WQ0043496_Application (FTSE)_20220531

May 27, 2022
Division of Water Resources
Department of Environmental Quality
Winston-Salem Regional Office
450 W. Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
Attention: Mr. Alex Lowe
NC Department of
Environmental ruallty
Received
MAY 3 1 7n72
, Winston-Salem
Regional Office
Subject: Fitesa- Project Frozen
Sanitary Sewer Authorize to Construct Submittal
Dear Mr. Lowe;
Please accept this submittal for review for the Wastewater Facilities for the
above referenced project. The project consists of removing approximately
296 LF of existing 12" RCP sewer line and one (1) manhole and re-routing the
sewer main to accommodate the proposed building. The project will include
approximately 455 linear feet of new 16" DIP sanitary sewer and six (6)
proposed sanitary sewer manholes to service one (1) manufacturing/
warehouse building. The proposed sewer line routes to Wastewater
Treatment Facility High Point Eastside Treatment Plant (NC0024210) owned
by City of High Point. This project generates 400 GPD and is 100% domestic
waste.
Attached you will find the following information:
• DWR Checklist
• (2) FTA Forms (Original & Copy)
• (2) FTSE Forms (Original & Copy)
• (1) Sewer Construction Plans
• $480 Application Fee (Check #6803)
• NC Secretary of State Business Registration
• USGS Topo Map & Aerial Map
Please let us know if you have any questions or comments. We look forward
to working with you on permitting this project.
Sincere Regards,
McCutchen Engineering Associates, PC
Tommy Karnes, P.E.
Project Manager
McCutchen Engineering Associates, PC
(`8§458T`o585':
© www.mcc

