WQ0040248_Application (FTSE)_20230710

D,
.00ODivision of Water Resources
�J ID ✓ 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: I �/S (to be completed by DWR)
MOP
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: City of High Point (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State/County ® Municipal
3. Signature authority's name: Robby Stone per 15A NCAC 02T .0106(b)
Title: Public Services Director
4. Applicant's mailing address: 211 S. Hamilton St. Suite 206
City: High Point State: NC Zip: 27261-
5. Applicant's contact information:
Phone number: 336) 883-3217 Email Address: robb..s�nhighpointnc.gov
II. PROJECT INFORMATION:
❑ Privately -Owned Public Utility
❑ Other
1. Project name: Gallimore Industrial Center
2. Application/Project status: ❑ Proposed (New Permit) ® Existing Permit/Project
If a modification, provide the existing permit number: WQ0040248 and issued date: 8/24/2018,
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: 36.06538' Longitude:-79.9794'
5. Parcel ID (if applicable): 7814143967 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Kent E. Barney License Number: 19275
Firm: Landmark Builders, Inc
Mailing address: 3520 Triad Court
City: Winston-Salem State: NC Zip: 27107-
Phone number: 336) 784-2000 Email Address: kbameyna,landmarkbuilders.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Eastside Treatment Plant Permit Number: NCO024210
Owner Name: City of High Point
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ
2. Downstream (Receiving) Sewer Information: inch ❑ Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS00010
Owner Name(s): City of High Point
FORM: FTA 06-21 Page 1 of 5

VI. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑ No ® 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 : % 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 b
No. of Units
Flow
Warehouse (Lot 1)
100 gal/loading bay
31
3,100 GPD
Warehouse (Lot 2)
100 gal/loading bay
30
3,000 GPD
Warehouse (Lot 3)
100 gal/loading bay
50
5,000 GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
11,100 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 .0I 14(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: 11,100 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):
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
➢ 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(f) & W? ❑ 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)
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( or (g), see Section X.1 of this application
*15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(f) cannot be achieved. Please check "yes"
above if these alternatives are used and provide narrative information to explain.
**Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
2. Does this project comply with the minimum separation requirements for water mains? [:]Yes ❑ No ❑ N/A
If n6, please refer to 15A NCAC 18C.0906(f) for documentation requirements and submit a separate document,
pgned/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 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(cL) (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 subject to longer
review times. For projects requiring two or more variances or where the variance is determined by the Division to be a
significant portion of the project, the full technical review is required.
2. Professional Engineer's Certification:
I, _Kent E. Barney, PE_, attest that this application for Gallimore Industrial Center
(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:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
H CAR
do
2%
SEAL
19275
E BA �•``� '71/0/ 3
............................,...,.y..................................... 2
I, R0 WGJ D . S-ro'-J& , attest that this application for GA L4_1, ,oar IN o U&r4Z%n w_ CrrPO&A
(Signature Authority Name from Application Item I.3.) (Project Name from 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: 71u6+ L Date: —7_ S— 20 Z.3
FORM: FTA 06-21 Page 5 of 5

�RO
PIN 7
AU
4
-3
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(ME 10-18)
Entity Requesting Allocation: HighPointNC
Project Name for which flow is being requested: Gallinnore Industrial Center
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 wastewater flow
I. Complete this section only if you are the owner of the wastewater treatnnnt plant.
a. WWTP Facilitynanne: Eastside WWTP -
b. W WTP Facility Perinit #: NC0024210
All flows are in MGD
c. WWTP facilitys Permitted flow
26
d. Fsti rnted obligated flow not yet tributary to the W WTP
0.0061
e. WWTP facnlity's actual average flow
14.35
£ Total flow for this speck request
0.0111
g. Total actual and obligated flows to the facility
14.3672
h Percent ofpermitted flow used
55.26%
H. Complete this section for each pump station your are responsible for along the route ofthis proposed wastewater flow
List pump station located between the project connection point and the W WTP.
(A)
(B)
(C)
(D)=(B+C)
(E)=(A D)
Design
Approx
Obligated
Total Current
Pump
Pump
Firm
Average Daily
Current
Not Yet
Flow Plus
Available
Station
Capacity, *
Flow**
Avg. Daily
Tributary
Obligated
Capacity***
(NanrStation
or
Permit
MGD
(Fir ipO
Flow
Daily Flow
Flow
MGD
Nunib
Number)
No.
MGD
MGD
MGD
MGD
Fastfork
WQ0015751
4.32
1.728
1.5117
0.0111
1.5228
0.2052
Riverdale
WQ0008572
30.0887
11.4842
8.3101
0.0172
8.3273
3.1569
* The Ff rm Capacity 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 (pf)
not less than 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 FacilityNane (Sewer): Eastside WWTP
Downstream Permk Number (Sewer): NC0024210
Page 1 of 6
FTSE 10-18

