WQ0041002_Application (FTSE)_20190528

State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
PionkofWateor Resources VIA 04-16 & SUPPORTING DOCUMENTATION
Application Number: t-,)
0 V l 10 0 A (to be complemi by DWR)
1
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1.
Applicant's name: City of Sanford (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: Paul Weeks. PE per 15A NCAC 02T .0106(b)
Title: City Engineer
4.
Applicant's mailing address: P.O. Box 3729
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City: Sanford State: NC Zip: 27331-372
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5.
Applicant's contact information:
Phone number: (9�1 } 777-1119 Email Address: [e-mail]
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II. PROJECT INFORMATION:
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1.
Project name: Sam's Xpress - Sanford
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2.
Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
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If a modification, provide the existing permit number: WQ00 and issued date:
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If new construction but part of a master plan, provide the existing permit number: WQ00
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3.
County where project is located: Lee
4.
Approximate Coordinates (Decimal Degrees): Latitude: 35 455952 Longitude: -7 .19 41494
5.
Parcel ID (if applicable): GPIN 9652-70-7981
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
I . Professional Engineer: Matthew Lowder.PE License Number: NC24434
Firm: Triangle Site Design, PLLC
Mailing address. 4004 Barrett Drive, Suite 101
City: Raleigh State: NQ Zip: 27609-
Phone number: (9f9)553-6570 Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
I. Facility Name: Big Buffalo Wastewater Treatement Plan Permit Number: 0024147
Owner Name: City of Sanford
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ LV [ ����` Downstream (Receiving) Sewer Size: 8 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s): City of Sanford
FORM: FTA 04-16 Page 1 of 5

VL GENERAL REQUIREMENT'S
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
[:]Yes [:]No ®NIA
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached?
[--]Yes [-]No ®NIA
3. If the Applicant is a Home/Property Owners' Association. has an Operational Agreement (FORM: HOAR been attached?
❑ Yes ❑No ®NIA
4. Origin of wastewater: (check all that apply):
❑ Residential Owned ® Retail (stores, centers, malls) ❑ Car Wash
❑ Residential Leased ❑ Retail with food preparation/service ❑ Hotel and/or Motels
❑ School / preschool / day care ❑ Medical / dental / veterinary facilities ❑ Swimming Pool /Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming PooUFilter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: % Domestic/Commercial 100 % Commercial
% Industrial See 15A NCAC 02T .0103 20
%Is there a Pretreatment Program in effect? ❑ Yes [:]No
6. Has a flow reduction been approved under 15A NCAC 02T .0114(f)? [--]Yes ®No
If yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 221.01140
Daily Design Flow tib
No. of Units
Flow
Service Station
250 gal/water closet
2
500 GPD
gav
GPD
gnu
GPD
gal/
GPD
gav
GPD
gav
GPD
Total
500 GPD
a See 15A NCAC_02T .0114(b), (d). (e)(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 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. 42A-4}.
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.
f
8. Wastewater generated by project: 5000 GPD (per 15A NCAC 02T .0114)
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 abrady 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

VM GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permtted:
Size (inches) Length (feet) Material
8 381 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)
➢ 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 (Puma 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: mullions 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):
D It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant (draft agreement)
and is compatible with the station.
➢ If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all the pump stations' storage
capacities and the rotation schedule of the portable power source or pump, including travel timeiiames, shall be provided
in the case of a multiple station power outage.
FORM: FTA 04-16 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T.0305(f)):
1. Does the project comply with all separations found in 15A NCAC 02T.0305(f) & 60
➢ 15A NCAC 02T.0305(f) contains minimum seoarations that shall be orovided for sewer systems:
® 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 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 H impounded 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 building foundation
5 feet
AnX basement
10 feet
Top 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 grade vertical
36 inches
➢ 15A NCAC 02T.0305(a) contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ "*Stream classifications can be identified using the Division's NC Surface Water Classifications webpaQe
➢ 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 ❑ NIA
➢ See the Division's draft separation requirements for situations where separation cannot be meet
➢ No variance is required if the alternative design criteria specified is utilized in design and construction
➢ As built documents should reference the location of areas effected
3. Does the project comply with setbacks found in the river basin rules per 15A NCAC 02H .0200? ® Yes ❑ No ❑ NIA
➢ This would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Does the project require coverage/authorization under a 404 Nationwide or [--]Yes ® No
individual permits or 401 Water Quality Certifications?
➢ Information can be obtained from the 401 & Buffer Permitting Branch
5. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permitslcertifications)? ® Yes ❑ No
Per 15A NCAC 02T.0105(c)(6), directly related environmental permits or certification applications are being prepared, have
been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion and
sedimentation control plans, stormwater management plans, etc.).
6. Does this project include any sewer collection lines that are deemed "high -priority?"
Per 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 ❑ NIA
➢ If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at least once every six -months and inspections
documented per 15A NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit.
FORM: FTA 04-16 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/Altemative Design Request application (VADC 10-14) and supporting documents for
review. Approval of the reguest is re uired Prior to submittal of the Fast Track Application and supporting documents.
2. Pro ional nn ineer's C ification:
attest that this 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, 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 venalties uv to $25.000 Der violation.
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per
-155A NCAC 02T .0106(b):
1
(Signature Authority's name & title from
that this application for
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all requited 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. 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 143-215.6A and 143-215-6B, any person who knowingly makes any false
statement, representation, or certification in any application ackage shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000 as well as civil pen es up to 00 per violation.
Signature:
Date
FORM: FTA 04-16 J Page 5 of 5

