WQ0042207_Application (FTSE)_20201230

i
Engineering &. Surveying, Inc.
To: NCDENR
Winston-Salem Regional Office- Water Quality Sec.
450 W. Hanes Mill Rd, Suite 300
Winston-Salem, NC 27105
We are sending you:
® Attached ❑ Under separate cover via:
LETTER OF TRANSMITTAL
Dater 12/28/2020
Job No: 1612-19
Attention:
Re: Rich Fork Hei hts Phase 2-3
Fast Track
the following items:
❑ Plans ❑ Diskette(s) ❑ For Approval ® For Review ❑ Specifications
® Other: applications
Quantity
Dw . No.
Description
Status
1
Fast Track application package
H
1
$480 check #6398
H
Status Code: A. Approved D. Rejected - See Remarks G Approved - As noted
B. Sign and Return E. For your information H. As Requested
C. Amend and Resubmit F. Refer to Remarks I. Review and Comment
Remarks:
Please find attached the Fast Track sewer application packages for the private systems for the above
project.
PLEASE LET ME KNOW IF YOU NEED ANYTHING FURTHER, OR HAVE ANY QUESTIONS.
THANK YOU Environmental Department
Quality
Received
DEC 3 0 2020
Winston-Salem
Jimgim 2aae%Regional Office
Tim Lauer
CPT Engineering and Surveying, Inc.
4400 Tyning Street • High Point, NC 27265 Phone: [phone] • Fax: [phone]
www.gptengincering.com

Engineering &. Surveying, inc.
December 28, 2020
NC Department of
Environmental Quality
Received
North Carolina Department of Environment and Natural Resources DEC 3 0 2020
Water Quality Section
450 West Hanes Mill Road, Suite 300 Winston-Salem
Winston-Salem, N.C. 27105
Regional Office
Re: Fast -Track Application (FTA 04-16)
For: Rich Fork Heights — Phase 2 and 3 , Private Sewer System Extension
Forsyth County, High Point, NC
On behalf True Homes, LLC , we are submitting herewith for your review and approval the following
documents relative to the above referenced project:
- (1)Fast-Tract Application packages
- (1) Flow Tracking / Acceptance form and letter
- (1) Check in the amount of $480.00
Specifications for this project will be per the City of High Point standards and specifications. We respectfully request
your review and approval of these items. If you have any questions or need any additional information, please give
me a call.
Thank you for your assistance with this matter.
Sincerely,
CPT Engineering and Surveying, Inc
,1 kn .Lauer
Tim Lauer
Enclosures
4400 Tyning Street • High Point, NC 27265 Phone: [phone] • Fax: [phone]
www.eptengineering.com

Public Services Department
Terry L. Houk
DIRECTOR
NORTH CAROLINNS INTERNATIONAL CITY"
December 9, 2020
NCDENR
Winston-Salem Regional Office
450 W. Hanes Mill Rd, Suite 300
Winston-Salem, NC 27105
Project: Rich Fork Heights Subdivision
Phases 2 & 3 Private Sewer
Applicant: True Homes LLC
Monroe, NC
Dear Sir or Madam:
This is to acknowledge that the City of High Point will accept for treatment in the Westside
Wastewater Treatment Plant (Permit ANC0024228), wastewater flow from the above referenced
project in the amount of 34,200 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. Houk
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

