WQ0041674_Application (FTSE)_20200501

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 INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION
This application is for sewer extensions involving gravity sewers, pump stations and force mains, or any combination that has been
certified by a professional engineer and the applicant that the project meets the requirements of 15A NCAC 02T and the Division's
Minimum Design Criteria and that plans, specifications and supporting documents have been prepared in accordance with, 15A
NCAC 02T, 15A NCAC 02T .0300, Division policies and good engineering practices.
While no upfront engineering design documents are required for submittal, in accordance with 15A NCAC 02T .0305(b), design
documents must be prepared prior to submittal of a fast track permit application to the Division. This would include plans, design
calculations, and project specifications referenced in 15A NCAC 02T .0305 and the applicable minimum design criteria. These
documents shall be available upon request by the Division.
Projects that are deemed permitted (do not require a permit from the Division) are explained in 15A NCAC 02T.0303.
Projects not eligible for review via the fast track process (must be submitted for full technical review):
➢ Projects that require an environmental assessment in accordance with 15A NCAC 1C .0100;
➢ Projects that do not meet any part of the minimum design criteria (MDC) document;
➢ Projects that involve a variance from the requirements of 15A NCAC 2T;
➢ Pressure sewer systems utilizing septic tank -effluent pumps (STEPS) or simplex grinder pumps;
➢ STEP or simplex grinder pumps connecting to pressurized systems (e.g. force mains);
➢ Vacuum sewer systems.
General — When submitting an application, please use the following instructions as a checklist in order to ensure all required items
are submitted. Adherence to these instructions and checking the provided boxes will help produce a quicker review time and
reduce the amount of requested additional information. Failure to submit all required items will necessitate additional
processing and review time, and may result in return of the application. Unless otherwise noted, the Applicant shall submit
one original and one copy of the application and supporting documentation.
A. One Original and One Copy of Application and Supporting Documents
® Required unless otherwise noted
B. Cover Letter (Required for All Application Packages):
® List all items included in the application package, as well as a brief description of the requested permitting action.
➢ Be specific as to the system type, number of homes served, flow allocation required, etc.
➢ If necessary for clarity, include attachments to the application form.
C. Application Fee (All New and Major Modification Application Packages):
® Submit a check or money order in the amount of $480.00 dated within 90 days of application submittal.
➢ Payable to North Carolina Department of Environmental Quality (NCDEQ)
D. Fast Track (Form: FTA 04-16) Application (Required for All Application Packages):
® Submit the completed and appropriately executed application.
➢ If necessary for clarity or due to space restrictions, attachments to the application may be made.
® If the Applicant Type in Item I.2 is a corporation or company, provide documentation it is registered for business with
the North Carolina Secretary of State.
❑ If the Applicant Type in Item I.2 is a partnership or d/b/a, enclose a copy of the certificate filed with the Register of
Deeds in the county of business.
® The Project Name in Item II.1 shall be consistent with the project name on the flow acceptance letters, agreements, etc.
® The Professional Engineer's Certification on Page 5 of the application shall be signed, sealed and dated by a North
Carolina licensed Professional Engineer.
® The Applicant's Certification on Page 5 of the application shall be signed in accordance with 15A NCAC 02T .0106(b).
Per 15A NCAC 02T .0106(c), an alternate person may be designated as the signing official if a delegation letter is
provided from a person who meets the criteria in 15A NCAC 02T .0106(b).
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 1 of 3

