WQ0042311_Application (FTSE)_20210205

Kimley>»Horn
Transmittal
NC Department of
Environmental Quality
Received
FEB 0 5 2021
Winston-Salem
Regional Office
Date: 02/04/2021 Job Number: 013500001
Project Name: Guilford Preparatory Academy
To: Winston- Salem Regional Office — Water Quality Section
450 W. Hanes Mill Road
Suite 300
Winston-Salem, NC 27105
421 Fayetteville Street, Suite 600
Raleigh, North Carolina 27601
TEL [phone]
We are sending these by
❑ U.S. Mail
Telephone No. 919-677-2197
® FedEx ❑ Hand Delivery
We are sending you the following items:
❑ Attached 0 Under separate cover via
O Shop drawings ® Prints/Plans ❑ Samples 0 Specifications ❑ Change Orders
No
Date
Conies Description
1
02/04/2021
1
Fast Track Sewer Application Package
2
02/04/2021
1
$480 Submittal Fee — Check #109549
3
4
6
7
8
9
10
These are transmitted as checked below:
❑ For your use 0 Approved as submitted ❑ Resubmit 0 Copies for approval
❑ As requested 0 Approved as noted ® Submit 0 Copies for distribution
® For review and comment 0 Returned for corrections 0 Return ❑ Corrected prints
Copy to: Signed: Tim Carter

NC Department of
Environmental Quality
Received
Kimley>>>Horn
FEB 0 5 2021
Winston-Salem
Regional Office
Guilford Preparatory Academy
FAST TRACK PRIVATE SEWER SYSTEM EXTENSION APPLICATION COVER LETTER
Description:
Attachments:
kimley-horn.com
The proposed development consists of 1 charter school, including a
gymnasium. The project has received a sewer flow variance from the
State allowing a reduction in flow to 7.0 gpd/student. A total sanitary
sewer flow discharge of 5,250 GPD (see section VI.7 of FTA 04-16)
has been calculated. To service the development, 225 linear feet of 8"
PVC sanitary sewer main, and sanitary sewer pump station, and 2100
linear feet of 2" PVC force main are being proposed. The applicant,
Guilford Preparatory Academy, will own and maintain the proposed
sanitary sewer extension and pump station.
1. Fast Track (Form FTA 04-16) Application
2. Copy of Fast Track (Form FTA 04-16) Application
3. NCDEQ Approved Flow Variance Letter
4. USGS topographic Map
5. Street Level Map
6. Flow Tracking Form
421 Fayetteville Street, Suite 600, Raleigh, NC 27601
919 677 2000

DWR
Division of Water Resources
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
I. APPLICANT INFORMATION:
1. Applicant's name: Guilford Preparatory Academy (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual 0 Corporation 0 General Partnership 0 Privately -Owned Public Utility
❑ Federal ❑ State/County ❑Municipal 0 Other
3. Signature authority's name: Alton A. Woods Jr. per 15A NCAC 02T .0106(b)
Tide: Director
4. Applicant's mailing address: 2210 E Cone Blvd NC Department of
Environmental Quality
City: Greensboro State: NC Zip: 27405-_ Received
5. Applicant's contact information: FEB 0 5 2021
Phone number. (336) 540-71_58 Email Address:
1L PROJECT INFORMATION:
1. Project name: Guilford Preparatory Academy
2. Application/Project, status: ® Proposed (New Permit)
0 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: Guilford
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.1125° Longitude: -79.7407°
5. Parcel ID (if applicable): 126504
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
I. Professional Engineer: Chris Bostic, PE License Number: 032582
Firm: Kimlev-Hon and Associates. Inc.
Mailing address: 421 Fayetteville St., Suite 600
City: Raleigh State: NC Zip: 27601-_
Phone number: 919 677-2000 Email Address: chris.bostic a)Jdmlev-horn.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: T.Z. Osborne WWTP Petmit Number: NC0047384
Owner Name: Citv of Greensboro
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
I. Permit Number(s): WQ Downstream (Receiving) Sewer Size: _ inch
System Wide Collection System Permit Number(s) (if applicable): WQCS
Owner Name(s):
Winston-Salem
Regional Office
FORM: FTA 04-16 Page 1 of 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 ®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
O Residential Leased
School / preschool / day care
❑ Food and drink facilities
❑ Businesses / offices / factories
❑ Retail (stores, centers, malls)
❑ Retail with food preparation/service
❑ Medical / dental / veterinary facilities
❑ Church
❑ Nursing Home
❑ Car Wash
❑ Hotel and/or Motels
❑ Swimming Pool /Clubhouse
❑ Swimming Pool/Filter Backwash
❑ Other (Explain in Attachment)
5. Nature of wastewater : 100 % Domestic/Commercial _% Commercial
% Industrial (See 15A NCAC 02T .0103(20))
3,Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Has a flow reduction been approved under 15A NCAC 02T .0114(fl? ® Yes ❑ No
> If yes. provide a copy of flow redaction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(fl)
Daily Design Flow nib
No. of Units
Flow
School with Cafeteria and Gym
7 gal/student
750
5250 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal/
GPD
Total
5250 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 ISA NCAC 02T .0114(c), design flow rates for establishments not identified [in table I5A NCAC 02T.01141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 5250 GPD (per 15A NCAC 02T .0114)
i 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

