WQ0041420_Application (FTSE)_20200117

JAMESTOWN ENGINEERING GROUP, INC.,
NC Department of
EnVIrO
Uailty
CIVIL ENGINEERS & SURVEYORS
AA,
'
Received
LAND PLANNING •MUNICIPAL CONSULTING
BAN 15 2020
inc. 117 East Main Street • P.O. Box 365 • Jamestown, N.C. 2728)
3
Telephone[phone] Fax[phone]i
Winston-Salem
www.jamestownengineering.com,.:.....-
January 14, 2020
C; -
usae
Regional Office
Ej
Re: Sewer Line Relocation - Panther Drive
High Point University
High Point, NC
JEG File No. 19017
Mr. Justin Henderson
Division of Water Resources
Winston Salem Regional Office
450 W. Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
Dear Mr. Henderson:
With regards to the referenced project, and on behalf of High Point University and the
City of High Point, we are requesting your review/approval of private and public sewer
extension applications required as part of the renovation of Panther Drive. Relocation of
398 L.F. of 12" D.I. public sewer will be required prior to the renovation of Panther Drive
due to the removal/replacement of a box culvert. In addition, an extension of 56 L.F. of 8"
D.I. private sewer will be necessary to tie-in sewer lines servicing existing facilities to the
new 12" public line. No new facilities will be serviced by the sewer line relocations so that
no new waste flow is expected.
On this basis, we have enclosed both public and private application packages in support
of the sewer line relocations, each of which include the following:
One original and one copy of the Fast Track Sewer Application (FTA 04-16)
$480.00 Application Fee
Two copies of Form FTSE 04-16 completed by the City of High Point
8.5 X 11" color USGS topographic map
If there are any questions or additional information required, please call.
Yours very truly,
JAMESTOWPritchett,PE
G GROUP, INC.
aniel . S
DW P/cp
Enclosures
Cc: Mr. Terry Houk, City of High Point
Mr. Tom Beckett, City of High Point
Mr. Stephen Potter, High Point University

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number:
(to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: High Point University (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ® Corporation ❑ General Partnership
❑ Federal ❑ State/County ❑ Municipal
3. Signature authority's name: Stephen Potter per 15A NCAC 02T .0106(b)
Title: Vice President for Facility & Auxiliary Operations
4. Applicant's mailing address: One University Parlcway
City: High Point State: N_Q Zip: 27268-0001
5. Applicant's contact information:
Phone number: 336) 841-9125 Email Address: spotter(a highpoint.edu
1 t s 1 RQ@1CfaCOR6F:4ICOYM
❑ Privately -Owned Public Utility
❑ Other
NC Department of tt
Environmental Quality
Received
JAN 15 2020
Winston-Salem
'
Regional Office
1. Project name: Sewer Line Relocation -Panther Drive
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: W000_
3. County where project is located: Guilford
4. Approximate Coordinates (Decimal Degrees): Latitude: 35_97' Longitude:-79.99°
5. Parcel ID (if applicable): 0182443
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Daniel W. Pritchett. PE License Number: NC 11659
Firm: Jamestown Engineering Group, Inc.
Mailing address: 117 E. Main Street. P.O. Box 365
City: Jamestown State: NC Zip: 27282-
Phone number: 336 886.5523 Email Address: dan aAeamestownengineering.com
IV. WASTEWATER TREATMENT FACILITY (W WTF) INFORMATION:
1. Facility Name: Eastside W WTP Permit Number: NCO024210
Owner Name: City of High Paint
V. RECEIVING DOWNSTREAM SEWER INFORMATION (If different than W WTF):
1. PermitNumber(s): WQ_
System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s):
FORM: FTA 04-16 Page 1 of 5

VI. 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 Developer's Operational Agreement (FORM: DEV) been attached?
❑ Yes []No ®N/A
3. If the Applicant is a Home/Property Owners' Association. has an Operational Agreement (FORM: HOA) been attached?
❑ Yes ❑No ®N/A
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/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: I 0 %Domestic/Commercial % Commercial
_ % Industrial (See 15A NCAC 02T .0103(20))
"Is there a Pretreatment Program in effect? ❑ Yes ® No
6. Hasa flow reduction been approved under 15A NCAC 02T .01 14(fl? ®Yes ❑ No
If Yes- provide a coot of flow reduction apuroval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(t))
Daily Design Flow"
No. of Units
Flow
gaU
GPD
gat/
GPD
gaU
GPD
gal/
GPD
gall
GPD
gal/
GPD
Total
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. 42A4 .
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.0114] 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 .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):
FORM: FTA 04-16 Page 2 of 5

