WQ0042374_Application (FTSE)_20210309

it Dewberry®
TRANSMITTAL
DATE:
March 04, 2021
PROJECT NAME:
R-5737 Davidson County
'V
PROJECT#:
50084275
RE:
NCDEQ Fast Track Sewer Permit
TO:
Lon Snider, Regional Supervisor
NCDEQ — Water Quality Section
450 West Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
PHONE:
336.776.9700
CC:
J Separate cover
U.S. mail
Messenger
1 Pick up
x Overnight carrier
Hand d - elivery
!I Prints
Product literature
X-1 Copies
Computations
-------
Reports
rI
CDs/DVDs
Studies
Other
Reproducible
I
1 12.22.211 $480 - Application Fee
2 3.04.21 Fast Track Sewer System Extension Application Package
2 3.04. 17-t
21 Utility Construction Plans
Comments
Please find enclosed the above referenced documents. Call with any questions. Thank you!
Received:
Lon Snider
Regional Supervisor
450 W Hanes Mill Rd., Suite 300
Winston-Salem, NC 27105
336.776.9700
Signed:
Timothy J. Ritacco, PE
Project Manager
2610 Wycliff Road, Suite 410
Raleigh, NC 27607
984.255.7052
If enclosures are not as noted, please notify us at once 1 OF 1

It Dewberry®
March 4, 2021
North Carolina Department of Environmental Quality
Winston-Salem Regional Office
Water Quality Section
450 W. Hanes Mill Road
Suite 300
Winston-Salem, NC 27105
Dewberry Engineers Inc. 919.881.9939
2610 Wycliff Road, Suite 410 919.881.9923 fax
Raleigh, NC 27607 www.dewberry.com
RE: 15A NCAC 02T .0300 — Fast Track Sewer System Extension Application
One behalf of our client, the City of Thomasville, Dewberry has prepared the Fast Track Sewer System
Extension Application. The purpose of the gravity sewer replacement is to relocate existing utilities that
conflict with and will be performed as part of the North Carolina Department of Transportation's
(NCDOT) Project R-5737•
The project is strictly a relocation project, meaning no new services or flow increases are anticipated.
Therefore, a Flow Tracking/Acceptance form is not needed because no new services or flows are being
added to the relocated gravity main. This Fast Track Sewer System Extension Application is to permit this
gravity sewer relocation.
The City has a system -wide collection system permit number WQCS00057 and therefore, we have
provided this information under Section 5 of the FTA and left the existing permit number blank under
Section 2 of the FTA application.
Enclosed for your review are one (t) original and (1) copy of the following:
• Fast Track Sewer System Extension Application
• Application Fee of $480.00
• One USGS Topographic and Street View Map of project area
Should you have any questions or comments please to not hesitate to call our office at [phone] or
email me at tritacco(@dewberry.com.
Sincerely,
3/4/2021
X TimothyJ.Ritacco
Timothy J. Ritacco, PE
Protect Manaqer
Siqned by TimothyJ Ritacco
Dewberry Engineers Inc.
Enclosures
Cc: Larry W. Mitchell, Dewberry
Page 1 of 1

