WQ0042492_Application (FTSE)_20210419

Letter of Transmittal- Hiram J. Marziano, P.E.
Date: April 12, 2021
To: Department of Environmental Quality
Winston —Salem -Water Quality Section
450 W. Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
From: Hiram J. Marziano, P.E.
P. 0. Box 278
Asheboro, NC 27204
Enclosed please find the following:
1. 2 copies of application - 1 original and 1 copy for a 5 lot subdivision producing 1800 gallons per day of
flow. This project is located at the intersection of Sealy Road and Oak Knoll Drive In Archdale, NC.
2. Flow acceptance letter from the City of High Point Eastside Wastewater Plant
3. Check in the amount of $480.00 application fee
4. One street view map of project
5. One topo map with project location
Please contact me if you have any questions or comments by email [e-mail], or by phone
336-493-4450.
Thank you in advance for your review.
NC Department of
Envirorwhental Quality
(deceived
Winston-Salem
Regional Office

State of North Carolina
Department of Environmental Quality
IPWR__�01
Division of Water Resources
15A NCAC 02T .0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
"Division of Water Resources FTA 04-16 & SUPPORTING DOCUMENTATION
Application Number:
(to be completed by DWR)
All items must be completed or the application will be returned
I. APPLICANT INFORMATION:
1. Applicant's name: City of Archdale (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership
❑ Federal ❑ State/County ® Municipal
3. Signature authority's name: Zeb Holden per 15A NCAC 02T .0106(b)
Title: City Manager
4. Applicant's mailing address: 307 Balfour Drive
City: Archdale State: NC Zip: 27263-
5. Applicant's contact information:
Phone number: [phone] Email Address: zholden(garchdale-ne.gov
❑ Privately -Owned Public Utility
❑ Other
rd C Dmla,ri:meni: of
Erni;� onr;� ! �i:al Quality
Recehled
Winston-Salern
Regional Office
II. PROJECT INFORMATION:
1. Project name: Chris Cox Subdivision
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: Randolph
4. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: - °
5. Parcel ID (if applicable):
(or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Hiram J. Marziano License Number: 7707
Finn: Hiram J. Marziano, P.E.
Mailing address: P. O. Box 278
City: Asheboro State: NC Zip: 27204-0278
Phone number: [phone] Email Address: hmarzianogtriadbiz.rr.com
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Eastside W W Plant Permit Number: NCO024210
Owner Name: City of High Point
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ_ 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. 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(201)
L----*Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCAC 02T .0114(fl? ❑ Yes ❑ No
➢ If Yes, provide a copy of flow reduction approval letter
7. Summarize wastewater generated by project:
Establishment Type (see 02T.0114(f))
Daily Design Flow s'b
No. of Units
Flow
Residential
360 gal/day
5
1,800 GPD
gal/
GPD
gal/
GPD
gal/
GPD
gall
GPD
gal/
GPD
Total
1,800 GPD
a See 15A NCAC 02T 0114(b). (d), (c)(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

VH. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
8 250 PVC
➢ 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
VHI. 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: 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. Sununarize 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)(13):
➢ 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(f)):
1. Does the project comply with all separations found in 15A NCAC 02T.0305(f) & (g) ® Yes [-]No
➢ 15A NCAC 02T.0305(f) contains minimum separations that shall be provided 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, HOW, 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 basernent
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 webpage
➢ If noncompliance with 02T.0305(f) or (tt), see Section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) ® 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 15 A NCAC 02B .0200? ® Yes ❑ No ❑ N/A
➢ This would include Trout Buffered Streams per 15A NCAC 213.0202
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 & Bnffer 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 lies 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 ❑ 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

X. CERTIFICATIONS:
1. Does (Resubmitted system comply with 0A NCAC tom. the Minimum Desum Criteria for the Pornulling ofputnp Su funs
an Force ivlains tinicstycrsioai. and>he Gravity Sewer Mihimom Design Criteria iiatest vctsion) as applicable?
Z Yes ❑ No
If No, complete and submit. the Variance/Alternative Design Request application (VADC 10.14) and supporting documents
for aeviety_ Aourovrd of the request is rttt wired :prior to submittal of the Fast 'Track Anullcation and supporting
documents.
2. ProfessiorudEngineer'sCerdfiiuliion:
1, %ram'T• l`t\C\rz-\Q�nn _ attest that this applicahonfor
has been reviewed by me and is accumtc, complete and consistent with the; information supplied in the plans, specifications,
engineering calculations. and all odicrsupporting documentation to the best of my knowledge. 1 further attest that to tile best,
of my knotvledgo the proposed design has been prepared :in accordance with the applicable regulations, Gravity Setter
Minimum Design Criteria for Gravity sewers (latest version), .and time Minimum Design Criteria for :tile 'Past -Track
Permitting of Pump. Stations and Force Mains (la(est version} Although other ,professionals may have developed certain
portions of ([its submittal package, inclusion of those materials under my signature and seal signifies that 1 have reviewed this
material and lrave judged it to be consistent with the proposed design:.
NOTE — In accordance with Gencrat Statutes 143-215,6A..and 143215,6B, any person who knowingly makes any false
statement, represontation, or certili'1:a(ton in any application package shall be guilty of a Class 2:misdemeanor- which uaay
include a "fine not to exceed $10„000, as well as civil penalties up to $25,000 per violation.. ..GuuA._
North -Carolina Professimial Entdnect's semi, signature, mid date:
SUL
3: Applicant's Cedificationper 15ANC:ACO2T.p106(b): Lf/
v
that this application for
name
Luis been reviewed by ape and is accurate and complete to the best of my knowledge i understand that if all required pails of
this application are not completed and that if all requiredsupporting documentation and attachments are not hteludcd, 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,iminedtale enforcement action that may include civil penalties,
intnuctive relief, and/or criminal . prosect Lion. f will make no claim against the Division of Witter Resources should a
condition of this;pennit be violated. T also understand that if all required parts of this application package are not cotnpieted
and that if all required supporting information and attachments are not included, ibis application package will be returned to
tile as incomplete,
NOTE — la accordance with General Statutes 143-215 GA and 143-2156B- any person Who knowingly makes any false
statement, represematiott or certification in ,any application package shallbe guilty of a Class 2 misdemeanor., ivluch may,
include afine not to exceed $10.0 0 as well as civil penalties up to $25,000,per violation.
Signature; / Dale:..
FT A 04-1B Page 5 of

