WQ0044698_Application (FTSE)_20230825

State of North Carolina
DW
R
Department of Environmental (duality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Dlvtslc n of Wwef tt+ss< tta'.tr`' FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number: ll, (to be completed by MR).
All items must be completed or the application will be returned
1. APPLICANT INFORMATION:
1. Applicant's name: Trosa, Inc. (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual [ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ StateiCounty ❑ Municipal ❑ Other
3. Signature authority's name: Keith Artin her I54 NCAC 02'I_.010 (b)
Title: CEO
4. Applicant's mailing address: 1820 James Street
City: Durham State: NC Zip: 27707
5. Applicant's contact information:
Plione number: [phone] Email Address: Icartin iosainc.oi•t;
11. PROJECT INFORMATION:
1. Project name: Trosa Triad Phase 2
2. Application/Project status: © Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ00___ 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: 36.0456" Longitude:-80.1369"
5. Parcel ID (if applicable): 6863378175000 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Brent Sievers License Number: 27339
Firm: FEI Civil Engineers
Mailing address: 8518 Triad Drive
City: Colfax State: NC Zip: 27235-
Phone number: [phone] Email Address: bsievei-s((bfeiconsultinf4.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Archie Elled>;e Permit Number: NC0037834
Owner Name: Forsyth Count
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQCS00003
2. Downstream (Receiving) Sewer hformatlon 8 inch L7 Gravity ❑ Force Main - -
3. System Wide Collection System Permit Number(s) (if applicable): WQCS00003
Owner Name(s): WS7FC Utility Commission
FORM: FTA 06-21 Page l 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: 50 % Domestic 50 % 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 a,b
No. of Units
Flow
Residents/Employees
60 gal/person
250
15000 GPD
Dining Hall with Kitchen
3 meals/day X5 GPD
250
3750 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
18750 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: 18750 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

V11. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T . )305 & MDC (Gcavity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8" 65 -- VCR— ;
Y Section 11 & 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 sewe(s)
r Oversizing lines to n►eet ►ni►►i►numn slope requi►•ements is not allayed and a violation of the MDC
VII1. 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
l . Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: 36.0443" Longitude:-80.1362'
3. Total number of pumps at the pump station: 2
3. Design flow of the pump station: 0 O_3- millions gallons per clay (term 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): 80 gallons per minute (GPM) at l3 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pua►p Station):
Size (inches)
Length (feet)
Material
4
600
PVC
If any portion of the force main is less than 4-inches in diameter, please identity the method of solids reduction per
MDCPSFM Section 2.01C.I.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 1 OA NC.hC 0?T .0_y05jhjI ):
® Standby power source or ❑ Standby purnp
L Must have automatic activation and telemetry - 15A NCAC 02T.0305(h)(1)(13)_
Y 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:
r 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 timeirames, shall be provided
as part of this permit application in the case of a multiple station power outage.
FORM: FTA 06-211 Page 3 of 5

X. SET-BAC-KKS-4"EPARATIONS—(OZB .0200-& 1-SA NCAC; OZT .0305(t)):
1. Does the project comply with all separations/alternatives (-ound in 15 � NCAC 02:1 0305�O � :_(/7 _? ❑Yes [:]No
15A NCAC 02T.0305(f) contains mininnun separations that shall be provided for sewer systems:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
'Water mains (vertical - water over sewer preferred, including in benched trenches)
-------10
18 inches
'Water mains (horizontal) -— --_-- ------
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 Il 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 fi-om 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
y If noncompliance with .0305(f� or- '- _, see Section X. l of this application
* 15A NCAC 02_T.t_). 5 contains alternatives where separations in 02_i_,03.05(1) 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 vCS arl�CC Water web), _._c
2. Does this project comply with the minimum separation requirements for water mains? ® Yes ❑ No ❑ N/A
r If no, please refer to 15A NCAC 18C.0906(t) for documentation requirements and submit a separate document,
slgned/sealgd 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
r Please provide supplemtntary information identifying the areas of non-conformance.
See the Division's draft seliaration re uirerncnts 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: Yadkin Pee Dee _❑ 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 15_A NCAC 213.0202
5. Does the project require coverage/authorization under a 404 Nationwide/individual permits ❑ Yes ® No
or 401 Water Quality Certifications?
Y Please provide the permit number/permitting status in the cover letter if coverage/authorization is required.:
6. Does project comply with 15A NCAC 02T01105.NAii) (additional permits/certifications)?-_--:--_____ ® Yes [:]No
Per 15A NCAC 02"I_._0105(c)(( ), 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 parall_el to_strearnhanks 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:
I. Does the submitted system comply with 1.5./.._N('.A _0 `Y, the, Minimurn Design_Cinu_ia for._tile Permitting of Putntp Stations
,-in(] For -cc _.Main late--sict, and the Gravity
......nD ,ign_t utcria_ (latest tie r-sion) as applicable!?
E Yes ❑ No
If no, for projects requiring a single variance, complete and submit the Variance/Alternative Design Request application
(VADC 10-14) and supporting d.ocunle.rlts for review to the Central Office. Approval of the request will be issued
concurrently with the approval of the hermit, and_►rojects 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:
1, _Brent Sievers _ , attest that this application for Trosa Trjad Phase 2
(Professional Engineer's name tiom Application Item 111.1.) (Proiect Name trcan Application Item 11.1)
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 hnowledg(1. ttte proposed desP.,11 hi,, been mr cpared in accordance with the applicable regulations,
Mininiuni Desitrn Criteria_fi)r Gravity_Scvers(l�test_uet-si Itt , and the Minimum iJesj< n Crjteria for the Fast -Track Perinjtrm
of Pumj)__Stations_Lnd f_orce N1 fins (latest versjem�. Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signattu-e and seal signifies that 1 have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.613, 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 Lip 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 scat, signature, and date:
3. Applicant's Certification per 15A NCAC 02'i' .0106(b):
1, Keith Ai -tin attest 111;11 fhiS !)ph" tion for Tr-osa Triad Phase
(Signature Authority Name fntm Apttlic2tion ticnt 1-3.) (hornet Nan:e 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 wafers 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 suppot•ting information and attachments are not included, this application
package will be returned to me as incomplete.
NOTE — in accordance with General Statutes 1.4_i-__'t_5_6A and 1= __.'..15.613, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor; which may
include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: Date: Z®Z
--- -- - - --------- - --- - -- - 3
FORM: FTA 06-21 Page 5 of 5

