WQ0040838_Application (FTSE)_20190401

State of North Carolina
Department of Environmental Quality
D. Division of Water Resources
,WR
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Dlvlslon of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number.. �� Q l 3 U (to be completed by DWR)
All items must be completed or the application well be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Town of Hillsborough (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: Ms. Marie Strandwitz per 15A NCAC 02T .0106(b)
Title: Utilities Director
4. Applicant's mailing address: I05 E. Corbin Street, PO Box 429
City: Hillsborough State: NC Zip: 27278 }
5. Applicant's contact information:
Phone number: 914 296-9631 Email Address: marie.strandwitz hillsborou hnc. ov
II. PROJECT INFORMATION:
l . Project name: Churton Street Sewer Renlacement
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 CY
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3. County where project is located: Orange County ;a p
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.065 = Longitude:-79,100�' E c� q
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5. Parcel ID (if applicable): NIA in SR-1009 RAV
(or Parcel ID to closest downstream sewer) > t °�
III. CONSULTANT INFORMATION:
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1. Professional Engineer. Mo Pacini License Number: 036896 q
Firm: Arcadis
z
Mailing address: 7029 Albert Pick Road Suite 101
City: Greensboro State: NC Zip: 27409-
Phone number: Q& 443-2433 Email Address: mo. acini arcadis.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Hillsborough WWTP Permit Number: NCO026433
Owner Name: Town of Hillsborough
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ Downstream (Receiving) Sewer Size: 100 inch
System Wide Collection System Permit Number(s) (if applicablc). WQCSCS00077
Owner Narne(s): Town of Hillsborough
FORM: FTA 04-16 Page 1 of 5

THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional Office
2090 US Highway 70
Avery, Buncombe, Burke, Caldwell, Cherokee,
Water Quality Section
Swannanoa, North Carolina 28778
Clay, Graham, Haywood, Henderson, Jackson,
[phone]
Macon, Madison, McDowell, Mitchell, Palk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Fayetteville Regional 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
610 E. Center Avenue
Alexander, Cabarrus, Catawba, Cleveland,
Water Quality Section
Mooresville, North Carolina 28115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
Raleigh Regional Office
1628 Mall Service Center
Chatham, Durham, Edgecombe, Franklin,
Water Quality Section
Raleigh, North Carolina 27699-1628
Granville, Halifax, Johnston, Lee, Nash,
[phone]
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
Warren, Wilson
Washington Regional Office_
943 Washington Square Mail
Beaufort, Bertie, Camden, Chowan, Craven,
Water Quality Section
Washington, North Carolina 27889
Currituck, Dare, Gates, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perqulmans, Pitt, Tyrrell, Washington, Wayne
Wilmington,Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
Water Quality Section
Wilmington, North Carolina 28405
Hanover, Onslow, Pender
[phone]
[phone] Fax
Winston-Salem Regional Office
450 W. Hanes Mill Road
Alamance, Allegheny, Ashe, Caswell, Davidson,
Water Quality Section
Suite 300
Davie, Forsyth, Guilford, Rockingham, Randolph,
Winston-Salem, North Carolina 27105
Stokes, Sury, Watauga, Wilkes, Yadkin
[phone]
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 3 of 3

VI. GENERAL REQUIREMENTS
L 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 ®NIA
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 I preschool I day care ® Medical / dental f veterinary facilities ❑ Swimming Pool /Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
® Businesses / offices i factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: % Domestic/Commercial 100 % Commercial
% Industrial (See_ 15A_NCAC 02T .0103(20))
1Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 02T .0114(f)? ❑ Yes ❑ No
D If Yes, provide a cot) of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.01140
Daily Design Flow ' b
No. of Units
Flow
No New Flows Generated
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gall
GPD
Total
GPD
a See 15A NCAC 02T .0114 b d), (Of 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.01141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 0 GPD (per 15A NCAC 02T .01 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

