WQ0021840_Application (FTSE)_20230505

Received 5-5-2023 State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 06-21 & SUPPORTING DOCUMENTATION
WQ0021840 MOD
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: High Point Christian Academy (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: Keith Curlee per 15A NCAC 02T .0106(b)
Title: Headmaster
4. Applicant's mailing address: 800 Phillips Ave.
City: High State: NC Zip: 27262-
5. Applicant's contact information:
Phone number: [phone] Email Address: [e-mail]
II. PROJECT INFORMATION:
1. Project name: HPCA Gymnasium
2. Application/Project status: ❑ Proposed (New Permit) ® Existing Permit/Project
If a modification, provide the existing permit number: WQ0021840 and issued date: October 28 2002,
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: Guilford
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.9514' Longitude:-80.0265'
5. Parcel ID (if applicable): 194035 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Norris Z. Clayton License Number: 10727
Firm: Hugh Creed Associates, Inc., P.A.
Mailing address: PO Box 9623
City: Greensboro State: NC Zip: 27408-
Phone number: [phone] Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Westside WWTP Permit Number: 0033285
Owner Name: City of High Point
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ0024228
2. Downstream (Receiving) Sewer Information: 12 inch ® Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS0024228
Owner Name(s): City of Hiizh 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 ® 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) ❑ Retail (stores, centers, malls) ❑ Car Wash
❑ Residential (Leased) ❑ Retail with food preparation/service ❑ Hotel and/or Motels
® School / preschool / day care ❑ Medical / dental / veterinary facilities ❑ Swimming Pool/Clubhouse
❑ Food and drink facilities ❑ Church ❑ Swimming Pool/Filter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 % Domestic % Commercial % 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(f)? ❑ 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',b
No. of Units
Flow
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
0 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): Proposed gymnasium is incidental to existing school, no additional wastewater will be produced.
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" 339 8" SDR PVC
➢ 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.l.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)? ® Yes ❑ No
15A NCAC 02T.0305(f) 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
ZWater 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 11 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(f) or (g), see Section X.1 of this application
*15A NCAC 02T.0305(y) 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? ® 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? ❑ 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 ❑ 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

CERTIFICATIONS:
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 protects requiring two or more variances or where the variance is determined by the Division to be
a significant portion of the protect the full technical review is required
2. Professional Engineer's Certification:
1, l(le"I -5 Z . C i�'i �r/ , attest that this application for_&&-4 !�7%1y1N,451 1yL
(Professional Engineer's name from Application Item III.1.) (Project Name from Application Item II.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 143-215.613, 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. 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: I•'••"""'•'.........
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I, 1 44oy Wes- , attest that this application for t—A to v,,, %A 6L-9i 1, ^­_
(Signature Authority Name from Application Item I.3.) (Project Namtlrom Application Item II.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.

;�.
1 CF W A 7F9 Michael F. Easley, Governor
William G. Ross Jr., Secretary
. co r North Carolina Department of Environment and Natural Resources
p Alan W. Klimek, P.E., Director
Division of Water Duality
October 28, 2002
RICHARD HARDEE, HEAD MASTER
HIGH POINT CHRISTIAN ACADEMY
307 NORTH ROTARY DRIVE
HIGH POINT, NC 27261-2443
Subject: Permit No. WQ0021840
High Point Christian Academy
Wastewater Collection System Extension
Guilford County
Dear Mr. Hardee:
In accordance with your application received September 16, 2002, we are forwarding herewith
Permit No. WQ0021840, dated October 28, 2002, to High Point Christian Academy for the construction
and operation of the subject wastewater collection system extension. This permit shall be effective
from the date of issuance until rescinded and shall be subject to the conditions and limitations as
•specified therein. This cover letter shall be considered a part of this permit and is therefore
incorporated therein by reference.
Please pay particular attention to Permit Condition 3 which requires that the wastewater
collection facilities be properly operated and maintained in accordance with 15A NCAC 2H .0227 or
any individual system -wide collection system permit issued to the Permittee. (--Please note Permit
Condition 12 regarding future flow allocation to the subject wastewater -collection- system —Delete this
item if not needed or call attention to other special conditions as needed.)
