WQ0041421_Application (FTSE)_20200115

JAMESTOWN ENGINEERING GROUP, INC.? NC Department of i
AA,
Environmental Qualityi
CIVIL ENGINEERS &SURVEYORS Received '
LAND PLANNING • MUNICIPAL CONSULTING r, . I
inc. 117 East Main Street • P.O. Box 365 • Jamestown, N C 2728 ,1
JAN 15 2020
Telephone [phone] Fax [phone]
www.jamestownenginecring.com Winston-Salem
January14, 2020 t 9>*:. Regional Office y
Re: Sewer Line Relocation - Panther Drive
High Point University
High Point, NC
JEG File No. 19017
Mr. Justin Henderson
Division of Water Resources
Winston Salem Regional Office
450 W. Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
Dear Mr. Henderson:
With regards to the referenced project, and on behalf of High Point University and the
City of High Point, we are requesting your review/approval of private and public sewer
extension applications required as part of the renovation of Panther Drive. Relocation of
398 L.F. of 12" D.I. public sewer will be required prior to the renovation of Panther Drive
due to the removal/replacement of a box culvert. In addition, an extension of 56 L.F. of 8"
D.I. private sewer will be necessary to tie-in sewer lines servicing existing facilities to the
new 12" public line. No new facilities will be serviced by the sewer line relocations so that
no new waste flow is expected.
On this basis, we have enclosed both public and private application packages in support
of the sewer line relocations, each of which include the following:
One original and one copy of the Fast Track Sewer Application (FTA 04-16)
$480.00 Application Fee
Two copies of Form FTSE 04-16 completed by the City of High Point
8.5" X 11" color USGS topographic map
If there are any questions or additional information required, please call.
Yours very truly,
JAMESTOWN ENGIN G GROUP, INC.
aniel . Pritchett, PE & PLS
D W P/cp
Enclosures
Cc: Mr. Terry Houk, City of High Point
Mr. Tom Beckett, City of High Point
Mr. Stephen Potter, High Point University

State of North Carolina
DWR Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: JJQ ri q I 2 (to be completed by DWR)
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: Terry Houk per 15A NCAC 02T .0106(b
Title: Public Services Director
4. Applicant's mailing address: PO Box 230
City: Hi Point State: NC Zip: 27261-_
5. Applicant's contact information:
Phone number: 336) 883-3215 Email Address: terry.houk0highpointnc,gov
❑ Privately -Owned Public Utility
❑ Other
NC Department of
t Environmental Quality 1
a Received 1
JAN 15 2020
k ! l
�s. Winston-Salem
II. PROJECT INFORMATION:_'. Regional Office?
.�< ...._
I. Project name: Sewer Line Relocation -Panther Drive
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Pennit>Project
If a modification, provide the existing permit number: W000_ and issued date:
If new construction but part of a master plan, provide the existing permit number: W000_
3. County where project is located: Guilford Countv
4. Approximate Coordinates (Decimal Degrees): Latitude: 35_97' Longitude:-79_99'
5. Parcel ID (if applicable): 0182445
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Daniel W. Pritchett, PE License Number: 11659
Firm: Jamestown Engineering Group, Inc.
Mailing address: 117 E. Main Street, P.O. Box 365
City: Jamestown State: NC Zip: 27282-_
Phone number: 3( 36) 886-5523 Email Address: dan 'amestownengineering com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: High Pohtt Eastside Treatment Plant Permit Number: NC 0024210
Owner Name: City of High Point
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. PermitNumber(s): WQ_
System Wide Collection System Permit Number(s) (If applicable): WQCS_
Owner Name(s):
FORM: FTA 04-16 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: DEVI been attached?
❑ Yes []No ®N/A
3. If the Applicant is a Home/Property Owners' Association, has an Operational Agreement (FORM: HOA) been attached?
❑ Yes ❑No ®N/A
4. Origin of wastewater: (check all that apply):
❑ Residential 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 Horne ❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 % Domestic/Commercial % Commercial
_ % Industrial (See 15A NCAC 02T .0103(20))
"Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(f)? [-]Yes ®No
D If yes, provide a copy of flow reduction aooroval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(M
Daily Design Flow "-b
No. of Units
Flow
gall
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
[—To,n!
GPD
a See 15A NCAC 02T .0114(b). (d), (eWD 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. 42
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)
D Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
❑ Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit Number:
® Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain):
FORM: FTA 04-16 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
12" 398 DI
➢ 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 requirement is not allowed and a violation of the MDC
VHL PUMP STATION DESIGN CRITERIA (If Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name: NA
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: - °
3. Design flow of the pump station: millions gallons per day (firm capacity)
4. Operational point(s) of the pmmp(s): _ gallons per minute at feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
6. Power reliability in accordance with 15A NCAC 02T .0305(h)(1):
❑ Standby power source or pump with 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
D Must be permanent to facility
Or if the pump station has an average daily flow less than 15,000 gallons per day:
❑ Portable power source with manual activation, quick -connection receptacle and telemetry - 15A NCAC 02T
.0305(h)(1)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry - 15A NCAC 02T .0305(h)(t)(C):
➢ It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant (draft agreement)
and is compatible with the station,
D 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 in the case of a multiple station power outage.
FORM: FTA 04.16 Page 3 of 5

