WQ0041705_Application (FTSE)_20200518

State of North Carolina
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: (to boo nVletedbyDWR)
All Items must be completed or the anolication will be returned
1. APPLICANT INFORMATION:
1. Applicant's,name: CITY OF KING (company, municipality, BOA, utility, etc)
2. Applicahi type: ❑ Individual 0 Corporation 0 General Partnership
❑Privately-Owned Public Utility
❑ Federate Stair u ty ® Municipal [j Other
3. Signature authority's name: , per I5ANCACO2T.0106(b) ['qCU NartniGntof
Title:CM1, 6 lb&ftJ� EnviroRmenvedQuaIit
y
4. Applicant's mailing address: 229 S. MAIN ST
City: KING State: NC Zip: 27021-_ h r Y 18 2020
5, Applicant's contact information: Winston-Salem
Phone number: 3( 3�f 2 5 Email Address: Regional Office
1I. PROJECT INFORMATION,,
1. Project name: MAPLE LEAF FARMS TOWNHOb-.M
2, Applicat Dw?rcject stahts: ® Proposed (New Permit) ❑ Existing Permit/Project
[fa modification, provide the existing permit number: WQW— and issued.date: _
If new construction but part of master plan, provide the existing permit number: W000_
3. County where project is located: Stdg
4t Approximate Coordinates (Deoimai Degreea): Latitude: 3 .25 Longitude: 40.33.05°
5. Parcel ID (if applicable): 6901698003
(or Parcel ID to closest downstream sewer)
M.CONSULTANT.INFORMATIOM
L Prolbssional Engineer: Chuck Truhv License Number. NC 14984
Firm: PPT Eneineering and Surveying, fnc
Mailing. address: 4400 Tvnina Street
City; High PDNS State: NC Zip: 27265
Phone number: 00 M-8800 Email Address: chuokt(a cntengtnneerine,com
IV. WASTEWATER TREATMENT FACILITY (W WTF) INFORMATION:
1. Facility Name: Lower Muddy Creek Permit NumbeCNC005N32
Owner Name: CCU of Winston-Salem
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than W WTF);
1. PermitNumber(s):WQ�s_
System Wide Collection System PermitNumber(s) (if applicable): WQCS 00350
OwnerName(s): Gt—r CIO KIrr6
FORM: FTA 04-16 Page I of 5

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 Ongrational Agreement (FORM DEV) been attached?
❑ Yes ❑No ®N/A
3. If the Applicant is a Home/Propaly Owners' Aaso&don has an Qzratio al Agreement (FORM ROM been attached?
❑ Yes []No ®N/A
4. Origin of wastewater. (check all that apply):
0 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 ❑ SwimmingPooi/Pilter Backwash
❑ Businesses / offices / factories ❑ Nursing Home ❑ Other (Explain in Attachment)
5. Naturcof wastewater: 100%Domestic/Commercial _°Commercial
Industrial (See 15A NCAC 02T .0101(M)
L--->-is there a Pretreatment Program in effect? []Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 021.0114f Q? ❑ Yes ❑ No
➢ If yes. Provide a cony of flow reduction approval left.
7. Summarize wastewater generated by project:
EHabQshment Type (see 02T.0114U))
Daffy Design Flow '°
No. of Units
Flew
Single Family Res16ntlat
360 gal/day
41
14,760 GPD
Pay
GPD
— Sw
GPD
gal/
GPD
gal/
GPD
gav
GPD
Total
14,760 GPD
a See 15A NCACO2T 0114(ll) (dl (elf1) and fe.!?) for caveats to wastewater design flow rates (l,e., minimum flow per
dwelling; proposed unknown non-Reidential 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 inKI.S. 42A 4 .
b Per I5A 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.
S. Wastewater generated,by ptoject:14760 GPD (per 1AAlilyAC 02T Q1J4)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why;
❑ Pump Station of Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit Number: —
FORM: FTA 04-16 Page 2 of 5

❑ Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain): _,
FORM: PTA 04.16 Page 3 of 5