Permitting of this project does not constitute an acceptance of any part of the project that does
not meet 15A NCAC 2H .0200; the Division of Water Quality's (Division) Gravity Sewer Minimum
Design Criteria adopted February 12, 1996 as applicable; and the Division's Minimum Design Criteria
for the Fast -Track Permitting of Pump Stations and Force Mains adopted June 1, 2000 as applicable,
unless specifically mentioned herein. Division approval is based on acceptance of the certification
provided by a North Carolina -licensed Professional Engineer in the application. It shall be the
Permittee's responsibility to ensure that the as -constructed project meets the appropriate design
criteria and rules. Failure to comply may result in penalties in accordance with North Carolina General
Statute §143-215.6A through §143-215.6C, construction of additional or replacement wastewater
collection facilities, and/or referral of the North Carolina -licensed Professional Engineer to the licensing
board.
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North
Carolina as amended, and other applicable laws, Rules, and Regulations, permission is hereby
granted to High Point Christian Academy for the construction and operation of approximately 380 linear
feet of 8-inch gravity sewer to serve employees and students as part of the High Point Christian
. Academy project, and the discharge of 2,650 gallons per day of collected domestic wastewat o
Non -Discharge Permitting Unit Internet http1/h2o.enr.state.nc.us/ndpu N
1617 Mail Service Center, Raleigh, NC 27699-1617 Telephone [phone] Fax [phone]
DENR Customer Service Center Telephone [phone]
An Equal Opportunity Action Employer 50% recycled/10% post -consumer paper

Ao
14
the City of High Point's existing sewerage system, pursuant to the application received September 16,
2002, and in conformity with 15A NCAC 2H .0200; the Division's Gravity Sewer Minimum Design .
Criteria adopted February 12, 1996 as applicable; the Division's Minimum Design Criteria for the Fast -
Track Permitting of Pump Stations and Force Mains adopted June 1, 2000 as applicable; and other
supporting data subsequently filed and approved by the Department of Environment and Natural
Resources and considered a part of this permit.
The sewage and wastewater collected by this system shall be treated in the City of High Point
Wastewater Treatment Facility (NPDES Permit No. NC0024210) prior to being discharged into the
receiving stream.
This permit shall become voidable unless the agreement between High Point Christian
Academy and the City of High Point for the collection and final treatment of wastewater is in full force
and effect.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the
right to request an adjudicatory hearing upon written request within 30 days following receipt of this
permit. This request must be in the form of a written petition, conforming to Chapter 150B of North
Carolina General Statutes, and filed with the Office of Administrative Hearings, 6714 Mail Service
Center, Raleigh, NC 27699-6714. Unless such demands are made, this permit shall be final and
binding.
If you need additional information concerning this matter, please contact Kristin E. Miguez at
[phone] extension 524.
Sincerely,
for Alan W. Klimelt, P.E.
cc: Guilford County Health Department
Winston-Salem Regional Office, Water Quality Section (WWTF Permit No. NCO024210)
LandDesign, Inc.
City of High Point (PO Box 230, High Point, NC 27261)
Water Quality Central Files
.NDFU_F.iles~

l
f
• NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH
WASTEWATER COLLECTION SYSTEM EXTENSION PERMIT
This permit shall be effective from the date of issuance until rescinded and shall be subject to the
following specified conditions and limitations:
1. This permit shall become voidable unless the wastewater collection facilities are constructed in
accordance with the conditions of this permit; 15A NCAC 2H .0200; the Division of Water Quality's
(Division) Gravity Sewer Minimum Design Criteria adopted February 12, 1996 as applicable; the
Division's Minimum Design Criteria for the Fast -Track Permitting of Pump Stations and Force
Mains adopted June 1, 2000 as applicable; and other supporting materials unless specifically
mentioned herein.
