WQ0042512_Application (FTSE)_20210503

THE COMPLETED APPLICATION PACKAGE INCLDING ALL SUPPORTING INFORMATION AND
MATERIALS, SHOULD BE SENT TO THE APPROPRIATE REGIONAL OFFICE:
REGIONAL OFFICE
ADDRESS
COUNTIES SERVED
Asheville Reaional Office
2090 US Highway 70
Avery, Buncombe, Burke, Caldwell, Cherokee,
Water Quality Section
Swannanoa, North Carolina 28778
Clay, Graham, Haywood, Henderson, Jackson,
(828) 2964500
Macon, Madison, McDowell, Mitchell, Polk,
[phone] Fax
Rutherford, Swain, Transylvania, Yancey
Fayetteville_Reaional Office
225 Green Street Suite 714
Anson, Bladen, Cumberland, Harnett, Hoke,
Water Quality Section
Fayetteville, North Carolina 28301-5094
Montgomery, Moore, Robeson, Richmond,
[phone]
Sampson, Scotland
[phone] Fax
Mooresville Realonal Office
610 E. Center Avenue
Alexander, Cabarrus, Catawba, Cleveland,
Water Quality Section
Mooresville, North Carolina 28115
Gaston, Iredeil, Lincoln, Mecklenburg, Rowan,
[phone]
Stanly, Union
[phone] Fax
Raleigh Reaional Office
1628 Mail Service Center
Chatham, Durham, Edgecombe, Franklin,
WaterQuality Section
Raleigh, North Carolina 27699-1628
Granville, Halifax, Johnston, Lee, Nash,
[phone]
Northampton, Orange, Person, Vance, Wake,
[phone] Fax
Warren, Wilson
Washington Regional Office
943 Washington Square Mail
Beaufort, Berne, Camden, Chowan, Craven,
Water QuIllbf Section
Washington, North Carolina 27889
Currituck, Date, Gates, Greene, Hertford, Hyde
[phone]
Jones, Lenoir, Martin, Pamlico, Pasquotank,
[phone] Fax
Perquimans, Pitt, Tyrrell, Washington, Wayne
Wilminaton Regional Office
127 Cardinal Drive Extension
Brunswick, Carteret, Columbus, Duplin, New
Water Quality Section
Wilmington, North Carolina 28405
Hanover, Onslow, Pender
[phone]
(910) 351 -2004 Fax
Winston-Salem Rellional Office
450 W. Hanes Mill Road
Alamance, Allegheny, Ashe, Caswell, Davidson,
Water Quality Section
Suite 300
Davie, Forsyth, Guilford, Rockingham, Randolph,
Winston-Salem. North Carolina 27105
Stokes, Surry, Watauga, Wilkes, Yadkin
[phone]
INSTRUCTIONS FOR FORM: FTA 04-16 & SUPPORTING DOCUMENTATION Page 3 of 3

DWR
Division of Water itesources
State of North Carolina
Department of Environmental Quality
15A
Division of Water Resources
NCAC 02T'0300 — FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
��II 1*TA 04-16 & SUPPORTING DOCUMENTATION
Application Number t!Q
(to br complete by nwRl
All ItLqLtjRq1Lhr 1 r
_gap,,
n t
1• APPLICANT INFORMATION:
I • Applicant's name: tin County (company, municipality,HOA utili
h'. etc.) Z• Applicant
type: ❑ Individual ❑ Corporation
❑ General Partnership El Privately -Owned Public Utility
❑ Federal ®StatrJCoun
h' ❑ Municipal ❑ Other
3. Signature authority's name: ris per I SA NCAC`
02T .0106r1,1
Title: P li ill 'c i
4. Applicant's mailing address: 1530 L1S Hi hwa i
City: Y ur asyillc State: NC
5• Applicant's contact information: zip: Z7_396-
Phone number. (LID 55 177 Email Address: —QdQ-k9M9!fi-ank1incountvncus
If. PROJECT INFORMATION:
1. Project name: Wi r
Z• Application/Prnjcct status:
® Proposed (New Permit)
If a modification, provide the existing� Existing Permit/Projtxt
Permit number. WQ00_ and issuod date If new construction but part of master plan, Provide the existing P , P g permit number: W 3. County where project is located: j~� Q
rank in
4• Approximate Coordinates (Decimal
fig ) Latitude: 26,952= Longitude- -7 .SU 9
5. Parcel lD(if applicable): � '
(or Parcel [p to closest downstream sewer)
III. CONSULTANT INFORMATION:
1. Professional Engineer: Brian 'Kan License Number. 437461i
Finn: c
Mailing address: POD$ l Q
City: R Ics 'Ile State: ICC Zip: 275a-
Phonc number Zg2 2
j1� Email Address:
Wkanc@JenauW core+
IV. WASTEWATER TREATMENT FACILITY (WWTF) INFORMATION:
I . Facility Name: Fra tin oun Wast
ter Tree t Facili Permit Number. NQQgLq11j
Owner Name: F nkli un Pu tic tiliti
V. RECEIVING DOWNSTREAM SEWER INFORMATION (if different than WWTF);
1. Pemtit Number(s): W Op g Downsfam
(Receiving) Sewer Size: $ inch
SyNtem Wi Col!
euiu—lyhu�m Rermit N�mbc:#�t •ifa�cablc�: WQCS 17
Owner Name(s): fiC�unty Public i rrirrl..�
FORM: FTA 04-16
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Page I of 5