D(. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(t)):
I. Does the project comply with all separations found in 15A NCAC 02T .0305(t) & (g)
➢ 15A NCAC 02T.0305(f) contains minimum separations that shall be orovided for sewer systems:
® Yes ❑ No
Setback Parameter*
Separation Reuired
Storm sewers and other utilities not listed below vertical
24 inches
Water mains vertical -water over sewer 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
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 see item IX.2
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
ditches
10 feet
Any building foundation
5 feet
Any basement
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
➢ 15A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(t) cannot be achieved.
**Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
➢ If noncompliance with 02T.0305(t) or (a). see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ® Yes [—]No
➢ See the Division's draft separation requirements for situations where separation cannot be meet
➢ No variance is required if the alternative design criteria specified is utilized in design and construction
➢ As built documents should reference the location of areas effected
3. Does the project comply with all setbacks found in the river basin rules per 15A NCAC 02B .0200? ® Yes ❑ No
➢ This would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Does the project comply with an individual 404 Permit or any 401 Certifications? ® Yes ❑ No
D Wetland -related permits shall be requested, obtained, and adhered to for projects that impact wetlands or surface waters
➢ Information can be obtained from the 401 & Buffer Permitting Branch
5. Does project comply with 15A NCAC 02T.0105(c)(6) (additional pennits/certifications)? ® Yes ❑ No
Per 15A NCAC 02T.0105(c)(6), directly related environmental permits or certification applications are 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.).
6• Does this project include any sewer collection lines that are deemed "high -priority?"
Per 15A NCAC 02T.0402. "high -priority sewer" means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to strearnbanks that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes ® No
➢ 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 permitee's Individual System -Wide Collection permit.
FORM: FTA 04-16 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T the Minimum Design Criteria for the Permittingof f Pump Stations
and Force Mains (latest version). and the Gravity Sewer Minimum Design Criteria (latest version) as applicable?
® Yes ❑ No
If No, complete and submit the Variance/Alternative Design Request application (VADC 10-14) and supporting documents
for review. Approval of the request is required prior to submittal of the Fast Track Application and supportine
documents.
2. Professional Engineer's Certification:
name from Application Item 111.1.)
that this application for
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, Gravity Sewer
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track
Permitting of Pump Stations and Force Mains (latest version). Although other professionals may have developed certain
portions of this submittal package, inclusion of these materials under my signature and seal signifies that I have reviewed this
material and have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who knowingly snakes 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.
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
that this application for
name &
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required pails 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. 1 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 snake 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: �' "C Date: J co 070 Z d
FORM: FTA 04-16 Page 5 of 5

Stnte of Nortll Carolina
Depal•tmout of Environmental Quality
Division of Wafer Resources
Slow Tracking for Sewer Extension Applications
lHvklnn of �t/.itcr k<. •:,ntucc y (PTSL 10.18)
Application Number: 120MI144
Entity Requesting Allocation: City of High Point
Project Name for whiclt flow is being requested: Nigh Point University (Public)
Afore f rut are !•TSE it) y be requiredfor a sfogle project I%ata olwler of the IY UP Is not responsible for ell pnulp
slNlons olong the retire of fhe proposed ivesteiveterfloty.
L Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility name: Eastside WWTP
b. WWTP Facility Permit #: NC-0024210
rill floor are In MGD
c. WWTP facility permitted flow: 26.0000
d. Estimated obligated flow not yet tributary to (Ire WWTP: 0.7672
e. WWTP facility's actual average flow, 16.7250
f. Total flow for this specific request: 0.0000
g. Total actual and obligated flows to the facility: 17.4922
It, Percent of permitted flow used: 67.28%
11. 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) (D) (C)
(D)-(D+C)
(E)'(A-D)
Pnlnp Pump Finn D"rel Approx. ObtlgNcd,
Total Curren
Avnilnble
Slnrlon Stntlon t
Cnpncity Aveaga Ctnrem Not Yet
1'ImvPlus
Capadlyr
(Nmrwor Permit Dally Fluwl Avg, Daily Tdbuinty,
Obgga(ed
Number) Number (Finalpf), How, Dully Plow,
Plow
MGD 1IGD AIGD NIGD
NIGD
MGD
Rir,rdAe {v00008571 2r103 N4837 M3990 0.7497
9.1493
-0.2054
- NMA MA NNIA NWA NWA
NWA
MNIA
NWA NWA NNIA NNIA NNIA MA
MN/A
pNIA
NWA NNIA NWA MIA NNIA NNIA
NWA
MWA
MA MA NNIA NNIA NWA NNIA
MIA
MA
"The l'Irm Cnpncity (design Dow) of any puutp slallon n leaned ns the mmiunua ponquA flow Ihaf
call be acideved with the largest pulp taken out of service.
Deslga Average Plow Is the Drnt cRpArlly of (be pump station divided by the pealdug facior (pQ nol
less Mail 2.5, per Seeliou 2,01(A)(4)(e) of the Allubuam Design Crilorla,
""" A Planning Assessment Addeitdum shall be AtlRclul for each pmnp Motion loca(ed between the
ilrolect conuedlon polar mill the WWTP where (he Available Capacity Is 60.
Downstream Pneilily Name (Sewer):
Downslrenut Permit Number:
Pape 1 of a PTSE 10.10

III. Crtiflcation Statement
I, Terry Houk 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 I'lon this project Is not anticipated to cause any capacity related
sanitary sewer overflows or overburden any downstream pump station on route to the receiving Iroatnent
plant under normal chouinstances, given tine implementation of the planted Improvements identlfled 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 It plus all attached planning assessment addendums for which I am the
responsible party. Signature of this form certifies that the receiving collection system or treatnentworks
has adequate capacity to transport and treat the proposed new wastewater.
Signing Offlclal
Tide of fining Official
12/23/2019
Date
Paao 2 of 0 FTea 10.10

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