VH. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 2 0 & MDC (Gravity Sewers):
Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8"
2,291
PVC
8"
49
DIP
➢ ,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 sewers)
➢ Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — .030 & MDC, (Puma Stations1Faece MSInS);
COMPLETE FOR EAIMP 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(a): _ 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 .AC 02T ,0305(h)(Il:
❑ Standby power source or pump with automatic activation and telemetry - I SA NCAC 02T .0305(h)(1)(B);
Requited 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 Iess 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)(1XQ:
➢ 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 multiple station power outage;
FORM: FTA 04-16 Page 4 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 & iQ) ® Yes ❑ No
D 15ANCAC 02T.0305(0.contatns minimum separations that shall he nrnvided far mwer system.e-
SetbackParameter*
Separation Ruired
Storm sewers and.other utilities not listed below (vertical)
24 inches
Water mains vertieal-waterover sewer including in benched treneias
18 inches
Water mains rivontal
10 feel
Reclaimed water lines vertical - reclaimed over sewer
18 inches
Reclaimed water lines horizontal - reclaimed over sewer
2 feet
**Any private or public water supplysource, including any wells, WS-1 waters of Class I or
Class 11 impounded reservoirs used as a source of drinking water
100 feet
**Waters classified WS (except WS-I or WS-V),13, SA, ORW, HQW, or SB from normal
high water or tide elevation and wetlands see item IX.2
50 feet
**Aay other stream, lake, impoundment, or ground water lowering and surface drainage
ditches
10 feet
Any building fbundatlon
5 feet
Any basement
10.feet
Top slope of embattlement or outs of 2 feet or more vertical height
10 feet
Drains o s stems and interceptor drains
5 feet
An swimmin o1s
10 feet
Final earth grade vertical
36 inches
➢ 15A NCAC 02T,0305(g) contains alternatives where separations in 02T.0305(fl cannot be achieved,
D **Stream classifications can be identified using the Division's NC Surface Wa(cr Classifications weboage
➢ If noncompliance with 02T,0305(f)or(e)..seeSectionXofthis application
2. Does the project comply with separation requirements for wetlands? (50 feet ofseparaflon) ® Yes Q No
➢ Sec the Division's draft separation.requiremems for situations where separation cannot be meet
D 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 028,020 ® Yes ❑ No
D This would include Trout Buffered Streams per (,f,O,NCAC 21I0202
4, Does the project comply with an individual 404 Permit or any 401 Cerdflcations? ED Yea ❑ No
)' Wetland -related permits shall be requested, obtained, and adhered to for projects drat impact wetlands or surface waters
D Information can be obtained from the 401&Bufferpgrmill.1 apch
5. Does project comply with 15A.NCAC 02T.0105(c)(0 (additional permits/certifloations)? ®Yes ❑ No
tom:
FORM: FTA 04-16 Page 5 of 5

Per 1 A NCAC 02TA11111A 1, 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-priorityT'
Per jjA 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 thatundermines or deteriorates the sewer.
❑ Yes ® No
If yea, include an attachment. with details for each line, including type (aerial line, size, material, and location).
High priority Imes shall be Inspoeted by the permittee or Its representative at least once every six -months and
inspections documented per ISA NCAC 0ZT.0403(a)(5) or the permitee's Individual System -Wide Collection permit.
FORM; FPA 04-16 Page 6 of 5

