WQ0043758_Application (FTSE)_20220909

State of North Carolina
Department of Environmental Quality
DWR Division of Water Resources
FAST TRACK SEWER SYSTEM EXTENSION APPLICATION
Division of Water Resources FTA 06-21 & SUPPORTING DOCUMENTATION
Application Number: (to be completed by DWR)
all items must be com leted or the applicat[on ►Fill he returned
1. APPLICANT INFORMATION:
I. Applicant's name: City ❑f Lexington (company, municipality, HOA, utility, etc.)
2. Applicant type: ❑ Individual ❑ Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
❑ Federal ❑ State/County ® Municipal ❑ Other
3. Signature authority's name: Roger Jon e+ per IS.'. NC AC' 02'r .0 1 061bl
Title: Public Services Manor
4. Applicant's mailing address: 28 W Center St
City: Lexingto State: NC Zip: 27292-
5. Applicant's contact information:
Phone number: [phone] Email Address: RDJones'ci.Lexin 7tonNC.�av
II. PROJECT INFORMATION:
1. Project name: David.',an Ridge industrial Park
2. Application/Project status: ® Proposed (New Pen -nit) ❑ Existing Permit/Project
If a modification, provide the existing permit number: WQ00 and issued date: ,
For modifications, also attach a detailed narrative description as described in Item G of the checklist.
If new constriction, but part of a master plan, provide the existing permit number: WQ00
3. County where project is located: Davidson
4. Approximate Coordinates (Decimal Degrees): Latitude: 35.9305- Longitude: -80 2256'
5. Parcel ID (if applicable): 113340000QO218 & 1133400000021A (or Parcel ID to closest downstream sewer)
III. CONSULTANT INFORNIATIOi
1. Professional Engineer: Paul S License Number: 22052
Firm: LaBelfa Associates. PC
Mailing address: 939 3urke Stmet, Suite H
City: Winston-Salem State: NC Zip: 27101-
Phone nwnber: [phone] Email Address:
�S% rM�JS�.� � � I !.t � �c0►'V�
IV. WASTEWATER TRE,4TMENT FACILITY (WWTF) INFORNI.4TION:
1..e,cr n far- Rom(; o •��- f
1. Facility Name: _ W Lu�TI� 1 ` Permit Number:
Owner Name: � j4`
V. RECEIVING DOWNSTREAM SEWER INFORMATION:
1. Permit Number(s): WQ< )
2. Downstream (Receiving) Sewer Information: 1 inch Gravity El Force Main
3. System Wide Collection System Pen -nit Number(s) (if applicable): WQCS
Owner Name(s):
Page 1 of 5
FORM: FTA 06-21

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 nrnt tFt)R11- DEYJ been attached'
[:]Yes [:]No ® N/A
3. If the Applicant is a Home/Property Owners' Association, has an ent I a"i)R\1. 1­10,kk and
supplementary documentation as required by 15A NCAC 02T.0115(c) been attached?
❑ Yes ❑ No ® N/A
4. Origin of wastewater: (check all that apply):
❑ Residential (Individually 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 : % Domestic % Commercial 100 % Industrial (ace 15A _N. AC 02T .010 MM)
If Industrial, is there a Pretreatment Program in effect? ❑ YesZ No
6. Has a flow reduction been approved under 15A N.C'AC ICT IFl l41 fj? ❑ Yes ® No
> If ves rovide a copy of floe' reduction approval letter with this a Ilcation
7, Summarize wastewater generated by project:
Establishment Type (see 02T.01 14(f)) Daily Design Flow a,b No. of Units Flow
Industrial Park 4 lots 28.08 acres 880 gal/acre 28.08 24,710.4 GPD
gal/ GPD
gal/ GPD
gal/ GPD
gal/ GPD
gal/ GPD
7T.:tal �24,71�04GPD�
a See 15.a VCAC11_ 1' .il [ 14ib I. �Ii_ c 1 J Ind c71 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.7. 42_A 1).
b Per 15A NCAC 02T .0114(c), design flow rates for establishments not identified [in table 15,E NCAL 0_T_01 I4] shall be
determined using available flow data, water using fixtures, occupancy or operation patterns, and other measured data.
S. Wastewater generated by project: 24,710.4 GPD (per 15,E .; C 02021 0114)
> Do not include future flows or previously permitted all cations
If permitted flow is zero, please indicate why:
❑ Pump Station: Force Main or Gravity Sewer where flow will be permitted in subsequent pennits that connect to this line_
Pleasc provide supplementary information indicating the approximate timeframe for permitting upstream sewers with flow.
❑ Flow has already been allocated in Permit Number: _ Issuance Date:
❑ Rehabilitation or replacement of existing sewers with no new flow expected
❑ Other (Explain):
Page 2 of 5
FORM: FTA 06-21

