WQ0042108_Application (FTSE)_20201110

State of North Carolina
DWR Department of Environmental Quality
/ Division of Water Resources
15A NCAC 02T .0300 — FAST TRACT{ SEWER SYSTEM EXTENSION APPLICATION
Dlvlslon of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number: b "I�IV (tobecompletedbypWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: City of Trinity NC (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County N Municipal ❑ Other
3. Signature authority's name: Debbie Hinson per 15A NCAC 02T .0I06(b)
Title: City Manager NC Department of
4. Applicant's mailing address: PO Box 50 Environmental Quality
City: Trinity State: NC Zip: 27370-_ Received
5. Applicant's contact information: NOV 10 2010
Phone number: [phone] Email Address: [e-mail] Winston-Salem
II. PROJECT INFORMATION: Regional Office
1. Project name: Steeplegate Village Phase 2 Sec. 1
2. Application/Project status: N 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: _
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.861190° Longitude:-80.034679'
5. Parcel ID (if applicable): 6797109131
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Norris Z. Clayton License Number: 10727
Firm: Hugh Creed Associates, INC., P.A.
Mailing address: 1306 W Wendover Ave
City: Greensboro State: NC Zip: 27408-_
Phone number: 336) 275-9826 Email Address: [e-mail]
IV, WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Hamby Creek W WTP Permit Number: NCO024112
Owner Name: City of Thomasville
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than W WTF):
I. Permit Nunrber(s): W00018816 Downstream (Receiving) Sewer Size: 12 inch
System Wide Collection System Permit Number(s) (if applicable): WQCS_
Owner Name(s): City of Trinity
FORM: FTA 04-16 Pagel 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 NN/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 NN/A
3. If the Applicant is a Home/Property Owners' Association, has an Operational Agreement (FORM: HOA) been attached?
❑ Yes ❑No NN/A
4. Origin of wastewater: (check all that apply):
N 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 N No
➢ If yes, provide a Copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 911.0114(fl)
Daily Design Flow ",n
No. of Units
Flow
Residental
480 gal/413edroom
17
8,160 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
8,160 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 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: _ GPD (per 15A NCAC 02T .0114)
➢ Do not include future flows or previously permitted allocations
If permitted flow is zero, indicate why:
❑ Pump Station or Gravity Sewer where flow will be permitted in subsequent permits that connect to this line
❑ Flow has already been allocated in Permit Number:
❑ Rehabilitation or replacement of existing sewer with no new flow expected
❑ Other (Explain):
FORM: FTA 04-16 Page 2 of 5

VII. GRAVITY SEWER DESIGN CRITERIA (if Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8" 450 PVC
D 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)
D Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
VIIL PUMP STATION DESIGN CRITERIA (If Applicable)—02T.0305 & MDC (Pump Stations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: 0Longitude: - °
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)(I):
❑ Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(h)(l)(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.
D 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):
1. Does the project comply with all separations found in 15A NCAC 02T.0305(f) & (e) ❑ Yes ❑ No
➢ 15A NCAC 02T.0305 contains minimum separations that shall be provided for sewers stems:
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
➢ I SA NCAC 02T.0305(e) contains alternatives where separations in 02T.0305(f) cannot be achieved.
➢ **Stream classifications can be identified using the Division's NC Surface Water Classifications webnage
➢ If noncompliance with 02T.0305(f) or (a). see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) N Yes ❑ No ❑ N/A
➢ See the Division's draft separation requirements for situations where separation cannot be meet
➢ No variance is required if the alternative design criteria specified is utilized in design and construction
➢ As built documents should reference the location of areas effected
3. Does the project comply with setbacks found in the river basin rules per 15A NCAC 02B .0200? ❑ Yes ❑ No N N/A
➢ This would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Does the project require coverage/authorization under a 404 Nationwide or []Yes ❑ No
individual permits or 401 Water Quality Certifications?
➢ Information can be obtained from the 401 & Buffer Permittinp 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 N No ❑ N/A
➢ If yes, include an attachment with details for each line, including type (aerial line, size, material, and location).
High priority lines shall be inspected by the permittee or its representative at least once every six -months and inspections
documented per ISA NCAC 02T.0403(a)(5) or the pernritee's individual System -Wide Collection permit.
FORM: FTA 04-16 Page 4 of 5

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T, the Minimum Design Criteria for the Permitting of Pump Stations
and Force Mains (latest version), and the Gravity Sewer Minimum Design Criteria (latest version) as applicable?
® Yes ❑ No
If No, complete and submit the Variance/Alternative Design Request application (VADC 10-14) and supporting documents for
review. Approval of the request is required prior to submittal of the Fast Track Application and supporting documents
2. Professional Engineer's Certification:
I, NORRIS Z. CLAYTON (HUGH CREED ASSOCIATES) attest that this application for
(Professional Engineer's name from Application Item III. L)
has been reviewed by me and is accurate, complete and consistent with the information supplied in the plans, specifications,
engineering calculations, and all other supporting documentation to the best of my knowledge. I further attest that to the best
of my knowledge the proposed design has been prepared in accordance with the applicable regulations, Gravity Sewer
Minimum Design Criteria for Gravity Sewers (latest version), and the Minimum Design Criteria for the Fast -Track Permitting
of Pump Stations and Force Mains (latest version). Although other professionals may have developed certain portions of this
submittal package, inclusion of these materials under my signature and seal signifies that I have reviewed this material and
have judged it to be consistent with the proposed design.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.613, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation.
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I Debbie Hinson, (City Manager of the City of Trinity)
(Signature Authority's name & title from
Item I.3.)
NAL
60777,
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand
this application are not completed and that if all required supporting documentation and attachm
application package is subject to being returned as incomplete. I understand that any discharge of
discharge system to surface waters or the land will result in an immediate enforcement action that r
injunctive relief, and/or criminal prosecution. I will make no claim against the Division of Water Ri
of this permit be violated. I also understand that if all required parts of this application package ar
all required supporting information and attachments are not included, this application package
incomplete.
NOTE — In accordance with General Statutes 143-215.6A and 143-215.6B, any person who k
statement, representation, or certification in any application package shall be guilty of a Class 2
include a fine not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Signature: a ��. � � Date:
io/701
that this application for
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FORM: FTA 04-16 1 Page 5 of 5