TRIANGLE
S I T E b t 5 1 G N
4004 Barrett arivc, Suilc 101
Raleigh, North Carolina 27609
[phone]
SANITARY SEWER NARRATIVE
PUBLIC SANITARY SEWER TO SERVE SAM'S XPRESS CAR WASH
SOUTH HORNER BOULEVARD
SANFORD, NORTH CAROLINA
LEE COUNTY
CITY OF SANFORD
MAY 28, 2019
Sam's Xpress is proposing to construct a new car wash and fuel station facility in the City of
Sanford. The proposed site is located on South Horner Boulevard across from the intersection with
Dogwood Street. The site was previously developed as a manufacturing facility that has been
demolished.
The City of Sanford has an existing 8" public water main that bisects the ex=sting property. As part
of the redevelopment of the site Sam's Xpress is proposing to remove and replace the existing
sanitary sewer line to avoid conflicts with the proposed fuel station canopy and other proposed site
features. There are existing sanitary sewer manholes within the property at South Horner Boulevard
and at Dalrymple Street that will remain.
Sam's Xpress is proposing to install a new 8" ductile iron (3811f) sanitary sewer main through the
property to replace the existing sanitary sewer that crosses the site.
The anticipated flow for the project is 500gpd as calculated below:
Service Station — 2 water closets at 250gpd/wc = 500gpd
Utility Department System Information:
City of Sanford
Wastewater Treatment Facility (WWTF) Name: Big Buffalo Wastewater Treatment Plan
WWTF Facility #NC0024147
Attn. Paul Weeks, PE
NCDept ofEnvironmentat Qualit%
MAY 2 8 2019
Raleigh Regional off-

Oft
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: City of Sanford
Project Name for which flow is being requested: Sam's Xpress- Sanford
More than one FTSE may be required for a single project if the owner of the WWTP is not responsible for all pump
stations along the route of the proposed wastewaterflow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
n
a. WWTP Facility Name: Big Buffalo WWTPtip
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b. WWTP Facility Permit #: NCO024147
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All flows are in MGD
c. WWTP facility's permitted flow 12.0
d. Estimated obligated flow not yet tributary to the WWTP 1.24265
e. WWTP facility's actual avg. flow 3.9020
f. Total flow for this specific request 0.0005
g. Total actual and obligated flows to the facility 5.14515
0
p
h. Percent of permitted flow used 42.88%
H. 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
Average
Approx.
Obligated,
Pump
Pump
Daily
Current
Not Yet
Total Current
Station
Station
Firm
Flow**
Avg. Daily
Tributary
Flow Plus
(Name or
Permit
Capacity, *
(Firm / pf),
Flow,
Daily Flow,
Obligated
Available
Number)
No.
MOD
MOD
MOD
MOD
Flow
Capacity***
Gaster's
WQ0036837
4.032
1.61
1.02
0.01388
1.03388
0.57612
* The Firm Capacity (design flow) of any pump station is defined as the maximum pumped flow
that can be achieved with the Iargest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a pealing factor
(pf) not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** 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 c 0.
Downstream Facility Name (Sewer):
Downstream Permit Number.
Page 1 of 6
FTSE 10-18

M. Certification Statement:
I Paul M Weeks Jr., 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 certifies that the receiving collection system or treatment
works has adequate capacity to transport and treat Ow pWosed new wastewater.
Signing Official Signature
Title of Signing bfficial
Date
Page 2 of b
FTSE 10-18

TRIANGLE
' SITE DE5IGN
Transmittal
Date: May 28, 2019 Job Number:
Project Name: Sam's Xpress — Sanford
To: WaterOualitvSection — Raleigh Regional Office
Barrett Drive
NC
We are sending these by
❑ U.S. Mail
❑ Other
We are sending you
❑ Attached
❑ Shop drawings
❑ Other
4004 Buffett Drive, Suite 101
Raleigh, North Carolina, 27609
TEL [phone]
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000001
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❑ Hand Delivery
❑ Under separalc cover via the following heirs:
® Prints/Plans ❑ Samples ❑ Specifications ❑ Change Orders
(-nnier 1)nle Nn_ 11-.crrinlinn
I
FTSE — Flow Tracking
I
Application fee of $480.00
2
FTA 4-16 application (original & Copy)
2
Site maps
I
Narrative
This application is for the Public sewer extension.
These are lroasntilted as checked beloss-:
❑ For your use ❑ Approved as submitted ❑ Resubmit ❑ Copies for approval
❑ As requested ❑ Approved as noted ❑ Submit ❑ Copies for distribution
® For review and comment ❑ Retumed for corrections ❑ Return ❑ Corrected prints
Remarks:
Copy to: Signed:
Matt Lowder, PE