III. Certification Staternent
I, Derrick Q. Boone, certify to the best of rrry knowledge that the addition of the vohme, 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 norrral circumstances, given the uTplerrentation of the planned improverrents identified in the
planning assessment where applicable. This analysis has been perfomed 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 H plus all attached planning assessr ent addendurns for which I am the
responsible party. Signature of this form indicates acceptance of this wastewater flow.
CG3LI 6I
Job
Title of Signing Official
% S23
Date
Page 2of6
FfSE 10-18

Environmental
Quality
WASTEWATER COLLECTION SYSTEM EXTENSION PERMIT
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 the
City of High Point
Guilford County
for the construction and operation of approximately 1,121 linear feet of 8-inch gravity sewer to
serve a commercial laundry facility as part of the Gallimore Industrial Center project, and the
discharge of 78,000 gallons per day of collected industrial wastewater into the City of High Point's
existing sewerage system, pursuant to the application received August 20, 2018, and additional
information received on August 22, 2018, and in conformity with 15A NCAC 2T; 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 Environmental Quality and considered a part of this permit.
This permit shall be effective from the date of issuance until rescinded and shall be subject to the
specified conditions and limitations contained therein.
for Linda Culpepper
Interim Director, Division of Water Resources
By Authority of The Environmental Management Commission
Permit Number: WQ0040248
Permit Issued: August 24, 2018
Page 3 of 8

Gallimore Industrial Center Public Sewer Aerial Map
Existing sanitary line location

Gallimore Industrial Center Public Sewer Topo Map
NG
U
SGS U.S. DEPARTMENT
S. GEOLJOGIICAL SURV YERIOR NORTH CAAROLINNA-GUUIGUILFORD FLFO D CO.
science fora changing world 7.5-MINUTE SERIES

T A Tk TT1A /F A "TT
1_lAi v MV11AAA.
We Build Confidence.
June 28, 2023
WQ0040248 additional flow allocation
Project description:
This is a request for an increase in flow allocation of an existing 8" Public Sanitary Gravity Sewer for the
City of High Point, NC. An increase of 11,100 gpd is requested due to additional facilities needing to
connect to this public sanitary line.
Landmark Builders 1 3520 Triad Court I Winston-Salem, NC 27107
p.336.784.2000 I www.landmarkbuilders.com

T A A TTIIlk )F A "TT
.H l V Llv l,y ire �
We Build Confidence.
Letter of transmittal
Date: 7/10/2023
To: NCDEQ
450 West Hanes Mill Road
Winston-Salem, NC 27105
NC Department of
Environmental Quality
Received
JUL 10 2023
Winston-Salem
Job No.: RE-23094 Regional Office
From: Kent E. Barney, PE
3520 Triad Court
Winston-Salem, NC 27107
Attn: Jenny Graznak, Asst. Regional
Supervisor, Water Resources
Re: Gallimore Industrial Center — permit modification WQ0040248
We are sending you (x)Attached ( )Under separate cover via
( )Shop Drawings ( )Prints (x)Plans ( )Samples
( )Copy of Letter ( )Change Order(s)
the following items:
( )Specifications
Copies
Date
Description
2
Project Narrative
2
FTA 06-21
2
FTSE 10-18
2
Copy of existing ermit #WQ0040248
2
Site Aerial
2
To o Ma
1
Check for $480
These are transmitted as checked below:
For approval
)Approved as submitted
Resubmit )copies for approval
For our use
)Approved as noted
Submit copies for distribution
As requested
Returned for corrections
Return corrected prints
For review and comment
Remarks:
Jenny,
Please call me at 336-784-2000 with any questions.
Thanks,
Kent E. Barney, PE
Copy to:
Signed:
.,
Landmark Builders 1 3520 Triad Court I Winston-Salem, NC 27107
p.336.784.2000 I www.landmarkbuilders.com