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)
AR items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: City of Thomasville (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State/County ® Municipal
3. Signature authority's name: Michael Brandt per 15A NCAC 02T .0106(b)
Title: City Manager
4. Applicant's mailing address: P.O. Box 368
City: Thomasville State: NC Zip: 27361-0368
5. Applicant's contact information:
Phone number: 3( 36) 475-5599 Email Address: michael.brandtAthomasville-nc.gov
❑ Privately -Owned Public Utility
❑ Other
II. PROJECT INFORMATION:
1. Project name: R-5737
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: Davidson
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.8668' Longitude:-80.1808'
5. Parcel ID (if applicable): N/A
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Timothy J. Ritacco License Number: 046000
Firm: Dewberry Engineers Inc.
Mailing address: 2610 Wycliff Road, Suite 410
City: Raleigh State: NC Zip: 27607-3073
Phone number: 984 255-7052 Email Address: tritaccoAdewberry.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Hamby Creek W WTP Permit Number: NCO024112
Owner Name: City of Thomasville
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ_ Downstream (Receiving) Sewer Size: 12 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS00057
Owner Name(s): City of Thomasville
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?
❑ 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 N 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 0 % Commercial
0 % Industrial (See 15A NCAC 02T .0103(20))
"Is there a Pretreatment Program in effect? ❑ Yes N No
6. Has a flow reduction been approved under 15A NCAC 02T .0I14(fl? ❑ Yes N No
➢ If yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f)
Daily Design Flow $b
No. of Units
Flow
No additional flow generated
0 gal/min
0 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
GPD
a See 15A NCAC 02T 0114 b(__). (d). (e)(1) and (e)(2) for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use areas;
and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals as defined
in G.S. 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: _ 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:
N Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain):
FORM: FTA 04-16 Page 2 of 5

VH. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8" 504 PVC
➢ Section II & III of the. MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section HI contains information related to minimum slopes for gravity sewer(s)
➢ Oversizing Hues to meet minimum slope requirement is not allowed and a violation of the MDC
VHL 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 (fora 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( & (e)
® Yes ❑ No
➢ 15A NCAC 02T.0305(fl contains minimum separations that shall be provided for sewer systems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below vertical
24 inches
Water mains vertical -water over sewer including in benched trenches
18 inches
Water mains horizontal
10 feet
Reclaimed water lines vertical - reclaimed over sewer
18 inches
Reclaimed water lines horizontal - reclaimed over sewer
2 feet
**Any private or public water supply source, including any wells, 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 sloe of embankment or cuts of 2 feet or more vertical height
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade vertical
36 inches
➢ 15A NCAC 02T.0305(e) 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( 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
➢ 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 setbacks found in the river basin rules per 15A NCAC 0213.0200? [-]Yes ❑ No ®N/A
➢ This would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Does the project require coverage/authorization under a 404 Nationwide or ❑ Yes ® No
individual permits or 401 Water Quality Certifications?
➢ Information can be obtained from the 401 & Buffer Permitting Branch
5. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? ® Yes []No
Per 15A NCAC 02T.0105(c)(6), directly related environmental permits or certification applications are being prepared, have
been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion and
sedimentation control plans, stormwater management plans, etc.).
6. Does this project include any sewer collection lines that are deemed "high -priority?"
Per 15A NCAC 02T.0402, "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to streambanks that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes ® No ❑ N/A
➢ If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at least once every six -months and inspections
documented per 15A NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit.
FORM: FTA 04-16 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Pump Stations
and Force Mains (latest version), and the Gravity Sewer Minimum Design Criteria latest version) as applicable?
® 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 reauired prior to submittal of the Fast Track Application and supporting documents.
2. Professional Engineer's Certification:
I Timothy J. Ritacco attest that this application for
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 143-215.6B, 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.
........................................................................................ .
North Carolina Professional Engineer's seal, signature, and date:
inb9Aryo1
3. Applicant's Certification per 15A NCAC 02T .0106(b):
Michael Brandt, City Manager 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. I understand that any discharge of wastewater from this non -
discharge system to surface waters or the land will result in an immediate enforcement action that may include civil penalties,
injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water Resources should a condition
of this permit be violated. I also understand that if all required parts of this application package are not completed and that if
all required supporting information and attachments are not included, this application package will be returned to me as
incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature:
Michael M. Brandt Date: l021.0.4gned y 0:32:3 -0 Brandt 03/04/2021
Date: 2021.03.04 10:32:35-O5'00' Date:
FORM: FTA 04-16 Page 5 of 5

f t
kd
q
N
ri
L;fi.
q
C
a �
i
� S
L
Y
M
O
N
ryp
iu
9:
f
r•.
r. IS S
{4 .
�1}
b
e•,
Y
•
r
eryy
E � r.y
•
•
f � {

m