WQ0043474_Application (FTSE)_20220511

stimmel
May 10, 2022
601 N. TRADE STREET, SUITE 200
WINSTON-SALEM, NC 27101
www.stimmelpa.com 336.723.1067
NC DEQ — Winston-Salem Regional Office
Division of Water Resources
450 W. Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
Re: Fast -Track Sewer System Extension Application for
Private Sewer System at Wake Forest University Campus
Davis Field Road
To whom it may concern:
Attached you will find a Fast -Track Sewer System Extension Application and supporting information for a
private sewer main system extension. The design includes a new 8-inch gravity sewer main that will discharge
to a City of Winston Salem 8-inch sewer main. The system will serve future a facility therefore currently no
proposed flow.
The following information is included for your review and approval:
J
# Copies Description
2 Fast-Track°Application Form FTA 10-16 (original & copy)
1 Review fee check in the amount of $480
1 Documentation that the Applicant is a registered business with NCSOS office.
2 Flow Tracking / Acceptance Form FTSE 04-18 (signed by City of Winston-Salem)
2 Site Map on 8.5" x 11" color USGS Quad Map
2 Site Map on 8.5" x 11" Aerial Street Map
If you have questions or need additional information, please contact me at [phone] or
K H owa rd @ sti m m e l pa. co m
Sincerely,
/(:4
Kelway L. Howard III, PE
Vice President
LANDSCAPE ARCHITECTURE CIVIL ENGINEERING LAND PLANNING

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: Wake Forest University (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: John Shenette per 15A NCAC 02T .0106(b)
Title: Vice President of Facilities & Campus Services
4. Applicant's mailing address: 1834 Wake Forest Road
City: Winston Salem State: NC Zip: 27106-
5. Applicant's contact information:
Phone number: [phone] Email Address: [e-mail]
II. PROJECT INFORMATION:
1. Project name: Davis Field Road
2. Application/Project status:
® Proposed (New Permit) ❑ 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: WQ00
3. County where project is located: Forsyth
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.1355° Longitude: -80.2792°
5. Parcel ID (if applicable): 6826-19-7572, 6826-09-0161 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
I. Professional Engineer: Kelway L. Howard III, PE
Firm: Stimmel Associates, PA
Mailing address: 601 N. Trade Street, Suite 200
City: Winston Salem State: NC Zip: 27101-
Phone number: [phone] Email Address: khoward(cdstimmelpa.com
License Number: 027912
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Archie Elledge WWTP Permit Number: NC0037834
Owner Name: WS/FC Utility Commission
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ
2. Downstream (Receiving) Sewer Information: 8- inch ® Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s): WS/FC Utility Commission
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 ®N/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 ® N/A
3. If the Applicant is a Home/Property Owners' Association, has an HOA/POA Operational Agreement (FORM: HOA) and
supplementary documentation as required by 15A NCAC 02T.0115(c) been attached?
❑Yes ❑No ®N/A
4. Origin of wastewater: (check all that apply):
❑ Residential (Individually Owned)
❑ Residential (Leased)
Z School / preschool / day care
❑ Food and drink facilities
® Businesses / offices / factories
❑ Retail (stores, centers, malls)
❑ Retail with food preparation/service
❑ Medical / dental / veterinary facilities
❑ Church
❑ Nursing Home
❑ Car Wash
❑ Hotel and/or Motels
❑ Swimming Pool/Clubhouse
❑ Swimming Pool/Filter Backwash
❑ Other (Explain in Attachment)
5. Nature of wastewater : 100 % Domestic % Commercial % Industrial (See 15ANCAC 02T..0103(20))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 02T .0114(f)? ❑ Yes ® No
➢ If yes, provide a copy of flow reduction approval letter with this application
7. Summarize wastewater generated by project:
J
Establishment Type (see 02T.0114(f))
Daily Design Flow a,"
No. of Units
Flow
gal/
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: 0 GPD (per 15A NCAC 02T .0114)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero, please indicate why:
❑ 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.
❑ Flow has already been allocated in Permit Number: Issuance Date:
❑ Rehabilitation or replacement of existing sewers with no new flow expected
®Other (Explain): Private sewer main is being installed under proposed roadway to serve a portion of the campus that will
be developed in the future.
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
8-inch
67
D.I.
> 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 (Pump Stations/Force Mains):
PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUij ED 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 pump(s): gallons per minute (GPM) at
5. Summarize the force main to be permitted (for this Pump Station):
feet total dynamic head (TDH)
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 ❑ 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):
❑ 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 15A NCAC 02T .0305(f) & (g)? Z Yes ❑ No
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)
18 inches
2Water 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 II impounded reservoirs used as a source of drinking water, and associated wetlands.
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 associated with these waters (see item IX.2) t
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.I 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 webpage
2. Does this project comply with the minimum separation requirements for water mains? N 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? ❑ Yes ❑ No N 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? N Yes Basin name: Yadkin Pee -Dee ❑ No
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? N Yes ❑ No
➢ This includes Trout Buffered Streams per 15A NCAC 213.0202
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ❑ Yes N No
or 401 Water Quality Certifications?
➢ Please provide the permit number/permitting status in the cover letter if coverage/authorization is required.
6. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? N Yes ❑ No
Per 15A NCAC 02T.0105(c)(6) 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 N 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:
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 El 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 projects requiring a variance approval may be subject to longer
review times. For projects requiring two or more variances or where the variance isdetermined by the Division to be a
significant portion of the project, the full technical review is required.
2. Professional Engineer's Certification:
I, Kelway L. Howard, III P.E. attest that this application for Davis Field Road
(Professional Engineer's name from Application Item 11I.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 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 IJhave 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, ortcertification 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)
0,fTeii/
North Carolina Professional Engineer's seal, signature, and date:
CL
0279 2
9Op,ti�.`_.
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I, John Shenette V. P. of Facilities & Campus Services attest that this application for Davis Field Road
(Signature Authority Name from Application Item I.3.)
(Project Name from Application Item IL 1)
attest that this application 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.
Wake Forest Univeity, aN.�, h Caro
Signature: BY:
John S
1
1
on -profit -orporation
Date:
ent of Facilities & Campus Services
Ski Ata
FORM: FTA 06-21
Page 5 of 5

