WQ0041724_Application (FTSE)_20200601

State of North Carolina
Department of Environmental Quality
IMAIR Division of Water Resources
15A NCAC 02T,0300— FAST" TRACK SEWER SYSTEM EXTENSION APPLICATION
Dlvislon of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: _ (to be completed by Dwal
All items must be completed or the apolicati011 will be returned
I. APPLICANT INFORMATION:
1. Applicant's manic: City ot•H. hg Point (cony>any, municipality, NOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corpeation ❑ General Pm4nersbip ❑ Privately-Ownecl Public Utility
❑ Federal ❑ State/County ® Municipal ❑ Other
3. Signature authority's name: Terr ly louk per 15n NCA( 02f _01,0(()
Title: Public Services Director tv C Department of
4. Applicant's mailing address: PO Box 23Q Environmental quality
Received
City: High Point State: NC Zip: 27261
5. Applicant's contact information: JUN 01 202U
Phone number:[phone] Email Address: tern .hook &1ughpoinhtc.eov Winston-Salem
II. PROJECT INFORMATION: Regional Office
1. Project name: Joyce Commons
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
[fit modification, provide the existing permit number: W000_ and issued date: .
If new construction but part of a master plan, provide the existing permit number: WQ00_—. .
3. County where project is located: GuilPmd an I o1SVfh County
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.023938° Longitude:-80.042594'
5. Parcel 11) (if applicable): 6892192761000.199015J99014
(or Parcel ID to closest downstream sewer)
111. CONSULTANT INFORMATION:
I. Professional Iingincer: 'Thomas R_. Glovcr. jr PE License Number: 27465
Firm: Jamestown 13nejjjm ng Grout, lnc.
Mailing address: 117 I;. Main Street, P.O. Box 365
City: Jamestown State: NC -Lip: 27282-_
Phone number: (336) HtJ-5523 C:mail Acich'ess: (,lover(QTmestownene,i3tee1�i17L.com
IV. WAS'I'L'WA9'IBRTREATMENTFACILITY(WWTF)INFORMATION:
I. Facility Name: Iiiph Point Wests.ide'I'reaonent Plant Permit Number: NC 0024228
Owner Name: City of tli h Point
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
Permit Number(s): WQ—_-..-
System Wide Collection System Pennit Number(s) (if applicable): WQCS__,.._
Owner Namc(s): _
FORM: PTA 04-16 Page 1 of 5

V1. GENERAL REQUIREMENTS
I. Ifthe Applicant is it Privately -Owned Public Utility, has it Certificate of Poblie Convenience and Necessity been attached?
❑ Ycs ❑No ®N/A
2. if the Applicant is a Developer of lots to be sold, has a Develupt;i s Operational Art ce.mgnt (FORM: M: DF V) been attached?
❑ Yes ❑No ®N/A
3. If the Applicant is a I tomuTiope ty Qtrnus Association, has an Opuahoti?tl A., convnI_(f Ult\d 110A) been attached?
❑ Yes ❑No MN/A
4. Origin of wastewater: (chock all that apply)
® Residential Owned ❑ Retail (stores, centers, malls) ❑ Car Wash
❑ Resitlenfial Leased ❑ Retail with food preparation/s6rvice ❑ 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. Natureofwaslcwater: 100%Domestic/Commercial %Commercial
% Indashial (See 15A NC A(' t121_.0103(20))
"Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Iles it flow reduction been approved under 15A NCIAC 02'1 01.14(f)? ® Yes ❑ No
➢ If yes, provide a copy of flow reduction approval letter
7. Sttnunarize wastewater generated by projecC
Establishment Type (see 02'1 01 Han)
Single family homes with 4 bedrooms/unit
- Duly Design Flow
90 gal/day/bedroom
No, of Units
109
Flow
39,240 GPD
_ .._....
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
lolol
39,240 GPD
a See I5A NCAC: 01 .01 Idtb),1<I)L)(I) ,tnd.(-)(-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 its vacation rentals
as defined ill O_S,_12A-4).
b Per 15A NCAC 02T.0114(c), design flow rates forestablishments not identified (in table IiA N( AC o 1-.f 1 l lj shall
be determined using available flow dam, Water using fixtures, occupancy or openrtion patterns, and other mcasuredl data.
8. Wastewatergenamted by project: 39 22n0 GPD (pct 15A NCAC 021 01-I.'l)
Y Do not include future (lows or previously penmilted allocations
Ifperntitfed flow is zero, indicate Why:
❑ Pump Stal lot, or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
❑ Flow has ah'eady been allocated in Permit Number:
❑ Rehabilitation or replacement of existing sewn. with no new flow expected
❑ Other (FXplain):
FORM: FTA 04-16 Page 2 of 5