VH. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8" 56 D.I
➢ Section II & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section ID 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
VIH. PUMP STATION DESIGN CRITERIA (If Applicable) — 02 30 & MDC (Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: NA
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
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 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) & (g)
➢ 15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
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, W S-I waters of Class I or
Class 11 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 D{.2)
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches
10 feet
An building 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
➢ 15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webame
➢ If noncompliance with 02T.0305(f) or (al, see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ® Yes El 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 all setbacks found in the river basin rules per 15A NCAC 02B .0200? ® Yes ❑ No
➢ This would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Does the project comply with an individual 404 Permit or any 401 Certifications? ❑ Yes ❑ No
➢ Weiland -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 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? ® 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
➢ 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?
N Yes ❑ No
If No, complete and submit the Variance/Alternative Design
for review. Approval of the request Is reouired prior t
documents.
2. Professional Engineer's Certification:
application (VADC 10-14) and supporting documents
name from Application Item III.1
that this application for
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 143-215.611, 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 d
3. Applicant's Certification per 15A NCAC 02T .0106(b):
1 &4.r
this application for
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. 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 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: I li 0
FORM: FTA 04-16 Page 5 of 5

fI t:
Mvision of Water Resource .i
State of North Carolina
Department of lanvironmental Quality
Division of Water Resources
Flow TracIdug for Sewer Extension Applications
(FTSE 10-18)
Application Number: 2019-145
......... ;::.,......:
Britity Requesting Allocation, City of High Point
Project Name for which flow is being requested: Iiigh Point University (Private)
Moellrancire IIorgybe1•egrrberlfornsingleproJecltribeoiWlerof[heIrIPTPisno[respons)ble•JLra!lpump
slallopis along pie male ofllte proposed ipnsleipalerJloip,
I, Complete this section only if you are the owner of the wastewater treatment plant.
it. W WTP Facility name: Sastside W WTP
b. WWTPFaoIIItyPonnit#: NC-0024210
c. WWTP facility permitted flow:
d, Estimated obligated flow not yet tributaiy to the W WTP:
e. W WTP facility's actual average flow:
f. Total flow for this speciflc request:
g. Total actual and obligated flows to the facility:
11. Percent of permitted flow used:
A11Jlops are In MOD
26.0000
0.7672
16.7250
0.0000
17.4922
67.28%
11. 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 W WTP.
(A) (13)
(C)
(D)e(D+C)
(E)=(A•D)
Pump pump pirm Design Approx.
Obligated,
Total Current
Available
station Station Capnotty Average Current
Not Yet
Plow Plus
Capacity'
(Nam or Pemdl Daily Floes MA, Daily
7libulery
Obligated
Number) Number (fdrm/pf), Flow,
Daily Flow,
Flow
19101) MGD MGD
MGD
MOD
MGD
Rlrvdrb W0000BS72 22.2091 1.9e17 aa996
0,7497
9.1491
4.2656
•• MNIA MWA AWA INA
MWA
MWA
NOA
AMA RUA MWA NUA MWA
MWA
MWA
MWA
#WA eNIA NUA MA NUA
MWA
#WK
MNIA
OVA MA aNIA MA MWA
NUA
NVA
MIA
* The Firm CnpmI1y (de4lgu nolr) of any pump slnaou is dol oed as the maximum pumped nos- that
emt be achieved with the largest pump Inleen out ofservice.
Design Average Flow la Ilia arnt capacity of the pump station divided by the penldug
factor" not
less them 25, per Section 2,02(A)(4)(c) of the Minimum Design Crilo•in.
A"" A Planning Assessment Addendum shall be otlached for each pump station located
behveen the
project connection point and the W WTP where the Available Capacity Is S 0.
Downstieam PRO]lity Ni me (Sewer):
Downstream Permit Number:
Pago i of 0 FTSE 40.10

111. Certification Statement
I, Terry Houk certify to the best of my knowledge that the addition of tbo 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 fi•om this project is not anticipated to cause any capacity related
sanitary sewer overflows or overburden any downstream pump station on route to the receiving treatment
plant under mmrrnl choumstances, 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 corlifioation 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 foam certifies that the receiving colleotion system or treatment works
has adequate capacity to transport and treat the proposed new wastewater.
Signing OfJlot(l Signature Dale
fv&tc 60VICG5 46P�c'loe
Vile of fining O,(Jlolal
12/23/2019
Page 2 of 6 PTSE 10-10

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