertical -reclaimed over sewer)
18 inches
Reclaimed water lines (horizontal - reclaimed over sewer)
2 1i et
**Any private or public water supply source, including any Wells, WS-1 waters of Class I or
Class II impounded reservoirs used as a source of drinking Water
100 feet
"Waters classified WS (e.xcept WS-1 or WS-V), B, SA, ORW, HQW, orSB front nomral
high water (or tide elevation) and wetlands (see item IX,_')
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 slope of embankment or cuts of2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Anyswimruing pools
10 feet
Final earth grade (vertical)
36 inches
ISA NCAC_02T.0305(el contains alternatives when; separations in 02T.03I15(f) cannot be achieved.
*"Stream classifications can be identified using the Div ision's NC Surface WaIerClassilicat ions web Vage
1W lfrioncompliance with 2 0 0' r seesection X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet ofseparation) El Yes ❑ No
i See the Division's drill separation requirerents 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 et%cted
3. Does the project comply with all setbacks found in the rig er basin rules per 15A NCAC_02B .0200? 77 Yes ❑ No
This would include Trout Buffered Streams per 15A NCAC 213.0202 L�J
4. Does the project comply with an individua[ 44 Permit or any 401 Certifications? 0 Yes ❑ No
Welland -related permits shalt be requested, obtained, and adhered to for projects that impact Wetlands or surface waters
Inibnnation can be obtained from the 401 & ButTer Permittine Branch
5. Does project corriply with 13A NCAC 02T.0105(cg ) (additional permitsicertiticaiions)? 0 Yes ❑ No
Per 15A NCAC 02T.0105(4)(N. directly related environmental permits or certification applications are being prepared, have
been applied lbr. or have been obtained. Issuanceofthis perms is contingent on issuanceof dependent pennits (erosion and
sedimentation control plans, stomnvater management plans, etc.).
6. Does this project include any sewer collection fines that are deemed "high-prionty?"
Per 15A NCAC 02T.0402. "high -priority sewer' means "any aerial sewer, sewer contacting surtace waters, siphon, or sewer
positioned parallel to sireatnbanks that is subject to erosion that undennines 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 Ix inspected by file permittee or its representnfiie ill leastonce "rry sis-months and inspections
documented lwr 15A NCAC 02T.0403(a)(5) or the permitee's individual S3,stenl_%lride Collection permit.
FORM: FTA 04-16 Page 4 o f 5

.W
X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the NJh3imun; Drs.[[an CH!,L! is for the PwngQtling ofPurm Stutionx
and Force Mains (latest version). and the Gravity Sewer Minimum Dest n Criteria latest %ersion as applicable?
] i'es ❑ No
If No, complete and submit the Variance'Altemative Design Request application (VADC 10-14) and supporting documents for
review. Annroval r r the rec uc t is re[ uired Vri2r to submittal or the Fast Track Application and su artin = documents.
?. Profess ionai Engineer's Certification:
3.
John C Martin
{Professional Engineer's name from Application Item Ill.).)
ttest that this application for
has been reviewed by me and is accurate. complete and consistent with the infornwion supplied in the plans• specifications.
engineering calculations, and all other supporting documentation to 1he best of my knowledge. I further attest that to the best
of man+ knowledge the proposed design has been prepared in accordance with the applicable regulations. Ca`av i[y Sewer
Minimum Design Criteria for Cmtvity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track Pennining
Of Pump Stations and Force plains (latest version). Although other professionals pray have developed certain portions of this
submittal package, inclusion of these materials under my signature and sea] signifies that I have reviewed this nwiterial :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
stateiem, 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 nena[ties un to S25-(n0 ner violation
,North Carolina Professional Engineer's seal, signature, and date
1'� CAR����%
�i
O' 7
_ 47
e SEAL r .
00 043217
C
. 7' ,NGfiV�S�L -
�'[ 1�?`���
Appiicar is •"emtitication !�A NCAC O?T ,0106(h):
{Signal a Authority's name & title from Application Item I.3')
attest that this application for
has been reviewed by me and is accurate and corMlete 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 docuentation 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 systenito surtace waters or the land will result in an immediate enforcement action that may include civil penalties.
injuncin a relief, and-orcriminal prosecution. I will nt►ke no claim against the Division of Water Resources should a condition
of this pentut be violated. I also understand that ifall required parts of this application package are not completed and t hat if
:alt required supporting information and attachments are not included, this application package will be returned to me as
incomplete.
NOTE - In accordance with Gcncrai Statutes 14-215.6A and 143-215.66. any person ►►ho knowingly stakes any false
slatement, representation. or certification in any application package shall be guilty of a Class ? nmderneanor, which may
include a fine not to exceed 510.000 as well as civil penalties up to S2..000 per violation.
Signature: -- _..--- - - - — ----- - Date_
FORM: FTA 04-16
Page 5of5

