WQ0041723_Application (FTSE)_20200601

State of North Carolina
WR Department of Environmental Quality
Division of Water Resources
15A NCAC 02T.0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Dlvislon 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
1. APPLICANT INFORMATION:
1. 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: Terry Houk per 15A NCAC 02T .0106(b) NC Department of
Title: Public Services Director Environmental QualityReceived
4. Applicant's mailing address: PO Box 230
City: High Point State: NC Zip: 27261 ��ry 1 2020
5. Applicant's contact information: Winston-Salem
Phone number: [phone] Email Address: terrv.houk(t,high1ointnc.gov Regional Office
If. PROJECT INFORMATION:
I . Project name: Sagemount Subdivision
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 County
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.978783' Longitude:-79.937587'
5. Parcel ID (if applicable): 160169
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
I. Professional Engineer: Thomas R. Glover, Jr, PE License Number: 27465
Finn: Jamestown Engineering Group, Inc.
Mailing address: 117 E. Main Street, P.O. Box 365
City: Jamestown State: NC Zip: 27282-
Phone number: [phone] Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
I. Facility Name: High Point Eastside Treatment Plant Permit Number: NC 0024210
Owner Name: City of High Point
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. PermitNumber(s): WQ_
System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s):
FORM: FTA 04-16 Page I of 5

VI. GENERAL REQUIREMENTS
I. 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: DEVI 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 : 100 % 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 .0114(f)? ®Yes ❑ No
➢ If yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(i)l
Daily Design Flow''"
No. of Units
Flow
Single family homes with 4 bedrooms/unit
90 gal/day/bedroom
74
26,640 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
26,640 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 021.0114] shall
be determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 26640 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-I6 Page 2 of 5

VIL GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (fee[)
Material
8"
2,191'+/-
SDR-26
8"
197' +/-
DI
Cb
n�
r Section It & 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
Vill. PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
I . 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)(I )(B):
v 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)
M
❑ Portable pumping unit with plugged emergency pump connection and telemetry - 15A NCAC 02T .0305(h)(1)(C):
Y 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 02'r .0305(fl &1g)
'v 15A N(`A(` 07T 0Z05(f) rontninc minimum generations that shall be provided for sewer systems:
H Yes ❑ No
Setback Parameter*
Se aration R_e2uired _
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 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 _
Any basement
10 feet
Top slope of embankment or cuts of 2 feet or more vertical height
10 feet
Drainages stems and interceptor drains
5 feet
Any swimming pools
10 feet _
Final earth grade (vertical)
36 inches
➢ I5A 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 webpage
➢ 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 all setbacks found in the river basin rules per 15A NCAC 02B .02009 ® 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 & Buffer Permittin Branch
ranch
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 ISA NCAC 02L 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 reauest is required prior to submittal of the Fast Track Application and supportine
documents.
2. Profession ngineer's Certification:
I, 2. 6�
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 certabr
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 tip to $25,000 per violation' -,,,,.,,
North Carolina Professional Engineer's seal, signature, and i
3. Applicant's Certification per 15A NCAC 02T .0106(b):
1, '�47" L . 110a;' fl-w4G S'Ancca5 h/RLfG&R 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. 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 pennit 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:
FORM: FTA 04-16 Page 5 of 5

