WQ0040751_Application (FTSE)_20200310

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 007i 'm6d(kttr-ran
pp (to be completed by DWR)
All items must be comnleted or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's none: City of High Poin[ (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: Terry Houk per 15A NCAC 02T .0106(b)
Title: Public Services Director
4. Applicant's mailing address: 221 S. Hamilton Sheet, Suite 206 N C Department of
Environmental Quality
City: High Point State: NC Zip: 27261- Received
5. Applicant's contact information: MAR 10 2020
Phone number: [phone] Email Address: teEa.houk .highpointnc.gov
Winston-Salem
II. PROJECT INFORMATION: Regional Office
I. Project name: Pegg Road Development
2. Application/Project status: ❑ Proposed (New Permit) ® Existing Permit/Project
If a modification, provide the existing permit number: WQ0040751 and issued date: May 14, 2019
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: 36.0687' Longitude:-79.9708'
5. Parcel ID (if applicable): 7814350147
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Wilbur E. Chtistmas License Number: 023552
Firm: Stimmel Associates, PA
Mailing address: 601 N Trade St., Suite 200
City: Winston-Salem State: NC Zip: 27101
Phone number: 336) 723-1 677 Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: High Point Eastside W WTF
Owner Name: City of High Point
Permit Number: NCO024210
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than W WTF):
1. Permit Number(s): WQ_ Downstream (Receiving) Sewer Size: _ inch
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 NN/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 NN/A
3. If the Applicant is a Home/Property Owners' Association, has an Operational Agreement (FORM: HOA) been attached?
❑ Yes ❑No NN/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
N Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Nature of wastewater : 100 % Domestic/Commercial 0 % Commercial
0 % Industrial (See I SA NCAC 02T .0103(201)
"Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(f)? ❑ Yes N No
If yes, nrovide a copv of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 0IT.0114(1)1
Daily Design Flow ° °
No. of Units
Flow
Warehouse
100 gal/Bay
45
4500 GPD
gaV
GPD
gal/
GPD
gav
GPD
gal/
GPD
gal/
GPD
Total
4500 GPD
a See 15A NCAC 02T .0114(bl. (d). (e)(I) 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: _ 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: FTA 04-16 Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Stmmiarize gravitysewer to be permitted:
Size (inches) Length (feet) Material
8 1334 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
1. Pump station number or name: _
2. Approximate Coordinates (Decimal Degrees): Latitude: 0Longitude: - °
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
G. 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)(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 timeftantes, 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(t)):
1. Does the project comply with all separations found in 15A NCAC 02T .0305(f) & (g)
➢ 15A NCAC 02T.0305(D contains minimum separations that shall be nrovided for sewer systems:
® Yes ❑ No
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 trains 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-1 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 webnage
➢ If noncompliance with 02T.0305(fl or (g), see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ®Yes ❑ No ❑ N/A
➢ 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 setbacks found in the river basin rules per 15A NCAC 02B .0200? ® Yes ❑ No ❑ N/A
➢ This would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Does the project require coverage/authorization under a 404 Nationwide or ® Yes ❑ No
individual permits or 401 Water Quality Certifications?
➢ 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 ❑ N/A
➢ 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-mmdlis and
inspections documented per 15A NCAC 02T.0403(a)(5) or the pernnitee'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 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. Annroval of the request is required prior to submittal of the Fast Tracts Application and supporting
documents.
2. Professional Engineer's Certification:
that this application for
Engineer's name fi•onm
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 143-215.613, 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 tip to $25,000 per violation.
North Carolina Professional Engineer's seal, signature, and date:
Applicant's Certification per 15A NCAC 02T .0I06(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 parts of
this application are not completed and that if all required supporting documentation and attachmments 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
tine 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 tip to $25,000 per violation.
Signature: � A- 4� Date: 3�'llLa2o
FORM: FTA 04-16 Page 5 of 5

Stimmel Associates, PA
EXHIBIT
Stimmel
Landscape Architecture
Civil Engineering
Land Planning
601 N. Trade Street
date:
03/13/2019
lob #: 18-164
Winston°
Winston Belem, Nc
project: Pegg Road Development
27101-291s
scale:
1" =loon'
sheet 1 of 1
P: 336.723.1067
F: 336.723.1069
description:
Sanitary Sewer
Extension
USGS Guilford
NC Quadrangle
SCALE: 1 " = 1000'
1000 0 1000
North

St i m m e l
Trade Street
Suite 200
Landscape Architecture
Winstt on Salem, NC
Winston
27101-2916
Civil Engineering
Stimmel Associates, PA Land Planning
P; 336.723.1067
r: 336.723,1069
EXHIBIT
date: 03/13/2019 lob #: 18-164
project' Pegg Road Development
scale: 1" = 600' sheet 1 of 1
description: Sanitary Sewer Extension
SCALE: 1 " = 600'
600 0 600
North

11) f
110030637110 1:0531011211:00051 "9'a94811'
\,)QC6 QC�sI ` rn cyl
CGv A�

7101
�'� stimmel 601N.TRADE STREET SUITE 200
WINSTtimmelaxorn 36.7
www.stimmelpa.com 336.723.1067
NC Department of
Environmental Quality
Received
March 10, 2020
NCDENR
DWR —Winston-Salem Regional Office
450 W. Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
Attn: Mr. Justin Henderson
Re: Permit #WQ0040751
Fast -Track Sewer Application -Modification
Pegg Road Development
High Point, NC
Dear Mr. Henderson:
MAR 10 1010
Winston-Salem
Regional Office
The sewer line in the existing permit referenced above was extended to Pegg Rd. at the request of the City of
High Point to provide additional access to surrounding properties. This resulted in the sewer length exceeding
the 10% allowed in the existing permit.
We are requesting a modification to the existing permit to increase the permitted linear feet of sewer from the
original 1175 LF to 1334 LF.
There are no other modifications to the original FTA and no modifications to the FTSE.
The following information is included for your review and approval:
# Cooies Description
2 Fast -Track Application Forms
1 Review fee check in the amount of $480
2 Permit #WQ0040451
2 Site Map on 8.5" x 11" USGS Quad Map
2 Site Map on 8.5" x 11" Google Earth Image
If you have questions or need additional information, please contact me at [phone] or
wch ristmas(&stimmelpa.com.
Sincerely,
Wilbur E. Christmas, PE
Project Engineer
Attachments
Cc: File
LANDSCAPE ARCHITECTURE CIVIL ENGINEERING LAND PLANNING