State of North Carolina
nW Department of Environmental Quality
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, 15A
NCAC 02T, 15A NCAC 02T .0300, Division policies and good 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 shall be available upon request by the Division.
Projects that are deemed permitted (do not require a permit from the Division) are explained in 15A 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 1C .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 (All 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 I.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 I.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 II.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 Eneineer.
® The Applicant's Certification on Page 5 of the application shall be signed in accordance with 15A NCAC 02T .0106(b).
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 15A 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 G.S. 143-
215.67 a .
➢ 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 11-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
® 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(h)(1), 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 15A 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 Sewer 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.
Operational Agreements (Applications from HOA/POA and Developers for lots to be sold):
❑ Home/Property Owners' Associations
❑ Per 15A NCAC 02T .0115(c), 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 Agreement (FORM: DEV).
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
Fayetteville Regional Office
225 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 Mail
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
450 W. Hanes Mill Road
Suite 300
Alamance, Allegheny, Ashe, Caswell, Davidson,
Davie, Forsyth, Guilford, Rockingham, Randolph,
Water Quality Section
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
DWR Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
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
I. APPLICANT INFORMATION:
1. Applicant's name: TRUE HOMES, LLC (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: Jeffrey C. Guernler per 15A NCAC 02T .0106(b)
Title: - Operations Partner -Land NC Department of
4. Applicant's mailing address: 2649 BRECKONRIDGE DR Environmental quality
Received
City: MONROE State: NC Zip: 28110-
5. Applicant's contact information: DEC 3 0 2020
Phone number: 336) 451-6682 Email Address: ieuermer(a),trusehomesusa.cont Winston-Salem
Regional Office
II. PROJECT INFORMATION:
1. Project name: Rich Fork Heights —Phase 2 and 3
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: Fors h
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.018578' Longitude:-80.056273'
5. Parcel ID (if applicable): 6882-87-3851, 6882-88-2913
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Chuck Tmbv License Number: NC 14984
Firm: CPT Engineering and Surveying. Inc.
Mailing address: 4400 Tuning Street
City: Ffigh Point State: NC Zip: 27265-_
Phone number: 336 812-8800 Email Address: chuckt(a)cptengineering com
IV. WASTEWATER TREATMENT FACILITY (W WTF) INFORMATION:
1. Facility Name: Westside Wastewater Plant Permit Number: NCO024228
Owner Name: City of High Point
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 NN/A
2. If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached?
N Yes [—]No ❑N/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):
N 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. Has a flow reduction been approved under 15A NCAC 02T .0114(fl? N Yes [—]No
➢ If yes. provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0I14(f)
Daily Design Flow s's
No. of Units
Flow
Single Family 3-bedrooms
120 gpd/bedroom x 3 = 360 gpd
95
34,200 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gall
GPD
gal/
GPD
Total
34,200 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 02T.0114] shall
be determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
Wastewater generated by project: 34,200 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

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1.
Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8"
509
D.I.P.
8"
1,438
SDR-26
�d
➢ 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
VIII. 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(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
➢ 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(8 & (g)
0
15A NCAC 02T.0305 contains minimum separations that shall be provided for sewer systems:
® Yes ❑ No
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, 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, orSB 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 swinaming 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 webpage
➢ If noncompliance with 02T.0305(fi 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 2B.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 Permitting Branch
5. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)?
® Yes ❑ No
FORM: FTA 04-16 Page 4 of 5

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 5 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permittin¢ 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 request is required prior to submittal of the Fast Track Application and supporting
documents.
2. Professional Engineer's Certification:
I, Chuck Trubv attest that this application for
(Professional Engineer's name from Application Item III.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 143-215.613, 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.
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
hJeffrey C. Guernier Operations Partner -Land —attest that this application for
(Signature Authority's name & title from Application Item I.3.)
Rich Fork Heights — Phase 2 and 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 retumed 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 143-215.613, 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.
Signature: Date:
FORM: FTA 04-16 Page 6 of 5

C•"$ 4.31 as L 1
x'Ale, In
NVI'Mote of tVilivr ttc°:oura e k;
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Application Number: �2020-159
Entity Requesting Allocation: True Homes LLC
Project Name for which flow is being requested: Rich Fork Heights Phase 2 & 3
More than one FTSE maj, be required for a single project if the owner of the WWTP is not responsible for all pump
stations along Ore route of tine proposetl ipastetvnter fioip.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a.
WWTP Facility name: Westside WWTP
b.
WWTP Facility Permit #: NC-0024228
Ail. Mows are in MGD
o.
WWTP facility permitted flow:
8.2000
d.
Estimated obligated flow not yet tributary to the WWTP:
0.1483
e,
WWTP facility's actual average flow:
3.1638
f
Total flow for this specific request:
0.0342
g.
Total actual and obligated flows to the facility:
3.3463
h.
Percent of permitted flow used:
40,81%
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 WWTP.
(A) (g) (C)
(D)-(D+C)
(E){A-D)
pump Pump Finn Design Approx. Obligated,
Total Current
Available
Station Station Capacity' Average Current Not Yet
Flow Plus
Capacity'
(Name or Penult Daily Fimv' Avg. Daily Tributary
Obligated
Number) Number (Firm/p0, Flow, Daily Flow,
Flow
MOD MGD MGD NIGD
MGD
MGD
MNIA MA MN/A NIA MA
MA
MNIA
MA MNIA MIA MNIA MA NN/A
MNIA
MNIA
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MNIA
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M01A
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M.N'/A NN/A NWA MIA MNIA MNIA
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* The Firui Capacity (design Dow) of any pump station is defined s the maximum pumped flow that
can he achieved with the largest pump taken out of service.
*A Design Average Flow, is the firm capacity of the pump station divided by the pealing factor (pr) not
less than 2.5, per Section 2,02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached fm each pump station located between the
project connection point and the WWTP where the Available Capacity is 5 0,
Downstream Facility Name (Sewer):
Downstream Permit Number:
Page 1 of 6 FTSE 10-18