V1, GENERAL REQUIREMENTS
1. If the Applicant is a Privately -Owned Public Utility, has a Certificate of Public Convenience and Necessity been attached?
❑ Yes ONO ®N/A
2. If the Applicant is a Developer of lots to be sold, has a Develo O rational •---lent FO V been altaclted?
❑ Yes ❑No ®N/A
3. If the Applicant is a Home Ouncr�' s. taut n h3s n earl nal r[e cnt F R . H
been attached?
❑ Yes ❑No ®N/A
4. Origin of wastewater. (check all that apply}:
® Residential Owned ❑ Retail (stores, centers, malls}
❑ Residential [.cased ❑Car Wash
❑ Retail with food prcparation/serviec ❑ Hotel and/or Motels
❑ School / preschool / day care ❑ Medical / dental / veterinary facilities
❑ Food and drink facilities ❑Church El Swimming Pool /Clubhouse
❑ Businesses / Ofi`ices / factories ❑ Nursing Home ❑Swimming (Explain
in Attachment)
Backwash
❑ Other (Explain in Attachment)
5. Nature of wastewater: 100 % Domestic/COrnmereial
—210 Commercial
% Industrial { cc I SA NCA 02T .0I0 20
—Is there a Pretreatment Program in effect? ❑ Yes ❑ No
6. Hasa flow reduction been approved under 15A NCACo2T.011 ? ® Ycs ❑ No
D IfVe& DrovidencopyOffl, w Mduction approval lett r
7. Summarize wastewatergenerated by project:
Establishment Type (see Rum 14
110 Single Family Homes
Daily Design Flow BA lNo, of Units Flow
250 gal/day
110 27,500 GPD
gal/
GPD
gall
GPD
gal/
GPD
gav
GPD
gall
GPD
Tots! 27,500 GPD
a See 1 A A 02T .)114 d c 1 and c 2 for caveats to wastewater design flow rates (i.e., minimum now per
dwelling; proposed unknown non-residcntiaf 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. . 42A4).
b Per 15A NCAC 02T .0114(c), design now rates for establishments not identified [in table I SA CAC 02T_0 i 14 shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data. 8. Wastewater generated by project: 22.10 GPD (per. 15A N A 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

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - 02T .0305 & MDC (Gravity Sewers):
[. Summarize gravity sewer to be permitted;
Size (inches) Length (feet) Material
$ 4465 PVC
$ 405 DIP
D Section II & [if of the MDC for Permitting of Gravity Sewers contains information related to design criteria
Y Section III contains infonmation related to minimum slopes for gravity sewer(s)
s' Oversizing lines to meet minimum slope requirement is not allowed and a violation of the MDC
VIII. PUMP STATION DESIGN CRITERIA (If Applicable) — 02� & IIIDC (PurnStations/Force Mains):
COMPLETE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
I . Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: Longitude: -
3. Design flaw 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 .(1i05thl(I l:
❑ Standby power source or pump with automatic activation and telemetry - 15A NCAC 02T .0305(h)(1 xB);
D Required for all pump stations with an average daily flow greater than or equal to 15,000 gallons per day
Y 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)( I XQ
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry - 15A NCAC 02T .0305(h)(I )(C):
D 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 ofall 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 & I5A NCAC 02T .0305(f)):
1. Does the project comply with all separations found in 15A NCAC 02T .0305(f) & (t•)
❑ Yes M No
r I A NCAC 02T. 305 contains alternatives where separations in 421.0305ff) cannot be achieved.
**Stream classifications can be identified using the Division's NC Surface Water Classifications wcbpage
Y If noncompliance with 02T.0305 f r (g), see section X of this application
2. Does the project comply with separation requirements for wetlands? (50 feet of separation) Byes ❑ No ❑ N A
D See the Division's draft separation requirements for situations where separation cannot be meet
Y No variance is required if the alternative design criteria specified is utilized in design and construction
D 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 .0700? ® Ycs ❑ No ❑ N.'A
Y 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?
y Information can be obtained from the 40I & Buffer Permittin Branch
5. Does project comply with 15A NCAC 02T.0105 c 6) (additional perrnits/ccrtifications)? ® Yes ❑ No
Pcr I5A NCAC 02T.0105 c 6 directly related environmental permits or certification applications are being prepared, have
been applied for, or have been obtained. Issuance of this permit is contingent on issuance of dependent permits (erosion and
sedimentation control plans, stormwatcr management plans, etc.).
6. Does this project include any sewer collection lines that arc deemed "high•pnonty?"
Per 15A NCAC 02T.0402 "high -priority sewer' means "any aerial sewer, sewer contacting surface waters, siphon, or sewer
positioned parallel to strcambanks that is subject to erosion that undermines or deteriorates the sewer.
❑ Yes ® No ❑ N.-'A
Y 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-I6
Page 4 of 5