D.V.W. R
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 06-21 & 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: Fitesa High Point, Inc.
2. Applicant type: ❑ Individual ® Corporation 0 General Partnership ❑,Privately -Owned Public Utility
❑ Federal 0 State/County ❑ Municipal
3. Signature authority's name: Hal Singley per 15A NCAC 02T .0I06(b)
Title: CFO
4. Applicant's mailing address: 840 SE Main Street
City: Simpsonville State: SC Zip: 29681
5. Applicant's contact information:
Phone number: f 864) 967-5600 Email Address: hsingley@n,fitesa.com
II. PROJECT INFORMATION:
1. Project name: Fitesa Project Frozen
2. Application/Project status:
❑ Other
Z Proposed (New Permit) 0 Existing Permit/Project
If a modification, provide the existing permit number: W000 and issued date:
For modifications, also attach a detailed narrative description as described in Item G of the checklist.
If new construction, but part of a master plan, provide the existing permit number: W000
3. County where project is located: Guilford
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.947° Longitude: -80.017°
5. Parcel ID (if applicable): 172345 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: J. David McCutchen
Firm: McCutchen Engineering Associates, PC
Mailing address: 898 West Saint John Street
City: Spartanburg State: SC
Zip: 29301
License Number: 025335
Phone number: (864)-582-0585 Email Address: dmccutchen ,mcc-ea.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: High Point Eastside Treatment Plant Permit Number: NC0024210
Owner Name: City of High Point
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. PermitNumber(s): WQ
2. Downstream (Receiving) Sewer Information: 12 inch El Gravity ❑ Force Main
3. System Wide Collection System PermitNumber(s) (if applicable): WQCS00010
Owner Name(s): City of High Point
FORM: FTA 06-21
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 Z N/A
If the Applicant is a Developer of lots to be sold, has a Developer's Operational Agreement (FORM: DEV) been attached?
❑Yes ❑No ZN/A
3. If the Applicant is a Home/Property Owners' Association, has an HOA/POA Operational Aereetnent (FORM: HOA) and
supplementary documentation as required by 15A NCAC 02T.0115(c) been attached?
❑ Yes ❑ No Z N/A
4. Origin of wastewater: (check all that apply):
❑ Residential (Individually Owned) ❑ Retail (stores, centers, malls)
❑ Residential (Leased) ❑ Retail with food preparation/service
❑ School / preschool / day care ❑ Medical / dental / veterinary facilities
❑ Food and drink facilities 0 Church
® Businesses / offices / factories ❑ Nursing Horne
0 Car Wash
0 Hotel and/or Motels
0 Swimming Pool/Clubhouse
0 Swimming Pool/Filter Backwash
❑ Other (Explain in Attachment)
5. Nature of wastewater : 100% Domestic % Commercial % Industrial (See I5A NCAC 02T .0103(20))
If Industrial, is there a Pretreatment Program in e feet? 0 Yes0 No
6. Has a flow reduction been approved under I5A NCAC 02T .0114(fl? 0 Yes Z No -'
> If yes, provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow nib
No. of Units
Flow
Manufacturing/Warehouse
100 gal/loading bay
4
400 GPD
Relocation/replacement of sanitary sewer
main
0 gal/day
0 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
400 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 jin 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: 400 GPD (per 15A NCAC 02T .0114)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero, please indicate why:
0 Pump Station/Force Main or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line.
Please provide supplementary information indicating the approximate timeframe for permitting upstream sewers with flow.
0 Flow has already been allocated in Permit Number: Issuance Date:
❑ Rehabilitation or replacement of existing sewers with no new flow expected
❑ Other (Explain):
FORM: FTA 06-21
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
16" Diameter
455.10
Ductile Iron Pipe
(DIP)
➢ 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 requirements is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable)—02T.0305 & MDC (PuminStatipns/Force Mainsl:
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: - .
3. Total number of pumps at the pump station:
3. Design flow of the pump station: millions gallons per day (firm capacity)
➢ This should reflect the total GPM for the pump station with the largest pump out of service.
4. Operational point(s) per pmnp(s): gallons per minute (GPM) at feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
If any portion of the force main is less than 4-inches in diameter, please identify the me hod of solids reduction per
MDCPSFM Section 2.01C.1.b. ❑ Grinder Pump ❑ Mechanical Bar Screen 0 Other (please specify)
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(1):
❑ Standby power source or ❑ Standby pump
➢ Must have 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 and may not be portable
Or if the pump station has an average daily flow less than 15,000 gallons per day 15A NCACO2T.0305(h)(1)(C):
O Portable power source with manual activation, quick -connection receptacle and telemetry -
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry:
➢ Include documentation that the portable source is owned or contracted by the applicant 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
as part of this permit application in the case of a multiple station power outage.
FORM: FTA 06-21 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations/alternatives found in I5A NCAC 02T .0305(f) & (g)? Z Yes ❑ No
I5A 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)
18 inches
'Water mains (vertical - water over sewer preferred, including in benched trenches)
18 inches
2Water 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 I1 impounded reservoirs used as a source of drinking water, and associated wetlands.
100 feet
**Waters classified WS (except WS-1 or WS-V), B, SA, ORW, HQW, or SB from normal
high water (or tide elevation) and wetlands associated with these waters (see item IX.2)
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches, as well as wetlands associated with these waters or classified as WL.
10 feet
Any building foundation (horizontal)
5 feet
Any basement (horizontal)
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
➢ If noncompliance with 02T.0305(f) or (g) see Section X.1 of this application
*15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(f) cannot be achieved. Please check "yes"
above if these alternatives are used and provide narrative information to explain.
**Stream classifications can be identified using the Division's NC Surface Water Classifications webpgge
2. Does this project comply with the minimum separation requirements for water mains? Z Yes ❑ No ❑ N/A
> If no, please refer to 15A NCAC 18C.0906(f) for documentation requirements and submit a separate document,
signed/sealed by an NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements for wetlands? Z Yes ❑ No ❑ N/A
> Please provide supplementary information identifying the areas of non-conformance.
> See the Division's draft separation requirements for situations where separation cannot be met.
> No variance is required if the alternative design criteria specified is utilized in design and construction.
4. Is the project located in a river basin subject to any State buffer rules? ❑ Yes Basin name: ® No
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ❑ Yes ❑ No
> This includes Trout Buffered Streams per 15A NCAC 2B.0202
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits
or 401 Water Quality Certifications?
> Please provide the permit number/permitting status in the cover letter if coverage/authorization is required.
❑ Yes /1 No
6. Does project comply with I5A NCAC 02T.0105(c)(6) (additional permits/certifications)? // Yes ❑ No
Per 15A NCAC 02T.0105(c)(61, directly related environmental permits or certification applications must be 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.).
7. Does this project include any sewer collection lines that are deemed "high -priority?" ❑ Yes ® No
Per 15A NCAC 02T.0402, "high -priority sewer" means any aerial sewer, sewer contacting surface waters,
siphon, or sewers positioned parallel to streambanks that are subject to erosion that undermines or deteriorates the sewer.
Siphons and sewers suspended through interference/conflict boxes require a variance approval.
> 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 permittee's individual System -Wide Collection permit.
FORM: FTA 06-21 Page 4 of 5

