WQ0044033_Application (FTSE)_20230104

Rec6v2d i—Lp-zoz j State of North Carolina
DWR Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number: WroW—I q r '� (tobe completed by DWR)
All items must be completed or the aoolication will be returned
1. APPLICANT INFORMATION:
1. Applicant's name: 350 South Land Holding 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: David Griffin, Jr. per 15A NCAC 02T .0106(b)
Title: Manager
4. Applicant's mailing address: 4716 Hilltop Rd
City: Greensboro State: NC Zip: 27407-
5. Applicant's contact information:
Phone number: [phone] Email Address: [e-mail]
11. PROJECT INFORMATION:
1. Project name: High Point North Industrial Center - Roadway Extension & Improvements
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: W000
3. County where project is located: Guilford
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.0778' Longitude:-79.9936°
5. Parcel ID (if applicable): 7804392106 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
l . Professional Engineer: Adam Carroll License Number: 038573
Firm: Timmons Groun
Mailing address: 8642 W. Market Street, Suite 136
City: Greensboro State: NC Zip: 27409
Phone number: [phone] Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
I. Facility Name: Eastside Wastewater Treatment Plant Permit Number: NCO024210
Owner Name: City of High Point
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Penn it Number(s): WQ_
2. Downstream (Receiving) Sewer Information: 12 inch Z Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s):
FORM: FTA 06-21 Pagel 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: DEVI 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) ❑ 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: % Domestic 100 % Commercial % Industrial (See 15A NCAC 02T .0103(20))
If Industrial, is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(fl? ❑ Yes ❑ 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'"
No. of Units
Flow
Warehouse
100 gal/loading bay
121
12,100 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
12,100 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.01141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 12 10000 GPD (per 15A NCAC 02T .0114)
➢ Do not include future flows or previously pennitted 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):
FORM: FTA 06-21 Page 2 of 5

VIL GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
12
4,196
SDR-26PVC
12
674
DUCTILE IRON
➢ 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 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 pump(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 method of solids reduction per
MDCPSFM Section 2.01C.Lb. ❑ 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(fl & (g)? ® Yes ❑ No
15A NCAC 02T.0305 contains minimum separations that shall be provided for sewers stems:
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
'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, 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)
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(fl or (g), see Section X.I of this application
*15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(fl 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 webnage
2. Does this project comply with the minimum separation requirements for water mains? ® 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/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? Z Yes Basin name: Cape Fear ❑ No
If yes, does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .02007 ® 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 ❑ 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)? ® 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 ® 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 ❑ 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 subiect 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: High Point North Industrial Center -
I Joseph A. Carroll, PE attest that this application for Roadway Extension & Improvements
(Professional Engineer's name from Application Item I11.1.) (Project Name from Application Item I1.1)
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,
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. 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):
CARO,
SEAL
38573 =
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I David H. Griffin, Jr. , attest that this application for 350 South Land Holding, LLC
(Signature Authority Name from Application Item I.3.) (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.
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: Date:
FORM: FTA 06-21 Page 5 of 5

1/2/23, 9:11 AM
North Carolina Secretary of State Search Results
• File an Annual Report/Amend an Annual Report • Upload a PDF Filing • Order a Document Online
Add Entity to My Email Notification List • View Filings • Print a Pre -Populated Annual Report form • Print
an Amended a Annual Report form
Limited Liability Company
Legal Name
350 South Land Holding, LLC
Information
Sosld: 1006963
Status: Current -Active O
Date Formed: 10/15/2007
Citizenship: Domestic
Annual Report Due Date: April 15th
Currentgnnual Report Status:
Registered Agent: Houchins, Cortney M
Addresses
Mailing
4716 Hilltop Road
Greensboro, NC 27407
Reg Mailing
4716 Hilltop Road
Greensboro, NC 27407
Company Officials
Principal Office Reg Office
4716 Hilltop Road 4716 Hilltop Road
Greensboro, NC 27407 Greensboro, NC 27407
All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20.
Manager
David H Griffin , Jr
4716 Hilltop Road
Member
D H Griffin , Sr
4716 Hilltop Road
Greensboro NC 27407 Greensboro NC 27407
https://v .sosnc.gov/online_services/search/Business_Registration_Results 1/1

Public Services Department
Derrick Q. Boone
ASSISTANT DIRECTOR
NORTH CAROLINNS INTERNATIONAL CIT'("
November 22, 2022
NCDENR
Winston-Salem Regional Office
450 W. Hanes Mill Rd, Suite 300
Winston-Salem, NC 27105
Project: High Point North Industrial Center
Private Sewer
Applicant: 350 South Land Holding, LLC
Greensboro, NC
Dear Sir or Madam:
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 12,100 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. Bo ne
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

