WQ0041734_Application (FTSE)_20200603

DWR
Division of Water Resources
State of North Carolina
E Department of Environmental Quality
Division of Water Resources
ISA NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number:. _ _ (to be completed by owR)
AU items must be completed or the aunlication will be returned
L APPLICANT INFORMATION:
I. Applicant's name: Ci:l of Reidsville (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ Oeneral Partnership
❑ Federal ❑ State/County ® Municipal
3. Signature authority's name: Mr, -Chuck Smi per 15A NCAC 02T .0106i.0
Title: Dim of Publio Works
4. Applicant's mailing address: 230 W. Morelte "tmot
City: Reidsvil� State: NQ Zip: 27320-_
5. Applicant's contact information:
Phone number: (3W "2-1Mq Email Address: csmith,nci.reidsvi lei itc,us
11. PROJECT INFORMATION:
❑ Privately -Owned Public Utility
❑ Other
1. Project name: LW _R"y111e Sower
2. Applimtkin/Project status: ® Proposed (Now Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: W000_ and issued date:
If now construction but part of a master plan, provide the existing pamtit number: W000_
3. County where project is located: B ockingham
4. Approximate Coordinates (Decimal Degrees): Latitude: 36,2930° Longitude:-79.6829°
5. Parcel ED (if applicable): 799202877077
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: L Micheel SWCkV License Number: 19843
Firm: $flocks Engineering P.A.
Mailing address: PO Hox 1 I08
City: l3ashybe State: NQ Zip: 27856-_
Phone number: GJ2J 459-S�,QI ¢ Email Address: mstocksnn stockseneineee rigxom
IV. WASTEWATER TREATMENT FACILITY (W WTI) INFORMATION:
1. Facility Permit Number: N00024881
Owner Name: I� lygfRe ville
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than W WTF):
1. Permit Namber(s): WQ_ Downstream (Receiving) Sewer Size; _ inch
System Wide Collection System Permit Number(s) (if applicable): WQCS__
Owner Name(s): _
FORM: FTA 04.16 Page I of

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 ®N/A
2. If the Applicant is a Developer of lots to be sold, has a De_ve101 �rati{11 al Agr etrtcnt_(�QjN;phY� been attached?
❑ Yes []No ®N/A
3. If the Applicant is a Home/Propert� Owur ' Association. bw-art,OPeratiop.2J.Agrmwnt i FORM: k1.QA1 been attached?
❑ Yes DNo NN/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 ❑ Switttn ing Pool /Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ® Other (Explain in Attachment)
5. Nature of wastewater: 1_00/oDomestic/Commercial _ %Commercial
_ % Industrial ($4g J 5A NCAC 02T .010201)
L—*Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .01141 I i? [:]Yes ®No
If yes provide a cony of flow reduction anaroval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(pl I Daily Design Flow °'s No. of Units Flow
Campground w/ Water &Sewer 100 gal/campsite — 45 _ 4,50
-- "-
Park w/ Restroom 250 gayfixture 20 1 5000 GPD
gay GPD
gay GPD
gal/ GPD
gay GPD
Totat 9,500 GPD
a See 15A NCAC 02T 0114(b)(d)bX I) and (gj(vl 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.
8. Wastewater generated by project: 9.500 GPD (per 15A-NCAC-02T aW)
D Do not include future flows or previously permitted allocatlons
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