E. Flow Tracking/Acceptance Form (Form: FTSE 04-16) (If Applicable):
® Submit the completed and executed FTSE form from the owners of the downstream sewers and treatment facility.
➢ Multiple forms maybe required where the downstream sewer owner and wastewater treatment facility are different.
➢ The flow acceptance indicated in form FTSE must not expire prior to permit issuance and must be dated less than one
year prior to the application date.
➢ Submittal of this application and form FTSE indicates that owner has adequate capacity and will not violate G.S. 143-
215.67 a .
➢ Intergovernmental agreements or other contracts will not be accepted in lieu of a project -specific FTSE.
F. Site Maps (All Application Packages):
® Submit an 8.5-inch x 11-inch color copy of a USGS Topographic Map of sufficient scale to identify the entire project
area and closest surface waters.
➢ Location of the project (gravity sewer, pump stations & force main)
➢ Downstream connection points and permit number (if known) for the receiving sewer
® Include a street level map (aerial) showing general project area so that Division staff can easily locate it in the field.
G. Existing Permit (All Modification Packages):
❑ Submit the most recently issued existing permit.
❑ Provide a list of any items within the permit the Applicant would like the Division to address during the permit
modification (i.e., permit description, flow allocation, treatment facility, etc.).
H. Power Reliability Plan (Required if portable reliability option utilized for Pump Station):
❑ Per 15A NCAC 02T .0305(h)(1), submit documentation of power reliability for pumping stations.
➢ This alternative is only available for average daily flows less than 15,000 gallons per day
➢ It shall be demonstrated to the Division that the portable source is owned or contracted by the applicant and is compatible
with the station. The Division will accept a letter signed by the applicant (see 15A NCAC 02T .0106(b)) or proposed
contractor, stating that "the portable power generation unit or portable, independently -powered pumping units, associated
appurtenances and personnel are available for distribution and operation of this pump 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 in the case of a multiple station power outage. (Required at time of certification)
I. Certificate of Public Convenience and Necessity (All Application Packages for Privately -Owned Public Utilities):
❑ Per 15A NCAC 02T .0115(a)(1) provide the Certificate of Public Convenience and Necessity from the North Carolina
Utilities Commission demonstrating the Applicant is authorized to hold the utility franchise for the area to be served by
the sewer extension, or
❑ Provide a letter from the North Carolina Utilities Commission's Water and Sewer Division Public Staff stating an
application for a franchise has been received and that the service area is contiguous to an existing franchised area or that
franchise approval is expected.
J. Operational Agreements (Applications from HOA/POA and Developers for lots to be sold):
❑ Home/PropeM Owners' Associations
❑ Per 15A NCAC 02T .0115(c), submit the properly executed Operational Agreement (FORM: HOA).
❑ Per 15A NCAC 02T .0115(c), submit a copy of the Articles of Incorporation, Declarations and By-laws.
❑ Developers of lots to be sold
❑ Per 15A NCAC 02T .0115(b), submit the properly executed Operational Agreement (FORM: DEV).
For more information, visit the Division's collection systems website
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 2 of 3

THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Regional Office
2090 US Highway 70
Avery, Buncombe, Burke, Caldwell, Cherokee,
Water Quality Section
Swannanoa, North Carolina 28778
Clay, Graham, Haywood, Henderson, Jackson,
[phone]
Macon, Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Fayetteville Regional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Harnett, Hoke,
Water Quality Section
Fayetteville, North Carolina 28301-5094
Montgomery, Moore, Robeson, Richmond,
[phone]
Sampson, Scotland
[phone] Fax
Mooresville Regional Office
610 E. Center Avenue
Alexander, Cabarrus, Catawba, Cleveland,
Water Quality Section
Mooresville, North Carolina 28115
Gaston, Iredell, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
Raleigh Regional Office
1628 Mail Service Center
Chatham, Durham, Edgecombe, Franklin,
Water Quality Section
Raleigh, North Carolina 27699-1628
Granville, Halifax, Johnston, Lee, Nash,
[phone]
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
Warren, Wilson
Washington Regional Office
943 Washington Square Mall
Beaufort, Bertie, Camden, Chowan, Craven,
Water Quality Section
Washington, North Carolina 27889
Currituck, Dare, Gates, Greene, Hertford, Hyde,
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
Wilmington Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
Water Quality Section
Wilmington, North Carolina 28405
Hanover, Onslow, Fender
[phone]
[phone] Fax
Winston-Salem Regional Office
450 W. Hanes Mill Road
Alamance, Alleghany, Ashe, Caswell, Davidson,
Water Quality Section
Suite 300
Davie, Forsyth, Guilford, Rockingham, Randolph,
Winston-Salem, North Carolina 27105
Stokes, Surry, Watauga, Wilkes, Yadkin
[phone]
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 3 of 3

