WQ0041738_Application (FTSE)_20200605

State of North Carolina
Department of Environmental Quality
Division of Water Resources
MW
15ANCAC 02T.0300—FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Dlvlslon of Water Resources 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
I. Applicant's name: Yadkht Valley Sewer Authority (company,municipahty,HOA, utility, etc.)
2. Applicant type: El Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State County ® Municipal ❑ Other
3. Signature authority's name: Nicole Johnston per1SAt�'CACO2f UIQ¢(bj Ivy Department of
Title: Executive Director Environmental Quality
Received
4. Applicant's mailing address: 50ONC Hwy 268 W
City: );Jkj1l State: North Carolina Zip: 28621-_ JJN 0 5 2020
5. Applicant's contact information: Winston-Salem
Phone number: (3336),935,-9Ul Email Address: nico .'ohnstom@.yvsa.ore Regional Office
11. PROJECT INFOIMATION:
I. Project name: Elkin Ridac Apartments
2. Application'Projeet status: ® Proposed (New Penn it) ❑ Existing Permit Project
Ifa modification, provide the existing permit number: W000_ and issued date:
If new construction butpan of masterplan, provide the existing pcmtit number: W000_
3. County where project is located:SIM
4. Approximate Coordinates (DecinoIDegrees): Latitude:36,27417 Longitude:-80,83639
5. Parcel ID (if applicable): 459216836916
(or Parcel ID to closest downstream sewer)
Ill. CONSULTANT INFORMATION:
I. Professional Engineer. Eugene Muslin License Number: C-0868
Flom: Horatn, Wade& Associates. P.A.
Mailing address: 621 Eugene Court (Suite 100)
City: Greensboro State: NC Zip: 27401-_
Phonenumber:(31¢)2_U-Q471 Email Address:jwadcQbomm-wade.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
I. Facility Name: Yadkin Valley Sewer Authority WWTP Permit Number: NCO020567
Owner Name: Yadkin Valley Sewer Authority
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQCS00376 Downstream (Receiving) Sewer Size: $ inch
System Wide Collection Svs�Permit Numb r1A fit a Inn;canld: WQCS00376
Owner Name(s): Yadkin Valley Sewer Authority
FORM: FTA04-16 Page I of 5

VI. GENERAL REQUIREMENTS
1. If the Applicant isaPrivately-Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑No ®NIA
2. If the Applicant is a Developer of lots to be sold, hasa NvcIgDgf s OnerationalAgrgSl)Snt (Ft?13M.__ DEV been attached?
❑ Yes ❑No ON A
3. If the Applicant is a lionicTrooctty Ownc* Assoc anon hasan (lnemtionalA mecmcnt (FORM, HOA) been attached?
❑ Yes ❑No ®NIA
4. Origin ofwastcwatcr..(check all that apply):
❑ Residential Owned ❑ Retail (stores, centers, mails) ❑ Car Wash
® Residential Leased ❑ Retail with food prepam tionisery ice ❑ Hotel and orMotels
❑ School; preschool; daycare ❑ Medical? dentaU 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°a DomestWCommercial %Commercial
w, Industrial (Sce 15 A NCAC 02T .0103120))
"Is there a Pretreatment Program in effect? ❑ Yes ®No
6. Hasa flow reduction been approved uhder 15A N('M' 02 T .01 141fl? ❑ Yes ® No
➢ If Yes. provide a cony of now reduction auvroval letter
7. Summarize wastewatergeneratedbyproject:
Establishment Type (see 02TA 114(f))
Daily Design Flow 2,n
No. of Units
Flow
ga U
GPD
gaV
GPD
gaV
GPD
gall
GPD
gaV
GPD
gav
GPD
Total
GPD
a See I5A NC'AC 0210114tb).td), tckl) andtcl(2) forcaveatsto wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non residential development uses; public access facilities located nearhigh public use areas;
and residential property located south or ea st of the Atlantic Intracoastal Waterway to be used as vacation rentals asdefined
in G,S— _4_2A--4).
b Per 15ANCAC 02T .01 14(c), design flow rates forestablishmentsnot identified [in table L4.A_N.C&:9JT (1]14]shall be
determined using available flow data, waterusmg fixtures, occupancy oropemtion pattems,and othermeasured data.
8. Wastewater generated by project. _GPD (per ISANCAL 021 ,0) 14)
Do not include future flows or previously permitted allocations
l f permitted flow is zero, indicate why:
10 Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been a ]located in Permit Number: _
❑ Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain): _
FORM: FTA 04-16 Page 2 of 5