11/26/2001 17:53 336-758-5933 LEGAL DEPT WFU
SOSID: 0158463
Date Filed: 11/27/2001 8:37 AM
Elaine F. Marshall
North Carolina Secretary of State
State of North Carolina
Department of the Secretary of State
Z 317 MI ARTICLES OF RESTATEMENT
FOR NONPROFIT CORPORATION
Pursuant to *SSA-104/6 of the General Statutes of North Carolina, the undersigned corporation hereby
submits the following Sr the purpose of restating its Articles of Incorporation.
1. The rags of the corporation is: Wake Forest University
2. The text of the Restated Articles of Incorporation is attached.
3. (Check a, b, c, and/or d, as applicable.)
a. These Restated Articles of Incorporation were adopted by the board of directors and
do not contain an amendment.
b. X These Restated Articles of Incorporation were adopted by the board of directors and
contain an amendment not requiring member approval. (Set firth a brie !explanation of why
member approval was not required formich amendment.)
The Corporation does not have members.
a These Restated Articles of Incorporation contain an amendment requiring member
approval, and member approval was obtained as required by Chapter SSA of the North
Carolina General Statutes.
d. These Restated Articles of incorporation contain an amendment requiring approval by
a person whose approval is required pursuant to N.C.G.S. 155A-10.30, and such approval was
Obtained.
4. These articles will be effective upon filing, unless a delayed date and/or time is specified.
This the. I( day of' 20A
Wake Po st University
Leon H. Corbett, Jr., Secretary
Notes:
I. Filing fee is 510, unless the Restated Articles of Incorporation include an amendment, in which case the filing roc
Is $25. This documatt and one exactor conformed copy of these articles must be filed with the Secretary of State.
(Revised January 2000) (Form !V-03)
CORPORATIONS DIVISION P.O. BOX 29622 RALEIGH, NC 27626-0622