2. This permit shall be effective only with respect to the nature and volume of wastes described in the
application and other supporting data.
3. The wastewater collection facilities shall be properly maintained and operated at all times. The
Permittee shall maintain compliance with an individual system -wide collection system permit for the
operation and maintenance of these facilities as required by 15A NCAC 2H .0227. If an individual
permit is not required, the following performance criteria shall'be met as provided in 15A NCAC 2H
.0227:
a. The sewer system shall be effectively maintained and operated at all times to prevent
discharge to land or surface waters, and any contravention of the groundwater standards in
15A NCAC 2L .0200 or the surface water standards in 15A NCAC 2B .0200.
b. A map of the sewer system shall be developed prior to January 1, 2004 and shall be actively
maintained.
c. An operation and maintenance plan shall be developed and implemented.
-d. Pump stations that are not connected to a telemetry system shall be inspected every day (i.e.
365 days per year). Pump stations that are connected to a telemetry system shall be
inspected at least once per week.
e. High -priority sewer lines shall be inspected at least once per every six-month period of time.
f. A general observation of the entire sewer system shall be conducted at least once per year.
g. Inspection and maintenance records shall be maintained for a period of at least three years.
h. Overflows and bypasses shall be reported to the appropriate Division regional office in
accordance with 15A NCAC 2B .0506(a), and public notice shall be provided as required by
• North Carolina General Statute §143-215.1 C.

4. This permit shall not be transferable. In the event there is a desire for the wastewater collection
facilities to change ownership, or there is a name change of the Permittee, a formal permit request •
shall be submitted to the Division accompanied by documentation from the parties involved, and
other supporting materials as may be appropriate. The approval of this request shall be
considered on its merits and may or may not be approved.
5. Construction of the gravity sewers, pump stations, and force mains shall be scheduled so as not to
interrupt service by the existing utilities nor result in an overflow or bypass discharge of wastewater
to the surface waters of the State.
6. Upon completion of construction and prior to operation of these permitted facilities, a certification,
a copy of the construction record drawings, as well as supporting design calculations for any pump
stations permitted as part of this project shall be received from a North Carolina -licensed
Professional Engineer certifying that the facilities have been installed in accordance with this
permit; 15A NCAC 2H .0200; the Division's Gravity Sewer Design Criteria adopted February 12,
1996 as applicable; the Division's Minimum Design Criteria for the Fast -Track Permitting of Pump
Station and Force Main adopted June 1, 2000 as applicable; and other supporting materials. If
this project is to be completed in phases and partially certified, you shall retain the responsibility to
track further construction approved under the same permit, and shall provide a final certificate of
completion once the entire project has been completed. A copy of the construction record
drawings, indicating the facilities constructed in the phase being certified, shall be submitted with
each partial certification. Mail the Engineer's Certification, one copy of the "Construction Record
Drawings," and one copy of the supporting design calculations to the Non -Discharge Permitting
Unit, 1617 Mail Service,Center, Raleigh, NC 27699-1617.
7. A copy of the construction record drawings shall be maintained on file by the Permittee for the life •
of the wastewater collection facilities.
B. Failure to abide by the conditions and limitations contained in this permit; 15A NCAC 2H .0200; the
Division's Gravity Sewer Design Criteria adopted February 12, 1996 as applicable; the Division's
Minimum Design Criteria for the Fast -Track Permitting of Pump Station and Force Mains adopted
June 1, 2000 as applicable; and other supporting materials may subject. the Permittee, to an
enforcement action by the Division, in accordance with North Carolina General Statutes §143-
215.6A through §143-215.6C.
9. In the event that the wastewater collection facilities fail to perform satisfactorily, including the
creation of nuisance conditions, the Permittee shall take immediate corrective action, including
those as may be required by this Division, such as the construction of additional or replacement
facilities.
