WQ0015355_Application (FTSE)_20210513

NC Department of
Environrrierrtai Duality
Received
Winston-Salem
Regional OiYice
Jenny Graznak
Mike Mickey
NCDEQ— Division of Water Resources
Winston Salem Regional Office
450 W. Hanes Mill Road, Suite 300
Winston Salem, North Carolina 27105
Ms. Graznak/Mr. Mickey:
DAMS • MARTIN • POWELL dmp
ENGINEERS & S.0 RVEYORS
May 6, 2021
Re: Davie County Schools
Pinebrook Elementary School
Permit Modification Request
Existing Permit No: WQ0015355
DMP Project 200201 (BF)
Davis • Martin • Powell & Associates is pleased to submit the enclosed permit modification application
on behalf of Davie County Schools regarding the Pinebrook Elementary School Pump Station.
When originally designed & permitted, the Pinebrook Elementary pump station forcemain was routed
along the outer edge/perimeter of the Vulcan Materials Smith Grove Quarry located on Farmington Road.
Since the original construction, the quarry operations have grown and expanded requiring a
relocation/extension of the existing forcemain in orderto accommodate planned expansion of operations.
Modifications to the existing pump station will not be required for the proposed forcemain relocation.
Davie County Schools is requesting a modification to Permit No. WQ0015355 for the following:
• Installation of 6,700 LF of 4" forcemain
In support of the modification request, please find enclosed the following:
• Two (2) executed Fast Track Applications for Gravity Sewers, Pump Stations and Forcemains
• Two (2) copies of color USGS quad map and street level map
• Copy of current permit
• $480 review fee (Check No. 1000527989)
We trust this information is complete, however, should you have questions or require additional
information please do not hesitate to contact our office.
Sincerely,
DAVIS • MARTIN • POWELL & ASSOCIATES
t",.�
Ben Palmer, PE
C: Mr. Michael Spillman, Davie County Schools (enc)
Mr. Tony Johnson, Vulcan Materials Company (enc)
File (enc)
P:1202012002011PermitslSewerJ200201-Pinebrook PS Permit Mod Xmittal.docx
T: 336-886-4821 • F: 336-886-4458 • License: F-0245
6415 Old Plank Road, High Point, NC 27265 • www.dmp-inc.com

State of North Carolina
Department of Environmental Quality
DWR 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: Davie County Schools (company, municipality, HOA, utility, etc.)
2.
Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/ u ❑ Municipal ❑ Other
3.
Signature authority's name %Al // per 15A NCAC 02T ,0106(b)
Title bCt(g/ d�/ / �/ -C i
4.
Applicant's mailing address: 220 Cherry Street
City: Mocksville State: NC Zip: 27028-
5.
Applicant's contact information:
Phone number: [phone] Email Address: /77q/7/y/®(�4///fo. �40K
H. PROJECT INFORMATION:
1.
Project name: Pinebrook Elementary School - Forcemain Relocation Project
2.
Application/Project status: ❑ Proposed (New Permit) ® Existing Permit/Project
If a modification, provide the existing permit number: WQ0015355 and issued date: June 15, 1998
If new construction but part of a master plan, provide the existing permit number: W000
3.
County where project is located: Davie
4.
Approximate Coordinates (Decimal Degrees): Latitude: 35.9681' Longitude:-80.5319'
5.
Parcel ID (if applicable):
(or Parcel ID to closest downstream sewer)
N!C Department of
III. CONSULTANT
INFORMATION:
Environmental Quality
Received
1.
Professional Engineer: Benjamain A. Pahner License Number: 25496
Firm: Davis -Martin -Powell
�IAIJ 2 eg
"1��� 10 r;�.daY
Mailing address: 6415 Old Plank Road
W i n st:o n-Salem
City: High Point State: NC Zip: 27265-
Regional Office
Phone number: 336 886-4821 Email Address: [e-mail]
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
1. Facility Name: Dutchman's Creek WWTF Permit Number: NCO021491
Owner Name: Town of Mocksville
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF):
1. Permit Number(s): WQ Downstream (Receiving) Sewer Size: 8 inch
System Wide Collection System Permit Number(s) (if ap lin cable): WQCS
Owner Name(s):
FORM: FTA 04-16 Page 1 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: FICA) 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(t))
Daily Design Flow a,n
No. of Units
Flow
School
12 gal/day/student
700
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)(l) 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.01141 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: WO0015355
❑ 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 & AMC (Gravity Sewers):
1. Summarize gravity sewer to be permitted:
Size (inches) Length (feet) Material
➢ 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:
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
4 -inch
6,700
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)(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 — (0213.0200 & 15A NCAC 02T.0305(f)):
1. Does the project comply with all separations found in 15A NCAC 02T.0305(f) & (g)
➢ 15A NCAC 02T.0305 contains minimum separations that shall be provided for sewers stems:
® Yes ❑ No
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
36inches
➢ 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 (a). 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 15A NCAC 02B .0200? ❑ Yes ❑ No ® 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 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 ❑ 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 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:
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 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):
CL.jl�rir attest that this application for
i nature Authority's name &title from pplication Item L3.)
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 143-215.6B, 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.
Date: --7L'—
FORM: FTA 04-16 Page 5 of 5