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 _Gravity Sewers, Pump
Stations, and Force Mains for extension to the Town of Holly Springs Sewer System
Project;
Design Engineer-
Honeycutt Farm -
WTi[ON LF1 MR
Phases 3 & 5
Address: 2905 Meridian Parkway, Durham, NC 27713
Phone Number: 919-361-5000 Email- [e-mail]
Date Complete Application Package Received by Town: on
Date Approved: (by RLC) (by KDP)
As design engineer for this project, I certify the following {please check (r) each applicahle box):
x❑ 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;
x❑ 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 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, Pu► ip 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 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
Design Engineer's Signature 4p,C •
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 Depar meat • P.O. Bar 8, Holly Springs, NC 27540
919-557-3938 - 919-552-9881 par)
2003 Sower Ncsign Application Cenification
04.11.2019
A
U
z
PENEMI .1

.. . t
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow TrackinWAcceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: Town Of Holly Springs
Project Name for which flow is being requested: Honeycutt Farm - Phases 3 & 5
More than one FTSE mar he required fitr a single pre feet if'the ou ner of the IVII P is not resprutsihie fitr all pump
Stations along the route r f the propnsecl rrash,watel, floe.
1. 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
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
f. TotaI flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
rill flows are in AIGD Cy
6.0r�
C"
j C
Q D '>
h'3
N
c
Z
v
A
II. Complete this section for each pump station you are responsible for along the route of this U
proposed wastewater flow.
List pump stations located between the project connection point and the WWTP:
(A)
(B)
Design
Pump
Average Daily
Approx.
Station
Firm
Flow'"*
Current Avg.
(Name or
Capacity. *
(Firm? pf).
Daily Flow,
Number)
MGD
MGD
MGD
1
X
(C)
(D)=(B+C) (E)=(A-D)
Obligated,
Not Yet
Total Current
Tributary
Flow Plus
Daily Flow,
Obligated Available
MGD
Flow Capacity• •"
C,10A
n.60
* 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 Floe 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 WW P Svhere the Available Capacity is < 0.
d
Downstream Facility Name (Sewer): dl7 (.+1}� �Ump S��jp7?
Downstream Permit Number: �D#D,<z9
9
Page I of 6
FTSE 04-16

I1I. Certification Statement:
t certify to the best of my knowledge that the addition of
the volume of %% s water to a permitted in this project has been evaluated along the route to the
receiving wastewater treatm t facility and that the flow from this project is not anticipated to
cause any capacity related sanitary server 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
Page 2 of
FTS E 04-16

PLANNING ASSESSNIENT ADDENDUNI (PAA)
Submit a planning assessment addendum for each pump station listed in Section II 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 (E) 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 tk.ith
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 Ofleial Signature Lhttc+
Page 3 of 6
FTSC 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 facility's permitted flow, MGD: From WWTP owner's NPDES or Non -Discharge permit.
d. Estimated obligated flow not yet 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 now 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 flo%v 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 ay.,,. 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 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 = 0.0151NIGD
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 °u
Each subsequent FTSE form will be updated in the same manner.
Page 4 of 6
FTSE 04-10

Section 111
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 cacti 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+C)
(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
(Find / pl)
MGD
MGD
Flow
Capacity*
Kaw Creels 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
FTS F 04- l 6

Planninu Assessment Addendum Instructions
Submit a planning assessment addendum for each pump station listed in Section II where mailable capacity
is<0.
A planning assessment for Kaw Creek PS (see example data above) may be performed to evaluate whether
there is si ,nificant 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 floe 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 ca ital Project
entitled Kaw Creek Pump Station upgrade with funding Olanned in July 2014. This pro4ect is l2lanned to
add 0.100 MGD to the firm capacity of the pump station by October 2015. Inclusion of this Proposed
capital Proicet as a condition of this Flow Trackime Acce Lance for Sewer Extension Permit Apl2lication
elevates this 12roject's.priority for funding and construction to be implemented ahead of the activation of`
obligated. not yet tributary flows in amounts that exceed the firm Rumn station ca acities identified in
Section II 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

N
HONEYCUTT ROAD
USGS TOPO MAP
0 500 1,000 2,000 PROJECT #: MIH-16010
Feet
I inch - 1000 feet HOLLY SPRINGS, NORTH CAROLINA
11
McADAMS