10. The issuance of this permit shall not exempt the Permittee from complying with any and all
statutes, rules, regulations, or ordinances that may be imposed by other government agencies
(local, state and federal) which have jurisdiction, including but not limited to applicable river buffer
rules in 15A NCAC 2B .0200, erosion and sedimentation control requirements in 15A NCAC Ch. 4
and under the Division's General Permit NCG010000, and any requirements pertaining to
wetlands under 15A NCAC 2B .0200 and 15A NCAC 2H .0500.
11. Noncompliance Notification:
The Permittee shall report by telephone to the Winston-Salem Regional Office, telephone number
[phone], as soon as possible, but in no case more than 24 hours or on the next working .
day, following the occurrence or first knowledge of the occurrence of either of the following:
2

.,A
a. Any process unit failure, due to known or unknown reasons, that renders the facility incapable
of adequate wastewater transport, such as mechanical or electrical failures of pumps, line
blockage or breakage, etc.; or
b. Any failure of a pumping station or sewer line resulting in a by-pass directly to receiving waters
without treatment of all or any portion of the influent to such station or facility.
Persons reporting such occurrences by telephone shall also file a written report in letter form within
five days following first knowledge of the occurrence. This report must outline the actions taken or
proposed to be taken to ensure that the problem does not recur.
Permit issued this the twenty-eighth day of October, 2002
NORTH CAROLINA ENVIRONMENTAL MANAGEMENT COMMISSION
'214 L�
for Alan W. Kli ek, P ., Director
Division of Water Quality
By Authority of the Environmental Management Commission
Permit Number W00021840
•
0
3

•.I
Permit No. W 00021840
October 28, 2002 0
ENGINEER'S CERTIFICATION
Partial Final
as a duly registered Professional Engineer in the State of North
Carolina, having been authorized to observe (periodically, weekly, full time) the construction of the
project, for the
Project Name Location and County
Permittee hereby state that, to the best of my abilities, due care and diligence was used in the
observation of the construction such that the construction was observed to be built within substantial
compliance of this permit; 15A NCAC 2H .0200; the Division of Water Quality's (Division) Gravity
Sewer Minimum Design Criteria adopted February 12, 1996 as applicable; the Division's Minimum
Design Criteria for the Fast -Track Permitting of Pump Stations and Force Mains adopted June 1, 2000
as applicable; and other supporting materials.
North Carolina Professional Engineer's seal, signature, and date:
•
The above Engineer's Certification shall be completed and submitted to the address below with one
copy of the "Construction Record Drawings" of the wastewater collection system extension as well as
supporting design calculations for any pump stations permitted as part of this project. This project shall
not be considered complete nor allowed to operate until this Engineer's Certification and all required
supporting documentation have been received by the Division. Any wastewater flow made tributary to
the wastewater collection system extension prior to completion of this Engineer's Certification shall be
considered a violation oll the permit and shall subject the Permittee to appropriate enforcement actions.
NORTH CAROLINA DIVISION OF WATER QUALITY
WATER QUALITY SECTION
NON -DISCHARGE PERMITTING UNIT
1617 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1617
•
4

Hugh Creed Associates, Inc. P.A.
Consulting Engineers & Land Surveyors
1306 W. WENDOVER AVENUE P.O. BOX 9623
GREENSBORO, N.C. 27408 GREENSBORO, N.C. 27429
TELE: [phone] OR [phone] FAX: [phone]
FIRM LICENSE #C-0551 E-MAIL: [e-mail]
May 4, 2023
Permit #W00021840 Modification Narrative:
High Point Christian Academy Gymnasium
Project Location: This project is located at 800 Phillips Ave. in High Point, NC. The area where
the modification will take place is directly north of the High Point Christian Academy (HPCA)
building, which is in the western portion of the subject property.
Project Scope: A new gymnasium is proposed to be built directly north of the ex. HPCA
building. There is an ex. private sanitary sewer manhole located 43' north of the existing
building that serves the HPCA building. This manhole discharges via 8" pipe to another existing
manhole located 204' NNE. This sewer line will be removed, and the manholes plugged as it
travels directly through the footprint of the proposed gymnasium.