VIL GRAVITY SEINER DESIGN CRITERIA (If Applicable) - 02T.0305 & MDC tGravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 535.75 DIP
➢ Section 11 & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
➢ Section IfIcontains information related tominimum slopes for gravity sewer(s)
D Ovtrsizing lines to meet minimum slope requirement Is not allowed and a violation o f the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) & MDC (Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station numberor name: _
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude:
-
3. Design flow of the pump station; _millions gallons per day (firm capacity)
4. Operationalpoini(s)ofthepump(s): _gallons per minute at_ feet iota I 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 I SA NCAC 021 R305(h)( I t:
❑ Standby power source or pump with automatic activation and telemetry -15ANCACO2T.0305(h)(1)(B):
➢ Required for all pump stations with an average doily now greater than orequal 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 -15ANCACO2T
.0305(h)(1 XQ
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry -15ANCACO2T.0305(hXlXC):
D 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.
D If the portable power source or pump is dedicated to multiple pump stations, an evaluation of all lbepumpslations'storage
capacitiesandthe rotation schedule of the portable power source or pump, including travellimeframes,shall be provided
in the case of multiple station power outage.
FORM: FT 04-16 Page 3 of 5

IX. SETBACKS &SEPARATIONS - (02B.0200& 15ANCAC 02T.0305(f)):
I. Does the project comply with aIf separalions foundmJ_S,&_NLA . fi "-,03USL0& (rd ® Yes ❑ No
➢ I SANCAC 02T.0305(f) contains mmunum separations that shall be r)rovidcd for sewer systems:
Setback Parameter*
Separation Required
Storm sewers and otherutilities not listed below vertical
24 inches
Water mains(vertical-water over sewer including in benched trenches)
18inches
Water mains (horizontal)
10 feet
Reclaimed waterlines vertical - reclaimedoversewer)
18inches
Reclaimed water lines horizontal - reclaimedoversewer)
2feet
**Any private or public watersuppiy source, including any wells, WS-I waters of Class Ior
Class 11 impounded reservoirs used asa source of drinking water
100 feet
* * Wa ters cla ssified WS (except WS 1 or WS-V), B, SA, ORW, HQW, orSB from nomtaI
high water (or tide elevation) and wetlands (see item IX.2)
50 feet
**Any other stream, lake, impoundmcnt,orground water lowering a nd surfa ce the ina ge
ditches
10 feet
Any building foundation
5 feet
Any basement
10 feet
Top slope of embankmentorcutsof 2 feet or more vertical height
10 feet
Drainage ssterns and interceptor drains
5feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
➢ 15&N(-62fUt05( el contains almmatrves where separations in VJ tt30al) cannot be achieved.
➢ **Stream classiticaliunscanbeidentified using the Division's NC-Stti(aye'giC.[S'lissilicationswcboauc
➢ 11 noncompliance withsee Section X of this application
2. Does theprojectcomplywithseparation requirements forwetlands?(50feet ofsepamtion) ❑Yes ❑No 0 N A
➢ Seethe Division's draft separation requirements for situations where separation cannot be meet
➢ No variance is required if the altematrvedesign crrtena 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 19A NCB (_'1 A?(l ' ❑ Yes ❑ No ®N, A
➢ This would 'include Trout Buffered Streams per 15LNC:AL-2_B_0.2Q
4. Does the project require coverage authorization undera 404 Nationwide or ❑ Yes ® No
individual permits or401 Water Quality CertiftcanonO
Information call be obtained from the 401 & Bu t fcr Pcim inane Branch
5. Does project comply with 15 NC-0210U(f)((!)(additionalpermits ceniftcations)? ® Yes ❑ No
Per I SA NC.AC 02T.0105ick01, directly related environmental pemtns or certification applications are being prepared, have
been applied for, or have been obtained. Issuance of this pennit is contingent on issuance of dependent permits (erosion and
sedinrentalion control plans, storm water man a gem ent plans, etc.).
6. Does this project include any sewer collection lines that am deemed "high -pnonty?"
Per 15ANCAC 02T.0402,"high-pnonty sewer' means "any aenal sewer, sewer contactmgsurface waters, siphon, or sewer
positioned pa ra liel to streambanks that is subject to erosion that underm Ines or deteriorates the sewer.
❑Yes []No ®NA
➢ If yes, include an attachment with details forcach line, including type (aerial line, size, matenal,and location).
High priority linesshall be inspected by the permittee or its representative at leastonce 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 15 A N A ' 02T, the Minimum Dcsum CrAcria Ibr the Pcmtitting Of f'Um > lalixts
and Force Mains Itatest version), and the Gravih• Scnef j_vljOjpppm Desiwi Cnicria (latest version) as apphcable?
to Yes ❑ No
If No, completeand submit the Vadance'AliemativeDesign Request application(VADC 10-14) and supporting documents for
review. Approval of the request Isrequit red prior to submittal of the Fast TrackApolication and IuM rfing documents,
2. Professional Engineer's Certification:
7 E-ow4E Wsrw_ _ attest that thisapplication for
(Professional EnginoWs name from Application Item 111,1 J
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 thebest 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), andtheMinimum Design Criteria forthe 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 1 have reviewed this material and
havejudged it to be consistent with the proposed design.
NOTE In accordance with General Statutes 143-215.6A and 143-215.68, 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 pena hies up to S25,000 per violation.
North Carolina Professional Engineer's seal, signature, and date: CA N IIR0 i����
;Q�pFESSIpN��/2
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IV
,NE�� Jy�\N (o '3 Ro20
nuault`�
3. Applicant's Certification per 15ANCAC 02T.0106(b):
I, Nicole Johnston r Executive Director _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. 1 understand that any discharge of wastewater from this non -
discharge system to surface waters orthc land will result in an immediate enforcement action that may include civil penalties,
injunctive relief, and orcriminalprosecution. Iwill make no claim against the Division of Water Resources should a condition
of this permit be violated. 1 also understand that if all required pans of this application package are not completed and t Irat 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 S 10,000 as well as civil penalties up to $25,000 per violation.
Signature:. - �. - _ _- Date %12912020
FORM: FT 04-16 Page 5 of 5