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State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
Mr. W.G. Potts, Director of Auxiliary Services
Davie County Schools
220 Cherry Street
Mocksville, North Carolina 27028
Dear Mr. Potts:
IONIA
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL REsouRCEs
July 15, 1998
Subject: Permit No. WQ0015355
Pinebrook Elementary School
Davie County Schools
Wastewater Collection System
Davie County
In accordance with your application received May 14, 1998, we are forwarding herewith Permit No.
W00015355 dated July 15, 1998, to Davie County Schools for the construction and operation of the subject
wastewater collection extension.
This permit shall be effective from the date of issuance until rescinded and shall be subject to the
conditions and limitations as specified therein.
If any parts, requirements, or limitations contained in this permit are unacceptable, you have the right to
request an adjudicatory hearing upon written request within thirty (30) days following receipt of this permit. This
request must be in the form of a written petition, conforming to Chapter 150B of the North Carolina General
Statutes, and filed with the Office of Administrative Hearings, P.O. Drawer 27447, Raleigh, NC 27611-7447.
Unless such demands are made this permit shall be final and binding.
One set of approved plans and specifications is being forwarded to you. If you need additional information
concerning this !natter, please contact Ms. Joni Cardin at [phone] extc n3ion 509.
Sincere
,/, A. Preston Howard, Jr., P.E.
cc: Davie County Health Department
Winston Salem Regional Office, Water Quality Section
a4m aam , -welt Aso InG 'i

NORTH CAROLINA
ENVIRONMENTAL MANAGEMENT COMMISSION
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
RALEIGH
WASTEWATER COLLECTION PERMIT
In accordance with the provisions of Article 21 of Chapter 143, General Statutes of North Carolina as amended,
and other applicable Laws, Rules, and Regulations
PERMISSION IS HEREBY GRANTED TO
Davie County Schools
Davie County
FOR THE
construction and operation of approximately 15 linear feet of 8-inch gravity sewer, a 100-GPM pump station with
duplex pumps, a standby generator, on -site audible and visual high water alarms, and approximately 5780 linear
feet of 4-inch force main to serve Pinebrook Elementary School, and the discharge of 8,400 GPD of collected
domestic wastewater into the Town of Mocksville's existing sewerage system, pursuant to the application
received May 14, 1998, and in conformity with the project plan, specifications, and other supporting data
subsequently filed and approved by the Department of Environment and Natural Resources and considered a part
of this permit.
This permit shall be effective from the date of issuance until rescinded and shall be subject to the following
specified conditions and limitations:
1. This permit shall become voidable unless the facilities are constructed in accordance with the conditions of
this permit, the approved plans and specifications, and other supporting data.
2. This permit is effective only with respect to the nature and volume of wastes described in the application
and other supporting data.
3. The facilities must be properly maintained and operated at all times.
4. The sewage and wastewater collected by this system shall be treated in the Dutchman's Creek Wastewater
Treatment Facility (NC0021491) prior to being discharged into the receiving stream.
5. This permit is not transferable. In the event there is a desire for the facilities to change ownership, or there
is a name change of the Permittee, a formal permit request must be submitted to the Division of Water
Quality (Division) accompanied by an application fee, documentation from the parties involved, and other
supporting materials as may be appropriate. The approval of this request will be considered on its merits
and may or may not be approved.
6. Construction of the sewers, pump station(s) and force main shall be scheduled so as not to interrupt service
by the existing utilities nor result in an overflow or bypass discharge of wastewater to the surface waters of
the State.