State of North Carolina
Departmeut of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
MVi•Jnn of VV,drf krsatlr(r' (FTSE 10-18)
Application Number: 2020-151
Entity Requesting Allocation: City of High Point
Project Name for which flow is being requested: Sageniount Subdivision
More then one T•'TSG maj, be regelred fop a single project (foie olwter of the IYIYTP Is aol i espoitslble f i, elllutoJp
stations along the roule of the proposed svesfesvelerflom.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a.
WWTP Facility name: EastsideWWTP
b.
WWTP Facility Permit M NC-0024210
flll Jfoips are lu MGD
c.
W W'IT facility permitted flow:
26.0000
d.
Estimated obligated flow not yet tributary to the W WTP:
0.7767
e.
W WTP facility's actual average flow:
16.3917
f.
Total flow for this specific request:
0.0266
g.
Total actual and obligated flows to the facility:
17.1950
It.
Percent of permitted flow used:
66.13%
Complete this section fm• each pump station you are responsible for along the rattle of this proposed
wastewater flow.
List pump stations located between the project connection point and the W WTP.
(A) (D) (C)
(D)-(neC)
(E)=(A-D)
Pump Pump Firm Design Approx. Obligated,
Total Curran
Available
Station Station Capacity Average Current Not Yet
Now Plus
Capacity'
(Name or Permil Daily Flow' Avg. Daily Tribulmy
Obligated
Number) Number (Firm/pi). Flory, Daily Flow.
Flow
hIGD MGD MGD MGD
Is
MGD
bh'4t' ok 0 1.1J93 0.5351 0.]19J 0.0108
0.3301
0.2056
ki.M. WQ008372 30.087 11.642 8.39% 0.7592
9.I597
2.3135
•• NWA NWA NWA NWA NWA
MA
NWA
MIA NWA NWA NWA NWA NWA
MIA
NWA
NNIA NWA NWA NWA NWA NWA
MA
NWA
" The Plr'al Cnpnelty (rllblgrr aeNY) Of nay ppnlp 81011011 If dCarled n5111e JIIaYhlln111 paolped aekY Ihflf
can be achleved with the inrgest pump Taken out of service.
•" Design Average Flow is the arm capacity of the pump station divided by the peaking fnclor (po not
less limit 2.5, per Section 2.02(A)(4)(c) of lite Minimum Design Criterin.
•"" A Pimudng Asseument AAdendum aknll be attached for each pump station lernted hehvcen the
project connection point and the wwTP where Ilse Available Cnpncily Is 5 0.
Downstream FacllilyNalne (Sewer):
DoYntslream Permit Number:
Page 1 of 6 FTSE 10.18

111. Cerlification Statement
1, 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 and that the flow from 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 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 addendmns 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 the proposed new wastewater.
SigningOff ela Ignalt e
Pagwe- sxAlice3 AlAWAG t
Me of'Signing Offlclal
4/23/2020
Dale
Page 2 of FTSE W1e

Public Services Department
Terry L. Houk
DIRECTOR
NORTH CAROLINNS DMRNATIONAL C1Tr
April 23, 2020
NCDENR
Winston-Salem Regional Office
450 W. Hanes Mill Rd, Suite 300
Winston-Salem, NC 27105
Project: Sagemount Subdivison
Public Sewer
Applicant: City of High Point, NC
Dear Sir or Madam:
This is to acknowledge that the City of High Point will accept for treatment in the Eastside
Wastewater Treatment Plant (Permit #NC0024210), wastewater flow from the above referenced
project in the amount of 26,640 GPD, which will be discharged to facilities operated and
maintained by the City of High Point.
If further information is needed, please let me know.
Very truly yours,
Terry L. ITouk
Director of Public Services
TLH/tab
City of High Point, P.O. Box 230, 211 South Hamilton Street, High Point, NC 27261 USA
Fax:[phone] Phone:[phone] TDD:336.883.8517

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JAMESTOWN ENGINEERING GROUP, INC.
` CIVIL ENGINEERS &SURVEYORS
LAND PLANNING • MUNICIPAL CONSULTING
ma 117 East Main Street • P.O. Box 365 Jamestown, N.C. 27282
Telephone [phone] Fax [phone]
www.jamestownengineering.com
Zq
May 26, 2020
Re: Sewer Line Extensions
Servicing Sagemount Subdivision
City of High Point
Guilford County
JEG File No. 2019-049
Mr. Justin Henderson
Division of Water Quality
NC Department of Environment and Natural Resources
450 W. Hanes Mill Road, Suite 300
Winston-Salem. NC 27105
Dear Mr. Henderson:
NC Department of
Environmental Quality
Received
YUN 01 2020
Winston-Salem
Regional Office
With regards to the referenced project, and on behalf of the City of High Point, we have
enclosed one original and one copy of the following for your review:
Fast Track Sewer Application
$480.00 Application Fee
Form FTSE 04-16 completed by the City of High Point
8.5" X 11" color USGS topographic map
Street level map
Sewer service to the Sagemount Subdivision includes 74 residential homes (26,640 gpd)
located along Sage Hill Road, Sagemount Street and Sudley Point. Flow allocations are
included in the attached FTSE 04-16 form for the additional 74 residential lots. Upon
completion of the sewer line installation and testing, the system will be maintained by the
City of High Point. The downstream sewer system and treatment facility are owned by
the City of High Point.
If there are any questions or additional information required, please call.
Sincerely,
JAMESTOWN ENGINEERING GROUP, INC.
omas R. (Rich) Glover, Jr., PE
Enclosures