Two new, private sewer manholes are proposed. Flow will travel from the existing manhole near
the ex. building 95' east to the first proposed manhole, which will be 35' NE of the existing
building and 40' S of the prop. gym. Flow will then travel 135' NNE along the eastern side of
the prop. Gym to the second proposed manhole, being 49' E of the prop. gym. From there, flow
will travel 109' NW to the second existing manhole described above, which is 50' N of the prop.
gym. All proposed sewer mains will be 8" SDR 26 PVC.
In summary, 204' of existing 8" sewer main will be removed, and 339' of 8" SDR 26 PVC sewer
main will be installed.
,*{III NINE
�.`' pQ' Foss/p �2''•,
SEAL
10727
�,���75 Z CAP, ••�•
�rIrIIIInI+���
Sincerely,
Hugh Creed Associates, Inc., P.A.
Norris Z. Clayton, P.E., P.L.S.
May 4, 2023

`���� U.S. DEPARTMENT OF THE INTERIOR The National Map HIGH POINT WEST QUADRANGLE
U.S. GEOLOGICAL SURVEY ��+ TOpO NORTH CAROLINA
science for a changing world'' J I 7.5-MINUTE SERIES
-80.1250'-80.0000,
36.0000' 57900011 E 80 81 82 83 84 85 86 87 88 89 90 36.0000'
398400011 N
83
82
81
79
78
77
76
75
74
73
72
71
¢p$ _AJ 90
900 I
WALLBURG-HIGH POINT-RD
6' _ � OA<;q ER LN - `8 %- p'l, ?��♦ ", �
OaliVleW E HARTLEY DR
° Ps �. • • O !!o ATERp 2j3 A �y a - / 2 gpOJ E PEACHTREE DR ds
�� t �• �� a I �9 0, John Wesley University
O O
a
Ile
8s �O Po Ov 7LEY DR `\ WELCH
c�1<o
WE -0 DR m o3 FORD
m �v
11burg a z NORTHPOINT AVE
CHESTER. DR-
1 O
I RK D -
0 800-
80 g0 \ I ARRISAVE ti E PARRIS AVE
0 � x
•
PRESTWICK DR
• RD o 0 �
W/ o °� �S �N O I ro Soo DR 68 q° 900
<<i eooj $y A (800 d� �PCR ago $yo o EASTCHESTER
\ ¢ Fi ro - z 00 fyo " F
g0 \ `o PgRK v , o
`o y0 $00 0 1 0 E R �w o FG ej FF O 0 60 I CWOOD DR F ER AVE © Aw, 4
ISH o
800 8 : v l �. _ PO_- - - I � E DAYTON AVE O
0 ^ 0 2�SHERBRp N m
ti (yyOKDA; j STATE AVE E o
800 O R
0 G, 8 c
o � H/ v� O 0-
-
� � �' yG 5� � \\ A � � x ; I `\ � : • . � o 0 900 Z Ego, N
so \ �yo �00 pORADO DR 0�� C ��o r 850J
Q,bb j V ////�� //' '4O %A\I> ,� WLEXINGTON AVE�-
.�l(V 850 I ? E FARRISS AVE 'rood
._ � o HILLCREST•OR � - z
o
v_ \ 0o
mayf. Co / O�\\\l^.V V TRAFALGAR O 0 o y v
s'` o° 1i VISE W z
`So' Hill Cem i �I ¢_l �� Jm o WFARRISSAVE �y �0 pVEE E i
\ C
ODES' o - DORADO E\� o v �So m Y \ O.TTERAYAVE `r%\ PRK�pR ON.! PJ ''C• o
h ( a ^ J z i o p R a
1 W
/� v'00 /1 Q < hod j c� o Q �p0 Oakwood Cem
/$ z on SpR W PARKWAYAV_E� Y� �E
S�5 80� ° LS�P-� JE �� N I �ro PEE , a
P Io', COLONIAL DR '(V
( \ \ CO 8s O n H 3 OC\
SUNSE <.. \ v
800
MM; w T �� WRAYAVE ~�;o; •1~,..