Cashion, Ted
From: Matt Lowder <mlowder@trianglesitedesign,com>
Sent: Wednesday, July 10, 2019 10:54 AM
To: Cashion, Ted; Michael Lamping
Cc: Robinson, Jason; Paul Weeks
Subject: RE: [External] RE- Sam's Xpress - Sanford fast track sewer extension application
maternal email. Do not elKlinks or open attachments unless you verlfy. Send alb suspicious emaq as an attachmertt to
That'NOUIL: be great, thank:,.
Matt Lowder, PIS
TRIANGLE
Triangle Site Desigm, PI_ ,C
4004 Barrett Drive, Suite 101
Raleigh, NC 27609
919-553-6570 16)
919-333-3729 fmj
rnlnv,-d er(@ trine Ie}itedesi Tn.cnm
From: Cashion, Ted {mailto:[e-mail]}
Sent: Wednesday, July 10, 2019 10:53 AM
To: Michael Lamping<[e-mail]>; Matt Lowder <[e-mail]>
Cc: Robinson, Jason <[e-mail]>; Paul Weeks <[e-mail]>
Subject: RE: [External] RE: Sams Xpress - Sanford fast track sewer extension application
With your permission, we'll include the collection system permit number, WQCS00047, item V on the application, for
you.
Ted Cashion
Water Quality Regional Operations
Division of Water Resources
NC Department of Environmental Quality
Raleigh Regional Office
919-791-4254
ted.cashion ncdenr. ov
1628 Mail Service Center
Raleigh, NC 27699-1628
3800 Barrett Drive
Raleigh, NC 27609

ID
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CC:r.1rUr.c7t Ct Enarcn:ncnsl C,u.rlrfy
Subscribe to Collection System & Sewer Permitting lJ dates
Email correspondence to and from this address may be subject to the North Carolina Public Records Law and may be
disclosed to third parties unless the content is exempt by statute or other regulation.
From: Michael Lamping <michael.lamoing0sanfordnc.net>
Sent: Wednesday, July 10, 2019 10:34 AM
To: 'Matt Lowder' <mlowder trian lesitedesi n.com>
Cc: Cashion, Ted <[e-mail]>; Robinson, Jason <[e-mail]>
Subject: [External] RE: Sam's Xpress - Sanford fast track sewer extension application
• er 'e � D naDr]ic#c.iinks dr 6ften aftachments unlessy-oaverify. Send_ aII -�usplclous emad(as an attachment to
The sewer you are tying into was built in 1972 (approximately). Hope that helps.
Michael Lamping, P.E.
Civil Engineer
City of Sanford, Engineering Division
P.Q. Box 3729
225 E. Weatherspoon St,
Sanford, N.C. 27331-3729
919-777-1121(P)
919-774-8179 (F)
www.sanfordnc.net
From: Matt Lowder <mlowderatrian lesitedesi n.com>
Sent: Tuesday, July 09, 2019 8:48 AM
To: Michael Lamping <[e-mail]>
Subject: Sam's Xpress - Sanford fast track sewer extension application
See below — do VOU I]are this Utforlrtatiott:�
Matt I-ou-ticr, PE,

I�TRIANGLE
`I"riangle Site Design, I'I_LC
4004 Barrett Drivc, Suite 10 t
Raleigh, NC 27609
919-553-6570 (o)
919-333-5729(m)
tnlr)u•cicr0 triinglcsi tedesigm_rnm
From: Cashion, Ted [ma ilto:ted.cashion @ncdenr.sov]
Sent: Tuesday, July 09, 2019 8:47 AM
To: Matt Lowder <mlowder trian lesitedesi n.com>; Paul Weeks <paul.weeks(&sanfordnc.net>
Cc: Robinson, Jason <iai [e-mail]>
Subject: Sam's Xpress - Sanford fast track sewer extension application
Matt and Paul,
We are reviewing the subject application. As required in item V of the application, please provide the collection system
permit number and the downstream sewer permit number. If the downstream sewer is really old and does not have a
permit number, please provide the approximate age of the line.
Thx
ted
Ted Cashion
Water Quality Regional Operations
Division of Water Resources
NC Department of Environmental Quality
Raleigh Regional Office
919-791-4254
[e-mail]
1628 Mail Service Center
Raleigh, NC 27699-1628
3800 Barrett Drive
Raleigh, NC 27609
flD-.. !`
QnpartmCn! CI Enruonn�Cn al pua6ry
Subscribe to Collection System & Sewer Permittinq Updates
Email correspondence to and from this address may be subject to the North Carolina Public Records Law and may be
disclosed to third parties unless the content is exempt by statute or other regulation.