Upon completion of construction and prior to operation of this permitted facility, a certification must be
received from a professional engineer certifying that the permitted facility has been installed in accordance
with this permit, the approved plans and specifications, and other supporting materials. If this project is to
be completed in phases and partially certified, you shall retain the responsibility to track further
construction approved under the same permit, and shall provide a final certificate of completion once the
entire project has been completed. Mail the Certification to the Non -Discharge Permitting Unit, P.O. Box
29535, Raleigh, NC 27626-0535.
8. A copy of the approved plans and specifications shall be maintained on fileby the Permittee for a minimum
of five years from the date of the completion of construction.
9. Failure to abide by the conditions and limitations contained in this permit may subject the Permittee to an
enforcement action by the Division, in accordance with North Carolina General Statute 143-215.6A to 143-
215.6C.
10. The issuance of .his permit does not preclude the Permittee from complying with any and all statutes, rules,
regulations, or ordinances which may be imposed by other government agencies (local, state, and federal)
which have jurisdiction.
11. The Permittee shall provide for the pump station and force main the following items:
a. Pump on/off elevations located so that 2-8 pumping cycles may be achieved per hour in the pump
station,
b. An air relief valve located at all high points along the force main,
c. A screened vent for the wet well,
d. Fillets located in the wet well at the intersection of the flooring and sidewalls,
e. Three feet of cover (minimum) over the force main or the use of ferrous material where three feet
cannot be maintained,
f. Sufficient devices which will protect the pump station from vandals, and
g. Flood protection if the pump station is located below the 100-year flood elevation.
12. In the event that the facilities fail to perform satisfactorily, including the creation of nuisance conditions, the
Permittee shall take immediate corrective action, including those as may be required by this Division, such
as the construction of additional or replacement wastewater collection facilities.
13. NONCOMPLIANCE NOTIFICATION:
The Permittee shall report by telephone to the Winston Salem Regional Office, telephone number (336)
771-4600, as soon as possible, but in no case more than 24 hours or on the next working day following the
occurrence or first knowledge of the occurrence of either of the following:
a. Any process unit failure, due to known or unknown reasons, that renders the facility incapable of
adequate wastewater transport, such as mechanical or electrical failures of pumps, line blockage or
breakage, etc.; or
b. Any failure of a pumping station or sewer line resulting in a by-pass directly to receiving waters
without treatment of all or any portion of the influent to such station or facility.
Persons reporting such occurrences by telephone shall also file a written report in letter form within five (5)
days following first knowledge of the occurrence. This report must outline the actions taken orproposed to
be taken to ensure that the problem does not recur.

14. This permit shall become voidable unless the agreement between Davie County Schools and the Town of
Mocksville for the collection and final treatment of wastewater is in full force and effect.
15. The Operational Agreement between the Permittee and the Environmental Management Commission is
incorporated herein by reference and is a condition of this permit. Noncompliance with the terms of the
Operational Agreement shall subject the Permittee to all sanctions provided by North Carolina General
Statute 143-215.6A to 143-215.6C for violation of or failure to act in accordance with the terms and
conditions of this Permit.
Permit issued this thyTifteenth day of July, 1998
NORTH
MANAGEMENT COMMISSION
A. Preston Howard, Jr., P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission
Permit Number WO0015355