VII. GRAVITY SEWER DESIGN CRITERIA (If Applicable) - Q2T .0305 & MDC Gra►•it► Sr►►ersl:
1. Summarize gravity sewer to be permitted:
Size (inches) i Length (feet) Material
g 1664.81 f'Ve SDR26
8 543.3 DI
> Section It & III of the MDC for Permitting of Gravity Sewers contains information related to design criteria
> Section III contains infonmation related to minimwn ;lopes for gray ity sewer(s)
> Oversizing lines to meet minimum slope requirements is not allowed and a violation of the MDC
VIllPUMP STATION DESIGN CRITERIA (If Applicable) — I)2T .0305 & MDC Pum Station+ Hu!'ce ►lairs]:
014 PROVIDE A SEPARATE COPY OF THIS PAGE FOR EACH PUMP STATION INCLUDED IN THIS PROJECT
1. Pump station number or name:
2. Approximate Coordinates (Decimal Degrees): Latitude: Longituae: -
3. Total number of pumps at the pump station:
3. Design flow of the pump station: millions gallons per day (firm capacity)
> This should reflect the total GPM for the pump station with the largest pump out of service.
4. Operational point(s) per pump(s): gallons per minute (GPM) at feet total dynamic head (TDH)
5. Summarize the force main to be permitted (for this Pump Station):
Size (inches) Length (feet) Material
If any portion of the force main is less than 4-inches in diameter, please identify the methnd of solids reduction per
MDCPSFM Section 2.01 C.l.b. ❑ Grinder Pump ❑ Mechanical Bar Screen ❑ Other (please specify)
6. Power reliability in accordance with 15A NC -AC 0?T .O 105 It 1 :
❑ Standby power source or ❑ Standby pump
> Must have 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
NjuSt be permanent to facility and may not be portable
Or if the pump station has an average daily flow less than 15.000 gallons per day 15A NCACO2T.0305(h)(1)(C):
❑ Portable power source with manual activation, quick -connection receptacle and telemetry -
or
❑ Portable pumping unit with plugged emergency pump connection and telemetry:
> Include documentation drat the PUrtable.source is owged orcontracted.by the applicant and is compatible with the station.
If the portable power source or pump is dedicated to multiple pump stations, an evaluation ufall the pump stations' storage
capacities aitci the rotation schedule of the portable power source or pomp, including Havel timcframes, shall be provided
as part of this permit application in the case of a multiple station power outage.
FORiM: FTA 06-21 Page 3 of 5