Vlll.
GRAVITY SEWER DESIGN CRITERIA (If Applicable) -till f1305 & MD(.1G rls� Sr rccrs);
Summarize gravity sewer to be permitted:
—_ Sze inches Length feet Msrteuial_--
R" 2,856'+/- SDR-26
R" 992'1/- D1
Section ❑ Fc 111 of the MDC for Pot III ill ing Of( I lVity Sewers contains information related to design m iteria
Y Section IN contains information related to mininnun slopes for gravity sower(s)
Y Ovet:sizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
PUMP STATION DESIGN CRITERIA (If Applicable) — UF.(13t15 & RiDC (I'imlt-Sf�llions/1"urn �ylains);
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
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 pamp(s): ---- gallons per minute at ____ feet total dynamic head (TDI1)
5. Sununarize file force main to be permitted (for this Punlp Station):
6. Power reliability in accordance with 15A-NCAC 02"1' .0305(h)(1,):
❑ Standby power source or pump With aulfnnatic activation and telemetry - 15A NCAC 02'1' .0305(h)(I)(R)_
Y 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 (low less than 15,000 gallons per day:
❑ Portable power source with manual activation, quick -connection receptacle and tclenlehy - 15A NCAC 02T
.0305(h)(1)(C)
or
❑ Portable pumping unit wilh plugged emergency pump connection and telemetry - 15A NCAC 02T .0305(h)(I)(C):
➢ It shall be demonstrated to the Division that the Portable source is owned or con0'acted by the applicant (draft agreement)
and is compatible with the station.
➢ If file portable power source or pump is dedicated to multiple pump stations, an evaluation of all file pump stations'
storage capacities and the rotation schedule of the portable power source or pump, including travel limef}ames, shall be
provided in the case of a multiple station power outage.
xv
FORM: FTA 04-16 Pagc 3 of 5