State of North Carolina
Departntent of Envit'omnental Quality
si 1 j It i 7 ' Division of Water' Resources
Flow Tiraeldug for Sewer Extension Applications
flivkloti of Water Resources (FTSE 10-18)
Application Number; 2020.182
Entity Requesting Allocation; 350 South Land Holding LLC
Project Name for which flow is being requested; High Point North Indushial Center - Roadway E
More lieu one PTSG nut y be required fore slagle project Jf J4e owner of fhe IYIFTP Is not responsible for all pulp
stations along the ronte offhe proposed tpestelpeterJlow.
I. Complete this section only if you are the owner of the wastewater treatment plant,
a. WWTP Facility name: EastsideWWTP
b. W WTP Facility Permit Il: NC-0024210
All floes areln MOD
c. W WTP facility permitted flow;
26.0000
d. Estimated obligated flow not yet tributary to the W WTP:
3.0649
e. W WTP facility's actual average flow:
13.7292
f. Total flow for this specific request:
0.0121
g. Total actual and obligated flows to the facility:
16.8062 1
h. Percent of permitted flow used:
64.64%
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 W WTP.
(A) (D) (C)
(D)=(a+C)
(a)=(A.D)
Pump Pump Fim1 Design Approx. Obligated,
Total Cunene
Available
Station Station Capacity' Average Cunene Not Yet
Flow Plus
Capacity'
P Y
(Name or Permit Daily Flows Av&Daily Tributary
Obligated
I
Number) Number (FIrMpQ, Flow, Dally Flow,
Flow
MGD MGD MGD MGD
MGD
MGD
ivaevimr W000243 0 2,2120 0.9929 o1S01 0A394
1.009S
0.1162
aivudde wQOW8522 30.0987 IIA142 6J996 1.9148
10.1144
1.1698
M/A RWA RWA MWA MWA
RWA
VWA
RWA MWA RWA RWA MA MWA
HWA
MA
MIA MWA OVA RWA MA MA
RNA
MWA
a The Firm Cnpneity, (design flow) of any pump station Is dented as the nmximum pumped flow That
can he achieved with the largest pump taken out of service.
•" Design Avernge Flow Is the arm capacity of the pump station divided by the peaking factor (p0 not
less limit 2.5, per Section 2,02(A)(4)(c) of the Minimum Design Criteria.
•-- A Planning Assessment Addendum shall be attacked for ench pump station located hchrcen elm
project connection pond and the w59TP where the Available Capacity is 5 0.
Downstream Facility Name (Sewer):
Downstream Permit Number:
Page 1 nl0 FTSE 10.10

lit. 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 patty. Signature of this form certifies that the receiving collection system or treatment works
has adequate capacity to transport and heat the proposed new wastewater.
5tgnlnP Oclal gnnlur�
ASSISMA% AAIC SGx✓I&E5 DAccroz
Title of Signing OJ)7clal
11/18/2022
Date
Pape 2 of a FTSE 10.10

PLANNING ASSESSMENT ADDENDUM (PAA)
Submit a planning assessment addendum for each pump station listed in Section 11 where Available Capacity is <
0.
Pump Station (Name or Number):
Given that:
a. The proportion and amount of Obligated, Not Yet Tributary Daily Flow (C) accounts for
% and MGD of the Available Capacity (E) in Pump Station
; and that
b. The rate of activation of this obligated, not yet tributary capacity is currently approximately
MGD per year; and that
c. A funded Capital Project that will provide the required planned capacity, namely
is in design or under construction with
planned completion in ; and/or
d. The following applies:
The waterview force main is currently under construction. When the pro
'ect is completed
the waterview pump station will be increased to 2,500 GPM. The expected date of
completion is March 28, 2023.
Therefore:
Given reasonably expected conditions and planning information, there is sufficient justification to allow
this flow to be permitted, without a significant likelihood of over -allocating capacity in the system
infrastructure.
I understand that this does not relieve the collection system owner from complying with G.S. 143-
215.67(a) which prohibits the introduction of any waste in excess of the capacity of the waste disposal
system.
Official Signature
Dale
Page 3 of 6
FTSE 10-18

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TIMMONS GROUP
YOUR VISION ACHIEVED THROUGH OURS.
TRANSMITTAL
NC Department o
Environmental Qual
JAN 0 4 2023
Winston-Salem
Regional Office
TO: NCDEQ — Division of Water Quality Date:01/02/2023 Job #: 48261
Winston-Salem Regional Office Project: Gallimore Dairy Rd. Ext.
450 W. Hanes Mill Rd, Suite 300 Reference:
Winston-Salem, NC 27105 Copies Sent To:
® ENCLOSED PLEASE FIND:
❑ WE ARE SENDING UNDER SEPARATE COVER: See below
COPIES
DATE
NUMBER
DESCRIPTION
2
Cover Letter
2
Application Form
2
Secretary of State Verification — 350 South Land Holdings, LLC
1
$480 Application Fee
2
Site Aerial Ma
2
1
1
1 Site USGS Ma
2
Flow Tracking/Acceptance Form
2
Sewer Acceptance Letter
THESE ITEMS ARE TRANSMITTED:
If enclosures are not as noted, please notify us at once.
COMMENTS:
Please find the attached items necessary for permit approval for the public gravity extension for
the High Point North Industrial — Public Roadway Extension & Improvements. Please reach out if
any additional information is needed.
Thank you.
SIGNED:
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Jacob Moore, PE

TIMMONS GROUP
YOUR VISION ACHIEVED THROUGH OURS.
January 2, 2023
NCDEQ— Division of Water Quality
Winston-Salem Regional Office
450 W. Hanes Mill Rd, Suite 300
Winston-Salem, NC 27105
RE: High Point North Industrial — Roadway Extension & Improvements
Please find enclosed, the necessary items for Fast -Track Application approval for the above
reference project. This project consists of a public extension of Gallimore Dairy Rd which
includes a public sewer extension and waterline extension. The waterline shall be permitted
through NCDEQ under a separate application. The roadway shall serve a current warehousing
project (designed by others), as well as other future light industrial and warehousing uses.
Sanitary sewer service will be extended to the business/industrial park by means of a 12" gravity
main to be installed by 350 South Land Holdings, LLC, and conveyed to the City of High Point
upon completion. All construction shall conform to City of High Point and NCDEQ standard and
specifications.
The design wastewater flow is 12,100 gallons per day as calculated using the 2T Rules for general
businesses and office facilities.
Feel free to call me at [phone] if you have any questions.
Sincerely,
Jacob Moore, PE
Project Manager
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