HomeMy WebLinkAboutWQ0041932_Application (FTSE)_20200826DWR
Division of Water Resources
State of North Carolina
Department of Envii-onrnental Quality
Division of Water- Rcsources
1 SA NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number:
Isn be ctmipleted by DWR)
All items must be completed or the application will he returned
1. APPLICANT INFORMATION:
1. Applicant's name: Davidson County (company, municipality. I-IOA. utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Udlit�
❑ Federal Y❑ SlaWCOUnly ❑ Municipal ❑ Other
3. Signature authority's name: Casey Smith per 15A NCAC 02'r-0106(b)
Title: COU111Y Manager
4. Applicant's mailing address: 913 Greensboro Road
City: Lexington State: NC Zip: 27292
5. Applicant's contact information:
Plione number. Q36) 2�42-2000 Email Address: casev.sniith.c da\idsoncountvnc.,ov
11. PROJECT INFORMATION:
l . Project name: Tally Pointe
2. Application/Project status: X❑ Proposed (New Permit) ❑ Existing PermitfProiect
If a modification, provide [lie existing permit number: WQOO and issued date:
If new construction but part of a master plan, provide [lie existing permit number: WQOO
3. County where project is located: Davidson COumV
4. Approximate Coordinates (Decinial Degrees): Latitude: 35.963" Longitude:-80?72`
5. Parcel ID (ifapplicable): 6320-01-37-3556
(or Parcel ID to closest downstream sewer)
Ill. CONSULTANT INFORMATION:
1. Processional Engineer: Thomas R. Glover, Jr, PEA
License Number: 27465
Firm: Jamestown i n,incerin, Group. hic.
Mailing address: 117 E. Main Street. 11.0. Box 365
City: Jamestown State: NC Lip: 27252
Phone number: (336) 886-5523 Email Address: r�loyer c iamestOtiyneti,illee� inn.coni
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
I. Facility Name: Lower Mudd\ Creek Permit Number: NC 0050342
Owner Name: Winston-SalemJFors\th COtintV Utility COIi1mISSlon
V. RECEIVING DOWNSTREAM SEWER INFORMATION (ii,(iirrei•ent than WWTF):
1, Permit Number(s): WQCS 00361
System Wide Collection System Permit Number(s) (it' applicable): WQCS
Owner Name(s): Davidson Count\ Sewer
FORM: FTA 04-16 Pa+le I ol,5
Vl. GENERAL REQUIREMENTS
1. If the Applicant is a Privately -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, has a Developer's Operational Agreement (FORM: DEV) been attached"
❑ Yes ❑No ®NIA
3. If the Applicant is a Home/Pr0 a Owners' Association has an Operational Agreement FORM: HOA been attached?
❑ Yes []No ®NIA
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))
%, 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 gglsrovai letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T,01140
Daily Design Flow a'°
No. of Emits
Flow
30 Residential Lots with 4 bedrooms/lot
70 gal/day/bedroom
30
8,400 GPD
gall
GPD
gall
GPD
gall
GPD
gall
GPD
gal/
GPD
Total
8,400 GPD
a See ISA NCAC 02T .01 14(b), (d). (c)(l) and (c)(2) for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use
areas; and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals
as defined in G.S. 42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02T.0114] shall
be determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 8,400 GPD (per 15A NCAC 02T .01 14)
r 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
li"
1,955' +1-
SDR-26/DIP
➢ Section 11 & 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
Vill. PUMP STATION DESIGN CRITERIA (if Applicable) -- 02T .0305 & MDC (Pumv Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. 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 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 I SA NCAC 02T .0305(h)(I }:
❑ 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
r 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
A305(h)(1)(C)
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry - 15A NCAC 02T .0305(h)(l)(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 S
IX. SETBACKS & SEPARATIONS — (02B .0200 & 1SA NCAC 02T.0305(f)):
1. Does the project comply with all separations found in 15A NCAC 02T.0305(f) & W
➢ 15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
VowM- 0
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 11 impounded reservoirs used as a source of drinkin 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 1X.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 oft feet or more vertical hei ht
10 feet
Drainage systems and interceptor drains
5 feet
Any swimming pools
10 feet
Final earth grade (vertical)
36 inches
➢ ISA_NCAC 02T.0305(g) contains alternatives where separations in 02T.0305 cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications_ webpa
➢ If noncompliance with 02T.0305(f) or (g), see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ® Yes ❑ No
➢ Seethe 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 all setbacks found in the river basin rules per 15A NCAC 02B .0200? ® Yes ❑ No
➢ This would include Trout Buffered Streams per 15A NCAC 213.0202
4. Does the project comply with an individual 404 Permit or any 401 Certifications? ® Yes ❑ No
D Wetiand-related permits shall be requested, obtained, and adhered to for projects that impact wetlands or surface waters
➢ Information can be obtained from the 401 & Buffer Permittin Branch
ranch
5. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)?