v a
D CEOP r 02 �� 1 I p0�\ J ESTM/NSTE-R D 3 v a I Q
�\
o 8 R �a o� o pSON AVE 900
U y0 i5 C boo Y\\ 0 80065
b0�QUAKER LN::-
1\
DR -
CT �o-
7 o I f o
g Z Z
� I _
�I rf y EEC sD 850 ^� I �.I �1 x / GATEWOODAVE s s�
VR
�o� o (HIGH POINT do
c.0 c 8po l Hulls Lake
FERNDALE BLVD
CRAVEN_RD yo g I 80 WICKLIFFAVE D�J'�� jJ900 j T G\\'PJE CE AV`
1 \
COMM
I
I 0 ' E
O ' ' . � a✓ O � � �, gV � � v —, � CHESTNUT DR = S� �OR
' _ � ' 6 ' o "' -tea ... , . s-a-_... • C^o c y0� '/�^. 1I oo r- 8S0� o HEDRICK AVE p� j I y,\��
1�Z50 U I z © KE ED AO
t.
O �n _I z � CREEKSIDE h
f D r' h 850 Z0 W RUSS z.
1 O F ®ORGE-CLY z o 8s 85 I 0 O
O h GE N O ELL AVE v �
o
\o ii< ♦ -s'iy � o IRO I o o cy ' � Z ¢
f�tiC OP l �o PORE p� I 44i`R° j W GRIMES AVE N
J/rl oi,� i � ?' i �0 M .•• DRY I I �o PHILLIPSAVE =1
��00, 800 ,, TAYL I AVE
n 5 PayTte R1GN I y gD Floral Gu1l�ord Technical
6 I /EGarden o j' Community -College
j Q O 1 0 _ Z50-� �l ✓ GOJ o Cem o o ' Hi h Point Campus
o RIDGE - 800 85
GE 0 q0 ❑ / v, AVE g n' j
o o. H/TEOgK 'O 1 'o "�' \J y ; 'm-�' )l''• /� �� TRYONAVE �.
R
VG .ti •; j �', �^` `� � `Z I c ,✓� /TTjERgVE U°J o �IEEIS AVE ~
J : do a n
r O O r m $ /
I IRONWOOD DR Co L' o m °oo y z y0 N Ly FO yo0 y o AVE.
80 T. 2 ��>, zo O v I c� 8 AgDq`F o ♦yZ as m COLTRANE
o �y
O O BURT n I 0D DR v�
II •. '' D Lso ON RD o n, BURTON AVE _ �00 W y\
•. `. s ro W B a = EDGE o � V1ARp AVE 1�'ljq�1 E�,R PEE
URTON R. 800
_ 0. �00 Q : I O 0Z �1 R
0
U °�oDo 800 850 I o L/N
Lu
w \� j RIS pVE TILE PL q90 pR GE DR
,tr < p 800 I � _, , DOR TEX CTOR S COLLE
WIND F° PROC• eg00 ,So J Q,��~ /\'� POTTSAVE q00
Do v TOR RD Q♦ti n I G.I.
c ,S � R _ 4 3" 2 H _.�.•' _ Amy
°
so
�...; 1 Kenned. Mi11 l °A°B BRENT RD
_� _ _o ems¢ II o •�
LISH SINCLAIR AV `E��E D ARR DR /
50 0 •1'\, � � o N W EN RD
n
,n, gV 3 �4 - - ,N.t�i o;.. AMHURST AVE _
1�
U �� 1\` m W `cam ¢ I V o o ° o FINCH AVE
7-50 I., y mil _ )_. ll(\ - 1 _ p0 $& O I o = \P= - p FOUST AVE
° W 800 TRINITY AVE BED
-0
HOy yo V r �O I O y'•• m o
SCy00 R `� _.1_0
rm / 8S I J o A
'' l I `� J o ° � � W C ° � AlR
��- Z ��HAST T HOOL RD I UNMORE. T FIELD RD
00
-_i LARKSPU I I•'. �,o _ _ GUILFO'RD CO
rFRRD 109 /_ �� / ----_ -1 f O �0 68 qoo I a / yo o RANDOLPIi
VON G 2 - q
LO AN OR I W I
\ i
LT
ON h \ o
DSO RICH H I o� _ N ( R � _ / p p CORP DR ._..
