WQ0041940_Application (FTSE)_20200828

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
PTA 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:
I. Applicant's name: The County of Davie (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State/County ® Municipal
3. Signature authority's name: Johnny Lambert per 15A NCAC 02T .0106(b)
Title: Director Public Utilitiesr
4. Applicant's mailing address: 2298 E. Depot St.
City: Mocksville State: NC Zip: 27028-_
5. Applicant's contact information:
Phone number: [phone] Email Address: ilantbertdaviecountyne.gov
11. PROJECT INFORMATION:
❑ Privately -Owned Public Utility
❑ Other
1. Project name: Davie County Government Center
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: Davie
4. Approximate Coordinates (Decimal Degrees): Latitude: 35,954823' Longitude:-80.5306530
5. Parcel ID (if applicable): 5840762208
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
I. Professional Engineer: Joseph V. O'Buch License Number: 029999
Firm: Green Mountain Engineering PLLC
Mailing address: 7A-Wendy Ct.
City: Greensboro State: NC Zip: 27409-_
Phone number: QJ3 ) 294-9394 Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
I. Facility Name: Duchman's Creek W WTF Permit Number: NC 0021491
Owner Name: Town of Mocksville
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
I. Permit Nurnber(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

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 NN/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV I been attached?
❑ Yes ❑No NN/A
3. If the Applicant is a Home/Property Owners' Association has an Operational Agreement (FORM: HOA) been attached?
❑ Yes ❑No 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 ❑ Swimming Pool /Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
N 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 .0I 14(f)? ❑ Yes N No
➢ If yes, provide a cony of flow reduction anproval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(D)
Daily Design Flow' '
No. of Units
Flow
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Torn!
0 GPD
a See I SA 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.0114] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: Q 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
N Flow has already been allocated in Permit Number: WO0041559
❑ Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain):
FORM: FTA 04-16 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 (feet)
Material
8
1,047
PVC
➢ 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
Vlll. PUMP STATION DESIGN CRITERIA (If Applicable)— 02T .0305 & MDC (Pump 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 15A NCAC 02T .0305(h1(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 - I SA 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)):
I. Does the project comply with all separations found in 15A NCAC 02T.0305(f) & (a) ® Yes []No
D 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 incites
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-1 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 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
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade vertical
36 inches
Y 15A NCAC 02T.0305(al contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications web-jage
➢ If noncompliance with 02T.0305(f) or (a). see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ❑ Yes ❑ No ®N/A
D 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
D 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 02B .0200? ❑ Yes ❑ No ® N/A
➢ This would include Trout Buffered Streams per 15A NCAC 213.0202
4. Does the project require coverage/authorization under a 404 Nationwide or []Yes ® No
individual permits or 401 Water Quality Certifications?
Y Information can be obtained from the 401 & Buffer Permitting Branch
5. Does project comply with ISA 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 I SA 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 ❑ N/A
If yes, include an attachment with details for each line, including type (aerial line, size, material, and ocation).
High priority lines shall be inspected by the perntittee 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

Etta]", 111114 411LII&T
I. Does the submitted system comply with 15A NCAC 02' , the Minimum Design Criteria for t'e Peri
and Force Mains (latest version), and the Gravity Sewer Minimum Design Criteria (latest versi n) as
® Yes ❑ No
If No, complete and submit the Variance/Altemative 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. Professional Engineer's Certification:
1, da-ea# it %%(�(',�f 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 supplled 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 de�eloped 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 $25,000 per violation. i
North Carolina Professional Engineer's seal, signature, and date:
3, Applicant's Certification per 15A NCAC 02T .0106(b):
that this application for
(Signature Authority's name,& title from Application Item 1
has been reviewed by me and is accurate and complete to the best of my knowledge. 1 understand that if all required parts of
this application are not completed and that If all required supporting documentation and att$chments 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 hat may include civil penalties,
Injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Watior Resources should a condition
of this permit be violated. 1 also understand that if all required parts of this application packs a are not completed and that if
all required supporting information and attachments are not included, this application pacl�age will be returned to me as
incomplete.
NOTE - In accordance with General Statutes 143.215,6A and 13-21 .6 , any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a C11Iss 2 misdemeanor, which may
include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation. i
Signature:I ( )b. Date: 111�"aQ2o
FORM: FTA 04-16 Page 5 of 5

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: Davie County Water System
Project Name for which flow is being requested: Davie County Government Center
Afore that one FTSE pray be required for a single project if the owner of the IVIVTP is not responsible for all pump
stations along the route of fire proposed wasteivaterffow.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. W WTP Facility Name:
b. W WTP Facility Permit
All flows are in MGD
c. W WTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the W WTP
c. W WTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
Il_ 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)
(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, * (Finn / pt),
Flow,
Daily Flow,
Obligated Available
Number)
No.
MOD MOD
MOD
MOD
Flow Capacity***
Duchmans
0.288 0.115 0.041 0.030 0,071 0.044
* 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
(pf) not less than 2.5, per Section 2.02(A)(4)(c) of the Minimmn Design Criteria,
*" A Planning Assessment Addendum shall be attached for each pmup station located
between the project connection point and the WWTP where the Available Capacity is <0.
Downstream Facility Name (Sewer): Farmington/US 158 Sewer
Downstream Permit Number: WO0041559
Page l of 6
FTSE 10-18