X. CERTIFICATIONS:
Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permittine of Pump Stations
and Force Mains (latest version). and the Gravity Sewer Minimum Design Criteria (latest version) as applicable?
®Yes ❑No
If no, for projects requiring a single variance, complete and submit the Variance/Alternative Design Request application
(VADC 10-14) and supporting documents for review to the Central Office. Approval of the request will be issued
concurrently with the approval of the permit. and proiects requiring a variance approval may be subject to longer
review times. For projects requiring two or more variances or where the variance is determined by the Division to be a
significant portion of the project, the full technical review is required.
2. Professional Engineer's Certification:
I J. David McCutchen , attest that this application for Fitesa Proiect Frozen
(Professional Engineer's name from Application Item 111.1.) (Project Name from Application Item II. I )
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,
Minimum Design Criteria for Gravity Sewers (latest version) and the Minimum Design Criteria for the Fast -Track Permitting
of Pump Stationsand Force Mains (latest version). Although other professionals may have d veloped certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that 1-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. Misrepresentation of the application
information, including failure to disclose any design non-compliance with the applicable Rules and design criteria, may subject
the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NCAC 56.0701)
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I, Hal Singlev attest that this application for
(Signature Authority Name from Application Item 1.3.)
°�ao\QSNuCAR�I
025
4h1,fa1NEt ��2
f UBCINl11 �Cfrs
orc—ar.Zaz2
Fitesa Project Frozen
(Project Name from Application Item 11.1)
attest that this application 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 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 143-215.613 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:
FORM: FTA 06-21
Date:
5 McajaP
Page 5 of 5

Public Services Department
Derrick Q. Boone
ASSISTANT DIRECTOR
May 23, 2022
NCDENR
Winston-Salem Regional Office
450 W. Hanes Mill Rd, Suite 300
Winston-Salem, NC 27105
Dear Sir or Madam:
� h /
NORTH CAROLINA'S INTERNATIONAL CITYTh
Project: Fitesa Project Frozen
Private Sewer
Applicant: Fitesa High Point, Inc.
High Point, NC
This is to acknowledge that the City of High Point will accept for treatment in the Eastside
Wastewater Treatment Plant (Permit #NC0024210), wastewater flow from the above referenced
project in the amount of 400 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,
Derrick Q. Boone
Assistant Public Services Director
DQB/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

Division of Water!te
ri es
Application Number:
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
2020-177
Entity Requesting Allocation: Fitesa High Point, Inc.
Project Name for which flow is being requested:
Fitesa Project Frozen
More than one FTSE may be required for a single project if owner ojibe WWTP is not responsible for all pmnp
stations along the route of the proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility name: Eastside WWTP
b. WWTP Facility Permit #: NC-0024210 J
c. WWTP facility permitted flow:
d. Estimated obligated flow not yet tributary to the WWTP:
e. WWTP facility's actual average flow:
f. Total flow for this specific request:
g. Total actual and obligated flows to the facility:
h. Percent of permitted flow used:
All flows are in MGD
26.0000
3.0528
13.8758
0.0004
16.9290
65.11%
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) (n) (C) (D) = (W+C) (E)=(A-D)
Pump Pump Firm Design Approx. Obligated, Total Current Available
Station Station Capacity Average Current Not Yet Flow Plus Capacity
(Name or Permit Daily Flov2 Avg. Daily Tributary Obligated
Number) Number (Firm/p9, Flow, Daily Flow, Flow
MGD MGD MGD MGD MGD MGD
&,Iside WWTP NC0024210 26.0008 26.0008 13.8759 3.0528 16.9287 9.0721
MIA HN/A HN/A MIA HNIA HN/A HN/A
HN/A HN/A #NIA HN/A MA HNIA HN/A HN/A
HN/A HN/A #N/A HN/A HNIA MA HN/A HN/A
#N/A HN/A /IN/A MA HNIA HNIA HN/A HNIA
* 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 Flow is the firm capacity of the pump station divided by the peaking factor (p9 not
less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Plamring Assessment Addendum shall be attached for 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

III. Certification Statement
I, Derrick Q. Boone 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 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.
Z_— 5/2/2022
Signing Official Sgnature Date
A55Is7AA/% &&,c sEX✓ICES 1»CeeflX
Title of Signing Official
Page 2 of 6
FTSE 10-18

Secretary of State
Elaine F. Marshall
f Y P 10 II QOIQSJINN3 FORMS EAU FMB MRY(S& EVENTS A000V.T CONTACT APPOINTMENTS SIGN IN
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Business Corporation
Legal Name
Fllesa High Point Inc.
Information
sosid 2043888
Status: Current -Acute O
Date Formed 9/4/2020
Citizenship: Foreign
State of Incorporation: DE
Fiseat Month: December
Annual Report Due Date: ARM loth
Annual Deport Status: Current
Registered Agent CT oltom coepn Svsle
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