X.
1. Does the submitted system comply with 1SA NqAC 02T, the MinimuLn pesign Criteria for the Pormiltingof Pump Stations
and Force Mains (latest version), and the Srmvity Sewer Minimum Design Criteria (latest vmia on) as applicable?
® Yes ❑ No
If No, complete and submit the Variance/Alternative Design Request application (VADC 10.14) and supporting documents
for review. Aooroval of the Miluest is required Prior to submittal of the fast Track Auullcation and sunPortine
documePts.
2. Professionalfingineer's Certification
I, Ckuc fe P�
that this application for
(Professional Engineer' name from Application Item 11I.1.)
lc r(e LevP iFnrn,%-rlwr-ihomej
n reviewed by me and rso urate, 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 sliest 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 Fora Mains (latest version). Although other professionals may have developed certain
'portions of this submittalpaekage, inclusion of these materials undermy 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 143-21 S.6% any petson who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include it fine not to exceed $t0,000, as well as civil penalties up to $25,000 per vloladon, _eweowes, �,_
North Carolina Professional Engineer's Beal, signature; and dater
Applicant's CertiSoatio'n'pc_r 1-SA /NCAC 02T A106(b); t
I. C� �"exye
esi that this application for
(Signature Authority's name & title from Application Item 1.3.)
(et? eat aftv�'To1.,w40n
h n reviewed by me and is accurate an mp ate 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, aids
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,
injunctiver 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 3t5.6A and 141-215,61i, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guitty.of a Class 2 misdemeanor, which may f
Include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: Date: 3-3-2bZo

ei3 %ice 'A a'� ryi
Division of Water ilce ourte
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-I8)
Entity Requesting Allocation: City of King
Project Name for which flow is being requested: 12441- Maple Leaf Farms
More than one FTSE aray be required jar a single project if the owner of the WWTP is not responsible for all punrp
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
c. WWTP facility's permitted flow
d. Estimated obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
It. Percent of permitted flow used
All flows are in MGD
21,000000
2.924085
16.800000
0.014760
19.738845
94.0%
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:
(A)
(B) (C) (D)=(B+C) (E)=(A-D)
Design
Obligated,
Pump Pump Average
Approx. Not Yet Total Current
Station Station Firm Daily Flow**
Current Tributary Flow Plus
(Name or Permit Capacity, * (Firm / pt),
Avg. Daily Daily Flow, Obligated Available
Number) No. MGD MGD
Flow, MOD MGD Flow 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
Downstream Permit Number: WQCS00003
Page 1 of 6
FTSE 10-18

111. 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 form certifies that the receiving collection system or treatment
works has adequate capacity to transport and treat the proposed new wastewater.
Signature
A5'! s15 IN
Title of Signing
Date
Page 2 of 6
FTSE 10-18

Jack
CITY OF KING armsWarren,,City
Mayor
Homer Dearmin Cf Manager
Scott Barrow, City Engineer
P.O. Drawer 1132
King, NC 27021-1132
March 5, 2020
Jack Fitzgerald, PE
City of W-S Util,
P.O. Box 2511
W-S, N.C. 27102
Re.: Proposed Maple Leaf
Dear Jack:
The purpose of
flow of this proposed pi
of an estimated deman
gpd out of the maxim{t
ART
{
(niin�ale
h m� [r,�twdaiy'�lbW
a1�OyJs(serday(ApdJ Thtsadtliboilc
i
.e :CwnAi.At.-A f }4 ilia �lyl .x
UmtAq` s ,
229 S. Main Street
Telephone [phone]
Fax [phone]
average daily wastewater
proposed project consists
Vtal allocation to 833,283

State of North Carolina
Y Department of Environmental Quality
D
z _ Division of Water Resources
fltvlstatt of wateu Resources Flow Tracking/Acceptance for Sewer Extension Applications
(FTSE 04-16)
Entity Requesting Allocation: City of King
Project Name for which flow is being requested: Maple Leaf
More than one FTSE may be required fora single project if the owner of the WWTP is not responsible for all pump
stations along the route ofthe proposed wastewaterjlow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Winston-Salem Lower Muddy Creek WWTP
b. WWTP Facility Permit #: (City of W-S) NC 0050342
AUJIows are in MGD
c. WWTP facility's permitted flow 0.97
d. Estimated obligated flow not yet tributary to the WWTP 0.2476
e. WWTP facility's actual avg. flow 0.582
f. Total flow for this specific request 0.01476
g. Total actual and obligated flows to the facility 0.833
It. Percent of permitted flow used 85.9
1I. 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) (B) (C) (D)=(B+C) (E)=(A-D)
Design Obligated,
Pump Average Daily Approx. Not Yet Total Current
Station Firm Flow** Current Avg. Tributary Flow Plus
(Name or Capacity, * (Firm / pt), Daily Flow, Daily Flow, Obligated Available
Number) MGD MGD MGD MGD Flow Capacity***
Muddy
,,,.L 0.684 0.2736 0.26 0.01 0.27 0.0036
* please note that this PS is in redesign phase & funded in FY20-21
The Farm 2.05 0.82 0.535 0.135 0.67 0.15
* The Firm Capacity 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 (pt) not less than 2.5.
*** 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): City of King
Downstream Permit Number: WQCS00350
Page 1 of 6
FTSE 04-16