IX.
SETBACKS & SEPARATIONS — (02B .0200 & 15A NCAC 02T .0305(f)):
1.
Does the project comply with all separations/alternatives found in 15 NC' at 02T .0105 fl
®Yes El
No
15A NCAC 02T.0305(f7 contains minimum sw arations that shall be provided for sewer
s sterns:
Setback Parameter*
Separation Required
Storm sewers and other utilities not listed below (vertical)
18 inches
'Water mains (vertical - water over sewer preferred, 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
100 feet
Class if impounded reservoirs used as a source of drinking water, and associated wetlands.
**Waters classified WS (except WS-1 or WS-V). B, SA, ORW, HQW, or SB from normal
high water (or tide elevation). and wetlands associated with these waters (see item IX.2)
50 feet
**Any other stream, lake, impoundment, or ground water lowering and surface drainage
10 feet
ditches, as well as wetlands associated with these waters or classified as WL.
Any building foundation (horizontal)
5 feet
Any basement (horizontal)
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
> If noncompliance with It2-1-,o,i15i i t m, g) see Section X.l of this application
* I �;� NC AC 02T.t73i]> contains alternatives where separations in 02T� 0�)� cannot be achieved. Please check "yes"
above if these alternatives are used and provide narrative infonnation to explain.
**Stream classifications can be identified using the Division's NC Surface w-,(ter C'lassl icatiuns wcbpiipii c
2. Does this project comply with the minimunr separation requirements ror water mains? ❑ Yes ❑ No ® N/A
If nu, phase refer to 15A NCAC ItiC.O'3OG(f7 for documentation requirements and submit a separate document,
signedrszale:d byan NC licensed PE, verifying the criteria outlined in that Rule.
3. Does the project comply with separation requirements For wetlands? ❑ Yes [-]No ® N/A
> Please provide supplementary information identifying the areas of non -con formance.
> See the Division's Llralt ;r ur:1titm rep u.iremei}s� for situations where separation cannot be met.
> No variance is required if the alternative design criteria speci[ied is utilized ill design and construction.
4. Is the project located in a river basin subject to any State buffer rules? ❑ Yes Basin name: No
If yes. does the project comply with setbacks Found in the river basin rules per I iA NCAC {.)213 .0200 ? ❑ Yes ® No
> This includes Trout Buffered Streams per 15A NCAC BB.G202
3: Does the project require coverage/authorization under a 404 Nationwide/individual permits
❑ Yes ® No
or 401 Water Quality Certifications?
> Please provide the permit number/permitting status in the cover letter if coverage/authorization is required.
6. Does project comply with l5r! _ NC� J12T.01.05(c 1(6) (additional permits�certifications)? Z Yes ❑ No
Per I ?.� NC fit. [)_ r.�� I r5t� b .directly related environmental permits nr certification applications must be 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.).
7. Does this project include any sewer collection lines that are deemed "high -priority?" Yes ❑ No
Per 15.E N .'AC 1)2T,0402...h1911-priority sewer'' means any aerial sewer, sewer con tacfin g.surface waters,
siphon, or sewers positioned parallel to streambanks that are subject to arosion that undermines or deteriorates the sewer.
Siphons and seivers suspended through interference/conflict boxes require a variance approval.
if yes, include an attachment with details for each line. including t_y'pc (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 permittee's individual Systetn-Wide Collection permit.
Page 4 of 5
FORM: FTA 06-21

X. CERTIFICATIONS:
1. Does the submitted system comply with 15A N a —Li, the \�iuiimum Dc, [i 4n C rit,-ria For the PermitlintJ of Punt --Stations
and Fare. ,\I ain., Ifat_sl , rsion', and the Cirtvi v tiewcr lins[mt[m f3e,ivn ('Ixcria latest vorsion) as applicable')
® Yes ❑ No
If no, for projects requiring a single variance, complete and submit the Variance/Alternative Design Request application
(VADC 10-14) and supporting documents for review to the Central Office. Approval of the request will be issued
concurrently with the a roval of the permit, and Rroiects requiringa variance approval may be subject to longer
review times. For projects re uirin2 two or more variances ar ►►here the variance is determined b►• the Division to be a
si_-nificant portion of the ro ect the Full technical revie'v► is re uired.
2. Professional Engineer's Certification:
1, _Paul A. Stimpson , attest that this application for Davidson Ridge Industrial Park
(Professional Engineer'; name from Application Item Ill. I_) (Project Name from Application Item [[.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 m` knowledge. I fUrther
attest that to the best of my knowledge the proposed design has been prepared in accordance with the applicable regulations.
Ilinimutn De-si=rig Crit ria far Cirav[tti Sept " latest vrtsiun), and the M.intsnunt Desists Cruena WrIlse Fasr Track I'ernsi[trn,
nf' Pam ;[atiuns dnd 1''tfrc- \loins 11:[t�s1 � crsion). Althuugh other professionals may have developed certain portions of tlsiti
submittal package. inclusion of these materials under my signature and seal signiltes 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 143-215.613, 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. Misrepresentation of the application
information, including failure to disclose any design non-compliance with the applicable Rules and design criteria, may subject
the North Carolina -licensed Professional Engineer to referral to the licensing board. (21 NCAC 56.0701)
�.�
North Carolina Professional Engineer's seal signature, and date: ti��� CA� i,I�fEi
Lf3_
�9 � eke 22052
Ale
ir+ns o cINE
�`.•.
3. Applicant's Certification per 15A NCAC 02T .0106(b):
I, Roger Jones , attest that this application for _Davidson Ridge Industrial Park
(Signawre Authority Name tiom Application Item 1.3. ) (Project Name from Application Item 11.1)
attest that this application has been reviewed by me and is accurate and complete to the best of m►• 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. 1 will make no. claim against the Divisiun
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 in Formation and attachments are not included, this application
package will be returned to me as incomplete.
NOTE — In accordance with General Statutes 143-215.t3.-k and 143-215.[313, any person who knowingly makes any False
statement, repmsentation., or certification in any application package shall be guilty of a Class 2 misdemeanor, which .may
include a line not to exceed $10,000 as well as civil penalties up to $25,000 per violation.
Digita11y4gr d by FkW, Jones
Roger Jones DNmRDJ0nlone;u2iryof Lein gton,ou=Water Resources,
mail202207231 :35:43 040gogc=US Date: 7/23/2022
Date: 2022 07 23 G:35:43 -04 00'
Signature:
FORM: FTA 06-21 Page 5 of 5