DWR
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number:
(to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: Past The Mall, LLC (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ® General Partnership
❑ Federal ❑ State/County ❑ Municipal
3. Signature authority's name: Linwood Davis per 15A NCAC 02T .0106(b)
Title: Manager, Registered Agent
4. Applicant's mailing address: 812 Sylvan Road
City: Winston-Salem State: NC Zip: 27104-
5. Applicant's contact information:
Phone number: [phone] Email Address: linwoodgUlvanroadpartners.com
II. PROJECT INFORMATION:
❑ Privately -Owned Public Utility
❑ Other
1. Project name: Essex Place Apartments
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ00 and issued date:
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: 36.069186' Longitude:-80.345833'
5. Parcel ID (if applicable): 6804-26-1234
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Nick Buysse, PE License Number: 047997
Firm: CESI, Inc
Mailing address: PO Box 268
City: Concord State: NC Zip: 28026-0268
Phone number: [phone] Email Address: nickbuysseAcesic sg com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Muddy Permit Number: NCO050342
Owner Name: Winston-Salem/Forsyth County Commission
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQCS00003 Downstream (Receiving) Sewer Size: 8 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 ®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: 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 Home ❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 % Domestic/Commercial % Commercial
% Industrial (See 15A NCAC 02T .0103(20))
4,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
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow a,b
No. of Units
Flow
3 bedroom residential apartment
240 gal/day
8
1920 GPD
2 bedroom residential apartment
240 gal/day
32
7680 GPD
1 bedroom residential apartment
240 gal/day
8
1920 GPD
1 Office
25 gal/employee/shift
1
25 GPD
gal/
GPD
gal/
GPD
Total
11545 GPD
a See 15A NCAC 02T .0114(b), (d), (e)(1) and L,L2) 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: 11545 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. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 284 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: 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 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
➢ 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 timeframes, 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)):
1. Does the project comply with all separations found in 15A NCAC 02T .0305(D & (g)
➢ 15A NCAC 02T.0305 contains minimum separations that shall be provided for sewers stems:
® 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 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(Q) 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( 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 -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 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:
I,
Nick Buysse, PE
(Professional Engineer's name from Application Item III.1.)
attest 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 143-215.613, 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.
North Carolina Professional Engineer's seal, signature, and date: CA
A
9
Gj
11111S D.
Applicants Certification per 15A NCAC 02T .0106(b): f
2� l
I,
Linwood Davis, Manager/Registered Agent
(Signature Authority's name & title from Application Item I.3.)
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 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:
Date: 4/23/20
FORM: FTA 04-16 Page 5 of 5

C S4-
Civil - Geotechnical - Surveying
Attn: Justin Henderson
Winston Salem Regional Office
Division of Water Resources
150 West Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
Re: Essex Place Apartments
Private Sanitary Sewer
CESI Job No. 190436.000
This submittal is for a proposed private sewer extension located in Winston-Salem in
Forsyth County. The proposed sanitary sewer will serve two residential multi -family
apartment buildings with a total of 48 units and a leasing office. In support of this submittal
are the following items:
1. One (1) Signed and Sealed Fast Track Sanitary Sewer Application
2. One (1) Signed Flow Tracking Sewer Extension Application
3. One (1) NC Secretary of State Report
4. One (1) USGS Quad Map with Project Location
5. One (1) Street Level Map with Project Location
6. One (1) Winston-Salem Flow Reduction Letter
7. One (1) Submittal Fee Check in the amount of $480 payable to NCDEQ
8. One (1) Signed and Sealed Sanitary Sewer Plan and Profile
I would also like to note the following items:
1. Winston-Salem Utility Commission requested the flow be adjusted to meet their flow
reduction allowance for the 3-bedroom apartment units. The flow reduction letter
has been included in this submittal.
2. The submittal fee check will be mailed separately.
Page 1 of 2

Please contact me with any questions,
Nick Buysse,
Civil Engineer
Office: [phone] ext. 1044
Cell: [phone]
[e-mail]
CESIAN-
Civil - Geotechnical- Surveying
Page 2 of 2

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: Past the Mall, LLC
Project Name for which flow is being requested: 12438/3027 Essex Place
More t/tmt one FTSE may be required for a singleproject if the owner of t/te WWTP is not responsible for allpamrp
stations along the route of the proposed wastewater flow.
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 #: NC0050342
All flows are in MGD
c. WWTP facility's permitted flow 21.000000
d. Estimated obligated flow not yet tributary to the WWTP 2.939648
e. WWTP facility's actual avg. flow 16.800000
f. Total flow for this specific request 0.011545
g. Total actual and obligated flows to the facility 19.751193
h. Percent of permitted flow used 94.1%
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:
Pump Pump
Station Station Firm
(Name or Permit Capacity,
Number) No. MGD
(A)
Design
Average
Daily Flow**
(Firm / p fl,
MGD
(B)
Approx.
Current
Avg. Daily
Flow, MGD
(c) (D)=(B+c)
Obligated,
Not Yet Total Current
Tributary Flow Plus
Daily Flow, Obligated
MGD Flow
(E)=(A-D)
Available
Capacity*
* The Firm Capacity (design flow) of any pump station is defined as the maximum pumped flow
that can be achieved with the largest pump taken out of service.
**Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor
(pf) not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer): Muddy Creek - NC0050342
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 foam certifies that the receiving collection system or treatment
works has adequate capacity to transport and treat the proposed new wastewater.
Signature
�551s779it� C�%1�/%%S
Title of Signing Official
Date
Page 2 of 6
FTSE 10-18