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D �iVn�A Engineersv �7 Planners
Surveyors
13oruin Wadc and Associates, 1'.A.
June 4, 2020
N.C. D.E.Q.
Division of Water Resources
Winston-Salem Regional Office
450 W. Hanes Mill Rd. — Suite 300
Winston-Salem, NC 27105
Regarding: Elkin Ridge Apartments
PGW Drive (Address t.b.d.)
Elikin, NC
FTA 04-16 for Gravity Sewer (Public)
Dear Sir or Madam:
NC Department of
Environmental Quality
Received
JUN 0 5 2020
Winston-Salem
Regional Office
Elkin Ridge, LLC proposes to develop the above noted 66 unit apartment complex. In
conjunction with this development, a new public gravity sanitary sewer line owned by the
Yadkin Valley Sewer Authority will be installed. The entrance to this project is located off
the PGW Drive in Elkin, North Carolina. The proposed public sanitary sewer line will tie in
to the Town of Elkin's existing gravity sanitary sewer line running perpendicular to the
existing PGW Drive.
Please find the following attached information for review for processing a Gravity Sewer
Permit for the above mentioned project. Included in this package are the following.
1. One original and one copy of the Fast Track Application.
2. One check for $480 (check# 5014)
3. One original and one copy of the Downstream Sewer Flow Tracking/Acceptance.
4. One original and on color copy USGS Topographic Map and one street level map.
Please call if you have any other questions.
Best Regards,
Jonathan Wade
621 Eugene Court, Suite 100, Greensboro, NC 27401-2711 • PO Box 21882, Greensboro, NC 27420-1882
Phone [phone] • Fax [phone]
Website: www.borum-wade.com