VIL
GRAVITY SEWER DESIGN CRITERIA (if Applicable) -02T.9395&lV1DC CCrrayfi Sewers):
1. Summarize gravity sewer to be permitted:
1.
Size (inches) Length (feet)
- 8 L 404
Material
SDR-35PVC
> Section 11 & 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
PUMP STATION DESIGN CRITERIA (If Applicable) j02T .11.305 & MDC :Pump Stations/Force Mains:
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
Pump station number or name: Lake Reidsville Sewer
2. Approximate Coordinates (Decimal Degrees): Latitude: 36,29300 Longitude:-79.6829'
3. Design flow of the pump station:.0095 millions gallons par day (firm capacity)
4. Operational point(s) of the pump(s): 8Q gallons per minute at 180 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size(laches) Length (feat) Material ll
4 11,685 SDR-3S PVC
6. Power reliability inaccordance with )SALIGACO2T.0305d0Ljj:
® 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):
➢ 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(l)):
1. Does the project comply with all separations found in 15A NCAC 021' .030511i i &
D 15A NCAC 02T.0305(0 contains minimum separations that shall be provided for sewer m stems:
Setback Parameter*
I Se arationReAumd
Storm sewers and other utilities not listed below (vertical)
24inches
Water mains (vertical -water over sewer including in benched trenches) _
181pches
Water mains (horizontal)
10 feat _
Reclaimed water lines (vertical - reclaimed over sewer)
18 inches
Reclaimed water lines (horizontal - reclaimed over sewer) _
2 feet
""An private or public water supply source including an wells, WS4 waters of Class I or
Y P Pu PP Y � g Y
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 (aee item IX.2)
50 feet
"An other stream, lake, impoundment; or y p ground water lowering and surface drainage
ditches
10 feet
I 'Oat
Any buildlam foundation
f
To r_siopa of embankment or cuts of 2 feet or more vertical height _
_ 0 feet 1
Drains__ ,e systems and interceptor drains _ -
5 feet --_-APY�
swhnntinx pcols _
10 feet
Final earth grade (vertleal)a _._ _
36 inches
➢ 15A NCACC O2T.0305w contains alternatives where separations in 02T.0305(fl cannot be achieved.
➢ "Stream classifications can be identified using the Division's NC Surface WaterrClassifications webp4ge
➢ If noncompliance with 02T.0305(() or (a). 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
D 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
D This would include Trout Buffered Streams per 15A NCAC2B4O202
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 Permitting Branch
5. Does project comply with 15A_NCAC 02T.00 (cDS) (additional permits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T.0105tcp6 i, directly related environmental permits or certification applications are being prepared, have
boon 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,'Ugh-priority sewer" mews "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 I,T, the Minimum DgejgpDjj®rj@fQLthp Permittine of Puml�_Statlftm
and Force Mains i latest version and the Gravits -Bewer M aimum Design. Qriterip ilgke6k yqr§iQW as applicable?
® Yes ❑ No
If No, complete and submit the Variance/Alternative Design Request application (VADC 10.14) and supporting documents
for review. Avi roval of the reuvest is reuuired nrior to submittal of the Fast Track Application and supporting
documents.
2. Professional Engineer's Certification:
W( &&,e. ( S C-L c 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 but
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 penalties up to $25,000 per violation.
sserruartar.ra.
North Carolina Professional Engineer's seal, sigaaturR, an dal �•`�� � C;r�• � �,vo
(%/20�0 f u 1 a43 t
'w V•��F Q'e •pJw
�/ o
3. Applicant's Certification/per 15A NCAC 02/(T .0106(b r I_ _
+r. LL(4,)v,-W Dvm pµ _,attest that this application for
(Signature Authority's name &ttitle from Application Item I.3.)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required parts of
this application are not completed and that if all required supporting documentation and attachments are not included, this
application package is subject to being returned as incomplete. I understand that any discharge of wastewater from this non -
discharge system to surface waters or the land will result in an immediate enforcement action that may include civil penalties,
injunctive relleC and/or criminal prosecution. I will make no claim against the Division of Water Resources should a
condition of this permit be violated. I also understand that if all required parts of this application package are not completed
and that if all required supporting information and attachments are not included, this application package will be returned to
me as incomplete.
NOTE — In accordance with General Statutes 143-21$.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: "9✓ Date: ' 2-o — 2oz4z:�
FORM: FTA 04-16 Page 5 of 5

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Resources Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: City of Reidsville
Project Name for which flow is being requested: Lake Reidsville Sewer
More than one FTSE maybe required for a single project if the owner of the WWTP is not responsible for all pump
stations along the route of lite proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Reidsville Wastewater Treatment Plant
b. WWTP Facility Permit #: NC0024881
A11 flows are in MGD
c. WWTP facility's permitted flow 7.50
d. Estimated obligated flow not yet tributary to the WWTP 1.013
e. WWTP facility's actual avg.- flow 2.44
f. Total flow for this specific request .0095
g. Total actual and obligated flows to the facility 3.462
h. Percent of permitted flow used 46.16
II. 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
Obligated,
Pump
Pump
Average
Approx.
Not Yet
Total Current
Station
Station
Firm Daily Flow**
Current
Tributary
Flow Plus
(Name or
Permit
Capacity, * (Firm / pi),
Avg. Daily
Daily Flow,
Obligated Available
Number)
No.
MOD MOD
Flow, MOD
MOD
Flow Capacity***
* The Firm Capacity (design flow) of any pump station Is defined as the maximum pumped flow
that can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor
(pi) 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 < 0.
Downstream Facility Name (Sewer):
Downstream Permit Number:
Page 1 of 6
FTSE 10-18

1II. Certification Statement:
I s-rey C mo ILA N, PPE 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
addendurns 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.
Signing Official Signature Date
G1
Title of Signing
SgAL.
MOO
RM
Page 2 of 6
FTSE 10-18

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Sewer Project Narrative
For
Lake Reidsville Sewer Force Main
Env onrn alentof
ReceivedQuality
JUN 0 3 2020
Winston-salern
RegionalOf�ce
The Lake Reidsville Sewer Force Main Project consists of a Sewage Pump Station at the
existing Lake Reidsville Campground. There are currently 45 campsites at the RV
Campground along with multiple Bathroom Facilities for day users. To account for the
proposed flow, 100 GPD per Campsite was used for the 45 campsites plus an additional
250 GPD per fixture for a Park with Restrooms at 20 fixtures. This provided a total
design flow of 9,500 GPD. All sewer flow will consist of 100% domestic waste. The
sewer system will be constructed of approximately 404 LF of 8-inch PVC gravity sewer
pipe and 11,685 LF of 4-inch force main with associated pump station. The pump station
is sized at 80 GPM at 175 Feet of Total Dynamic Head which produces a velocity of 2.04
FPS. The wastewater treatment plant facility that will be handling this flow is the
Reidsville WWTP (Permit # NC 0024881). The permitted flow for this WWTF is 7.50
MGD. This flow will bring the total actual and obligated flows to this facility to 46.16%.