IX. SETBACKS & SEPARATIONS — (0211 ,0200 & 15A NCAC 02T .0305(f)):
I. Does the project comply will, all separations found ill 15A NCAC 02 f .t13a5(I7s�C t.r�_1
➢ 15A NCAC 02T.0305(t) contains min innuu sensvalinns d"d chaII I" „ ,;d"d G— ......
® Yes ❑ No
-...._ _... -..-._ __._ Setback_ I'mametet_ _.... .__...
rmr tionRequiied
Storm sewers and other utilities not listed below vertica24
inches
ins (vertical -water over se%ver includiII , in benched trenches
ate ma .
13 inches
Wa lei -ma ills horizontal ..(_�IO
test
Tor
Reclaimed hater IineS vel'tical - i"eclat ill e(iover sewer')_
IS itches
Rcclamlcdwater Imes ica izolltal reclain ed ovel :sewer
2 fCCt
**Any pr ivale or public water supply solace. including my wells, WS 1 waters of Class
�__
C ass ll un vul ded lee ._ _- ... _
used as a source of drinkm_ lam•_
__---- 100 feet
(voirs
*'Waters classified WS except WS-1 or WS V) B, SA, ORW, HQW, or SB from normal
--
hrKh hater (or fide elevation and wetlands (see item IX.2)
50 feel
**Any other sleani, lake, impoundment, or ground water lowering and surface drainage
-.
ditches
Any �uildinQ frnmdation
5 feel
Ally basement ——......... _... _--. .._._..
10 feel
fop slope of embankment or cuts of feet of more vertical height
10 feet
Draina>e systems and inierce poi drains
-- -
5 feel
_. ..
An swinnnpools
10 feet
_Final earth grade veltn,el).._. _ -_ _--
36 inches
➢ 15A NCAC 02 1030sfv) contains alternatives where separations ill 02f _0305(I) cannot be achieved
➢ "Stream classifications can be identified using the Division's N( Sur lacc Water Classifications �,chlvw
➢ If noncompliance with 02'1-0305(f)_or (e), see Section X of IIIis application
2. Doss the project comply wilb sepmation ra@irenlents for wetlands? (50 feet of separation) ® Yes ❑ No
➢ Sec the Division's drafl separation requirements for situations where separation cannot be meet
➢ No variance is required if the alternative design crite"ia specified is utilized in design and construction
As built documents shoul(1 reference the location of areas effected
3. Does the project comply with all setbacks found in the river basin lilies psi 15A NOW 1128 o2Q0? ® Yes ❑ No
This would include Tiou1 Buffered Streams per 15ANCAC 213.0201
4. Does the project comply with an individual404 Permit or any 401 Certifications? ® Yes ❑ No
➢ Wetland -related permits shall be requested, obtained, and adhered to for projects that impact wetlands or surface water
➢ Infornation can be obtained from the lent & I1t111'cr Permitlnt; ltr<tnch
5. Does project comply with I.5A NCA('_W LO1(l5(c)yi) (additional pe,niits/ceiificatiolls)? ® Yes ❑ No
Per 15A NCA(.0r [.0105,(c)(0), directly related environmental permits or ce"tification applications are being prepared, have
been applied for, or have been obtained. Issuance of Ibis PC] Ill is contingent on issunice of dependent permits (erosion and
sedimentation control plans, storniwmer management plans, etc.).
6. Does this project include any sewer collection lines [hat are deenied "high -priority?"
Pe- 151A NCAC 02 f..0,102, "high -priority sewer" means "any aerial saver, sewer contacting surface waters, siphon, or sewer
positioned parallel to sti'cambanks that is subject to erosion that undermines or deleriorntes 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 pernlittee or its representative at least once every six-mnnlbs and
inspections (loetnaell tell Pei, 15A NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permi[.
FORM: FTA 04-I6 Page I of5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 021, 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 supnorting
documents.
2. Professional Engineer's Certification:
I • attest that this application for
fi•om Application Item 111.1.)
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 havejudged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-2I5.6A 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, anc
3. Applicant's Certification per ISA NCAC 02T.0I06(b):
,. ft%-Ax /'flLfG/C SAW/C£S A LAZeXyZ attest that this application for
(Signature Authority's name & title from Application Item 1.3.)
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 143-215.611, 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 rip to $25,000 per violation.
Signature:
Date: •� a/ '�d Za
FORM: FTA 04-16 Page 5 of 5

OlvNion of Water Qesourc•es
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(rTSE 10-18)
Application Number: 2020-150
Entity Requesting Allocation: City of High Point
Project Name for which flow is being requested: Joyce Commons
More flora one FTSC rrmy be required for a single pwJect lithe owner of the IFIM Is not responsiblefor all punrp
stations along the route of theproposed tpasfeumferJlorp.
1. Complete this section only if you are the owner of the wastewater treatment plant.
a. W WTP Facility name: Westside W WTP
b. W WTP Facility Permit S: NC-0024228
A11 flcips are /it MGD
c, W WTP facility permitted flow: 6,2000
d. Estimated obligated flow not yet tributary to the W WTP: 0.0794
e. W WTP facility's actual average flow: 3.0942
f. Total flow for this specific request: 0.0392
g. Total actual and obligated flows to the facility: 3.2128
If. Percent of permitted flow used: 51.82%
It. 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 W WTP.
(A)
(D)
(C)
(D)e(Bi•C)
(S)-(A-D)
Pump
Pump
lint
Design
Approx.
Obligated,
Total Current
Available
Station
Station
Capacltyn
Average
Current
Not Yet
plow Plus
Ca aci s
F ry
(Name or
Permit
DellyFlosv'
Avg. belly
Tributary
Obligated
Number)
Number
(FimdpQ,
Flow,
Daily Flow,
Flow
MGD
MGD
MGD
MGD
MGD
MGD
MIA
MA
aWA
MIA
MIA
RNA
RNA
MA
MIA
aWA
MIA
M/A
MU
MA
MA
MIA MIA MIA MA aWA MA
MA M/A MIA RNA MIA MIA
WIA MIA MIA MIA aWA aWA
"The Firm Cnpscily (design now) of any pump station Is defined no the mAximum pumped flow that
can be achieved with the ingest pump infun out ofsesvice.
Design Average Flow Is flit arm capacity of the pump station divided by the peaWng factor (pQ not
less Than 2,5, per Section 2,02(A)(4)(e) of the Minimum Design Criteria.
""* A Planning Assessment Addendum sbnll be attached for each pump station located behreen the
pi elect connection point and Ilse wwTP where the Available Capacity is A 0.
Downstream Facility Name (Sewer):
Downstream Permit Number:
aWA MA
MIA aWA
aWA MA
Page 1 of 6 FTSE 10.10