2 A
l o
SRO. _. I �
ll _ O�
Ir O
/. PLEASANT GROVE CHURCH RD ti E
0 '0� o � 'po � J
800 BE
TRIAp BLVD I 1 _
1 O
I
BALL PARK RD �y0 - - ¢� ...�_ ARCHDALE
� I
J
... ,. ,.,< NORTH DR - _ O.-Q _.. C�Op
r / \
j
o //II
NORTH RD aVERBR00KDR of�tS-FOTIf o �� �f.:./\ i� .• ��� °v z 8pD �yo OR
�wl\ )\ i I
l ( 800 0 ^y♦ w� I M/ODCE Z
6
J V �1 75 0 _ C/ I h OOiVj ' E�
1 0 1yJ �Q <FPo �o ~ QLA oo l WERYD �, I �pRSPECFCHURCHR O 800
Il % O
a D E m
g0 .. KATHLAND AVE O�Q° �I - �o,\`' ,%' - �•o� -
_ IIn1 P V
I '
BELL DR Q� - _ -
JACOB ST \/ -1 F `- - ♦ ?� 'U U __ `_ - - o. - - D
��! •� JACOB SiExn 900—'- 160
l-JAM ES AVE �'� yST. ° '" I q -- HOWARD C
IR
100
109 \h j q I DR
1G��
R
1\ I � 1I h0 .
�� ��'�� �OAJ �..%��So_ O� - TygGF,*�. I \l C� I URNP/KE.RD
z750
�,�
o
i- eoovoo
�C l - 0� - 0
FCA'la A 800 3 ~ N OR 0
R I - �o Q
j1MMV°�.; I • OOU �,JQ �' EGO\VE TRINITYS,T I
S
a GC F DST `J� MP 5 �` NHam.by-Gr I 750
R E
R
- OLD US HWY 29 p .vim-. qs ¢ G�1L O _. - I... �D
�o _W..a<F-Li,VGTONR o)LEA ,850 "l - _ - - DAVIDSON \-
ti j I' TON I ,� �♦ o .®,.— _ ��G� I �•
a TH M � -
O ASVILLE
°
© N VJ,MpIN:ST m' I�/ o° Lower Lake
- - --- z GEORGIAAVf - v I -: -. _
mils Cr �� \♦°� o/n ��� 62 v
,, oo a I J VVV
• - -^ © � 2 PR' ." > z j E SUNRISE AVE � � �, Lake
.. � n - m W .. s M2ClClle
JLm y � R
o Boo ¢` Z y 9° E Z m A ? I �� $yo �zoo�
Z�•- ,
> E A < v \i -_p I. IJppelr Lake ONIA-\-C♦ -COLONIAL CIR ...A- g^00
T TY
35.8750° 79 80 81 82
-80.1250'
Produced by the United States Geological Survey MN
North American Datum of 1983 (NAD83)
World Geodetic System of 1984 (WGS84). Projection and N
1 000-meter grid:Universal Transverse Mercator, Zone 17S I
This map is not a legal document. Boundaries may be 8°22
generalized for this map scale. Private lands within government 149 MILS
0°33'
reservations may not be shown. Obtain permission before j 10 MILS
entering private lands.