III. Certification Statement:
I T. Scott Barrow 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 indicates acceptance of this wastewater flow.
3-5-ODD
Dore
Page 2 of 6
FTSE 04-16

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NARRATIVE
FOR
Maple Leaf Farms
FORSYTH COUNTY
KING, NORTH CAROLINA
May 18, 2020
OWNER / DEVELOPER:
City of King
229 South Main Street
King, NC 270214
[phone]
ENGINEER:
CPT Engineering and Surveying, Inc.
4400 Tyning Street High Point, NC 27265
Phone [phone] • Fax [phone]

PROJECT DESCRIPTION
The project is located on an approximately 45.12 acre tract in Stokes County, City of
King, NC. The purpose of the project is to construct 35 3-BR townhomes and 6 3-BR
single family homes with public roads, water and sewer. This application is for a
wastewater flow of 14,760 GPD. An 8" gravity sewer will be extended to serve as a
future connection point for an estimated 57 single family homes that are planned to be
built at a later date. Future phase lines and construction dates are presently undetermined.
SITE DESCRIPTION
The site consists of 45.12 acres more or less and is currently field/wooded and vacant.
ADJACENT PROPERTY
Land use in the vicinity is single family residential. The site will access the public street
network by extending a new access roadway from Spainhour Road.
SOILS INFORMATION
The soil in the project area is mapped as FcP2 - Fairview Poplar Forest, CeB2 — Clifford
Sandy Loam per USDA Natural Resources Conservation Service Web Soil Survey. Soils
are in hydrologic group `B" and "C". The existing site slopes are approximately 2 to
10.0% average slope.
OWNERSHIP
M.J. Silmser Corporation Incorporated currently owns the entire 45.12 acre tract

EM
Engineering & Surveying, Inc.
To: Justin Henderson
NCDENR
450 West Hanes Mill Road, Suite 300
Winston-Salem, NC 27105 336-776-9800
We are sending you:
® Attached
❑ Plans
❑ Other:
LETTER OF TRANSMITTAL
Date 5-18-20
Job No: 598-06
Attention:
Re: Maple Leaf Townhomes
GRAVITY SEWER FTA
❑ Under separate cover via :
❑ Diskette(s) ❑ For Approval ® For Review
"C Department of
Environmental Received Quality
the following itagy�:' 8 2020
❑ Specificatitston-salern
Regional office
Quantity
Dw . No.
Description
Status
2
Gravity Sewer - Fast Track Application
2
FTSE(City of King & City of Winston-Salem included
2
USGS Quad ma
2
Local Street Maps
2
Review Fee -$480
2
Aerial Ma
2
Narrative
Status Code: A. Approved D. Rejected - See Remarks G Approved - As noted
B. Sign and Return E. For your information H. As Requested
C. Amend and Resubmit F. Refer to Remarks I. Review and Comment
Remarks: Please find attached the above referenced for issuance of a public gravity sewer extension Fast
Track permit for Maple Leaf Townhomes in King, NC. All sewer will be owned and maintained by
the City of King. Wastewater flows have been accepted by the City of Winston-Salem. FTSE
forms for both City of King and the City of Winston-Salem are included. If you have any
questions, please do not hesitate to give me a call. Thanks.
John A. Butler
CPT Engineering and Surveying, Inc.
4400 Tyning Street • High Point, NC 27265 Phone: [phone] • Fax: [phone]
www.cptengineering.co