WQ0044515_Application (FTSE)_20230614

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DWR ,
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 06-21 & SUPPORTING DOCUMENTATION
Application NumberkOD (� 1-6 (to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: BSP Investment, LLC. (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ® General Partnership
❑ Federal ❑ State/County ❑ Municipal
3. Signature authority's name: Pankaj Jinwala per 15A NCAC 02T .0106(b)
Title: Reizistered Agent
4. Applicant's mailing address: 7099 Toscana Trace
City: Summerfield State: NC Zip: 27358-
5. Applicant's contact information:
Phone number: [phone] Email Address: pjinwala(i4amail.com
II. PROJECT INFORMATION:
❑ Privately -Owned Public Utility
❑ Other
1. Project name: Golden Gate at Skeet Club
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: Guilford
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.034061' Longitude:-80.025585'
5. Parcel ID (if applicable): 6893627217 (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Ryan S. Thompson License Number: 048858
Firm: Davis -Martin -Powell & Associates
Mailing address: 6415 Old Plank Road
City: High Point State: NC Zip: 27265-
Phone number: [phone] Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: High Point Eastside WWTP Permit Number: NCO024210
Owner Name: City of High Point
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ
2. Downstream (Receiving) Sewer Information: 8 inch ® Gravity ❑ Force Main
3. System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s): Ci of High Point
FORM: FTA 06-21 Paget 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 a,b
No. of Units
Flow
Single Family Dwelling (3-Bedroom)
360 gal/unit/day
17
6,120 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
6,120 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: 6,120 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

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"
220
DIP
8"
709
PVC (SDR-26)
➢ 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: 0Longitude: - °
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 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)
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(f) or (g), see Section X.1 of this application
*15A NCAC 02T.0305(a) 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 webpaae
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 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:
I, Ryan Thompson , attest that this application for Golden Gate at Skeet Club
(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: \\SO' C'A"R;'���,,,���
10
9�-
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I, Pankaj Jinwala, Registered Agent , attest that this application for Golden Gate at Skeet Club
(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: "tea T
Date: 06/01 /2023
FORM: FTA 06-21 Page 5 of 5

NVI'.loil of Vd,tic) ke',ollrcl-;
State of*North Carolina
Depal-hnent of Elllvil-011111clital Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Application Number: 2020-190
Entity Requesting Allocation: BSP Investment, LLC
Project Name for which flow is being requested: Golden Gate at Skeet Club
Vlore fluid one FTSE maj, he requiredfor a Single project if the 011,71er of the ► 11177' is not responslhle for all primp
stations along the route of the proposed mistelvaler floor
I. Complete this section only if you are the owner of the wastewater treatment plant.
a.
WWTP Facility name: Eastside WWTP
b.
WWTP Facility Permit ll: NC-0024210
All flops am in MGD
c.
WWTP facility permitted flow:
26.0000
d.
Estimated obligated flow not yet tributary to the WWTP:
3.4820
e.
WWTP facility's actual average flow:
13.7292
f.
Total flow for this specific request:
0.0061
g.
Total actual and obligated flows to the facility:
17.2173
h.
Percent of permitted flow used:
66.22%
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)
(11)
(C)
(D)=(n+C)
(R)=(A-D)
Pump
Pump
Firm
Design
Approx.
Obligated,
Total Current
Available
Station
Station
Capacityl
Average
Current
Not Yet
Flow Plus
Capacity
(Name or
Permit
Daily Flow2
Avg. Daily
Tributary
Obligated
Number)
Number
(Firm/pf),
Flow,
Daily Plow,
Flow
hIGD
MGD
MGD
hIGD
AIGD
NIGD
wonen•iew
W00024100
2.2320
0.8928
03501
0.2928
0.8429
0.0499
Rieedilc W00003572 30.0887 11A842 8.3996 1.8740 10.2735 1.2107
•- AN/A hN1A AN/A AN/A AN/A ANIA ANIA
I A AN/A ANIA AN/A MIA AN/A AN/A I1NlA
AN/A AN/A hN/A YNIA AN/A #WA AN/A AWA
* The Firm Capacity (design now) of any ])unit) Mallon is deliued as the maximum pumped flow flint
call be achiever) with the Im•gest pump fallen out orsa•vice.
** Design Average Flow is the firm capacity of the punnp stnllon divided by the pealdug factor (po not
less tlmu 2.5, per Section 2.02(A)(4)(c) orllte minimum Design Critcrla.
*** A Planning Assessment Addendum shall be attached for ench pump station located between file
project connection point and the \1'11'TP where the Available Capacity is 5 0.
Downstream Facility Name (Sewer):
Downstream Permit Number:
Page 1 of 6 FTSE 10-10