® Yes ❑ No
Per I5A 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
➢ 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:
y comply Design Criteria for the Permitting of Pump Stations
I. Does the submitted system com ( with 15A NCAC 0_T, the Minimum I�,
and Force Mains (latest version), and the Gravity+ Sewer Minimum Design Criteria (latest version) as applicable?
M 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:
1,
(Professional Engineer's name from Application Item III.1.)
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 1 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 111;3\
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
Applicant's Certification per 15A NCAC 02T .0106(b):
I_ CAr rq ( .^n ,-eu (--n,i _rrr
Authority's name & title from Application Item 1.3.)
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. 1 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:
IF/j(z o
FORM: FTA 04-16 Page 5 of 5
/4'inc.
August 24, 2020
JAMESTOWN
GROUP, INC.
CIVIL ENGINEERS & SURVEYORS
LAND PLANNING • MUNICIPAL CONSULTING
117 East Main Street • P.O. Box 365 • Jamestown, N.C. 27282
Telephone(336) 886.5523 Fax (336)886-5478
www.jamestownengineering.com
Re: Sewer Line Extensions
Servicing Tally Pointe Subdivision
Davidson County
JEG File No. 2020-025
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:
Environmental quality
4. Received
AUG 2 6 2020
Winston-Salem
Regional Office
With regards to the referenced project, and on behalf of the Tally Pointe, LLC, we have
enclosed one original and one copy of the following for your review:
- Fast Track Sewer Application
- $480.00 Application Fee
- Form FTSE 10-18 completed by Davidson County
- Form FTSE 10-18 completed by Winston-Salem/Forsyth County
8.5" x 11" USGS topographic map
- Street level map
- Flow Acceptance Letter
- Form DEV 03-19
- Davidson County Sewer Construction Agreement
- Articles of Incorporation
- Declaration of Covenants, Conditions, and Restrictions
Sewer service to the Tally Pointe Subdivision includes 30 single family residential
detached townhomes (8,400 gpd) located on Hege Road. Flow allocations are included in
the attached FTSE 10-18 form for the additional 30 residential lots. Upon completion and
acceptance of the sewer line installation and testing, the system will be maintained by
Davidson County. The downstream treatment facility is owned by Winston-
Salem/Forsyth County.
If there are any questions or additional information required, please call.
Sincerely,
JAMESTOWN ENGINEERING GROUP, INC.
homas R. (Rich) Glover, Jr., PE
I I
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
1. APPLICANT INFORMATION
1. Applicant's name: Tally Pointe, LLC (company, municipality, FICA, utility, etc.)
2. Applicant type: ❑ Individual
® Corporation ❑ General Partnership
❑ Federal
❑ State/County ❑ Municipal
3. Signature authority's name: Greg
Garrett, Manager per 15A NCAC 02T .0106(b)
Title: Managing Member
4. Applicant's mailing address: 6420 Hampton Knoll Rd.
City: Clemmons State: NC
Zip: 27012-
5. Applicant's contact information:
Phone number: (336) 399-7197
Email Address: braxtonreanddevggmail.com
❑ Privately -Owned Public Utility
❑ Other
NC Department of
Environmental Quality
Received
AUG 2 6 2020
Winston-Salem
Regional Office
II. PROJECT INFORMATION:
1. Project name: Tally Pointe
2. Application/Project status: ® Proposed (New Permit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: W000 and issued date:
If new construction but part of a master plan, provide the existing permit number: W000_
3. County where project is located: Davidson County
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.963°Longitude: -80.272'
5. Parcel ID (if applicable): 6820-01-35-7901
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
I. Professional Engineer: Thomas R. Glover, Jr, PE License Number: 27465
Firm: Jamestown Engineering Group, Inc.