111, Certification 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 II 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.
A— V
Signing Offic Signature
PyQctc SEx'✓icES D/RCcC720
Title of Signing Official
12/9/2020
Date
Page 2 of 6 FTSE 10-18

LIMITED LIABILITY COMPANY ANNUAL REPORT
1012017
NAME OF LIMITED LIABILITY COMPANY: True Homes, LLC
SECRETARY OF STATE ID NUMBER: 1025497 STATE OF FORMATION: DE
REPORT FOR THE CALENDAR YEAR: 2019
SECTION A: REGISTERED AGENT'S INFORMATION
1. NAME OF REGISTERED AGENT: Hinson Wesley S.
E - Filed Annual Report
1025497
CA201910514465
4/15/2019 02:55
2. SIGNATURE OF THE NEW REGISTERED AGENT:
SIGNATURE CONSTITUTES CONSENT TO THE. APPOINTMENT
3. REGISTERED AGENT OFFICE STREET ADDRESS & COUNTY 4. REGISTERED AGENT OFFICE MAILING ADDRESS
309 Post Office Drive
309 Post Office Drive
Indian Trail, NC 28079-7671 Union County Indian Trail, NC 28079-7671
SECTION B: PRINCIPAL OFFICE INFORMATION
1. DESCRIPTION OF NATURE OF BUSINESS: Construction
2. PRINCIPAL OFFICE PHONE NUMBER: [phone] 3. PRINCIPAL OFFICE EMAIL: Privacy Redaction
4. PRINCIPAL OFFICE STREET ADDRESS
5. PRINCIPAL OFFICE MAILING ADDRESS
2649 Brekonridge Centre Drive 2649 Brekonridge Centre Drive
Monroe, NC 28110-5629 Monroe, NC 28110-5629
6. Select one of the following if applicable. (Optional see instructions)
❑ The company is a veteran -owned small business
❑ The company is a service -disabled veteran -owned small business
SECTION C: COMPANY OFFICIALS (Enter additional company officials in Section E.)
NAME: David Cuthbertson
NAME: Mark Boyce NAME: Daniel Horner
TITLE: Member TITLE: Member
ADDRESS:
ADDRESS:
TITLE: Member
ADDRESS:
2649 Brekonridge Centre Drive 2649 Brekonridge Centre Dr. 2649 Brekonridge Centre Dr.
Monroe, NC 28110 Monroe, NC 28110 Monroe, NC 28110
SECTION D: CERTIFICATION OF ANNUAL REPORT. Section D must be completed in its entirety by a person/business entity.
David Cuthbertson
SIGNATURE
Form must be signed by a Company Official listed under Section C of This form.
4/15/2019
David Cuthbertson Member
Print or Type Name of Company Official Print or Type Title of Company Official
This Annual Report has been filed electronically.
MAIL TO: Secretary of State, Business Registration Division, Post Office Box 29525, Raleigh, NC 27626-0525

FM Iltafl5 GWO MAPS 0-0 --- 0 PROPOSED SANITARY 5EWER
WaB&YILL&NG ♦—r— EXI5TIN6SANITARY SEWER
20K1
/� 1=N61NEERIN& AND SURVEYING, INC.
LAND DEVELOPMENT GON 6
NGBELS FIRM LIGBiSE N0. G-13'15
13'15
4400 TYNING 5TREET
HIGH POINT, NORTH CAROLINA 2T265
PHONE: [phone] — FAX. MW 812-6'180
Rich Pork Heights - Phase Z # S
U565QUADMAP
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HIGH POINT, NG
5GAL5 I' = 400'