11/26/2001 17:53 336-758-5933
LEGAL DEPT WFU - PAGE 04
RESTATED ARTICLES OF INCORPORATION
21 ► 5WAKE FOREST UNIVERSITY
Pursuant to §55A-2-02 of the General Statutes of North Carolina, the undersigned Wake Forest University does
hereby submit these restated Articles of Incorporation for a nonprofit corporation.
1. The name of the corporation is Wake Forest University,
2. The corporation is a "charitable or religious corporation" as defined in NCOS §55A-1.40(4).
3. The street address and county of the registered office of the corporation is:
214 Reynolda Hall, Wake Forest University
1834 Wake Forest Road
Winston-Salem, NC 27106
County of Forsyth
4. The mailing address of the registered office is:
Wake Forest University
P.O. Box 7656
Winston-Salom,NC 27109
5. The name of the registered agent is:
Leon H, Corbett, Jr.
6. Wake Forest University was incorporated by an act of the General Assembly of North Carolina in the year
1834.
7. The corporation does not have members.
8. Upon dissolution of the Corporation and after the payment, or provision for the payment, of all the liabilities of
the Corporation, all the assets of the Corporation will be transferred and conveyed to an organization or
organization operated exclusively for charitable, educational; religious or scientific purposes qualifying as
exempt muter Section 501(0(3) of the Internal Revenue Code.of 1986 as amended (or the corresponding
provisions of any future United States Internal Revenue Law) as directed by a majority of the Board of Trustees
of the Corporation.
9. Other Provisions
9.1. The purpose of the Corporation is to operate Wake Forest University, an institution of Christian higher
education. The Corporation is organized exclusively for religious, charitable, scientific, literary, and
Sweden! purposes within the meaning of Section 501(c)(3) of the Internal Revenue Code of 1986 as
amended (or the corresponding provisions of any future United States Internal Revenue Law).
9.2. The directors of the corporation are known as "Trustees" and the Board of Directors is known as the
"Board of Trustees".
3536-11

11/26/2001 17:53 336-758-5533
LEGAL DEPT WFU PAGE 05
93. To the full extent permitted by law, no person who is serving or who has served as a trustee of the
uaivetsity will be personally liable in any action for monetary damages for breach of his or her duty as a
trustee. The protection provided by this provision will not be reduced by any amendment or repeal of this
provision, or the adoption of provisions inconsistent with this section, after the event giving rise to the right
of protection.
10. The street address and county of the principal office of the corporation is:
1834 Wake Forest Road
Winston-Salem,NC 27106
County of Forsyth
11, The mailing address of the principal office is:
Wake Forest University
P, O. Box 7656
Winston-Se/cm, NC 27109
12. These stated articles will be effective upon filing.
This is the 01 day offite4 , 20 D /.
3536.13
n El. Corbett, Jr..
Secretary, Board of Trustees