VH. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T.0305 & MDC (Gravity Sewers):
I. Summarize gravity sewer to be permitted:
Size (inches)
Length (feet)
Material
8
225
PVC
6
25
PVC
i Section II & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
i Section III contains information related to minimum slopes for gravity sewer(s)
i Oversizing lines to meet minimum slope requirement is net 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: Guilford Prep Pump Station
2. Approximate Coordinates (Decimal Degrees): Latitude: 36.1122° Longitude:-79.7408°
3. Design flow of the pump station:0.0432millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): 30 gallons per minute at 75 feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
2
2100
PVC
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)(IXC)
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 (drat) 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 — (0213.0200 & 15A NCAC 02T .0305(0):
1. Does the project comply with all separations found in 15A NCAC 02T .0305(f & (g)
i 15A NCAC 02T.0305(f) contains minimum senarations tbat shall be provided for sewer systems:
NYes No
Setback Parameter*
Separation Required
24 inches
Storm sewers and other utilities not listed below (vertical)
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
**My private or public water supply source, including any wells, WS-1 waters of Class I or
Class 11 impounded reservoirs used as a source of drinking water
100 feet
**Waters classified WS (except WS-I or WS-V), 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(2) contains alternatives where separations in 02T.0305(f1 cannot be achieved.
i **Stream classifications can be identified using the Division's NC Surface Water Classifications weboaae
i 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) N Yes ❑ No ❑ N/A
i See the Division's draft separation requirements for situations where separation cannot be meet
i No variance is required if the alternative design criteria specified is utilized in design and construction
i 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 0213 .0200? / 1 Yes ❑ No ❑ N/A
i This would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Does the project require coverage/authorization under a 404 Nationwide or
individual permits or 401 Water Quality Certifications?
i Information can be obtained from the 401 & Buffer Permitting Branch
❑ Yes 0 No
5. Does project comply with 15A NCAC 02T.0105(c)(6) (additional permits/certifications)? N 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 I5A 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 15A NCAC 02T.0403(a)(5) or the permitee's individual System -Wide Collection permit.
FORM: FTA 04-16 Page 4 of 5

CERTIFICATIONS:
1. Does the submitted system comply with I5A NCAC 02T, the Minimum Design Criteria for the Permitting of Pumo Stations
and Force Mains (latest version) and the Gravity Sewer Minimum Design Criteria (latest version). as applicable?
ElYes No
1f No, complete and submit the Variance/Alternative Design Request application (VADC 10-14) and supporting documents for
review. A.00roval of the rearrest is required prior to submittal of the Fast Track Appllcatioo and supporting documents.
2. Professional Engineer's Certification:
r' al Hr 6 • a t attest that this application for
I, Ch.
(Pro tonal Engineer's name from Application Item IIL1.)
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 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation.
North Carolina Professional Engineer's seat, signature, and date:
3. Applicants Certification
gper I5A NCAC 02T .0106(b):((( i
I, ttiit5r1 �J42ds & 2i L ertfd
(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-
discltargo 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:
attest that this application for
Date: arch
FORM: FTA 04-16 Page 5 of 5