Mailing address: 117 E. Main Street, P.O. Box 365
City: Jamestown State: NC Zip: 27282-
Phone number: (336) 886-5523 Email Address: rglover@iamestownengineering.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Lower Muddy Creek Permit Number: NC 0050342
Owner Name: Winston-Salem/Forsyth County Utility Commission
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. PermitNumber(s): WQCS00361
System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s): Davidson Count,, Sewer
FORM: ETA 04-16 Page I 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))
"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(fl)
Daily Design Flow "'
No. of Units
Flow
300 Residential Lots with 4 bedrooms/lot
70 gal/day/bedroom
30
8,400 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
8,400 GPD
a See 15A NCAC 02T .0114(b), (d), (e)(1) and (e),(2) for caveats to wastewater design flow rates (i.e., minimum flow per
dwelling; proposed unknown non-residential development uses; public access facilities located near high public use
areas; and residential property located south or east of the Atlantic Intracoastal Waterway to be used as vacation rentals
as defined in G.S. 42A-4).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15A NCAC 02101 141 shall
be determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 8 400 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):
I. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8" 1,955' +/- SDR-26/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 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: 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 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(0):
® Yes ❑ No
1. Does the project comply with all separations found in 15A NCAC 02T.0305(f) & (g)
➢ 15A NCAC 02T.0305(f) contains minimum separations that shall be Drovided for sewer systems:
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(g) contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications weboage
➢ If noncompliance with 02T.0305(f) or (g), see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ® Yes ❑ No
➢ 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 all setbacks found in the river basin rules per 15A NCAC 02B .0200? ® Yes ❑ No
➢ This would include Trout Buffered Streams per 15A NCAC 213.0202
4. Does the project comply with an individual 404 Permit or any 401 Certifications? ® Yes []No
➢ Wetland -related permits shall be requested, obtained, and adhered to for projects that impact wetlands or surface waters
➢ 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
➢ 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:
that this application for
(Professional Engineers name from Application Item Ill.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 have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6E, 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 d
Applicant's Certification per 15A NCAC 02T .0106(b):
B. C�avf* t- me,�6
(Signature Authority's name & title from Application Item I.3.)
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 143-215.613, 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.
Signature: /A i �. Date: 2q Zd
FORM: FTA 04-16 Page 5 of 5
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: Tally Pointe, LLC
Project Name for which flow is being requested: 12455,Tally Pointe
More than one FTSE map be required for a single project if the owner of the {VR'TP is not responsible for all pump
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: _
b. WWTP Facility Permit #:
are in MGD
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
h. Percent of permitted flow used
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
Fryes
WQCS00361
2.304
(A)
(B)
(C)
(D)=(B+C)
(E)=(A-D)
Design
Average
Approx.
Obligated,
Total
Dailv
Current
Not Yet
Current Flow
Flow**
Avg. Daily
Tributary
Plus
(Firm / pf).
Flory,
Daily Flow.
Obligated
Available
MGD
MGD
MGD
Flow
Capacity***
.921
.154
.211
.365
.556
* 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
(po 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): Davidson County Sewer
Downstream Permit Number: WQCS00361
Page I of 6
III. Certification Statement:
I IF.1 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.
Signing Oycial Signature
Title
Date
Page 2 of 6
g,+d ix ant'
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: Tally Pointe, LLC
Project Name for which flow is being requested: 12455,Tally Pointe
More than one FTSE may be required for a single project if the owner of tire WWTP is not responsible for all pump
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
e. WWTP facility's actual avg. flow
f. Total flow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
All flows are in MGD
21.000000
WWTP 2.982581
16.690000
0.008400
19.680981
93.7%
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 / pf),
Avg. Daily
Daily Flow,
Obligated Available
Number)
No.
