WQ0040382_Application (FTSE)_20200122

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
000�e6_
Application Number: -IJ,(to be -c�ompClecte.d—bty DtWwR,)\�
All items must be completed or the application will be returned
1. APPLICANT INFORMATION:
1. Applicant's name: High Point University (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: Stephen Potter per 15A NCAC 02T .0106(b)
Title: Vice President for Facility & Auxiliary Operations NC Department of
4. Applicant's mailing address: One University Parkway Environmental Quality
Received
City: High Point State: NC Zip: 27268.0001 JAN 2 2 2020
5. Applicant's contact information:
Phone number: [phone] Email Address: [e-mail] Winston-Salem
Regional Office
11. PROJECT INFORMATION:
1. Project name: Nido and Mariana Oubein Arena
2. Application/Project status: ❑ Proposed (New Permit) ® Existing Permit/Project
If a modification, provide the existing permit number: W00040382 and issued date: Oct. 22, 2018
If new construction but part of a master plan, provide the existing permit number: W000_
3. County where project is located: Guilford
4. Approximate Coordinates (Decimal Degrees): Latitude: 35_98' Longitude: -80 00'
5. Parcel ID (if applicable): 0182906
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Daniel W. Pritchett, PE License Number: NC 11659
Firm: Jamestown Engineering Group, Inc
Mailing address: 117 E. Main Street, P.O. Box 365
City: Jamestown State: NC Zip: 27282-_
Phone number: [phone] Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Eastside WWTP Permit Number: NCO024210
Owner Name: City of High Point
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
I. Permit Number(s): WQ_
System Wide Collection System Permit Nmnber(s) (if applicable): WQCS
Owner Name(s): _
FORM: FTA 04-16 Page I 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 Operational Agreement (FORM: FICA) 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
El Businesses / offices / factories El Swimming in Pool/Filter Backwash
❑ Nursing Home El Other (Explain n Attachment)
chment)
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. Has a Flow reduction been approved under 15A NCAC 02T 0I 14(f)? ® Yes ❑ No
➢ If Yes, provide a cony of now reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow "'"
No. of Units
Flow
Arena Seats
5 gal/seat
4,017
20,085 GPD
Restaurant
40 gal/seat
130
5,200 GPD
Conference Center
5 gal/seat
1,350
6,750 GPD
Hotel
120 gal/room
30
3,600 GPD
gal/
GPD
gal/
GPD
Total
35,635 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 021'.01 14I shall
be determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 35635 GPD (per 15A NCAC 02T .0114)
➢ 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: ETA 04-16 Page 2 ol'.5

VII. GRAVITY SEWER DESIGN CRITERIA (►f Applicable) - 02T 60305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8" 497 D.1
6 30 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 requirement is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (if Applicable) — 02T .0305 & MDC (Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
I. 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 pump(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 1SA NCAC 02T 0305(h)(1):
❑ Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(h)(1)(13)
➢ 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
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)(1)(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.
➢ 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 tinteframes, shall be
provided in the case of a multiple station power outage.
FORM: FTA 04-16 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T.0305(f)):
I. Does the project comply with all separations found in 15A NCAC 02T 0305(f) & (g)
® Yes ❑ No
➢ 15A NCAC 02T.0305(f) contains minimum senarationc that shall hP n1AVi11M fnr CP 1 C110PMQ:
Setback Parameter*
Separation Required
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 11 impounded reservoirs used as a source of drinking water
100 feet
**Waters classified WS (except WS-1 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
Drainages stems 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(f) cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webpa&c
➢ If noncompliance with 02T.0305(f) or (g), 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 213.0202
4. Does the project comply with an individual 404 Permit or any 401 Certifications? [:]Yes []No
➢ 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 permits/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 streambanks 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

X. CERTIFICATIONS:
I 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, 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 supporting
documents.
2. Professional Engineer's Certification:
Engineer's name
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. 1 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 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.
North Carolina Professional Engineer's seal, signature, and date:
Applicant's Certification/pier 15A NCAC 02T .0106(b):
Authority's name & title from Application Item I
Auk ir", o(�. t,11,
�' attest that this application for
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 docurentation and attachments are not included, this
application package is subject to being returned as incomplete. I understand that any discharge of wastewater fi•om this non -
discharge system to surface waters or the land will result in an immediate enforcement action that may include civil penalties,
njunctive 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: V d �-U
I'ORM: FTA 04-16 Page 5 of 5

JAMESTOWN ENGINEERING GROUP, INC.
L CIVIL ENGINEERS & SURVEYORS H C Department of
LAND PLANNING • MUNICIPAL CONSULTING Environmental Quality
Received
r Ana 117 East Main Street • P.O. Box 365 •Jamestown, N.C. 27282
Telephone [phone] Fax [phone] t�t,' Z
wwwjamestownenginecring.com J 1`1 BolL Lo
January 20, 2020 Winston-Salem
Regional Office
Re: Private Sewer Line Extensions to Service the
Nido and Mariana Qubein Arena and
Conference Center
High Point University
High Point, NC
JEG File No. 16060
Permit No. WQ 0040382
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, we are
requesting a modification to Permit No. WQ 0040382 issued October 22, 2018. Due to
infrastructure modification to existing sewer lines west of the arena facility, it will be
necessary to increase the length of permitted sewer lines from 302 L.F. to a total of 527
L.F. of sewer line. There are no proposed changes in waste flows from the facility so that
the current FTSE forms are not affected.
On this basis, we have enclosed one original and one copy of the Fast Track Sewer
Application (FTA 04-16) and $480.00 application fee in support of this permit
modification.
If there are any questions or additional information required, please call.
Yours very truly,
JAMESTOWN ENQINEERING GROUP, INC.
Aamel ri ch , & PLS
DWP/cp
Enclosures
Cc: Mr. Tom Beckett, City of High Point
Mr. Stephen Potter, High Point University