DWR
Division of Water Resources
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
L APPLICANT INFORMATION:
1. Applicant's name: Guilford Preparatory Academy (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual Corporation ❑ General Partnership
0 Federal ❑ State/County ❑ Municipal
3. Signature authority's name: Alton A. Woods Jr. per 15A NCAC 02T .0106(b)
Title: Director
4. Applicant's mailing address: 2210 E Cone Blvd
City: Greensboro State: NC Zip: 27405-__
5. Applicant's contact information:
Phone number: (336) 540- Email Address:
IL PROJECT INFORMATION:
1. Project name: Guilford Preparatory Academy
❑ Privately -Owned Public Utility
0 Other
NC Department of
Enviro Received uallty
FEB 0 5 2021
Winston-Salem
Regional Office
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: Guilford
4. Approximate Coordinates (Decimal Degrees): Latitude: 36.1125° Longitude: -79.7407°
5. Parcel ID (if applicable): 126504
(or Parcel ID to closest downstream sewer)
I11. CONSULTANT INFORMATION:
1. Professional Engineer: Chris Bostic, PE License Number: 032582
Firm: Kimlev-Hon and Associates. Inc.
Mailing address:421 Fayetteville St. Suite 600
City: Raleigh State: NC Zip: 27601-
Phone number: [phone] Email Address: chris.bostic(akimlev-hom.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: T.Z. Osborne WWTP Permit Number: NC0047384
Owner Name: City of Greensboro
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WO Downstream (Receiving) Sewer Size: _ inch
System Wide Collection System Permit Number(s) (if applicable): WQCS_
Owner Name(s):
FORM: FTA 04-16 Page 1 of 5

VL GENERALREQULREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ❑No EN/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 EN/A
3. If the Applicant is a Home/Property Owners' Association has an Operational Agreement (FORM: HOA) been attached?
❑ Yes ❑No EN/A
4. Origin of wastewater. (check all that apply):
❑ Residential Owned
O Residential Leased
E School / preschool / day care
❑ Food and drink facilities
❑ Businesses / offices / factories
❑ Retail (stores, centers, malls)
❑ Retail with food preparation/service
❑ Medical / dental / veterinary facilities
❑ Church
❑ Nursing Home
❑ Car Wash
❑ Hotel and/or Motels
❑ Swimming Pool/Clubhouse
❑ Swimming Pool/Filter Backwash
0 Other (Explain in Attachment)
5. Nature of wastewater : 100 % Domestic/Commercial _% Commercial
% Industrial (See 15A NCAC 02T .0103(20))
Hs there a Pretreatment Program in effect? ❑ Yes 0 No
6. Has a flow reduction been approved under 15A NCAC 02T .0114(fl? E Yes ❑ No
p If yes. provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(t))
Daily Design Flow iyb
No. of Units
Flow
School with Cafeteria and Gym
7 gal/student
750
5250 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gal
GPD
gal/
GPD
Total
5250 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 facili ies 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 .01I4(c), design flow rates for establishments not identified [in table 15A NCAC 02T.01141 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
8. Wastewater generated by project: 5250 GPD (per 15A NCAC 02T .0114)
v 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
225
PVC
6
25
PVC
• Section II & DI of the MDC for Permitting of Gravity Sewers contains information related to design criteria
i Section III contains information related to minimum slopes for gravity sewer(s)
i 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 TILLS PROJECT
I. Pump station number or name: Guilford Prep PUMP Station
2. Approximate Coordinates (Decimal Degrees): Latitude: 36.1122° Longitude: -79.7408°
3. Design flow of the pump station:0.0432millions gallons per day (firm capacity)
4. Operational point(s) of the pump(s): 30 gallons per minute at 75 feet total dynamic head (TDB)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches)
Length (feet)
Material
2
2100
PVC
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
i 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):
i 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 timefrarnes, shall be provided
in the case of a multiple station power outage.
FORM: FTA 04-16 Page 3 of 5