MGD MGD
Flow, MGD
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
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 form certifies that the receiving collection system or treatment
works has adequate capacity to transport and treat the proposed new wastewater.
7/30/2020
Signature — Date
Capital Projects Engineer
Title of Signing Off cial
Page 2 of 6
FTSE 10-18
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Winston-Salem / Forsyth County
es
Ad
Jr "¢Water • Wastewater • Solid Waste
Administration, P.O. Box 2511, Winston-Salem, NC 27102
O: 336-727-8000, F; 336-727-8432, wskutilities.arg
July 30, 2020
Mr. Scott Leonard
913 Greensboro Street
Lexington, NC 27293
In Re: Tally Pointe Flow Acceptance
Dear Mr. Leonard:
This letter is to confirm that the City/County Utility Commission will accept the sewerage from Tally
Pointe.
We are currently treating 849,225 gallons per day. Our contract with Davidson County has a maximum
discharge of 1,500,000 gallons per day; therefore, we should encounter no problems in treating an
additional 8,400 gallons per day. This sewerage will be treated at our Muddy Creek Wastewater
Treatment Plant (NC0050342). The wastewater collection system serving this area is properly sized and
maintained for this service.
If you have any questions concerning this subject, please give me a call at (336) 747-6842.
Sincerely,
UTILIITTIES ADMINISTRATION
Todd Leyis /P.E.
Senior 5y1 Engineer
Winston-Salem/Forsyth County Utilities
EE3 City Council: Mayor Allen Joiner; Vivian H. Burks, Mayor Pro TwA,ei Northeast Ward; Denise D. Adams, North Ward; Nan Besse, Southwest Ward; Robert C. dark,
p West Ward; Jahn C. Larson, South Word; Jeff Mail rumn Northwest Ward; Annette Scippio, East Ward; lames Trri Jr., Southeast Ward; City Manager: Lee O. Ga rrily
i County Commissioners: David R. Plyler,Chair; Don Martin, Vice Chair, Fleming El- Amin; Ted Ke pia m Richa rd V.Linville; Toys McDaniel; Gloria D. Whiseohunt; Cou my
Call 311 m 336-727-8000 Manager. Dudley Wall, Jr.
Winston-Salem/Forsyth county Utility Commission: Randall 5, Tuttle, Chair; L. Wesley Curtis, Jr., Vice Chair; Harnld E. Day; Tom Griffin; Yvonne H. Hines; Deane Long;
C3jyii(;�:)pltyUilN$.01'{i Hugh WJernigan; Chris Parker; James Ruffin; Donald R. Stewart; Allan Younger
STATE OF NORTH CAROLINA
COUNTYOF DAvrNsnt4
Permit No.
DEVELOPER'S OPERATIONAL AGREEMENT
This AGREEMENT made pursuant to G.S. 143-215.1 (d1) and entered into this day of
by and between the North Carolina Environmental Management
Commission, an agency of the State of North Carolina, hereinafter known as the COMMISSION; and
ALLY i70 w-(E LL.G , a corporation/general partnership registered/licensed to do
business in the State of North Carolina, hereinafter known as the DEVELOPER.
WITNESSETH:
1. The DEVELOPER is the owner of the certain lands lying in �)411 r'%>soN County, upon
which it is erecting and will erect dwelling units and other improvements, said development to be known
as ALL`( PorNtC (hereinafter the Development).
2. The DEVELOPER desires, to construct a wastewater collection system with pumps, wastewater treatment
works, and/or disposal facilities (hereinafter Disposal System) to provide sanitary sewage disposal to serve
the Development on said lands.
3. The DEVELOPER has applied to the COMMISSION for the issuance of a permit pursuant to G.S. 143-
215.1 to construct, maintain, and operate the Disposal System.
4. The DEVELOPER has created or shall create unit ownership in said dwellings units, other improvements
and lands through filing of a Declaration of Unit Ownership (hereinafter Declaration), pursuant to Chapter
47C or 47F of the North Carolina General Statutes.