Imagery .....................................................NAIP, June 2020 June 2020
Roads ......................................... U.S. Census Bureau, 2016 C NORTH
19 MAGNETIC Names............................................................................GNIS, 1980 - 2022 UTM GRID AND DECLINATION 2020 CENTER TI SHEET
Hydrography...............................National Hydrography Dataset, 2002 - 2018
Contours............................................National Elevation Dataset, 2008 U.S. National Grid
Boundaries ..............Multiple sources; see metadata file 2019 2021 100,000-In Square ID
Wetlands.................FWS National Wetlands Inventory Not Available
NV
Grid Zone Designation
178
83 84 85 86
SCALE 1:24 000
1 0.5 0 KILOMETERS 1 2
1000 500 0 METERS 1000 2000
1 0.5 0 1
MILES
1000 0 1000 2000 3000 4000 5000 6000 7000 8000 9000 10000
FEET
CONTOUR INTERVAL10 FEET
NORTH AMERICAN VERTICAL DATUM OF 1988
This map was produced to conform with the
National Geospatial Program US Topo Product Standard
87
*ORTH
CAROLINA
QUADRANGLE LOCATION
1 Winston-Salem East
1 2 3 2 Kernersville
3 Guilford
4 5 4 Midway
5 High Point East
6 Lexington East
6 7 8 7 Fair Grove
8 Glenola
ADJOINING QUADRANGLES
84
83
82
81
79
78
77
76
75
74
73
72
397100om N
88
89 590000rnE
35.8750'
-80.0000'
N
ROAD CLASSIFICATION
M r`
Expressway
Local Connector
M
00 0
Secondary Hwy
Local Road
00 N
Ramp
4WD
Y
M �
. Interstate Route
US Route O State Route
co X
o �
Z
r- LL
za
HIGH POINT WEST, NC z z
2022

Guilford County, NC
Parcel Number
194035
6890625730
GREEN STREET BAPTIST CHURCH
Card Image
PO BOX 2443
HIGH POINT
NC
27261
303 N ROTARY DR
EXC FOR GREEN ST BAPTIST CHURCH LOA PL153-12
000000-00000
153-12
Total Out Building Value
56000
PIN
Total Land Value
Total Deferred Value
Bldg Card
1016400
Owner
0
Owner History
1
Mail Address
Appraisal Model Code
1
Mail City
Deed Data
1/1/1900
Mail State
Neighborhood
6890004
Mail Zip
Property Type
INSTITUTIONAL
Property Address
Structure Size
Legal Description
Deed
Plat
Lot Size
24.2
Year Built
1984
Bedrooms
Condo
Bathrooms
Total Assessed
12507700
Grade
Very Good
Total Building Value
11435300
Disclaimer While every effort is made to keep information provided over the internet accurate and Map Scale
up-to-date, Guilford County does not certify the authenticity or accuracy of such information. No
warranties, express or implied, are provided for the records and/or mapping data herein, or for their 1 inch = feet
use or interpretation by the User 4/10/202023

Hugh Creed Associates, Inc. P.A.
Consulting Engineers & Land Surveyors
1306 W. WENDOVER AVENUE P.O. BOX 9623
GREENSBORO, N.C. 27408 GREENSBORO, N.C. 27429
TELE: [phone] OR [phone] FAX: [phone]
FIRM LICENSE #C-0551 E-MAIL: HCA(a)HUGHCREEDASSOCIATES.COM
May 4, 2023
COVER LETTER
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Attn: Jenny Graznak
Winston-Salem Regional Office
Division of Water Resources
North Carolina Department of Environmental Quality
Re: Private Sewer Permit Modification/Addition
Green Street Baptist Church
High Point Christian Academy Gymnasium
Permit WQ0021840
Ms. Graznak,
The following package has been assembled and submitted for the modification to the Private
Sewer Collection System owned by High Point Christian Academy as part of the construction of
a Gymnasium for the owner. This collection system currently serves the high school building for
HPCA and will serve the new gymnasium after construction, though no additional flow is
proposed. The enclosed documents include:
Application Fee
FTA 06-21
Existing Permit
Existing Permit Modification Narrative
USGS Topographic Map
Aerial Map
Still RRRE"
CA
�.`' pQ' Foss/p �2''•,
` SEAL
10727
#,���75 Z CAP, ••�•
'rRrRRRRn�+���
Sincerely,
Hugh Creed Associates, Inc., P.A.
Norris Z. Clayton, P.E., P.L.S.
May 4, 2023