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 274 DI
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)
Oversizing 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):
t 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.
z 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(n & (e) ® Yes ❑ No
> 15A NCAC 02T.0305(f) contains minimum separations that shall be nrovided far sewer cvstemr
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 over sewer
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 Il im ounded reservoirs used as a source of drinking water
100 feet
**Waters classified WS (except WS-1 or WS-V), B, SA, ORW, HQW, or SB from normal
high water or tide elevation and wetlands see item IX.2
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches
10 feet
Any building foundation
5 feet
Any basement
10 feet
T2R slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth arade vertical
36 inches
15A NCAC 02T,0305(u) contains alternatives where separations in 02T 0305(f) cannot be achieved.
**Stream classifications can be identified using the Division's NC Surface Water Classifications webnaee
If noncompliance with 02T.0305(t) or (g), see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ❑ Yes ❑ No ® NA
➢ See the Division's draft separation requirements for situations where separation cannot be meet
D No variance is required if the alternative design criteria specified is utilized in design and construction
As built documents should reference the location of areas effected
3. Does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ❑ Yes ❑ No ®N?A
S- 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?
I- Information can be obtained from the 401 & Buffer Permitting Branch
5. Does project comply with 15A NCAC 02T.0I05(c)(6} (additional penn ts/certifications}? Yes ❑ No
Per 15A NCAC 0.2TA105(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 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 ❑No ®NA
If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at least once every six -months and inspections
documented per 15A NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit.
FORM: FTA 04- l6 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Pump Stations
and Force Mains (latest version), and the Gravity Sewer Minimum Design 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. Approval of the request is required prior to submittal of the Fast Track Application and supporting documents.
2. Professional Engineer's Certification:
�{
I, _ ��1`'t._� �� C.i�� attest that this application for
(Professional Engineer's name from Application Item III.1.)
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans, specifications,
engineering calculations, and all other supporting documentation to the best of my knowledge. I further 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 -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 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: ••,•••;�1�1 -C A q(5,%��
�• �. �FESSIpN.�j '�.
IS
r '
r
03689Fi -
Applicant's Certification per 15A NCAC 02T .0106(b):
I, , V 5_(� \ � � � ��� i P L_ 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 system to surface waters or the land will result in an immediate enforcement action that may include civil penalties,
injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water Resources should a condition
of this permit be violated. 1 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 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: Date .. c) �`'
FORM: FTA 04-16 Page 5 of 5

N
Legend r y
(Partial) TOH Manholes Streams /
O Existing 1 ` j Parcels (per Orange Co. GIS) y* /
• Proposed (Approximate) Project Area
O To be Removed/Abandoned k.
(Partial) TOH Sewer I
Existing "f
Proposed (Approximate) # 'T
To be Removed/Abandoned + �%
f
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Churton St Sanitary Sewer Improvements FIGURE
Aerial Site Map 2
04ARCADIS Town of Hillsborough
Orange County, NC March 2019

9 ARCADIS' a"A tancy
NC Dept of Environmental Quality
APR -1 2019
Raleigh Regional Oflicr
Water Quality Section Arcadis G&M of North Carolina.
Department of Environmental Quality — Division of Water Resources Inc.
1628 Mail Service Center 7029 Albert Pick Road
Raleigh, NC 27699-1628
Subject
Hillsborough, North Carolina
Churton Street Sanitary Sewer Improvements
Dear WQS Reviewer:
On behalf of the Town of Hillsborough we are pleased to submit the enclosed
Fast Track Sewer System Extension application for the Churton Street Sanitary
Sewer Improvements.
The Project is a replacement of an existing 6-inch and 8-inch gravity sewer that
runs parallel to and across S. Churton Street near Orange Grove Road/Orange
Grove Street. The existing gravity sewer crossing S. Churton Street has a sag in
the pipe which is causing the sewer flows to back up into the upstream manhole
located on the east side of the street. The existing 6-inch gravity sewer line
flowing north along the east side of Churton Street has several fittings/bends in
the line and is undersized as a collector sewer line. The replacement would
upsize the 6-inch line to an 8-inch line as well.
Suite 101
Greensboro
North Carolina 27407409
Tel [phone]
Date:
March 28, 2019
Contact:
Amanda Weikmann
Plane:
336-443-2479
Email
amanda.weikmann@arcadis_
com
Our ref-
GRHIL100.D001
ARCADIS G&M of North Carolina, Inc.
The section of sewer serves commercial enterprises located along Churton NC Engineering License # C-1869
Street and Orange Grove Street. No new flows are expected as this is an NC Surveying License # C-1869
improvement to the existing system to eliminate several issues within the existing
sewer. The Town of Hillsborough has a system -wide collection system permit
(WQSCS00077) and discharges to Hillsborough's wastewater treatment plant
(NC0026433).
This submittal package includes the following:
• One (1) original and one (1) copy of the last Track (FTA 04-16) Application
• Application Fee
• Figure 1 — t1SGS Topographic Map
• Figure 2 — Aerial Image
Page
GAPROJEGTWm
illsborough NC1Churton St Sewer Reploceanl4RegulatorylDEO Fast Track Sewer ExlenslonlCover Loner - FTSA.docx 1 /2

1 rf`

NCDEd DWR
We appreciate your assistance with this important project for the Town of Hillsborough and look forward
to your approval.
Sincerely,
Arcadis G&M of North Carolina, Inc.
Amanda Weikmann
Copies:
Mo Pacini (Arcadis)
David Hamilton (Arcadis)
Marie Strandwitz (Town of Hillsborough)
arcadis com
Page'
GAPROJECTWIlsboraugh NC1Churton St Sewer ReplecemenllRegulator)ADEO Fast Track Sewer ExtensionlCover Letter - FTSA.docx 2/2