X- CERTIFICATIONS:
1. Does the submitted system comply with 15A NCAC 02T. the Minimum Design Cntcria for the Permillin a of Pump Station,,
and Force Mains latest version and the Gravity Sewer Minimum Design Criteria (latest vets� as applicable?
® Yes ❑ No
If No, complete and submit the Variance/Alternative Design Request application (VADC 10-I4) and supporting documents for
review. Aptiroval orthe mayest isSeQuired rior Lq_submiutal of thl-Fast Track Aprillcation and supRorting Jocurngnts.
2. Professional Engineer's Certification:
1, attest that this application for
(Professional Engineer's name front Application Item il[.I.)
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 Crileria 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 143-2I5.6B, 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 $23,000 per violation.
North Carolina Professional Engineer's seal, signature, and date:
3. Applicant's Certification per I5A NCAC 02T .0106(b):
I. t Tes 04:1 AC- Cur v �s*tc. U'�t�-tT7ES i7 t 1Z arrest that this application for
(Signature Authority's name title from Application Item I.3.)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that if all required pans 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 43-215.6n, 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: [a Z�Z_
FORM: FTA 04-16
Page 5 of 5

Nc p
apt off
hvtr°nmental Quality State of North Carolina
MAY - Department of Environmental Quality
3 ZQz� Division of Water Resources
t sleigh Rog1gnal � ff w Tracking for Sewer Extension Applications
t)ivtslan of Water Resources
CC (FTSE 10-18)
Entity Requesting Allocation: _ Franklin County
Project Name for which flow is being requested: Winston Ridge Subdivsion -Phase 4
More than one FTSE may be required for a single project ifthe owner of the WWTP is not responsible for all pump
stations along the route of the proposed wastewater flow.
1. Complete this section only if you arc the owner of the wastewater treatment plant.
a. WWTP Facility Name: Franklin County Wastewater Treatment Plant
K WWTP Facility Permit #: NC006931
c. WWTP facility's permitted flow All flows are in MCD
0
d. Estimated obligated flow not yet tributary to the W WTP _ . Zti 3 5
e. WWTP facility's actual avg. flow L_.2C-)30
f. Total flow for this specific request 0.0275
g. Total actual and obligated flows to the facility $,3�
h. Percent of permitted flow used 5 I a/,,.,,
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)
(S)
(C)
(D)=(s+C)
(E)s(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 i p�,
Avg. Daily
Daily Flow,
Obligated
Available
Number)
No.
MOD MCD
Flow, MOD
MOD
Flow
Capacity-0
* 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 < Q,
Downstream Facility Name (Sewer):
Downstream Permit Number:
Page 1 of G
FTSE 10-18

III. Certification Statement:
I C k QS'iV?O4F— bo qjq ify to the best of my knowledge that the addition of
the volume of wastewater to be permitted in ibis 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.
Title of'Signi►ig Officiul
Page 2 of 6
FTS H 1 q-18

The Nau Company
Consulting Civil Engineers
April 30, 2021
NC Department of Environmental Quality
Division of Water Resources
Raleigh Regional Office
RE: Winston Ridge Phase 4-5 Sanitary Sewer Permit
To whom it may concern:
ItIL
MAY , 3 207,
al�igh Regxon$i office
Attached are the required documents for the permitting of the gravity sanitary sewer line
required for the Winston Ridge Phase 4-5 project located in Franklin County, NC. Below is a
summary of the system to be permitted:
System Name: Winston Ridge Phases 4/5
Homes served: 110
Flow allocation required: 27,500 GPD
Pipe data: 4,465 LF of 8" PVC gravity sanitary sewer
405 LF of 8" DIP gravity sanitary sewer
If you have any questions or concerns, please let me know.
Sincerely,
The Nau Company, PLLC
Jonatkan Ea ins, PE
leakins nauco.com
PO Box 810 / Rolesville, North Carolina 27571 / [phone]

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