5. The DEVELOPER has caused to be formed or will cause to be formed at the time of filing of the
Declaration, �rALIY Poi.-jTE gn6 OL4,i9915 455ncr,AT)OIy (hereinafter
Association), anon -profit corporation organized and existing under and by the virtue of the laws of the State
of North Carolina, for the purpose, among others, of handling the property, affairs and business of the
Development; of operating, maintaining, re -constructing and repairing the common elements of the lands
and improvements subject to unit ownership, including the Disposal System; and of collecting dues and
assessments to provide funds for such operation, maintenance, re -construction and repair.
6. The COMMISSION desires to assure that the Disposal System of the Development is properly constructed,
maintained and operated in accordance with law and permit provisions in order to protect the quality of the
waters of the State and the public interest therein.
NOW, THEREFORE, in consideration of the promises and the benefits to be derived by each of the parties
hereto, the COMMISSION and DEVELOPER do hereby mutually agree as follows:
1. The DEVELOPER shall construct the Disposal System in accordance with the permit and plans and
specifications hereafter issued and approved by the COMMISSION, and shall thereafter properly operate
and maintain such systems and facilities in accordance with applicable permit provisions and law.
2. The DEVELOPER shall not transfer ownership and/or control of the Disposal System to the Association
until construction has been completed in accordance with the permit and approved plans, and the staff of
the Division of Water Resources has inspected and approved of the facilities. In order to change the name
of the permit holder, the DEVELOPER must request that the permit be reissued to the Association. The
request must include a copy of the Association Bylaws and Declaration.
3. The DEVELOPER shall not transfer, convey, assign or otherwise relinquish or release its responsibility for
the operation and maintenance of its Disposal System until a permit has been reissued to the DEVELOPER's
successor.
FORM: DEV 03-19 Page I oft
North Carolina )
Davidson County )
SEWER CONSTRUCTION AGREEMENT
This Agreement is made as of the day of August, 2020 by and between
DAVIDSON COUNTY; a body politic and corporate of the State of North Carolina,. hereinafter
referred to as "COUNTY", and _Talley Point, LLC hereinafter referred to as "Developer".
WHEREAS, Developer owns property located as on 'NC State Road 1511 near
Hege Road west of Sedona and wants develop a 30 lot sub -division from and it desires to have
County sewer services for said property and has agreed to pay the full costs of all construction
necessary to provide said service to the properties and to comply with the obligations set out in
this Agreement; and
WHEREAS, pursuant to the Davidson County Sewer Ordinance. the County is willing to
accept the proposed sewer extension for ownership and maintenance if it is constructed to
County standards and N.C. Department of Environment and 'Natural Resources (NCDENR)
Gravity Sewer Minimum Design Criteria;
NOW, THEREFORE, in consideration of the mutual promises herein made, it is
hereby agreed as follows:
1. Developer will proceed to construct approximately 1955 linear feet of 8" public
sanitary sewer along the property specifically identified hereinabove. The total wastewater
volume for the property is estimated at 8,400 gallons per day. The plans and construction of said
public sanitary sewer will be in compliance with and made pursuant to County's construction
standards and specifications. Construction of the sanitary sewer shall not be initiated until all
local, state and federal pennits, certifications, and approvals have been received by Developer.
2. The parties agree that the Jamestown Engineering Group, Inc. for the construction
of the public sanitary sewer.
3. A mandatory Pre -construction Conference has been held and attended by the public
utilities contractor; the engineer, and the County Public Works Inspector. Sanitary sewer
construction activities shall be coordinated with the County Public Works Inspector, as hisiher
schedule permits. Work to begin the construction of said system may begin only when the
County Public Works Inspector is on site and issues the Authorization to Construct. The County
shall require the public utilities contractor to provide evidence of current licensure and
certificate(s) of insurance acceptable to the County prior to the commencement of any
construction.
