WQ0041218_Application (FTSE)_20190917

G n State of North Carolina
l I I G Department of Environmental Quality
RXgmwmw� I I Division of Water Resources
15A NCAC 02T .0300 —FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION
This application is for sewer extensions involving gravity sewers, pump stations and force mains, or any combination that has been
certified by a professional engineer and the applicant that the project meets the requirements of 15A NCAC 02T and the Division's
Minimum Design Criteria and that plans, specifications and supporting documents have been prepared in accordance with, L�A
NCAC 02T, 15A NCAC 02T .0300, Division policies and Qood engineering practices.
While 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 Division. This would include plans, design
calculations, and project specifications referenced in 15A NCAC 02T .0305 and the applicable minimum design criteria. These
documents shalt be available upon request by the Division.
Projects that are deemed permitted (do not require a permit from the Division) are explained in I SA NCAC 02T.0303.
Projects not eligible for review via the fast track process (must be submitted for full technical review):
➢ Projects that require an environmental assessment in accordance with 15A NCAC IC .0100;
➢ Projects that do not meet any part of the minimum design criteria (MDC) document;
➢ Projects that involve a variance from the requirements of 15A NCAC 2T;
➢ Pressure sewer systems utilizing septic tank -effluent pumps (STEPS) or simplex grinder pumps;
➢ STEP or simplex grinder pumps connecting to pressurized systems (e.g. force mains);
➢ Vacuum sewer systems.
General — When submitting an application, please use the following instructions as a checklist in order to ensure all 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 will 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 Copy of Application and Supporting Documents
® Required unless otherwise noted
B. Cover Letter (Required for All Application Packages):
® 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 (Ail New and Major Modification Application Packages):
® Submit a check 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: FTA 04-16) Application (Required for All Application Packages):
® Submit the completed and appropriately executed application.
➢ If necessary for clarity or due to space restrictions, attachments to the application may be made.
❑ If the 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.
❑ 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.
❑ The Project Name in Item I1.1 shall be consistent with the project name on the flow acceptance letters, agreements, etc.
® The Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a North
Carolina licensed Professional Engineer.
® The Applicant's Certification on Page 5 of the application shall be signed in accordance with 1 SA NCAC 02T .0,106(bI.
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 I SA NCAC 02T .0106(b).
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 1 of 3

E. Flow Tracking/Acceptance Form (Form: FTSE 04-16) (If Applicable):
® 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 form 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 Q.S. 143-
2I5.67(a1.
➢ Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific FTSE.
F. Site Maps (All Application Packages):
® Submit an 8.5-inch x I I -inch color copy of a 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
0 Include 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(hh)(I ), 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 .0106(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 be provided in the case of a multiple station power outage. (Required at time of certification)
I. Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per i SA 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 Sower 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
franchise approval is expected.
J. Operational Agreements (Applications from HOA/POA and Developers for lots to be sold):
❑ Home/Propegy Owners' Associations
❑ Per 15A NCAC 02T .0l 15(c1, submit the properly executed Operational Agreement (FORM: HOA).
❑ Per 15A NCAC 02T .0115(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
❑ Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(b), submit the properly executed Operational Agmingrit (FORM: DEVI.
For more information, visit the Division's collection systems website
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 2 of 3

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, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Favettevilie Regional Office
226 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 Mail 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 Mall
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
Perquimans, 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, Pander
[phone]
[phone] Fax
Winston-Salem Regional Office
460 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, Surry, Watauga, Wilkes, Yadkin
[phone]
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 3 of 3