111. Certification Statement
1, 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 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.
Sig►ti»g OfftcMtl Signature Date
/-1 SS+ P, 61;C SCr✓JGe S' -b `re tic r
Title of SigningOfcial
5/22/2023
Page 2 of 6 FTSE 10-10

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DAMS • MARTIN • POWELL ENGINEERS & SURVEYORSdrn p
NC Department of
Environmental Quality
TRANSMITTAL Received
Date: June 1, 2023
To: NCDEQ— Division of Water Resources
Winston-Salem Regional Office
450 West Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
We are sending you attached the following items:
J U N' 14 ?n9_J
Winston-Salem
Regional
Re: Golden Gate at Skeet Club
High Point, NC
Sewer Extension Application
DMP Project #210164
❑ Shop Drawings
❑
Samples
❑
Copy of Letter
❑ Prints
❑
Specifications
®
Other
® Plans
❑
Disk
❑
Change Order
# Copies
Drawing #
Description
Disposition
2
Project Narrative
For Review/Approval
2
FTA 06-21
For Review/Approval
2
FTSE 10-18 (City of High Point)
For Review/Approval
1
USGS Topographic Map
1
Site Location Map
1
Application Fee ($480)
Remarks
Please contact me at [e-mail] or 336-886-4821 if you have any questions or
require additional information. Thank you.
Connor C. Peacock, El
c: P:\2021\210164\Permits\Sewer
T: 336-886-4821 • F: 336-886-4458 • License: F-0245
6415 Old Plank Road, High Point, NC 27265 • www.dmp-inc.com

T: 336-886-4821 • F: 336-886-4458 • License: F-0245
6415 Old Plank Road, High Point, NC 27265 • www.dmp-inc.com
Project Overview:
DAMS • N ARTIN • POWELL dMPENGINEERS & SURVEYORS
The proposed Golden Gate at Skeet Club Subdivision development is located on an existing 6.47-acre tract
in Guilford County, within High Point city limits. The property is located along Skeet Club Rd, just west of
the Skeet Club Road & Johnson Street intersection. The proposed development will include a total of 17
single-family lots, to be completed in a single phase. No future phases are planned at this time.
Existing Site Description:
The 6.47-acre tract (Parcel No. 203473) is currently undeveloped, wooded, and is bisected by an
intermittent stream running from West to East. The project will disturb approximately 5.20 acres of the
site. The soil on site consists largely of 'Mecklenburg sandy clay loam' (MhB2), 'Iredell fine sandy loam'
(IrB), and 'Enon fine sandy loam' (EnB & EnC). The site lies within the Oak Hollow Lake — Watershed
Critical Area (Tier 4), which limits the maximum built -upon area to 50%.
Proposed Project Description:
The proposed development consists of 17 single family residential lots — including public roadway,
sidewalk, stormwater control device, and associated utilities. Access to the site will be provided via a
single (1) entrance on Skeet Club Rd.
Sewer Construction:
The proposed 8" gravity sewer will follow the alignment of the subdivision roadway (Motisheri Cove) and
will tie into an existing public gravity sewer manhole located on the north side of Skeet Club Rd, within
NCDOT right-of-way limits. Bore and Jack method will be used to cross Skeet Club Rd. All necessary
401/404 permits are approved & in -hand for the existing stream crossing. Proposed sewer material will
consist primarily of SDR-26 PVC, except in areas where DIP is required.
Ryan Thompson, PE
Land Development Engineering Manager
704-564-7852
[e-mail]
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