Public ServicesDepartment'
Terry L. Houk
DIRECTOR
April 1, 2021
NCDFNIt
Winston-Salem Regional Office
?l50 W. Banes Mill Rd, Suite 300
Winston-Salem, NC 27105
Project: Chris Cox Subdivision
City of Archdale
Applicant: City of Archdale
Dear Sir or Madam:
This is to acknowledge that the City of High Point wi11 accept for treatment in the Eastside
Wastewater Treatment Plant (Permit #NC0024210), wastewater flow from the above referenced'
project in the amount of 1,800'OPD, which will be discharged to facilities operated and
maintained by the City of Archdale, then to the City of High Point facilities,
Flows from this area be deducted from the City of Arnhdale's current capacity allotment -in
the Eastside Treatment Plant.
If further information is needed, please let me know.
Very truly your,-,,
y
Terry L, 13 k
Director of Public Services
T'Li3ltab
City of High Point, P,O, 8ax 230, 211 South Hamilton Street, High Point, NC 27261 USA
Fax:336,883.1675 Phone:[phone] TDD:336.883,8517

Ill. Certification Stwoment
1, Terry Houk cartify lathe best of my knowledge that theatdditiot of the -volt
wastewater to bepetm@tcd In this projeet has be evaluated along the roiiteto
treatment facllity and that the #low fiotn this project is not anticipated to cause;
sanitary sewer overflows or overburden any downstream pomp station of roule
it where pp
ttsted above'; in Sections I And It plus all aftnehed,planning assessment addendcnns f'or which I am they „
i'esponsiblo party. Signahue Of this forth co lifies that the recolvhrg confection systom or treatmetttworks
has adequate capacity to transport foul treat the proposed new wastewater.
I
...
3125/2021
Dale
HAu82of 6 :r•Tsf; t0.1n

l.l.
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fllvisirtal nt �i+kfrr Kr=a,+ecr+'m�-:
Application Number,
Entity Requesting Allocation: City of Arel
Project Name for which flow is being requestedl
a. WWTP Facility name:
b. WWTP Facility Porn it M
State of North Carolina
Department ofRriviroalnerrtal Quality
Dipiston of Watel- Resiturces;
Flory `i'raciti g for 801YOr Extension Applications
(FT5t 10-18)
Eastslde, WWTP
i CC0024210
;411:1i0tVsnre'irr.M�Xr ..
c. WWTP facility permitted flow,
fi, Estimate! obligated flow not yetttlibatary to tile WWTP;
o, WWTP fscifity's actual average flow:
f, Total flow for this speeifte request:
g. Tolat actual and obligated flows to the faellltyt
h, Pefeent of permitted flow used:
if. complete tills section for each pullIP MAtlon You ;in6 resporlsible for along ko rnu(o of tills
proposed
wastewater flow,
List pump stations located between tile,prOMI` connection point end the WWTP,
(A)(m (C)
(]))-(afiry
(NMA=D)
Pump Pump. Fiifn Desith Appmx; Obligated;
Stnitml stntion copae(tyl Average. curroll- Nof Yet'..
Total cwx;nt
Flow mils'
Available
i.
Fennit Dellyl'rety 'AVA. DA11y: Trlbllnty,
obligated'
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NumVtar) Norther- :(Fiie"Po" PbtV, Daily Plots;
Plitt'
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- -
can he gghloved Wall lll,e largest', line)], tahen old gfsovim
kR Design Avergko rlotr Is (fig al , onpdelly Oran, Pamp Stnaeli divided by like ptahltlif,:raelor (110 not
tens Wait2.5. pcl' Seeflen 2d020t)(4)(e);Oran, h'rlelellen Design t3rtferta.
AAk A Mantling Assernnenl mflaotlual shaft be of Inched toe Inert purep station loeniedhaf reeanfflit
twoiect eorinvalon point and the WWTr t0loYelite AVidlnhlo erancihr IRS G.
)mvnslleamFacility Namo(Siti ):
)OVY110''eatn PertnitNumber:
Page : Oro FM 10-1s

Chris Cox SD
4-�4`r Disclaimer: This map was compiled from recorded deeds, plats, and otherpublic records MaP Scale
and data. Users of this data are hereby notified that the aforementionedpublic information1 inch = 500 feet
sources should be consulted for verification ofthe information. Randolph County, its 4/12/2021
in°%' agents and employees make no warranty as to the accuracy of the information on this map.