4h

CT
State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Environmental Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
March 31,1995
Stepanie L. Sudano, P.E., Town Engineer
Town of Holly Springs
Post Office Box 8
Holly Springs, North Carolina 27540
RE: Town of Holly Springs
Request for Adjusted Daily Wastewater Flow
Wake County
Dear Ms. Sudan;
,&T.WM'AI
E3EHNR
NC Dept of Environmental Quality
JAN 2 3 2019
Ralcigh Regional Office
On March 15,1995, the Division received your wastewater flow reduction request and supporting
documentation concerning wastewater flows associated with present residences within the Town of Holly
Springs. Your letter requested the Division allow the reduction of wastewater flows from 120 GPD per
bedroom as required in required by North Carolina Administrative Code to 255 GPD per household for
single family residential units. In support of your request, water consumption data and wastewater
information was supplied from households located in Holly Springs.
An evaluation was completed by the Division in accordance with 15A NCAC .02190)(3) using the
water consumption. data submitted, twelve (12) months of data starting from January 1994. The peak
month was determined to be January 1994 based on average wastewater generated per customer. Using
the upper 10% of the water consumption data for the month of January, eliminating industries, commercial
properties and several inaccurate residential readings, Division staff verified the flow rate of 255 GPD per
household.
In view of the information submitted, the Division of Environmental Management hereby approves
the use of 255 GPD per single family residence in all applicable non -discharge permit applications for
future wastewater collection extensions which will be made tributary to the Town of Holly Springs
Wastewater Treatment Plant (Permit No. NC0063096). This consideration applies to any applicable future
projects submitted to this Division as well as any projects which are presently under review. Wastewater
flows presently tributary to the wastewater treatment facilities can be adjusted upon negotiations between
the Town of Holly Springs and the Raleigh Regional Office.
If you have any questions or comments regarding this matter, please contact Mr. Michael D. Alldn
at [phone] ext. 547.
Since y, Vle L ,e,
/,--
A. Preston Howard, Jr., P.E.
cc: RaIeygh Regional Office, Water Quality Section
State Engineering Review Group
P.O. Box 29535, Raleigh, North Carolina 27626-OS35 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 60% recycled/ 10% post -consumer paper

JI McADAMS
January 4, 2019
NCDENR - DWR
Raleigh Regional Office
1628 Mail Service Center
Raleigh, North Carolina 27699-1628
Re: Honeycutt Farm Phases 3 & 5
Holly Springs, North Carolina
MIH-16010
NC Dept of Environmental Quality
JAN 2 3 2019
Raleigh Regional Office
The accompanied East -Track Application (FTA 04-16) includes 3,865 lineal
feet of 8" PVC sanitary sewer associated with the proposed Honeycutt Farm
Phases 3 & 5 development located off Honeycutt Road in Holly Springs, NC.
The gravity sewer will all be a public system owned and operated by the
Town of Holly Springs. Phases 3 & 5 of the project will consist of
approximately 89 residential units. The total wastewater flow generated by
Phases 3 & 5 of the project is 22,695 GPD.
Sincerely,
THE JOHN R. MCADAMS COMPANY, INC.
John C. Martin, P.E.
Technical Manager, Residential
Enclosures
The Jahn n. McAdams
Company, Inc.
Raleigh / Durham, NC
2905 Meridian Parkway
Durham, North Carolina 27713
[phone]
Charlotte, NC
11301 Carmel Commons 0ivd.
wile II I
Charlotte North Carolina 28226
[phone]
McadamsCo,com Designing Tomorrow's Infrastructure & Communities

T H E TO W N OF
January 16, 2019
Director, Division of Water Resources
Raleigh Regional Office
Water Quality Operation Section
1628 Mail Service Center
Raleigh, NC 27699-1628
,,Wol &n�ngs
Re: Application for Sewer Extension Permit
Project: Honeycutt farm Phases 3 & 5
Dear Sir or Madam:
NC Dept of Environmental Quaht%
JAN 2 3 2019
Raleigh Regional Office
Please find enclosed the following items in application for a sewer extension permit to the Town
of Holly 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
o One original and one copy of the State of North Carolina Fast Track Seger System
Extension Application (PTA 04-16)
o Two copies of FTSE 04-16 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
Feel free to contact me at 919-557-3938 should you have any questions or need additional
information in order to process this application.
Sincerely,
endra D. P ish, P.E., C1=M
Director of Engineering
KP/se
cc: Project Consultant Engineer, John C. Martin, PE, McAdams Company
Administrative Manager (for addition to sewer permit log)
Rodney Campbell, Development Administrator
Project file/Correspondence #41706
3002
04.17,201 R
Engineering Department
P.O. Box 8 • 128 S. Main Street • Holly Springs, NC 27540 • www.holIyspringsnc.us