State of North Carolina
DW
Department of Environmental Quality
Division of Water Resources
, 15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
N
Division of Water Resources
FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: (to be completed by DWR)
All items must be completed or the application will be returned
L APPLICANT INFORMATION:
I. Applicant's name: city of High Point (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: Teny L. Houk per 15A NCAC 02T 0106(b)
Title: Public Services Director
4. Applicant's mailing address: PO Box 230
City: High Point State: NC Zip: 27261-_
5. Applicant's contact information:
Phone number: (-36) 883-3215 Email Address: terry.houk a,highpobntue.gov
If. PROJECT INFORMATION:
1. Project name: James River Equipment Site (Public Sewer)
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: W000—, and issued date: _
If new construction but part of a master plan, provide the existing permit number: WQ00
3. County where project is located: Guilford County
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.06580 Longitude: - 97 9665°
5. Parcel ID (if applicable): Q169749
(or Parcel ID to closest downstream sewer)
Ill. CONSULTANT INFORMATION:
I. Professional Engineer: L. Allan Hill, P.E. License Number: NC 18 9
Firm: Triad Design Group. PC
Mailing address: 4807-C Koger Boulevar
City: Greensboro State: NC Zip: 27407-_
Phone number: Q0 21 -= Email Address: ahill(g triad-designgroup.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Eastside WWTF Permit Number: NCO0242 10
Owner Name: Cily of High Point
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ_
System Wide Collection System Permit Number(s) (if applicable): WQCS_
Owner Name(s): _
FORM: PTA 04.16 no�o i ..rc

VL GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes []No [DN/A
2. if the Applicant Is a Developer of lots to be sold, has a Deyft is Opmtional Agreement (FORM DEVI been attached?
❑ Yes ❑No ®NIA
3. Ifthe Applicant is a Home/Pro ep_rtyOwners' 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 / preschool / day care ❑ Medical / dental / veterinary facilities ❑ Swimming Pool /Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Fi[ter Backwash
® Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: )Q0 % Domestic/Commercial %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(fl? ❑ Yes ® No
➢ If yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.01 l4(D)
Daily Design Flow'"
No. of Units
Flow
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal
GPD
Total
0 GPD
a See 15A NCAC 02T .0114(b), Q. (eN1) 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 .0l 14(c), design flow rates for establishments not identified [in table 1 SA NCAC 02T.0114] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
&. Wastewater generated by project: 0 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 already been allocated in Permit Number:
❑ Rehabilitation or replacement of existing sewer with no new flow expected
Other (Explain): Flow allocation has been requested under protect titled "James River Equipment Site"
flew h� �e � I/JQov�{�ZZ�
FORM: FTA 04-16
pacer 7 of S

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T.0305 & MDC (Gravity Sew•ersIt
I. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 1,082 PVC SDR-26
8 221 DIP
A Section 11 & Ill of the MDC for Permitting of Gravity Sewers contains information related to design criteria
D Section ICI contains information related to minimum slopes for gravity sewer(s)
D Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
Vill. PUMP STATION DESIGN CRITERIA (If Applieable) — 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: _ 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 ISA NCAC 02T.0305 1)(1):
❑ Standby power source or pump with automatic activation and telemetry • 15A NCAC 02T .0305(h)(1)(D),
D Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
D 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 (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 timeframes, shall be provided
in the case of a multiple station power outage.
FORM: FTA 04-16 naa.. 9 „ f

IX. SETBACKS & SEPARATIONS — (02B.0200 & I5A NCAC 02T.0305(I)):
1. Does the project comply with all separations found in 15A NCAC 02T .0305(f) & IS)
➢ I5A NCAC 02T.0305 contains minimum separations that shall be provided for sewers stems:
Setback Parameter*
Sa aration 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, WSd waters of Class I or
Class 11 impounded reservoirs used as a source of drinking water
100 feet
**Waters classified WS (except WS-1 or WS-V), B, SA, ORW, HQW, or 913 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 bullifing 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
5 feet
Any swimming pools
10 feet
Final earth grade vertical
36 inches
➢ I5A NCAC 02T.0305(e) contains alternatives where separations in 02T.0305(t) cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webnaae
➢ If noncompliance with 02T.0305(f) or M. see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ® Yes ❑ No
➢ Seethe Division's draft separation requirements for situations where separation cannot be meet
➢ No variance is required if the alternative design criteria specified is utilized in design and construction
➢ As built documents should reference the location of areas effected
3. Does the project comply with all setbacks found in the river basin rules per 15A NCAC 026 0200y Z 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? 0 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 & Buffer Permitting Branch
5. Does project comply with I5A NCAC 02T.0105(aX6) (additional permits/eertifleations)? 0 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, stornwater 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 line, size, material, and location).
High priority tines 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 Pane d of 4