4. The performance of the contract. however, will be carried out in such a manner as
to provide inspection and certification deemed appropriate to the County that such construction
meets the requirements of the County. All sanitary sewer construction, inspection, and testing
provided by the Developer's designee will be in compliance with the state engineering
certification(s) and shall further fully comply with County standards. The County Public Works
Inspector expressly reserves the right to observe all sanitary sewer testing and shall receive
notification of testing from the public utilities contractor a minimum of two working days in
advance of such testing. All sewer mains shall become the property of the County upon notice of
acceptance by the County. Developer must obtain and assign sewer easements to the County at
no cost to the County. All sanitary sewer easements will be identified and provided on the final
recorded plat of those three tracts or in properly executed and recorded deeds. In addition, deeds
shall be provided for access easements where sewer mains are isolated due to steep stream banks
and topographic features which restrict access from the general alignment.
5. Prior to acceptance by County. County will require certification from the engineer
that the finished construction of the sewer mains is in accordance with the County approved
plans and specifications. Furthermore, acceptance will be contingent upon satisfactory
completion of all sewer testing; receipt of record drawings which meet County standards; receipt
of final plat ancUor recorded easements; completed change of ownership form for the Non -
discharge Permit; notification by NCDENR of receipt of engineer's certification and record
drawings for public sanitary sewer; notification provided to County by NCDOT that all work
within the right-of-way is completed in an acceptable manner;; and the County's receipt of the
developer's declaration of warranty covering workmanship and materials for a minimum of one
year; the contractor's waiver of lien, and the contractor's affidavit of payment for materials and
labor.
b. Developer agrees to indemnify and hold the County harmless from and against any
and all claims, actions, causes of action, demands, damages, losses. costs, expenses and
compensation of whatsoever kind or nature. which may hereafter arise on account of or in any
way growing out of the personal injuries and. or property damage and the consequences thereof
which might result from any occurrence in connection with the construction, maintenance and
services, performed by the Developer set out in this agreement between the County and the
Developer.
7. All fees and charges established by the County from tune to time will be charged
for the property or properties senTed and shall be promptly paid by Developer.
S. Developer will comply at all times with the Davidson County Sewer Ordinance, as
such may be amended fi-om time to time.
9. The parties acknowledge that several of the provisions of this contract have already
been performed in accordance with its terms and the parties stand ready to complete the
transaction by the Counties acceptance of the sewer line extension.
IN WITNESS WHEREOF, the parties hereto have made and executed this agreement as
of the day and year first above written.
ATTT:
I
beborafi Harris
Clerk to the Board of Commissioners
COUNTY OF DAVIDSON
BY:
lith S Casey
se �Iitb'
Davidson County Manager
DEVELOPER: Talley Point, LLC
"A
CJ
BY:
NORTH CAROLINA
DAVIDSON COUNTY
1, N�fr J ufi5 a Notary Public of said County and State, do
hereby certify that personally appeared before me this day and acknowledged
the execution of the fore oing instrument.
Witness my hand and notarial seal this day of 20M
r� rt
Notary Pu6ljc
My Commission Expires: 513't,51
41
i
SOSID: 2009504
Date Filed: 7/13/2020 10:13:00 AM
Elaine F. Marshall
North Carolina Secretary of State
C2020 178 00448
ARTICLES OF ORGANIZATION
OF
TALLY POINTE, LLC
Pursuant to Article 2 of Chapter 57C of the North Carolina General Statutes, the
undersigned natural persons of the age of eighteen years .or more do hereby make and
acknowledge these Articles of Organization for the purpose of establishing a limited liability
company (the "Company") under and by virtue of the laws of the State of North Carolina, and to
that end do hereby set forth the following:
ARTICLE I
The name of the Company is Tally Pointe, LLC.
ARTICLE II
The company shall exist until it has concluded all of its business.
ARTICLE III
The Company shall have the purpose of engaging in any lawful business and shall have
all the powers set forth in Section 57C-2-02 of the North Carolina General Statutes.
ARTICLE IV
The address of the initial registered office of the Company is: 6420 Hampton Knoll Road,
Forsyth County, Clemmons, North Carolina 27012, and the name of the initial registered agent
of the Company at such address is Gregory B. Garrett.
