WQ0040980_Application (FTSE)_20190523

h
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
VC QU81
Application Number: W00 �07 0 (to be completed by DWR)
MAY Z 3 2019
All items must be completed or the application will be returned
I. APPLICANT INFORMATION: Wdgh Reg101WOfte
1. Applicant's name: Orange Water & Sewer Authority (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ❑ MunicipaI ® Other
3. Signature authority's name: Ed Kerwin per I5A NCAC 02T .0106(b)
Title: Executive Director
4. Applicant's mailing address: 400 Jones Ferry Road
City: Carrboro State: NC Zip: 27510-
5. Applicant's contact information:
Phone number: 9(_19) 5374201 Email Address: nnparkerCowasa.org
IL PROJECT INFORMATION:
1. Project name: EASTOWNE MOB 1
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 located: Orange Count_
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.948 Longitude:-79.007
5. Parcel ID (if applicable): 9890800195
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: William H Derks License Number: 215�Z
Firm: McAdams
Mailing address: 2905 Meridian Parkway
City: Durham State: NC Zip: 27713-_
Phone number: 919 361-5000 Email Address: derksCmcadamsco.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Mason Farm Wastewater Treatment Plant Permit Number: NC 0025241
Owner Name: OWASA
V. RECEIVING DOWNSTREAMSEWER INFORMATION (if different than WWTF):
I . Permit Number(s): WQ N—N Downstream (Receiving) Sewer Size: $ inch
System Wide Collection System Permit Number(s) (if applicable): WQCS0003I
Owner Name(s): Orange Water & Sewr Authority
DO�s►.bh'�,►►�. 5C,40Y
ho Qt,rnn� V%,AV&W Asti��- +.• .
FORM: FTA 04-16 Pagel of 5

V1. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
[:]Yes [:]No ®N'A
2. If the Applicant is a Developer of lots to be sold, has a Deyelaper's Qperational Ae.reemcm.(FOILY: DEV3 been attached?
❑ Yes ❑No ®NIA
3. If the Applicant is a ome?Property_Oxyrters' Association, )4as an Gueration l Ag_reerr gnt LFO ; 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 f day care ® Medical I dental 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: 100 % Domestic/Commercial % Commercial
_ % Industrial (See ! 5A NCAC 02'r _0103(20))
,,Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under A N C 02T A l l_4 t ? ❑ Yes ® No
If yes, i2rovide a copy of flow reduction aRproval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.01140
Daily Design Flow'-e
No. of Units
Flow
Medical Office
250 gal/day/practitioner
96
24,000 GPD
Existing Office Demo
25 gal/employee
gal/
gal/
385
(9,625) GPD
GPD
GPD
gall
GPD
gal/
Tonal
GAD
14,375 GPD
a See 15A NCAC.02.T .01 14(b), (d). (c)(1) 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 Iocated 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 51 A NAC 02T0114j shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: (24.000 Rroposed - 9,625 existing) = 14,375 GPD (per ISA_.NCAC 02T .01
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

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 530 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)
i 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_,0305ih)t 1):
❑ Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(h)(I)(13):
Z 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 (drafl 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(t)):
1. Does the project comply with all separations found in 15A hELA9 02T .0305 ®Yes []No
➢ 15A NCAC 02T.0305 contains minimum se arations that shall be provided for sewers stems•
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 II im ounded reservoirs used as a source of drinking water
100 feet
**Waters classified WS (except WS-I 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 buildin foundation
5 feet
Any basement
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
Any swimming ools
5 feet
10 feet
Final earth grade vertical
36 inches
➢ 15A NCAC 02T.0305(gj contains alternatives where separations in 02T.0305(i) cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webpap
➢ 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
➢ 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 aII setbacks found in the river basin rules per 15A NCAC 02B ,0200? ® Yes [:]No
➢ This would include Trout Buffered Streams per 15A NCAC 213.0202
4. Does the project comply with an individual 404 Permit or any 401 Certifications? ® Yes ❑ No
➢ Wetland -related permits shall be requested, obtained, and adhered to for projects that impact wetlands or surface waters
➢ Information can be obtained from the 401.,B4ffer Perrnitting Branch
5. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)?
® Yes ❑ No
Per 15A NCAC 02T.0105icIt6), 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.
❑ Yes ® No
➢ If yes, include an attachment with details for each line, including type (aerial Iine, 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-I6 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with I.* A NCAC 02T, the LAinimurn Desip-n criteria for the Pcrmjnjgl._f pump Stations
and Force.Mains.{latest version), and the GravitjLSewer Minimum Design Criteria ilatest version as applicable?
® Yes ❑ No
If No, complete and submit the Variance/Altemative Design Request application (VADC 10- I4) and supporting documents for
review. Approval of the renuest is required orior to submittal of the Fast Track Application and supporting documents.
2. Professional Engineer's Certification:
_ 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 sea[ 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 $ I0,000, as well as civil penalties up to $25,000 per violation. _ _„ ,, ,_
North Carolina Professional Engineer's sea], signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
attest that this application for
(Signature Authority's name & title from Application Item 1.3.)
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 Iand 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. I also understand that if all required parts of this application package are not completed and that if
all required supporting information and attachments are not included, this application package will be returned to me as
incomplete.
NOTE - In accordance with General Statutes 143-215AA and 143-215.65, 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 $25,000 per violation.
Signature:
Date;
FORM: FTA 04-16
Page 5 of 5

Eel.i[[[pi ii �T[.T iN

M'W�ASA MANGE WATER AND SEWER AUTHORITY
A public, noti-profit agency providing wale;,, sewer and reclainied wales sei-viccs
to the Cati•boro-Chapel Hill connnmrit.y.
NC Dept of Environmental Quality
May 21, 2019
MAY 2 3 2019
NCDEQ Division of Water Resources
3800 Barrett Drive Raleigh Regional Office
Raleigh, NC 27609
SUBJECT: Permit Application for Eastowne Medical Office Building and Parking Deck
DWR Staff,
Enclosed are the following items for your review and approval. The project includes a public sewer main
extension, 530-ft of 8-inch pipe, to serve new buildings as part of a demolition and redevelopment project.
Application Pee - Check in the amount of $480.00
Fast -track Application} Form FTA 04-16 — original and copy
Flow TrackinglAcceptance Form — Form FTSE 04-16, original anti copy
Maps — 8-112" x 11-112" color copy USGS Topographic and Street Level, original and copy
Please contact me, by telephone at 919 537-4201 or email to [e-mail] , if you have any
questions or comments.
Sincerely,
Nicholas L. Parker
Engineering Associate
CC' Jessica Godreau, PE — OWASA
William Derks, PE, Lee Weaver, PE, Laura Haywood - McAdams
400 Jones Ferry Road Equal OElrartuniti Emphlier Voice [phone]
Carrboro, NC 275 10- 2001 Printed on Recycled Paper ++us+,cp+uiu.019