22 203 5001
State of North Carolina
Department of the Secretary of State
SOSID: 0158463
Date Filed: 712412002 10:33 AM
Elaine F. Marshall
North Carolina Secretary of State
NONPROFIT CORPORATION'S STATEMENT OF CHANGE OF RI
Pursuant to §55A-5-0I and §55D-31 of the General Statutes of North Carolina, the undersigned nonprofit
corporation does hereby submit the following for the purpose of changing its registered agent currently on file
with the Secretary of State.
INFORMATION CURRENTLY ON FILE
The name of the corporation is: Wake Forest University
The street address and county of the principal office of the corporation currently on file is:
Number and Street: 214 Reynolda Halk 1834 Wake Forest Road
City, State, Zip Code: Winston-Salem, NC27109 County: Forsyth
The mailing address if different from the street address of the principal office currently onjfile is:
P. O. Box 7656, Winston-Salem, NC 27109
Name of the Retiring Registered Agent: Leon H. Corbett,, Jr.
NEW INFORMATION
1. The name of the New Registered Agent: James Reid Morgan who has signed below to indicate his
written consent to theappointment.
2. After the change is made, the addresses of the registered office and the business office of the registered
agent will be identical.
3. This statement will be effective upon filing,
dosnied
This is the 14 day of t f ne L , 2002.
1 consent to the appointment:
James Reid Morgan
20108.13
Wake Forest University
Name ofCorporation
Signature
Leon H. Corbett, Jr., Secretary
Type or Print Name and Title

DIvrsion of Wa Cr Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: Wake Forest University
Project Name for which flow is being requested: 12594 WFU Davis Field Road
More Ikon one TTSE may be required for a single project If the owner of the WWTP Is not responsible for all pump
stations along lire route of the proposed wastewater flow.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: MUDDY CREEK
b. WWTP Facility Pertnit #: NC0050342
All flows are'Jn MOD
o, WWTP facility's permitted flow 21.000000 ,
d. Estimated obligated flow not yet tributary to the WWTP 2.934654
e. WWTP facility's actual avg. flow 13.930000
f. Total flow for this specific request 0.0000000
g. Total actual and obligated flows to the facility 16.864654
h. Percent of permitted flow used 80,3
II. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
List pump stations located between the project connection point and the WWTP:
(A) (B) (C) (D)=(B+C) (E)=(A-D)
Design Obligated,
Pump Pump Average Approx. Not Yet Total Current
Station Station Firm Daily Plow* Current Tributary Flow Plus
(Name or Permit Capacity, * (Firm / pfl, Avg. Daily Daily Flow, Obligated Available
Number) No. MGD MGD Flow, MGD MGD Flow Capacity***
* Tite 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 titan 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): Muddy Creek
Downstream Permit Number: WQCS00003
Page 1 of 6
FTSE 10-18

Ill, Certification Statement:
I Courtney Driver, P.E. 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. ,.
Signing Offcia Signature
cc j ectc rr eei
Title o Signing Official
Page 2 of 6
Date
J
FTSE 10-18

)Iulslon of Water Itesoarces
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: Wake Forest University
Project Name for which flow is being requested: 12594 WFU Davis Field Road
More than one FTSE may be required for a single project if the owner of the WWTP is not responsible for all pump
stations along the route of the proposed wasletvaler flow.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a, WWTP Facility Name: MUDDY CREEK
b. WWTP Facility Perrnit #: NC0050342
All flows are' in MGD
e, WWTP facility's permitted flow 21.000000 ,
d. Estimated obligated flow not yet tributary to the WWTP 2.934654
e. WWTP facility's actual avg. flow 13.930000
f. Total flow for this specific request 0.0000000
g. Total actual and obligated flows to the facility 16,864654
h. Percent of permitted flow used 80.3
J
I1. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
List pump stations located between the project connection point and the WWTP:
(A) (B) (C) (D)=(B+C) (E)=(A-D)
Design Obligated,
Pump Pump Average Approx. Not Yet Total Current
Station Station Firm Daily Flow** Current Tributary Flow Plus
(Name or Permit Capacity, * (Finn / pf), Avg. Daily Daily Flow, Obligated Available
Number) No. MGD MGD Flow, MGD MGD 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
(pt) not less titan 2.5, per Section 2.02(A)(4)(e) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): Muddy Creek
Downstream Permit Number: WQCS00003
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I Courtney Driver, P.E. 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 addendum 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 Offtcia Signature • Date
1�corj ,ct t.vi'5,r'ee,c-
Title of Signing Official J
Page 2 of 6
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