State of North Carolina
DIVI9{ou of WM") t2csourccs
Entity Requesting Allocation: Trosa Inc.
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Project Name for which flow is being requested: Trosa Triad Phase 2
More than ate FTSE mqp he required for a single project if the owner of the TVWTP Is not respoitsihle for all pump
stations along the route oftheproposed rvastewaterflow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Muddy Creek
b. WWTP Facility Permit M NC0050342
A11 flows are in MGD
c. WWTP facility's permitted flow 21.000000
d. Estimated obligated flow not yet tributary to the WWTP 2.9583400
e. WWTP facility's actual avg. flow 14.260000
f Total flow for this specific request
g. Total actual and obligated flows to the facility
It. Percent of permitted flow used
0.0187500
17.237090
82.1
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)=(fl+C) (k)=(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, * (Firm / pf),
Avg. Daily Daily Flow, Obligated Available
Number) No. MGD MGD
Flow, MGD MOD Flow Capacity***
* The Firm Capacity (design flow) of any pump station is defined as the niaxinnun pumped flow
that can be achieved with the largest pinup taken out of service.
** Design Average Daily Flow is the flrut capacity of the punip station divided by a peaking factor
(pf) not less than 2.5, per Section 2.02(A)(4)(c) of the Minims nt Design Criteria.
"* A Planning Assessment Addendum shall be attached for each pmnp 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 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.
Official
Official
Date
Page 2 of 6
FTSE 10-18

Project Narrative
Private Sewer Lift Station for Trosa Triad
The proposed project will serve 250 residents/employees that will remain on site 24
hours a day/7 days a week and a dining hall with a kitchen that has a proposed 15000
GPD flow. This project is located on Union Cross Road in Forsyth County, North
Carolina. Sanitary sewer lift station will dual 1.5 HP non clog pumps with a 4" discharge.
There will be approximately 600 LF of 4" force main. Total flow is projected to be 30,000
GPD.

N C Depatl rnoe f bf
�hvirohnlohrtol QW011y
FEI Received
77-3
CIVIL ENGINEERS AND LAND SURVEYORS Winston-Salem
Regional Office
Transmittal Mere
To: Attention:
NCDWR- Water Quality Section Jenny Graznak
450 W. Hanes Mill Road, Suite 300 Assistant District Engineer
Winston Salem, NC 27105 336-776-9695
From: Date: Wednesday, August 23, 2023
Brent Sievers, PE FEI Project Number: 05053.004
336-544-6432
[e-mail]
Subject: Fast track application for Lift Station
Urgent: El Review:M Please Comment: El Please Reply:❑ Please Recycle:❑
Notes
Enclosed is the original and 1 copy of the Fast Track Sewer System Extension
Application with supporting documents and applicable fees. Please call with any
questions
Thanks,
Brent Sievers, PE
Senior Project Manager
FEI
8518 Tried Drive
Colfax, NC 27235
FEI
Civil Engineers and Land Surveyors