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Pumll Stations
and Force Mains (latest version), and the Gravity Sewer Minimum Design Criteria (latest version) as applicable?
® Yes 0 No
If No, complete and submit the Variance/Altemadve 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:
4u.4A/ r attest that this application for
(Professional Engineer's name from Application Item Ill.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 143-215.6B, 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.
a' •,
North Carolina Professional Engineer's seal, signature, and date: � GA .�`Q'(
3. Applicant's Certification per 15A NCAC 02T A106(b): 101--11¢1i9
GG70JC attest that this application for
title from Application Item 1.3.)
has been reviewed by me and is accurate and complete to the best of my knowledge. 1 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. 1 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 14 - 6 , 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: Uri ./ l Date: f e
FORM- FTA 114-16 0— c ..oc

mr
1.',
fi�.
Division of Water
Ressoorccya
Application Number:
Entity Requesting Allocation: City of High Point
Project'Name.for whichtlow is.being requested:
State of North Carolina
Department of Environmet►tal Quality
Division of Water Resources
Flow Trackingfor Server Extension Applications
(FTSE 1048)
More titan aue. FTSE turfy be required jor a siugle projecf if the owner. of tbe.)PYTP Lc not respoosiblefer all pIf i/p
Rations oloug file route of tha propaser(tvastelvalerf ow.
I. Complete. this section only if you arc the owner of the wastewater treatment plant.
a. WWI'Pracilitynine: E.asiside,WWTP
b. WWTP Pacilitiy Permit 4: NG0024210
rfll;/Inivs.are.fti�iY1GD:: '
o. WWT 1 facility permitted#low: 26,0000
d, Estimated: obligated flow not yet tributary to the W WTP: 0.7672.
e: WWTP facility's actual average flow: 16.72$Q
F. Total flow for this: speci6c.requestt 0.0000
g. Total actual and obligated flows to the facility: 17:4922:
II. Percent of permitted Flow used: 67:28%
IL Complete this section for each pump'siation you are responsible for alor lte route of this proposed
wastewater flow.
List pump stations located between the.projeol connection point and the..W WTP:
(A) (a) I(%).
. '(D) A (5)+C),
(E)`(A-D):
Pllmp Pump Finn Design Approx. Oblipgod.
'fole(C1lrrent
Avgilable
Ste lion Slatioll Capacity'. 'Average Current Not vet
Flow Pius
Capecli?
(Name or Permit Daily FtoW Avg. Daily Tribunary
Oblipled
Nunber) Nambcr (FinNpl). Plow. Daily Plow,
Flow
AIGDi%TGD WIGD IIIGD
'NIGD
MGD
If.0 :k WQe0I3151 5.04an 10160 0.8611 0.3199
fll to
09050
Rimad. w000ga572 .2j.1093 s.6an 6)996 0.71V
9.149)
-0.2656
.. Wen MWA VIA aNIA 9N/A
'aN/A
NIVA
OWA YN(A -gNIA pub} MA eN/A
OMA
VIVA
a.WA MA PN/A IMfA aNIA IIN/A
11NIA
IINIA
^`Tllk Firm Capacity (design nosy) of ally pllnit),$IatlOa is Ofthed AS tile nlalinlual puluped now 111at.
can be ncltieyed wl tl the largeYl pump taken out Of. urvtco,
^k Otakgit Average Flow i5 tha firm. rap ad ty'of tile pump Onto dfyided. by Ibe penman IaelOr (60 AOt
less than .2.5, per section 2.02(A)(4)(c) of the Minimum Design Critcrtn,
•^^APinnming.Assessment Addttufum shall livillneNcd for inch ininto intion located between.thc
project connection point and theUNWP.where Ibe Avallnble Capacity isS e.
Downstream Facility Name(Scwcr)r
Downstream Permit Number:.
Page 1 of FTSE 10-18

Iff. Certification Statement
I, Terry Houk 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 end 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 11 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
lies adequate capacity to transport and treat the proposed new wastewater.
/e
Signing
Padua Sa✓liras
Title of Signing Official
11/13/2019
Date
Page 2 of a Me lolls