;,;.;;i- , ,i,, Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: City Of Trinity - Steeplegate Village
Project Name for which flow is being requested: Steeplegate Village Phase 2
More than one FTSE maybe required for a single project if the owner of tire WWTP is not responsible for all pump
stations along the route of theproposed wastewaterfiow.
I. Complete this section only if you are the owner of the wastewater treatment plant,
a. WWTP Facility Name: City of Thomasville Hamby Creek WWTP
b. WWTP Facility Permit #: NCO024112
All flows are in MGD
c. WWTP facility's permitted flow - 6.00
d. Estimated obligated flow not yet tributary to the WWTP 0.9345
e. WWTP facility's actual avg. flow 2.90
f. Total flow for this specific request 0.0081
g. Total actual and obligated flows to the facility 3.8426
h. Percent of permitted flow used 64.04%
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): City of Thomasville
Downstream Permit Number: WQCS00057
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I Morgan Huffman 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.
Page 2 of 6
FTSE 10-18

NC Department of
Environmental dQuality
RecState of North Carolina
MNR- NOV 10 2020 Department of Environmental Quality
Division of Water Resources
Winston-Salem
D_
Divislon of Water Resources Regional Office Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: City of Trinity
Project Name for which flow is being requested: Steeplegate Village Phase 2
More than one FTSE nmy be required for a shrgle project If the owner of the WWTP is trot responsible for all pinup
stations along the route of the proposed wastewaterJlow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name:
b. WWTP Facility Permit M
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
All flows are in MGD
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
Finn
(Name or Permit
Capacity,
Number) No.
MGD
Steeplegate
0.72
(A)
(B)
(C)
(D)=(B+C)
(E)=(A-D)
Design
Average
Approx.
Obligated,
Total
Daily
Current
Not Yet
Current Flow
Flow**
Avg. Daily
Tributary
Plus
(Firm / pf),
Flow,
Daily Flow,
Obligated
Available
MGD
MGD
MOD
Flow
Capacity***
0.288
0.18735
0.10674
0.29409
— (0.00609)
* The Firm Capacity (design flow) of any pump stanfined 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): City of Thomasville
Downstream Permit Number: WQCS00057
Page 1 of 6
=0T . I 10

III. Certification Statement:
I Debbie Hinson, City Manager 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 Official Signature
Title of Signing Off
;�3/LoZrJ
Date
Page 2 of 6
rmOV IA 10

PLANNING ASSESSMENT ADDENDUM (PAA)
Submit a planning assessment addendum for each pump station listed in Section 11 where Available Capacity is <
0.
Pump Station (Name or Number):
Given that:
a. The proportion and amount of Obligated, Not Yet Tributary Daily Flow (C) accounts for
37.06 % and 0.10674 MGD of the Available Capacity (E) in Pmnp Station
Steeplegate ; and that
b. The rate of activation of this obligated, not yet tributary capacity is currently approximately
0.0162 MGD per year; and that
c. A funded Capital Project that will provide the required planned capacity, namely
Lift Station and Force Main Improvinents is in design or under construction with
planned completion in 2024 ; and/or
d. The following applies:
The City of Trinity plans on revising their discharge to the City of High Point.
Therefore:
Given reasonably expected conditions and planning information, there is sufficient justification to allow
this flow to be permitted, without a significant likelihood of over -allocating capacity in the system
infrastructure.
I understand that this does not relieve the collection system owner from complying with G.S. 143-
215.67(a) which prohibits the introduction of any waste in excess of the capacity of the waste disposal
system.
Signing
zo
Date
Page 3 of 6
FTCF. 1()-1 R

Hugh Creed Associates, Inc. P.A.
Consulting Engineers & Land Surveyors
1306 W. WENDOVER AVENUE P.O. BOX 9623
GREENSBORO, N.C. 27408 GREENSBORO, N.C. 27429
TELE: [phone] OR [phone] FAX: [phone]
FIRM LICENSE #C-0551 E-MAIL: HCA0HUGHCREEDASSOCIATES.COM
November 6, 2020
COVER LETTER
State of North Carolina
Department of Environmental Quality
Division of Water Resources
NC
Env lonme tal Quality
artment of
Attn: Winston-Salem Regional Office —Water Quality Section Q
Received
Re: City of Thomasville NOV 10 2020
Steeplegate Village — Phase 2 Section 1 Sewer Extension
City of Thomasville Hamby Creek WWTP Winston-Salem
WWTP Facility Permit: #NC0024112 Regional Office
To Whom it May Concern,
The following package has been completed and submitted for the Sewer Extension to the City of Thomasville
Hamby Creek WWTP from an existing Subdivision, Steeplegate Village Phase 2 Section 1 (17-Lots), with an
additional 8,160 GPD. The enclosed documents include:
Cover Letter
Application Fee
FTA 04-16
FTSE 10-16
Site Map/Plan
$480.00 Check
Sincerely,
Hugh Creed Associates, Inc., P.A.
Norris Z. Clayton, P.E., P.L.S.
20 00811
SEAL `
10727
'Z�9 F1QIN - �C2
C�:i
November 6, 2020