r
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C+
o r r�

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources Flow Tracking for Sewer Extension Applications
(FTSE 10-18)
Entity Requesting Allocation: City of Lexington
Project Name for which flow is being requested: Davidson Rid e Industrial Park
More than one FTSE may be required for a single project if the owner of the WWTP is not responsible for all pump
stations along the route of the proposed wastewater flow.
I. Complete this section only if you are the owner of the wastewater treatment plant.
a. WWTP Facility Name: Lexington Regional WWTF
b. WWTP Facility Permit #: NCO055786
All flows are in MGD
c. WWTP facility's permitted flow 6.5
d. Estimated obligated flow not yet tributary to the WWTP .1605
e. WWTP facility's actual avg. flow 2.4
f. Total flow for this specific request .024710
g. Total actual and obligated flows to the facility 2.58521
h. Percent of permitted flow used 39.77
II. Complete this section for each pump station you are responsible for along the route of this proposed
wastewater flow.
List pump stations located between the project connection point and the WWTP:
Pump Pump
Station Station
(Name or Permit
Number) No.
N/A
(A)
(B)
Design
Average
Approx.
Firm Daily Flow**
Current
Capacity, * (Firm / po,
Avg. Daily
MGD MGD
Flow, MGD
(C)
(D)=(B+C)
(E)=(A-D)
Obligated,
Not Yet
Total Current
Tributary
Flow Plus
Daily Flow,
Obligated
Available
MGD
Flow
Capacity***
* The Firm Capacity (design flow) of any pump station is defined as the maximum pumped flow
that can be achieved with the largest pump taken out of service.
** Design Average Daily Flow is the firm capacity of the pump station divided by a peaking factor
(pf) not less than 2.5, per Section 2.02(A)(4)(c) of the Minimum Design Criteria.
*** A Planning Assessment Addendum shall be attached for each pump station located
between the project connection point and the WWTP where the Available Capacity is < 0.
Downstream Facility Name (Sewer):
Downstream Permit Number:
Page 1 of 6
FTSE 10-18

III. Certification Statement:
I Roger Jones certify to the best of my knowledge that the addition of
the volume of wastewater to be permitted in this project has been evaluated along the route to the receiving
wastewater treatment facility and that the flow from this project is not anticipated to cause any capacity
related sanitary sewer overflows or overburden any downstream pump station en route to the receiving
treatment plant under normal circumstances, given the implementation of the planned improvements
identified in the planning assessment where applicable. This analysis has been performed in accordance
with local established policies and procedures using the best available data. This certification applies to
those items listed above in Sections I and II plus all attached planning assessment addendums for which I
am the responsible party. Signature of this form certifies that the receiving collection system or treatment
works has adequate capacity to transport and treat the proposed new wastewater.
G�g;ially signed 6g sugar 7unn
Roger Jones « may" ���e% onNCgorrr TJS 7/25/2022
03
te:ID2201 25'�9:22 V -04'90-
Signing Official Signature
Public Services Manager
Title of Signing Official
Date
Page 2 of 6
FTSE 10-18

LaBeLLa t L=
Powered by partnership. Q�
July , 2022
Winston-Salem Regional Office
Water Quality Section
450 West Hanes Mill Road,
Suite 300
Winston-Salem, NC 27105
Re: Davidson Ridge Industrial- Sanitary Sewer
To whom this concerns:
This will serve as the cover letter associated with the fast track permitting request for 1,664.81 linear feet of
8" SDR 26 PVC and 543.30 linear feet of 8" Ductile Iron (DI) gravity sanitary sewer system to serve the four
Industrial lots on the 28.08 acre site. The flow allocation is 24,710.40 gallons per day.
One original and one copy of the application is included. Likewise, a $480 check is included,
We appreciate your help.
Respectfully submitted,
LABELLA
Paul A. Stimpson, PE
Regional Civil Leader/Office Manager
939 Burke Street, Suite H ! Winston-Salem, NC 271011 p [phone]
www.Labellapc.com