PLANNING ASSESSMENT ADDENDUM (PAA)
Submit a planning assessment addendum for each pump station listed in Section 11 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 MOD 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 with
planned completion in ; and/or
d. The following applies:
The City of High Point met with NCDEQ on February 9, 2017 to discuss the flow
allocation to Riverdale Pump Station while the station was being studied for an additional
increased capacity of 2.0 MGD. As a result of the meeting the City and DEQ agreed that
the current average daily flow for the Riverdale Pump Station was 8.4 MGD The City of
High Point has contracted with 3 engineering firms to expand the capacity of the Riverdale
Pump Station to 30 MGD The pump station upgrades are anticipated to be completed by
December 2019.
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
J
Page 3 of 6
V� 017 1n in

Instructions for FlowTracking/Arceptance form (FTSE) and Planning Assessment Addendum (PAA)
Section I
a. WWT-.. Facility Name: Enter the naive of the WW-T'P that Will receive the wastewater flow.
b. WWTP Facility Permit #: Enter the NPDES or-Non,Discliarge 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. EstimateThis Includes flows allocated. to other
construction. projects not vet contributing flaw to the
on system. Flows allocated through
ifiterlocal agreements or other contracts not yet, contributing flow to the collection system .are also:
included. For POTWs that impternei it. a pretreatment program, include flows allocated to: industrial
users who may not be using all of their flow allocation. Ple'ase contact your , Pretreatment Coordinator
'for infiotmation on industrial flow tributary to your WWTP.
As of January 15, 20.09 the .POTWshould have reviewed flow allocations made over the last tw S 6yem
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 am 6c accordance with local policies and
.procedures employed bythe reporting entity.
e.. WWTP facility's actual aysz. flow. MGb:. Previous.11month,average.
f. Total flowifor this specific request. MGD: Enter the requested flow volume
g. Total actual and obligated flows to the faoility, MGD EquMs [d +.e,+ fJ
h. Percent of permitted flow Used: Equals [(g/c)*100]
For example:..
On. January 15. a POTW with a permitted flow of 6.0. M04, reportj;d to the Regional Office that there
is U MOD of flow that is.pbligated but not yet tributary. The annual average. flow For 2007 is 2.7
MGD. There is a,proposed flow expamion orO.01.5 MGD.
The.fi6t-Form FTSE submAte.cl after January 1.5, 2008
08 may have numbers, like this;
6.0 MOD
d. = 0.5 MGD
e. = 2.17 7 MGD
f. = 0.0.15 MOD
g. = 3.215. MGD
h; = 53.6%
The next Form FTSE may be updated like this with a proposed flow expansion of 0.102 MCI'l);
6, = 6.0 MGD
d. 0.515 MOD
zb MOD
f. = OJ 02 MOD
= 3,349. MGD
55'8 %
Each subsequentETSE.form will be updated inthe same manner.
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NC Department of
Environmental Quality
Transmittal Letter Received
=t 17 2019
Winston-Salem
Regional Office
Date: September 15, 2019
To: NC Department of Environmental Quality
Water Quality Section
450 W. Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
Phone # [phone]
Project: James River Equipment Site — Public Sewer Project #: 17-106/D
High Point, NC
We Transmit: For Your:
(X) herewith () approval
Q under separate cover (X) review and comment
() use
Copies Date Description
2 Fast Track Sewer System Extension Application (FTA 04-16)
2 Flow Tracking/Acceptance for Sewer (FTSE 04-16)
1 $480.00 Application Fee
2 USGS Location Map, Vicinity Map
Comments:
The proposed project is to extend a public sanitary sewer main from the existing City of High Point
sewer main located 880 If south and approximately parallel to Gallimore Dairy Road (SR 1556) to
the proposed James River Equipment Site on Gallimore Dairy Road in High Point, NC. The total
length of Public main to be permitted under this application is approximately 1,303 linear feet. If
you have any questions or require additional information, please call.
Copies: File
Submitted by:
L.Allan Hill, P.E.
L. AUa*i/Yal/
Chief Civil Engineer
4807 - C Koger Boulevard, Greensboro, NC 27407 1 T - 336-218-8282 F - 336-218-8010 1 wwwAriad-designgroup.com