III. Certification Statement:
I —�wy Cawba� H 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 plait 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 Il 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 the proposed new wastewater.
.Signature Date
Title gjSigning Of
Tcial
Page 2 of 6
FTSE 10-18

Division of Water Resources
Entity Requesting Allocation
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Town of Mocksville
Project Name for which flow is being requested: Davie County government Center
Afore than one FTSE nap be required for a single project if the owner of the II'IVTP is not responsible for all pump
stations along the roue of the proposed wastecvaterflow.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Ducthman's Creek WWTP
b. WWTP Facility Permit #: N00021491
All flows are in MGD
a WWTP facility's permitted flow
0.95
d. Estimated obligated flow not yet tributary to the WWTP
0
e. WWTP facility's actual avg. flow
0.500
f. Total flow for this specific request
0.005
g. Total actual and obligated flows to the facility
0.505
h. Percent of permitted flow used
51.53%
IL Complete this section for each pump station you are responsible for along the route of this
proposed
wastewater flow.
Lis( 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** Cuient
Tributary Flow Plus
(Name or Pcrmit Capacity, * (Firm / pt), Avg, Daily
Daily Flow, Obligated
Available
Number) No. MGD MOD Flow, MOD
NIGD 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 pinup station located
between the project connection point and (he WWTP where the Available Capacity is <0.
Downstream Facility Nmne (Sewer): DUMIIIlanS'S Creek WWTP
Downstream Permit Nunnber: NCO021491
Page I of G
FTSE 10-18

111. Certification Statement:
Aim certify to the best of my knowledge that the addition of
the volume of wastewater to be pprntitted 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 1 and If 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 the proposed new wastewater.
Signing Official Signanu•e
-'.H.N AANAS
Title o%Signing Official
Y•za•J.AZd
Dale
Page 2 of 6
FTSE 10-18

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Green Mountain Engineering, PLLC Civil Engineering Consultants
Project Narrative
For
Davie County Government Center
Located in Mocksville, NC
August 28, 2020
To Whom It May Concern:
The Davie County Government Center project is a government project off Farmington
Road. The sewer outfall serving this project will tie in at one existing sewer manhole of
an existing 8" sewer outfall running across Farmington Road. Approximately 1,047
linear feet of new 8 inch sewer mains with 1 new service from the new building and four
(4) services from the renovated building are planned to connect to this sewer at this time.
The flow allocation was previously permitted with Permit WQ0041559
The design and plan review was done in accordance with NCDEQ's Gravity Sewer
Minimum Design Criteria and Davie County's standards and specifications. Work on the
sewer installation will begin in early summer if all goes according to the current
development plans.
Please contact me if you require additional information. You can reach me via email
ioeggreenmountainengineers.com or by telephone [phone] at your convenience.
Respectfully submitted,
I JO11, �
Joseph V. O'Buch, PE
Green Mountain Engineering, PLLC
7A Wendy Court - Greensboro, NC 27409 - [phone]
Page 1 of 1

Green Mountain Engineering, PLLC Civil Engineering Consultants
To: NCDEQ — Water Quality Section / 716T11/ hrs0)W'(/nN
Address: 450 W. Hanes Mill Rd — Suite 300., Winston-Salem, NC 27105
From: Joseph V. O'Buch, PE, Green Mountain Engineering, PLLC
Date: 2020-Al* W"1 44urr Y
Re: BRJ Properties — Farmington Rd. Sewer
Messages
Attached please find application packages for sewer extension off Farmington Rd. near
Interstate 40 to serve the proposed Davie County Government Center project. Included
are one (1) original and one (1) copy of the Application Package, and one (1) check for
$480.00.
Please let us know if you have any questions or require additional information. I can be
reached via email ioeggreenmountainengineers.com or by cell phone [phone]) at
your convenience.
Best Regards,
Joseph V. UBuch, P.E.
NC Department of
Environmental Quality
Received
AUG 2 8 2020
Winston-Salem
Regional Office
7A Wendy Court - Greensboro, NC 27409 - [phone]

7_ Summarize wastewatergenerated by project.
)Eistablishment Type {see 02T.01 14fi11
Daily Design Flow
No. of Units Flour
Office - General Busines fOfficc Facilities
25 gallemployeelshift
109
2,725 GPD
Office - Business wl Showers (Sherift)
35 galiempboyWday shift
40
1,400 GPD
Office - nosiness W1 Showers (Sheriff)
35 gallemployeefnight shift
20
700 GPD
gall
GPD
,gal/
GPD
GNU
gall
Total
4,825 C;PD