ARTICLE V
The business of the Company shall be conducted under the exclusive management of its
member(s) who shall vote according to their proportionate interest in the Company and who shall
have exclusive authority to act for the Company in all matters in accordance with the operating
agreement.
ARTICLE VI
The name and address of the organizer of the Company is: Gregory B. Garrett, 4620
Hampton Knoll Road, Forsyth County, North Carolina, 27012.
ARTICLE VII
These Articles shall be effective upon filing.
IN WITNESS WHEREOF, the undersigned has hereunto set his hand, this the a3
day of Tuna, 2020.
Gregorf B. Garrett, Organizer
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation, _DAV +bso N Ccy - +`'l
Project Nam for which flow is being requested: 12455,Tally Pointe
?More than o re FTSE may be required for a single project if the owner of the t`f'; TP is not responsible for all pump
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, WW P Facility Name:
b. WW P Facility Permit #:
c. NAV P facility's permitted flow
d. Estim ited obligated flow not yet tributary to the WWTP
e. WWTP facility's actual avg. flow
f. Total Jflow for this specific request
g. Total actual and obligated flows to the facility
h. Percent of permitted flow used
All flows are in MGD
II. Completq this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
i
List pump stations located between
the project connection point
and the WWTP:
(A)
(B)
(C) (D)=(B+C)
(E)--(A-D)
Design
Average
Approx.
Obligated, Total
Pump Pump
Daily
Current
Not Yet Current Flow
Station Station Firm
Flow; *
Ave. Daily
Tributary Plus
(Name or Permit Capacity. *
(Firm ; p0.
Flow,
Dail} Flow. Obligated
Availablc
Number) No. MGD
MGD
MGD
MGD Flow
Capacity
Fryes
WQCS00361 2.304
.921
.154
.211 .365
.5S6
* 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 anaing Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < 0.
Downstrea ; Facility Name (Sewer); Davidson County Sewer
Downstrea Permit Number: WQCS00361
Page 1 of 6
III. Certification Statement:
I � �certify to the best of my knowtedge 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 sanitaiy sewer overflows or overburden any downstream pump station en route to the receiving
treatment pla it under normal circumstances, given the implementation of the planned improvements
identified in t ie planning assessment where applicable. This analysis has been performed in accordance
with local est blished 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.
-7 /-Z
Signing 4f ial Signature Date
Title of Signi g Official
Page 2 of 6
i
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Re nesting Allocation: "DAy 11t, 5,5 N (Q u "i- I
Project N rrte for which flow is being requested: 12455,Tally Pointe
More than one FTSE maybe required fora single project if the owner of the WWTP is not responsible for all pitnrp
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. W TP Facility Name: Muddy Creek _
b. W TP Facility Permit 4: NC0050342
c. W TP facility's permitted flow
d. Est mated obligated flow not yet tributary to the WWTP
e. W TP facility's actual avg. flow
f. Tot l flow for this specific request
g. Tot I actual and obligated flows to the facility
h. Percent of permitted flow used
A11 flows are in MGD
21.000000
2.9825 81 w
16.690000
0.008400 —
19.680981
93.7%
11. Complelte 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)
Design
Pump
Pump
Average
Approx.
Station
Station
Firm Daily Flow"
Current
(Name or
Permit
Capacity, (Firm / pf),
Avg. Daily
Number)
No.
MGD MGD
Flow, MGD
(C)
Obligated,
Not Yet
Tributary
Daily Flow,
MGD
(D)=(B+C) (E)=(A-I))
Total Current
Flow Plus
Obligated Available
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)j 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
Downstrem Permit Number: WQCS00003
Page I of 6
FTSE 10-18
III. Certificaition Statement:
I Courtney Driver, P.E. certify to the best of my knowledge that the addition of
the volume cf 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 sanit ry sewer overflows or overburden any downstream pump station en route to the receiving;
treatment pl nt 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 a tablished 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 addendurris for which 1
am the responsible party. Signature of this form certifies that the receiving collection system or treatment
works has a equate capacity to transport and treat the proposed new wastewater.
tc & e
Signing Nf Oial Signature LI
Title of Sig .ing Official
7/30/2020
Date
Page 2 of 6
FTSE 10-18