111. Certification 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 life 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 plamred 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 It plus all attached planning assessment addendams for which I am the
responsible party. Signature of this form cerlifles that the receiving collection system or treatment works
has adequate capacity to transport and treat the proposed new wastewater.
4/2212020
Signing Ofc! ign hire Date
Title of Signing Offlclal
Page 2 of 0 FTSE 10-18

Public Services Department
Terry L. Houk
DIRECTOR
NORTH CAROLINN'S INTERNATIONAL CITY'
April 23, 2020
NCDENR
Winston-Salem Regional Office
450 W. Hanes Mill Rd, Suite 300
Winston-Salem, NC 27105
Project: Joyce Commons
Public Sewer
Applicant: City of High Point, NC
Dear Sir or Madam,
This is to acknowledge that the City of High Point will accept for treatment in the Westside
Wastewater Treatment Plant (Permit #NC0024228), wastewater flow from the above referenced
project in the amount of 39,240 GPD, which will be discharged to facilities operated and
maintained by the City of High Point.
If further information is needed, please let me know.
Very truly yours,
X.
Terry L. uk
Director of Public Services
TLH/tab
City of High Point, P.O. Box 230, 211 South Hamilton Street, High Point, NC 27261 USA
Fax:336.883,1675 Phone:[phone] TDD:336.883.8517

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JAMESTOWN ENGINEERING GROUP, INC.
CIVIL ENGINEERS & SURVEYORS
LAND PLANNING • MUNICIPAL CONSULTING
117 East Main Street • P.O. Box 365 • Jamestown, N.C. 27282
Telephone [phone] Fax [phone]
www.jamestownengineering.com
May 26, 2020
Re: Sewer Line Extensions
Servicing Joyce Commons
City of High Point
Guilford County
JEG File No. 2017-113
Mr. Justin Henderson
Division of Water Quality
NC Department of Environment and Natural Resources
450 W. Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
Dear Mr. Henderson:
E Vironmental Quality
Received
JUN 01 2020
Winston-Salem
Regional Office
With regards to the referenced project, and on behalf of the City of High Point, we have
enclosed one original and one copy of the following for your review:
Fast Track Sewer Application
$480.00 Application Fee
Form FTSE 04-16 completed by the City of High Point
8.5" X 11" color USGS topographic map
Street level map
Sewer service to the Joyce Commons includes 109 residential homes (39,240 gpd)
located along Gowen Street, Angel Hill Lane and Cam Circle. Flow allocations are
included in the attached FTSE 04-16 form for the additional 109 residential lots. Upon
completion of the sewer line installation and testing, the system will be maintained by the
City of High Point. The downstream sewer system and treatment facility are owned by
the City of High Point.
If there are any questions or additional information required, please call.
Sincerely,
JAMESTOWN ENGINEERING GROUP. INC.
r'
Thomas R. (Rich) Glover, Jr., PE
Enclosures