NARRATIVE
IM
Rich Fork Heights (Phase 2 and 3)
PUBLIC SANITARY SEWER EXTENSION
FORSYTH COUNTY
HIGH POINT, NORTH CAROLINA
November 23, 2020
OWNER
City of High Point
DEVELOPER:
True Homes, LLC
Contact: Jeff Guernier
2649 Breckonridge Dr
Monroe, North Carolina 28110
[phone]
CPT Engineering and Surveyin2. Inc.
4400 Tyning Street High Point, NC 27265
Phone [phone] • Fax [phone]

Rich Fork Heights (Phase 2 and 3):
Public Sanitary Sewer Extension
PROJECT DESCRIPTION
The project is located on an approximately 40.9 acre tract at 4024 N Main St in The City
of High Point, Forsyth County, NC. The purpose of the project is to construct 95 single
family lots with associated public streets and private utilities. The proposed water and
sewer extensions will be privately owned and maintained systems, upon certification the
systems will be transferred to the public for ownership and maintenance. The Proposed
private sanitary sewer extension will consist of 8" Gravity Sewer lines. The allocation is
based on a flow rate of 120 gallons per day per bedroom (based on all home being 3
bedroom) for a total flow allocation of 34,200 GPD.
SITE DESCRIPTION
The site consists of 40.9 acres more or less, site is vacant.
ADJACENT PROPERTY
Land use in the vicinity is single family residential, with some commercial uses. The site
fronts along N Main St, Delray Ave and Interstate-74.
SOILS INFORMATION
Per the USDA, NRCS the soils in the project area are mapped as
ChA-Chewacla loam, 0 to 2 percent slopes, frequently flooded
EnB-Enon fine sandy loam, 2 to 6 percent slopes
EnC-Enon fine sandy loam, 6 to 10 percent slopes
MeB-Mecklenburg loam, dark surface, 2 to 6 percent slopes
PcC2-Pacolet clay loam, 6 to 10 percent slopes, moderately eroded
VaB-Vance sandy loam, 2 to 6 percent slopes
WpF-Wilkes-Poindexter-Wynott complex, 15 to 45 percent slopes

STATE OF NORTH CAROLINA
COUNTY OF
Permit No.
DEVELOPER'S OPERATIONAL AGREEMENT
This AGREEMENT made pursuant to G.S. 143-215.1 (dI) and entered into this day of
, by and between the North Carolina Environmental Management
Commission, an agency of the State of North Carolina, hereinafter known as the COMMISSION; and
, a corporation/general partnership registered/licensed to do
business in the State of North Carolina, hereinafter known as the DEVELOPER.
WITNESSETH:
1. The DEVELOPER is the owner of the certain lands lying in EOP-5YL County, upon
which it is erecting and will erect dwelling units and other improvements, said development to be known
as Rrcl+ Fork 46161+7-S (hereinafter the Development).
2. The DEVELOPER desires, to construct a wastewater collection system with pumps, wastewater treatment
works, and/or disposal facilities (hereinafter Disposal System) to provide sanitary sewage disposal to serve
the Development on said lands.
3. The DEVELOPER has applied to the COMMISSION for the issuance of a permit pursuant to G.S. 143-
215.1 to construct, maintain, and operate the Disposal System.
4. The DEVELOPER has created or shall create unit ownership in said dwellings units, other improvements
and lands through filing of a Declaration of Unit Ownership (hereinafter Declaration), pursuant to Chapter
47C or 47F of the North Carolina General Statutes.
5. The DEVELOPER has caused to be formed or will cause to be formed at the time of filing of the
Declaration, lnereinar[er
Association), a non-profit corporation organized and existing under and by the virtue of the laws of the State
of North Carolina, for the purpose, among others, of handling the property, affairs and business of the
Development; of operating, maintaining, re -constructing and repairing the common elements of the lands
and improvements subject to unit ownership, including the Disposal System; and of collecting dues and
assessments to provide funds for such operation, maintenance, re -construction and repair.
6. The COMMISSION desires to assure that the Disposal System of the Development is properly constructed,
maintained and operated in accordance with law and permit provisions in order to protect the quality of the
waters of the State and the public interesttherein.
NOW, THEREFORE, in consideration of the promises and the benefits to be derived by each of the parties
hereto, the COMMISSION and DEVELOPER do hereby mutually agree as follows:
1. The DEVELOPER shall construct the Disposal System in accordance with the permit and plans and
specifications hereafter issued and approved by the COMMISSION, and shall thereafter properly operate
and maintain such systems and facilities in accordance with applicable permit provisions andlaw.
2. The DEVELOPER shall not transfer ownership and/or control of the Disposal System to the Association
until construction has been completed in accordance with the permit and approved plans, and the staff of
the Division of Water Resources has inspected and approved of the facilities. In order to change the name
of the permit holder, the DEVELOPER must request that the permit be reissued to the Association. The
request must include a copy of the Association Bylaws andDeclaration.
3. The DEVELOPER shall not transfer, convey, assign or otherwise relinquish or release its responsibility for
the operation and maintenance of its Disposal System until a permit has been reissued to the DEVELOPER's
successor.
FORM: DEV 03-19 Page 1 of