• File an Annual Report/Amend an Annual Report • Upload a PDF Filing • Order a Document Online • Add Entity
to My Email Notification List • View Filings • Print a Pre -Populated Annual Report form • Print an Amended a
Annual Report form
Limited Liability Company
Legal Name
Past the Mall, LLC
Information
Sos l d: 7884790
Status: Current -Active
Date Formed: 812612079
Citizenship: Domestic
Annual Report Due Date: April 15th
CurrentAnnual Report Status:
Registered Agent: Davis, Linwood
Addresses
Mailing
812 Sylvan Road
Winston Salem, NC 27704
Reg Mailing
812 Sylvan Road
Winston Salem, NC 27104
Company Officials
Principal Office
812 Sylvan Road
Winston Salem, NC 27104
Reg Office
812 Sylvan Road
Winston Salem, NC 27704
All LLCs are managed by their managers pursuant to N.C. G.S. 57D-3-20.
Manager
Linwood Davis
812 Sylvan Road
Winston Salem NC 27104

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PO BOX 268
CONCORD, NC 28026-0268
P. 704.786.5404
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www.cesicgs.com
NCBELS CORP. NO. C-0263
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science for a changing world
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Produced by the United States Geological Survey
SCALE 1:24 000
MN.
North American Datum of 1983 (NAD83)
World Geodetic System of 1984 (WGS84). Projection and
1
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1 000-meter grid: Universal Transverse Mercator, Zone 17S
N
8°19
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This map is not a legal document. Boundaries may be
148 MILS
1
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generalized for this map scale. Private lands within government
0024'
reservations may not be shown. Obtain permission before
7 MILS
MILES
entering private lands.
1000 0
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Imagery.....................................................NAIP, June 2016 - November
2016
FEET
Roads ......................................... U.S. Census
Bureau,
2016
Names............................................................................GNIS,
1980
- 2019
UTM GRID AND 2019 MAGNETIC NORTH
Hydrography...............................National Hydrography
Dataset,
2002
DECLINATION AT CENTER OF SHEET
Contours............................................National Elevation
Dataset,
2008
CONTOUR INTERVAL 10 FEET
Boundaries ..............Multiple sources; see metadata file
2017
2018
U.S. National Grid
NORTH AMERICAN VERTICAL DATUM OF 1988
100,000-rn Square lD
Wetlands.................FWS National Wetlands Inventory
1980
1982
This map was produced to conform with the
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Grid Zone Designation
17S
64
64 65
65
�J0RTH
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8 Midway
ADJOINING QUADRANGLES
WINSTON-SALEM WEST QUADRANGLE
NORTH CAROLINA - FORSYTH COUNTY
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WINSTON-SALEM WEST, NC
2019
ZZ