IX. SETBACKS & SEPARATIONS — (028 .0200 & 15A NCAC 02T .0305(f)):
1. Does the project comply with all separations found in 15A NCAC 02T .0305(0 & (g)
i 15A NCAC 02T.0305(f) contains minimum separations that shall be provided for sewer systems:
® Yes ❑ No
Setback Parameter*
Separation Required
24 inches
Storm sewers and other utilities not listed below (vertical)
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 Il 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 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 embanlanent 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 I5A NCAC 02T.0305(g) contains alternatives where separations in 02T.0305(f) cannot be achieved.
i **Stream classifications can be identified using the Division's NC Surface Water Classifications webpage
i 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 ❑ N/A
i See the Division's draft separation requirements for situations where separation cannot be meet
i No variance is required if the alternative design criteria specified is utilized in design and construction
Y 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/A
i This would include Trout Buffered Streams per 15A NCAC 2B.0202
4. Does the project require coverage/authorization under a 404 Nationwide or
individual permits or 401 Water Quality Certifications?
i Information can be obtained from the 401 & Buffer Permitting Branch
❑ Yes ®No
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 I5A 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 ❑ N/A
i 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 I5A NCAC 02T. the Minimum Desian Criteria for e Penult -tine of Pump Stations
and Force Mains (latest version) and the Gravity Sewer Minimum Design Criteria (latest versionl as applicable?
Yes ❑ No
1f No, complete and submit the Variance/Alternative Design Request application (VADC 10-14) and supporting documents for
review. gpproval of the request is required prior to submittal of the Fast Track Application and supporting documents,
2. Professional Engineer's Certification:
1, CW' + 4.v 6. 1g ti;
(Profe tonal Engineer's name from Application Item 1II.1.)
attest 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 143-215.6B, any person who knowingly makes any false
statement, representation, or certification in any application package shall be guilty of a Class 2 misdemeanor, which may
include a fine not to exceed $10,000, as well as civil penalties up to $25,000 per violation.
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per I5A NCAC 02T .0106(b):
I, 161 f,Jt ds &Pk (ead.Clna.1r
(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 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:
attest that this application for
Date: PM
FORM: FTA 04-16 Page 5 of 5

2/4/2021 North Carolina Secretary of State Search Results
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Limited Liability Company
Legal Name
Guilford Prep Holdings, LLC
Information
Sosld: 2064392
Status: Current -Active 0
Date Formed: 10/9/2020
Citizenship: Domestic
Annual Report Due Date: April 15th
CurrentAnnual Report Status:
Registered Agent:.i,
Addresses
lR 6,1111 4. ,JN f,'t:
Mailing Principal Office Reg Office
2210 East Cone Blvd 2210 East Cone Blvd 2210 East Cone Blvd
Greensboro, NC 27405 Greensboro, NC 27405 Greensboro, NC 27405
Reg Mailing
2210 East Cone Blvd
Greensboro, NC 27405
Company Officials
All LLCs are managed by their managers pursuant to N.C.G.S. 57D-3-20.
Member
Guilford Charter School Corp.d/b/a
2210 East Cone Blvd
Greensboro NC 27405
https://www.sosnc.gov/online_services/search/Business_Registration_Results 1/1

ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. DANIEL SMITH NORTH CAROLINA
Director Environmental Quality
December 3, 2020
Alton A. Woods, Jr., Board Chair
Guilford Charter School Corp.
2210 E. Cone Boulevard
Greensboro, NC 27605
Subject: Flow Reduction Request Approval
Guilford Preparatory Academy
Guilford County
Dear Mr. Woods,
On June 22, 2020, with additional information received on September 18, 2020, the Division of
Water Resources (Division) received a request for an adjusted daily sewage flow rate (flow
reduction) for the proposed Guilford Preparatory Academy located in Guilford County, NC. The
letter requested an allowable flow rate of 3.11 gallons per day (gpd) per student.
In accordance with 1SA NCAC 02T.0114(f)(2), the Division has evaluated the request using the data
submitted and Division of Water Infrastructure (DWI) guidance. The evaluation was based on the
water meter readings and monthly water usage provided for the comparable TRIAD Math and
Science Academy from December 2018 to November 2019. The data was used to determine the
highest flow month. The highest typical flow month was estimated to be March 2019, and the
gpd/student was calculated using the number of school days and the total number of students.
Based on a detailed evaluation of the provided data, the Division hereby grants a reduction in
flow to 7.0 gpd/student for the proposed Guilford Preparatory Academy facility. This flow
reduction shall not apply to sewer extension applications and/or permits for any other facilities
or any other public/private organizations.
Future sewer extension applications should be made using the flow reduction amount stated above.
All other aspects of the permitting process remain unchanged, and all applications must be in
compliance with the statues, rules, regulations and minimum design criteria as certified by the
owner and engineer.
Regardless of the adjusted design daily wastewater flow rate, at no time shall the wastewater flows
exceed the effluent limits defined in the permit for the treatment facility or exceed the capacity of
the sewers downstream of any new sewer extension or service connection(s).
D_E
DIP: IWO munwmanw0UNry _
NORTH CAROL INA
North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 11617 Mail Service Center I Raleigh. North Carolina 27699-1617
919.707.9000

Guilford Preparatory Academy
Adjusted Daily Sewage Flow Design Rate
The granting of this flow reduction does not prohibit the Division from reopening, revoking,
reissuing and/or modifying the flow reduction as allowed by the laws, rules, and regulations
contained in 15A NCAC 02T, NCGS 143-215.1, or as needed to address changes in State and/or
Federal regulations with respect to wastewater collection systems, protection of surface waters
and/or wastewater treatment.
If you have any questions, please contact Kristin Litzenberger at [phone], or via email at
[e-mail].
Sincerely,
EDocu-tby: µ�,�,
Signed
isjJ� ��
99AEF363909A40E...
forS. Daniel Smith
Director, Division of Water Resources
by Christyn L. Fertenbaugh, P.E.
Municipal Permitting Unit
Cc: Tim Carter, E.I., Kimley-Horn ([e-mail])
Winston-Salem Regional Office, Water Quality Regional Operations
Municipal Permitting Unit (electronic copy)

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Guilford Preparatory Academy
Street Level Map

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Water Resources Department
Engineering Division
Flow Tracking/Acceptance for Sewer Extension Permit Applications
(COG-FTSE-10/07)
GREENSBORO
Permit Number: N/A
Project Applicant Name: Guilford Preparatory Academy
Project Name for which flow is being requested: 2240 E Cone Blvd
More than one COG-pTSE-/0/07 may be required for a single projec/ ifthe owner of the fJIVTP isnot responsible for all pump stations along the rouse of the
proposed wastewaterflow, Flow acceptance is contingent upon City Council approval.
The Flow Tracking/ Acceptance Permit is valid for a period of one year from the dale of issuance. Failure to renew the permit prior to the expiration date, by
submission ofa revised application, will resndl in relinquishment of any waste woterflow allocated for the project in question. A revised application must be
submitted to Water Resources Department ifflow conditions or development plans change other than what was slated Mike original application.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: T.Z. Osborne Water Reclamation Facility
b. WWTP Facility Permit Number: NC0047384
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
40.0000
CS • 0.3450 SIU - 1.4223
33.36008583
0.00525
35.1326
87.83
II. Complete this section for each pump station you are responsible for along the route of this proposed wastewater flow.
Are there any pump stations affected? Yes
List pump stations located between the project connection point and the WWTP
Pump Station Name Approx. Capacity, MGD Approx. Current Avg.
(Firm/Design) Daily Flow, MGD
NB Transfer Station 0 0
Not Applicable nth n/a
Not Applicable n/a n/a.
Not Applicable n/a n/a
III. Certification Statement:
I, Wendy Messer certify that, to the best of my knowledge, 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 downstreatn pump stations enroute to the receiving treatment plant. 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 for which I am the responsible party. Signature of this form indicates acceptance of
this wastewater flow.
12/30/2020
Signing Official Signature Date