4. The DEVELOPER shall provide in the Declaration and Association Bylaws that the Disposal System and
appurtenances thereto are part of the common elements and shall thereafter be properly maintained and
operated in conformity with law and the provisions of the permit for construction, operation, repair, and
maintenance of the system and facilities. The Declaration and Bylaws shall identify the entire wastewater
treatment, collection and disposal system as a common element which will receive the highest priority for
expenditures by the Association except for Federal, State, and local taxes and insurance.
5. The DEVELOPER shall provide in the Declaration and Association Bylaws that the Disposal System will
be maintained out of the common expenses. In order to assure that there shall be funds readily available to
repair, maintain or construct the Disposal System, beyond the routine operation and maintenance expenses,
the Declaration and Association Bylaws shall provide that a fund be created out of the common expenses.
Such fund shall be separate from the routine maintenance funds allocated for the facility and shall be part
of the yearly budget.
6. In the event the common expense allocation and separate fund are not adequate for the construction, repair,
and maintenance of the Disposal System, the Declaration and Association Bylaws shall provide for special
assessments to cover such necessary costs. There shall be no limit on the amount of such assessments, and
the Declaration and Bylaws shall provide that such special assessments can be made as necessary at any
time.
7. If a wastewater collection system and wastewater treatment and/or disposal facility provided by any city,
town, village, county, water and sewer authorities, or other unit of government shall hereinafter become
available to serve the Development, the DEVELOPER shall take such action as is necessary to cause the
existing and future wastewater of the Development to be accepted and discharged into said governmental
system, and shall convey or transfer as much of the Disposal System and such necessary easements as the
governmental unit mayrequire as condition of accepting the Development's wastewater.
8. Recognizing that it would be contrary to the public interest and to the public health, safety and welfare for
the Association to enter into voluntary dissolution without having made adequate provision for the continued
proper maintenance, repair and operation of its Disposal System, the DEVELOPER shall provide in the
Association Bylaws that the Association shall not enter into voluntary dissolution without first having
transferred its said system and facilities to some person, corporation or other entity acceptable to and
approved by the COMMISSION by the issuance of apermit.
9. The agreements set forth in numbered paragraphs 1, 2, 3, 4, 5, 6, 7, and 8 above shall be conditions of any
permit issued by the COMMISSION to the DEVELOPER for the construction, maintenance, repair and
operation of the Disposal System.
10. A copy of this agreement shall be filed at the Register of Deeds in the County(ies) where the Declaration is
filed and in the offices of the Secretary of State of North Carolina with the Articles of Incorporation of the
Association.
IN WITNESS WHEREOF, this agreement was executed in duplicate originals by the duly authorized
representative of the parties hereto on the day and year written as indicated by each of the parties named below:
FOR THE ENVIRONMENTAL
MANAGEMENT COMMISSION
S. Daniel Smith
Director, Division of Water Resources
kue L6,10a c-
Name ofDEVELOOPER
By:\`°s (1 % j rFa-ems'
(Si ire) I uPaRprn
10EFI-&Y C. GuGR,v�ce- LAAJO
Print Name and Title
(Date) (Date)
FORM: DEN 03-19 Page 2 of 2