F WArF
Q�Q �QQG Michael F. Easley, Governor
William G. Ross Jr., Secretary
CO
> r North Carolina Department of Environment and Natural Resources
p Alan W. Klimek, P.E., Director
Division of Water Quality
July 28, 2005
Ron Hargrove, PE, Deputy Utilities Director
City/County Utilities
Utilities Administration
PO Box 2511
Winston-Salem, NC 27102
— Subject. - - Ctty o Wtriston- a em
Residential Flow Reduction Approval
Forsyth County
Dear Mr. Hargrove:
On June 29, 2005, the Division of Water Quality received a flow reduction request for residences
connecting to the Winston-Salem collection system. The letter requests an allowable flow rate of 240 GPD per
single-family residential unit (three bedroom) based on the evaluated data for the current service area. As you
are aware, the issue of an approved flow reduction has been outstanding for quite some time. We appreciate
your assistance and patience in the matter and are pleased to offer a resolution.
The methodology and data evaluated for this request was discussed with you and your staff, regional
office staff and central office staff during a meeting on June 14, 2005. The evaluation included data collection
From tax records (age and bedrooms) and utility billing (water consumption) and DMR records for the treatment
plants. Based upon this data and with concurrence from our Winston-Salem Regional Office, the Division
hereby approves the use of 240 GPD per single-family residential unit (up to three bedrooms) in all applicable
non -discharge permit applications whether issued by the Division or through your delegated sewer extension
permit program. This value shall be incremented by 80 gpd per additional bedroom above three.
Regardless of the adjusted design daily wastewater flow rate, at no time shall the wastewater flows
exceed the effluent limits defined in the NPDES�ermits for the treatment facilities or exceed the capacity of the
sewers downstream of any new sewer extension or service connection(s).
If you have any questions or comments regarding this matter, please contact Marie Doklovic at
[phone] ext. 371.
P.E.Ian W. Klimek,
cc: Steve Tedder, Winston-Salem Regional Office
Charles Weaver, NPDES West Progam
PERCS Flow Reduction File
One 1 1 Pretreatment, Emergency Response and Collection Systems Unit Internet http://h2o.enr,nc,state,us/ndpu
Noft CarOhna 1617 Mail Service Center, Raleigh, NC 27699-1617 An Equal Opportunity Action Employer
a'aturia//' / Telephone [phone] Fax [phone]% recycled/10% post -consumer paper

Winston-Salem /Forsyth Couniy
U
Wattilities
er •Wastewater •Solid Waste
Administration, r.o. Box m6 , A nston-Salem, NC 2, A2
O: 336-727-8000, F: 336-727-8432, wsfcutilities.org
December 20, 2019
Jenny Graznak, Assistant Regional Supervisor
North Carolina Department of Environmental Quality
Division of Water Resources
450 West Hanes Mill Road, Suite 300
Winston Salem, NC 27105
Dear Ms. Graznak,
Please allow this letter to serve as documentation that Winston-Salem/Forsyth County Utilities is
currently engaged in a project at the Muddy Creek Wastewater Treatment plant to address future
wastewater capacity needs. Upgrades to the plant are expected to be completed by December 2020,
The project was originally scheduled to be completed in July 2017, however significant unforeseen
delays have caused the construction to be extended longer than anticipated. The upgrades include
replacement of the existing headworks, grit removal and influent pumping facilities, 3.75 million gallons
of storm equalization storage, and 2 million gallons of diurnal equalization storage. The equalization
storage will reduce treatment impacts due to heavy wet weather events and provide for a more uniform
flow to the plant. The project will also allow excess flows from the Muddy Creek WWTP to be
transferred to the Archie Elledge WWTP for treatment to utilize excess capacity at that plant. This
opportunity is unique and provides our system the ability to optimize efficiency at both plants by setting
a baseline flow at the Muddy Creek WWTP, based off of hydraulic and financial considerations, and send
any remaining flow to either the Archie Elledge WWTP or the storm equalization facilities. The
integrated influent system and flow storage provides significant reliability, allows us to balance flows
between plants, and provides optimum treatment performance during dry and wet weather.
Please let this letter serve as justification to continue permitting wastewater flows to the Muddy Creek
Wastewater Treatment Plant.
Bards, _
WA
Courtney Driv r, P.E.
Utilities Director
Gry Council: Mayor Allen loines; Vivian H. Burke, Mayor Pro Tempore, Northeast Ward; Denise D. Adams, North Ward; Dan Besze, Southwest Ward; Robert C. Clark,
West Ward; John C. Larson, South Ward; Jeff Macintosh, Northwest Ward; Annette Scippio, East Ward; lames Taylor, Jr., Southeast Ward; City Manager: Lee D. Garrity
County Commissloners: David R. PlVier, Chair; Dan Martin, Vice chair; Fleming EI-Amin; Ted Kaplan; RicFiard V. Linville; Tonya McOaniel;Gloria D. Whisenhun[; county
Call 311 or 336-727-8000 ma"ager:onmeywaes,Jr.
Winston-Salem/Forsyth County Utility Commission: Randall S. Tuttle, Chair; L. Wesley Curtis, Jr., Vice Chair; Harold E. Day; Tam Griffin; Yvonne H. Hines; Duane Long;
[e-mail] Hugh W.Jernigan; Chris Parker; James Ruffin; Donald R. Stewart; Allan Younger